What Health Looks Like in Matrilineal Societies of Northeast India?

Matrilineal kinship systems are often assumed to confer health advantages, yet their health implications remain poorly understood. We examined the associations between matriliny-related arrangements and nutritional, cardiometabolic, and child health outcomes in Meghalaya, Northeast India. Data from the Meghalaya NFHS-5 included 8802 women, 1409 men, and 5265 children from the Khasi and Garo populations. Matriliny was operationalized using matrilocal residence and female ownership of house and land. Multivariable logistic regression assessed associations with nutritional status, central obesity, hypertension, diabetes, anemia, and childhood morbidity. Meghalaya had a higher prevalence of matrilocal residence and female ownership of house and land than most Indian states. Matriliny-related indicators were associated with higher levels of women's empowerment, lower tobacco use, and reduced unhealthy food consumption. Compared with female land ownership, women in households with male and joint land ownership had 2.5-fold and 2.4-fold higher odds of underweight, respectively, while joint land ownership was associated with 42% lower odds of high waist circumference. Joint house ownership was associated with 4.7-fold higher odds of underweight among men and 43% lower odds of diabetes among women. Children living in non-matrilocal and male-owned house had 32% and 38% lower odds of reported sickness, respectively. Hypertension and anemia were independently associated with broader demographic and socioeconomic factors. Matriliny was associated with gendered, outcome-specific patterns of health, with asset ownership central to nutritional security, whereas cardiometabolic and child health outcomes were more consistently associated with broader demographic, socioeconomic, and structural factors, highlighting kinship institutions as consequential but contingent influences on health.