1. Gender and women’s participation in reproductive health policy making in state and indigenous governance systems Shillong, Meghalaya, India
Pauline Oosterhoff, Lipekho Saprii, Darisuk Kharlyngdoh and Sandra Albert

2. Meghalaya urbanizing state in India’s ‘tribal belt’
11/14/2018

3. Introduction
Predominantly matrilineal indigenous population (86%) Khasi – Jaintia and Garo.
Women literacy is 74% and 85% women able to make decision on health.
The state has some of the worst maternal health indices in the country
Unmet need for contraception one of the highest in India 35% (NFHS-3) 55.5 % (DLHS-4) High fertility rates, especially rural fertility rates
Urban health is not on the health policy agenda in general
Little is known about the health status, health priorities and women’s ability to participate in political decision making in the poor urban slums of Shillong

4. Study Questions We examined
How are urban health needs in Meghalaya prioritised?
How and whether poor and indigenous women are able to participate in decisions about their sexual and reproductive health in a context where indigenous and state governance systems co-exist.

5. Methodology Document Analysis
Policy review on urban health, gender, SRH and citizen participation in policy making (state – national level)
Collate secondary health data on SRH (Example, DLHS, NFHS, Census report etc)
Qualitative primary data collection
In-depth Interviews
(policy makers, end users)
Focus group discussion (end users)
Digital story telling
Political system mapping
Random Sampling of 6 urban slums in Shillong city by drawing a straight line across the city. Slums falling on / by the line were selected.
Ethical approval by IIPH
11/14/2018

6. Women’s participation in government

7. Khasi women largely excluded from voting/holding office in traditional dorbar
‘Women are barred from holding office… they can’t be rangbah shnong [headman] or executive members, they can only be in the periphery …you know to sort of help the men to carry on their work’ – Khasi women
‘But finally when it comes into the decision-making we [dorbar] are the ones to take the decision not them [women]’ - Headman
Seng Kynthei the traditional women organisation have limited role and capacity in decision making on community matters

8. Khasi women in state government (modern)
Khasi women have relatively better opportunities in state governance system where women can vote and hold office at all levels

9. Barriers to political participation
Both institutionalized and internalized gender roles and norms
Top–down central government programs
Lack of capacity within civil society to engage with government
No effective grievances cells in hospitals / health centres

10. Barriers to political participation
Silencing on sexuality as a social norms specific barrier to political participation on SRHR
“…tough to speak about sexual matters with people. They will say that women do not have manners or are shameless” – Khasi woman
Narrow view of SRH limited to accessing contraceptive and pregnancy related services. Poor knowledge of SRH
“I had a baby in my stomach. I did not even know that I was pregnant” - Khasi woman

11. Digital Story Telling
Digital stories are individual stories composed by the participants themselves on iPad using apps for drawing, animation and scanning
DST is a participant driven process: participants decide what to share
Six women from slum areas were trained in a 4 day workshop to document their life stories using ipads

12. Intimate views and experiences
DST provided additional insights in women’s barriers to participation in public life
Poverty, alcoholism and domestic violence within families marginalize and burden women
Female headed poor households due to alcoholism and domestic violence
Large families and care burdens because men refused family planning.
Low wages in public sector for community work many positions are for “volunteers”

13. Examples DST Four women gave consent to global dissemination
“Ups and Downs in Shillong”,
“Better than my Mother”
“Never Back down”
“My Decision”

14. Thank you Kublei Shibon