3.1 million children under five die of malnutrition annually


 

Author(s): 
Jyotsna Singh
Issue Date: 
2013-6-10

Study says child mortality linked to maternal undernutrition, obesity

Forty-five per cent of deaths of children below the age of five globally are attributed to malnutrition, says a study published as part of a compendium of research papers from The Lancet. The study looks at maternal and child undernutrition and overweight in low- and middle-income countries (LMICs) and calls for an enabling environment to tackle malnutrition and incorporate specific nutrition goals and actions.

The authors of the paper led by Robert Black, professor, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA, performed a comprehensive analysis of the different causes of maternal and childhood malnutrition, including poor breastfeeding practices and deficiencies of vitamins and minerals such as vitamin A, zinc, iron and calcium. They also analysed the consequences of malnutrition, including stunting (low height for age), wasting (low weight for height), and underweight (low weight for age), all of which result in increased risk of death and illness for both pregnant women and children.

Mother’s health matters

image [1]

The research links child mortality to maternal health, with iron deficiency in mothers associated with low birth weight (<2,500g) in babies. Maternal undernutrition also restricts the growth of the baby in the womb and is responsible for a quarter of child deaths. The study finds children born too small–27 per cent in LMICs–are at a substantially higher risk of dying. Maternal short stature and underweight also limit foetal growth and cause 12 per cent of neonatal deaths. Suboptimum breastfeeding too is associated with deaths of more than 800,000 children annually.
 
According to the researchers, India’s biggest problem is the number of young anaemic mothers–55.8 per cent of adolescents aged between 15 and 19 years and 56.7 per cent of women aged between 20 and 24 years were found to be anaemic. In contrast, corresponding values for Guatemala were 21.0 per cent and 20.4 per cent respectively. Eleven per cent of adolescent girls in India were found to be underweight.

“Currently, only 0.4 per cent of aid is spent combating malnutrition despite it being the leading cause of child deaths,” says Ishaprasad Bhagwat, doctor and health manager with non-profit Save the Children, India.

Stunting still high

The global prevalence of stunting has gradually decreased in the past 20 years, but still remains high in absolute numbers. The researchers estimate that stunting affected at least 165 million children worldwide in 2011. In the same year, at least 50 million children were affected by wasting and 100 million children were underweight. Over 90 per cent of these were in Asia and Africa. Africa is the only major region in the world where the number of stunted children has increased in the past decade.

The authors correlate the prevalence of stunting to equality in different countries. Nigeria showed no change in prevalence of stunting from 2003 to 2008, and the degree of inequality, too, remained almost unchanged. Bangladesh demonstrated a decrease in the prevalence of stunting, though inequality levels remained unchanged. Brazil showed a much lower prevalence of stunting. The researchers thus concluded that equality in the country improved because of a substantial decrease in stunting in the poorest populations.

Obesity brings risks

The research demonstrates that obesity is fast becoming a cause for child undernutrition and mortality. The prevalence of maternal overweight has steadily increased since 1980 and exceeds that of underweight in all regions of the world. Obese pregnant women, whose body mass index is more than 30 kg/m2, are four times more likely to develop gestational diabetes and two times more likely to develop pre-eclampsia. During labour and delivery, maternal obesity is associated with maternal death, haemorrhage, caesarean delivery, or infection; and a higher risk of neonatal and infant death, birth trauma, and macrosomic infants. In the post-partum period, obese women are more likely to delay or fail to lactate and have more weight retention than women of normal weight.

The framework of the report is an improvement on the 2008 conceptual framework of the United Nations Children’s Fund (Unicef), which was also prepared under Black’s lead. The new framework shows the dietary, behavioural and health determinants of optimum nutrition, growth and development. It analyses how they are affected by policies related to food security, care giving resources and environmental conditions. Apart from immediate reasons related to maternal and bodily health of a child, the new framework also encompasses “economic and social conditions, national and global contexts, resources, and governance”.

The paper has been published in the Lancet series on maternal and child nutrition 2013 that was released on June 6.  

 


Source URL: http://www.downtoearth.org.in/content/31-million-children-under-five-die-malnutrition-annually

 

BMC – Keep Off Privatising Education #mustread


Vol – XLVIII No. 23, June 08, 2013 | Anand Teltumbde,EPW

Today it is the Brihanmumbai Municipal Corporation’s decision to privatise its schools, tomorrow it may be the resolution of all the other municipalities of the country.

I am grateful to Simantini Dhuru and Prachi Salve for sharing data which they obtained under the Right to Information Act, as also the Mumbai Shikshan Kampanikaran Virodhi Abhiyan, which is fi ghting against the Brihanmumbai Municipal Corporation’s decision to privatise its schools.

Neo-liberal policies have not delivered on any of their promises. Indeed, they have aggravated India’s age-old problems of inequality, unemployment, caste and communalism, to name a few. Yet, the ruling classes hold them up as a proven panacea. A key neo-liberal policy thrust is the release of services, traditionally provided by the state, to private capital. The state, in turn, uses its might against those who feel the heat of this transformation. The public utilities and infrastructure are now largely in private hands, and the state has turned its attention to education, the most critical instrument in the social transformation of any society. The process has been underway in higher education and now the rulers have begun to deva­state school education, particularly for the downtrodden strata. A decision taken at the beginning of this year by the Brihanmumbai Municipal Corporation (BMC) to hand over its schools to private parties, this within the framework of the much-flaunted public-private partnership (PPP) model, is a case in point.

Auctioning the BMC Schools

BMC, the richest municipal corporation in India, provides free education to nearly 4,00,000 children enrolled in around 1,174 schools with 11,500 teachers imparting education in eight mediums. Besides, BMC runs 18 schools for the mentally challenged and 55 Mumbai Public Schools offering education in English medium. The BMC spends around 8% to 9% of its income on education; its planned spend this year is Rs 2,342 crore, 65% more than the previous year. Its expense per student at Rs 36,750 for its schools is among the highest in the country. The number of students attending BMC schools has been falling over the years. It fell from 4,20,440 in 2007-08 to 3,85,657 in 2011-12. It is the poorest of the very poor who send their children to BMC schools. Even the
so-called class IV employees, for example, sweepers and helpers working in BMC schools, do not send their children to these schools. Mumbai, the so-called “Urbs Prima of India”, the first city of India, accounting for more than 33% of the nation’s tax collection and the highest per capita income of Rs 65,361 in the country, more than twice the country’s average of Rs 29,382, has more than four million people earning less than Rs 20 a day. It is these people mainly belonging to the scheduled castes and scheduled tribes (SCs/STs), Other Backward Classes, Muslims and Christians who send their children to BMC schools.

On 23 January this year, the BMC, without consulting the parents of these children or the teachers in these schools, the major stakeholders, decided to auction its schools to private bidders under the euphemism of PPP, admittedly based on studies by the World Bank and Depart­ment for International Development (DFID). This is the first time in the country that a constitutional entity has decided to renounce its constitutional obligation and hand over its schools to private parties. Nonetheless, it had a nice sounding objective of giving an opportunity to poor children to get higher quality education with the support of organisations that had a record of “excellent work” in the educational field, charitable trusts and private companies.

The schools are to be auctioned to well-established corporate houses that would enter into memoranda of understanding (MoUs) with entities that have been recognised for their work in the “technical or educational field”. The process would be managed under the existing MoU bet­ween the United Nations Children’s Fund (UNICEF) and BMC for conducting the “School Enhancement Programme” (initiated by UNICEF and McKinsey & Company since 2009, and having non-governmental organisations (NGOs) such as Akanksha, Aseema and Nandi Foundation on board). Neither the BMC provided any reasons for its failure to impart quality education nor did it provide any justification for its assumption that the private partner, with dubious credentials, will accomplish what it could not despite being experienced for more than 125 years. It has not even taken contrary evidence available through its own experience of the running of one of its schools by an NGO into account. For instance, a school run by Akanksha, important enough to be on the Board of the School Enhancement Programme, in the Cotton Green area of Mumbai, was found to have only one qualified teacher to teach the classes from one to eight. It basically drew its teachers from its Teach India Project, under which employees of companies took a sabbatical of a kind to teach in schools.

Private Profits at Public Cost

The PPP as a concept is not new but as a model serving the object of privatisation without public resistance it is to be attri­buted to the genius of neo-liberals. It only requires the state to rehearse its concern for the development of the down­trodden and plead lack of resources and failure to attain productive efficiency. The main selling proposition beyond the paucity
of resources is that the private sector
is intrinsically efficient. PPP has been pop­ular with rulers all over the world as it facilitates the transfer of huge public resources to private hands with contractual sieves that leak significant benefits to them. PPP has become a default vehicle for most infrastructural projects in recent years. In India, the PPP first appeared in the election manifesto of the Bharatiya Janata Party (BJP)/National Democratic Alliance (NDA) in 1999. The NDA government had formed a committee in the office of Prime Minister Atal Bihari ­Vajpayee to apply the PPP model in various fields. Later, this committee was transfer­red to the Planning Commission. In 2004, when the Congress-led United Progressive Alliance (UPA) came to power, the same committee continued to function and submitted its report to Prime Minister Manmohan Singh. In September 2007, Manmohan Singh, while presiding over a meeting of the Planning Com­mission, declared that initiatives at all levels of education shall be through PPP. Since then, in the Eleventh and Twelfth Five-Year Plans, there has been a rush of corporate houses, NGOs and religious organisations to grab public assets in the educational system.

The charity of the state in favour of private players includes grant of lands either free or at hugely subsidised rates, grants for building infrastructure, subsidised provision of electricity, water and bus service, exemption in income tax, payments of fees of students belonging to the SC/ST category, huge opportunities for outsourcing, etc. There is no evidence yet of any expertise being marshalled by the private players to whom huge public assets are devolved. The value of the BMC’s 11,500 schools, for instance, could easily run into thousands of crores of rupees.

Private education has been around in the country for years but whatever islands of quality education that exist have all been in the public sector. The overwhelming presence of private institutions could not produce a single institution to match the Indian Institutes of Technology, the Indian Institutes of Management, the All India Institute of Medical Sciences, the Jawaharlal Nehru University or the University of Delhi. In the neo-liberal din, it is not even admitted that until the early 1970s, quality education was associated with only government institutions. It is only with the advent of increasing competition in politics that the academic autonomy of the schools was breached and they became subservient to the political bosses. These very BMC schools were famed for quality education and have produced scores of illustrious people. J B G Tilak of the National University of Educational Planning and Administration, New Delhi, after analysing the plan for setting up 2,500 model schools in the PPP mode under the Eleventh Plan, has rightly concluded that notwithstanding the claim that PPP is not privatisation and the promotion of the profit motive, the plan will surely promote the opposite – privatisation and a high degree of commercialisation, albeit with a difference, namely, with the utilisation of public funds (The Hindu, 24 May 2010).

No Tradable Service

The neo-liberal juggernaut has reduced what were once public services into trad­able commodities. It sees education as a tradable service to transform raw youth into wage labour as a feedstock for its ­capitalist machine. But pedagogy is too hallowed to be treated as such. Universally, education is regarded as an instrument of social change. Our founding fathers saw education as an equaliser and sought to include it among the fundamental rights in the Constitution. Unfortunately they could not do so and education remained confined to the area of Directive Principles (not legally binding on the state). Nonetheless, they had stipulated a time limit of 10 years to accomplish education for all children up to the age of 14. Our rulers however disregarded it until they were shaken up by the Supreme Court judgment in the Unnikrishnan case in 1993 treating education as a part of the fundamental right to life vide Article 21. But the so-called right to education they passed in 2009 is only trickery; it violates the spirit of the Constitution by excluding the most vulnerable children between 0 and 6 years and legitimises the multi­layered educational system. Rather, in view of the alarming degree of malnutrition of pregnant women, the state should be obligated to provide healthcare so that no child is born with an inborn handicap.

The first Education Commission (1964-66), the Kothari Commission, had obser­ved that realisation of the country’s aspirations involves changes in the knowledge, skills, interests and values of the people as a whole. This is basic to every programme of social and economic betterment of which India stands in need. It made a profound observation: “If this change on a grand scale is to be achieved without violent revolution (and even then it would still be necessary), there is one instrument, and one instrument only that can be used, Education.” It envisaged free and compulsory education through a common neighbourhood school system for all children following in the spirit of the Constitution. Even if this simple dictum had been heeded by the rulers, many of India’s evils would have been overcome. I will argue that if the state had ensured that no child is born with the handicap of malnutrition and every child received the same education, there would not have been the need for reservation and thereby the constitutional castes.

Today it is BMC; tomorrow it will be the entire country. We must say a firm no to the privatisation of education.

 

India loses up to $46 billion to malnourishment #WTFnews


Malnourished child

Malnourished child (Photo credit: Wikipedia)

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Author(s):
Jitendra
Issue Date:
2013-5-29

Report by children’s non-profit links childhood malnourishment to educational performance, adult income and GDP

 

Malnutrition decrease the gross domestic product (GDP) in low- and middle-income countries, says a report by international non-profit Save the Children. Malnutrition affects educational development, physical productivity and health, and also perpetuates inequalities, such as those created by caste in India, says the report.

The report, Food for thought: Tackling child malnutrition to unlock potential to boost prosperity, is based on a study conducted in four countries—India, Vietnam, Peru and Ethiopia. It argues that investment in preventing malnutrition in women and children would be the down payment for future prosperity.

The study estimates that the economic cost of micro-nutrient malnutrition costs India between 0.8 per cent and 2.5 per cent of its GDP, which is equivalent to $15–46 billion. China, too, loses between 0.2 and 0.4 per cent of GDP, equivalent to $15– 29 billion because of malnutrition.

The study looks at various pathways of malnutrition, and elaborates on the cognitive and physical impacts on children, as well as additional medical costs due to ill health. These cumulative effects can reduce GDP by 2 per cent to 11 per cent.

Hindrance to inclusive growth

This study is the first of its kind to link child malnutrition to educational outcomes. Children who are malnourished from an early age are severely disadvantaged in their ability to learn.

The lack of proper nutrition for pregnant women, breastfeeding mothers and young children, especially before their second birthday can impair the child’s brain development, cognitive abilities and physical development, leading to stunting or reduced growth. Brain drain

In comparison to children who are provided with proper nutrition, children malnourished at age five would be expected to demonstrate the following impacts of malnutrition three years later:
They score 7 per cent lower in maths tests
Such children are19 per cent less likely to be able to read a simple sentence at the age of eight
They are 12.5 per cent less likely to be able to write a simple sentence
They are 13 per cent less likely to be in the appropriate grade for their age at school

The report clearly links child malnutrition to educational outcomes, and demonstrates that children who are malnourished from an early age are severely disadvantaged in their ability to learn. These children later in life go on to earn 20 per cent less that other adults who are well-nourished in their childhood.

In effect, malnourishment perpetuates the cycle of poverty, as poverty-stricken and malnourished mothers have stunted children. The report states that children born to the poorest of families in developing countries are 2.8 times more likely to be malnourished than those in the richest, and are likely to go on to earn less than their better-off and better-nourished peers.

Thus the unequal social prevalence of malnourishment acts as a barrier to inclusive growth and the reduction of inequalities.

In India, the problem of malnourishment is helping to perpetuate the caste system, says the report. It goes on to say that if nutritional inequalities were tackled in such a way that low-caste children gained the same average nutritional status as their upper caste counterpart, this would close existing caste cognitive differentials by 25 per cent.

Hard facts

According to the report, State of the World’s Children, 2012, by United Nations Children’s Fund (UNICEF), 47 per cent children under five in South Asia and 39 per cent under-fives in sub-Saharan Africa are stunted and their potential severely damaged. In Nigeria, 10.9 million children under five are stunted while in India, the figure is 61.4 million.

As many as 19,000 children continue to die worldwide each day from diseases which could have been easily prevented. Malnutrition is responsible for 2.3 million children’s deaths annually, and 130 million malnourished children who managed to reach school failed to learn even basics and are left without core skills and abilities they need to make their lives more productive.

The report suggests that direct nutrition interventions, such as promoting breastfeeding, and indirect nutrition interventions, such as social protection, investments in agriculture, and ensuring access to safe water and sanitation, can address malnutrition’s underlying causes.

Source URL: http://www.downtoearth.org.in/content/india-loses-46-billion-malnourishment

 

The Reality behind Gujarat Model and Narendra Modi #mustshare


By Pravada Meethal, Facebook

Did you know ?

• Wages
The wage rates of casual and regular workers of both men and women workers in rural and urban areas are very low compared to other States. As per the latest National Sample Survey Office statistics, the daily wage rates of casual men and women workers in rural areas are lower than the corresponding rates in India, with the State ranking 14th (Rs.69) and ninth (Rs.56) in men’s and women’s wage rates respectively among the major 20 States. In the case of urban casual workers’ daily wages, the State ranked seventh (Rs.109) and 14th (Rs.56) for male and female wage rates. In the case of regular rural workers also the State ranked 17th (Rs.152) and ninth (Rs.108) in the male and female wage rates respectively. The corresponding ranks for urban areas are 18th (Rs.205) and 13th (Rs.182) respectively among the major 20 States in India. According to NSSO 2011 figures about 98 per cent of the women workers and about 89 per cent of the male workers in the State are engaged in informal work .

• Nutrition
The NFHS-3 tells us that 47 per cent of children below the age of three in the State were underweight. That figure was 45 per cent in NFHS-2. That’s about twice the average for sub-Saharan Africa. It is also marginally higher than the nationwide average of 46 per cent. The percentage of Gujarat’s children who are ‘wasted’ also went up from 16 to 17 per cent between the two NFHS surveys
According to statistics from a report of the Ministry of Statistics and Programme Implementation, “Children in India, 2012—A Statistical Appraisal”, between 40 and 50 per cent of children in Gujarat are underweight, which bursts one more myth in Gujarat’s story of growth. Other States in this low weight category are Meghalaya, Chhattisgarh, Uttar Pradesh and Odisha. Human Development Report 2011 said around half of Gujarat’s children were malnourished.

• Gujarat is the 7th worst state in adult men having a body mass index of less than 18.5.

Infant mortality :
Infant mortality is high in Gujarat, which ranks 11th countrywide in the rate of decline of infant mortality. According to “Children in India, 2012”, the infant mortality rate in Gujarat was still high, with 44 fatalities of infants per 1,000 live births.
In its 2012 State-wise report, the United Nation’s Children’s Fund (UNICEF) said, “Almost every second child in Gujarat under the age of five years is undernourished and three out of four are anaemic. Infant and maternal mortality rates have reduced very slowly in the last decade…. One mother in three in Gujarat struggles with acute under-nutrition….”

• child marriage :
Gujarat ranks fourth in reported cases of child marriage.

• School dropout rate : United Nations Development Programme (UNDP) statistics show that Gujarat ranks 18th when it comes to success in keeping children in schools. 59% school drop out

• The school life expectancy of children in Kerala (which ranks first) is 11.33 years, while that of children in Gujarat is 8.79 years.

• percentage of reduction of poverty :
Statistics of the NSSO show that the percentage of reduction of poverty between 2004 and 2010 was the lowest in Gujarat, at 8.6 per cent.

• Water:
According to Census 2011, 43 per cent of the rural households in Gujarat get water supply on their premises and 16.7 per cent get treated water from a common tap

• Toilets:
The data show that 67 per cent of rural households in the State have no access to toilets and members of more than 65 per cent of the households defecate in the open, very often polluting common water sources. Waste collection and disposal are matters practically unheard of. The State ranks 10th in the use of latrines

• Comprehensive Environmental Pollution Index (CEPI):
Anything over 70 on this index is considered to have crossed critical levels, that is, the pollution exceeds the capacity of the environment to handle it and it becomes a dangerous health hazard. According to statistics from the Central Pollution Control Board, Ankleshwar and Vapi in Gujarat top the list of 88 severely polluted industrial areas in India. Ankleshwar has a CEPI rating of 88.50 while Vapi’s is 88.09. Of the 88 areas, eight are in Gujarat

• Employment growth:
NSSO data show that in Gujarat , growth in employment has dropped to almost zero in the past 12 years

Human Development Index :
Gujarat (0.519) stands 11th in Human Development Index among the states in India. Where Kerala(0.790) stands first.

• Sex ratio :
Gujarat (918) stands 24th . where kerala(1084) stands first.

• Vaccination coverage :
In Gujarat percentage of children between 12-23 months of age who received all recommended vaccines is 45 % . that is in 19th among the states in India.

• Gujarat stands 12th in literacy among the states in india

• In Gujarat 28.2% man and 32.3 % women are underweight .

• In Gujarat percentage of children delivered in hospital is only 55%

REFERENCES
“Socio-Economic Review, Gujarat State, 2011-12”
National Sample Survey Organisation (NSSO)
• Census 2011
• Planning commission
• Children in india 2012 – a statistical appraisal – ministry of statistics and program implementation
• 2012 State-wise report, the United Nation’s Children’s Fund (UNICEF)
• United Nations Development Programme (UNDP) statistics
• statistics from the Central Pollution Control Board
• National Family Health Survey
http://censusindia.gov.in/2011census/hlo/hlo_highlights.html , http://www.pratirodh.com/pdf/human_development_report2011.pdf , http://mospi.nic.in/Mospi_New/site/home.aspx , http://www.ifpri.org/sites/default/files/publications/ghi11.pdf , https://nrhm-mis.nic.in/PublicPeriodicReports.aspx , http://mospi.gov.in/national_data_bank/table_20nov12_labour/table_20nov12_labour.htm ,http://iri.org.in/related_readings/India%20Corruption%20Study%202005.pdf ,

http://en.wikipedia.org/wiki/List_of_Indian_states_and_territories_by_Human_Development_Index

 

Gujarat- Mirage of Development


Frontline
08MAR2013
GUJARAT
Mirage of development
LYLA BAVADAM
Social development indicators in Gujarat are poor, proving that development in the State is lopsided.

On a hot day last November near Rajkot, Ramjibhai Patel, an octogenarian farmer, pointed to the middle distance and said, “See that lake?” There was indeed a shimmer in the dry landscape indicating water, but after a relatively poor monsoon, it seemed improbable. Chuckling, he said, “Yes, I see doubt on your face and you are correct. It is a mirage!” With this he launched into a diatribe against the government on issues that ranged from the non-availability of water and the high cost of farming to the skyrocketing prices of basic commodities and the cost of higher education of his grandchildren. “Life is a struggle for us. Whatever we have achieved, it is by our own sweat. Promises of the government for ordinary people like us are a mrugjal [mirage].”
The story of growth in Gujarat mirrors Ramjibhai’s mrugjal. Social development indicators in this State of over 60 million people tell a story completely different from the one of success, prosperity and economic development that Chief Minister Narendra Modi would have everyone believe. The Vibrant Gujarat Global Investors Summits and Modi’s projection of himself as a vikas purush, a sort of development leader, are all part of the illusion that Modi builds around himself.
Despite the much-touted Vibrant Gujarat programmes, it is interesting to note that foreign direct investment is not the highest in Gujarat. Maharashtra leads this list while Gujarat is fifth. Vibrant Gujarat summits have not yielded as much as the State government would like others to believe. According to the government’s own “Socio-Economic Review, Gujarat State, 2011-12”, the promised investments in 2011 were over Rs.20 lakh crore, but only about Rs.29,813 crore was actually invested. In the same year, out of more than 8,300 memorandums of understanding (MoUs) signed, only about 250 became a reality. The importance given to the Vibrant Gujarat programmes is explained simply. The Gujarat model of development is focussed solely on economic growth via industrial development. For this blinkered approach to succeed, it is necessary for the government to look to private capital. A comparison of promised and actual investments in Vibrant Gujarat programmes since 2003 shows a consistent trend of investors promising more than they actually deliver.
Even though the growth of the gross domestic product (GDP) of the State has been significant over the past 15 years, Gujarat scores low in areas of nutrition, education, employment, wages, consumer price index, rural planning, health, the status of the environment and other indicators of the overall health of society. Indeed a look at official data gathered from the National Sample Survey Organisation (NSSO), Census 2011 and others shows that the high economic growth rate in Gujarat has been at the expense of basic human development.
Employment growth stagnates
Paradoxically, employment has not kept pace with the spurt in economic growth. NSSO data show that growth in employment has dropped to almost zero in the past 12 years. Rural Gujarat has been particularly hit despite the fact that there has been an increase in growth in the rural sector. The explanation seems to lie with the policy changes in the sale and purchase of land. Small and medium farmers, who make up a large part of the agricultural community, are increasingly being tempted into selling their land. The lure of a large amount of money is often too much for cash-strapped farmers to resist, but the outcome of this is the sudden creation of a jobless section of people. Thus, rural residents are hit. The jobs that are created in rural areas through the construction of special economic zones (SEZ), small-scale industries and similar projects are usually unsuitable for local people.
Even though there is a slightly higher workforce participation rate in Gujarat, it is offset by the fact that it is poor-quality employment and the nature of the work is largely casual. Transport infrastructure accounts for a large number of work opportunities in the State, but since these are project based, the jobs are temporary. A high demand for casual labour combined with an increase in migrant labour from other States means that the job security of workers is low and the levels of exploitation are high. The average wages (for jobs other than those under the Mahatma Gandhi National Rural Employment Guarantee Scheme) are also very poor, putting Gujarat at a low 14th rank among the States.
The disparity in wages speaks of exploitation and an increasing use of contract workers. According to NSSO 2011 figures, the average daily wage a labourer in the informal sector in urban areas can expect in Gujarat is Rs.106 against Rs.218 in Kerala (which ranks first). In rural areas, Punjab ranks the highest at Rs.152 a day while Gujarat stands 12th at Rs.83. About 98 per cent of the women workers and about 89 per cent of the male workers in the State are engaged in informal work (against the corresponding national figures of 96 per cent and 90 per cent).
Health and nutrition
The workers’ low wages and poor purchasing power result in poor nutrition or malnutrition among them and their children. According to statistics from a report of the Ministry of Statistics and Programme Implementation, “Children in India, 2012—A Statistical Appraisal”, between 40 and 50 per cent of children in Gujarat are underweight, which bursts one more myth in Gujarat’s story of growth. Other States in this low weight category are Meghalaya, Chhattisgarh, Uttar Pradesh and Odisha. Human Development Report 2011 said around half of Gujarat’s children were malnourished.
Infant mortality, one of the basic indicators of the success of a government, is high in Gujarat, which ranks 11th countrywide in the rate of decline of infant mortality. According to “Children in India, 2012”, the infant mortality rate in Gujarat was still high, with 44 fatalities of infants per 1,000 live births. And with fewer health care facilities in rural areas, it is no surprise that the Scheduled Castes and the Scheduled Tribes, both of whom are kept at the bottom of the social ladder, have a higher mortality rate. In its 2012 State-wise report, the United Nation’s Children’s Fund (UNICEF) said, “Almost every second child in Gujarat under the age of five years is undernourished and three out of four are anaemic. Infant and maternal mortality rates have reduced very slowly in the last decade…. One mother in three in Gujarat struggles with acute under-nutrition….” The issue of children’s health is further compounded by the continuance of child marriage. Gujarat ranks fourth in reported cases of child marriage.
Education spending low
Education also seems to be low on priority when it comes to government spending. The Bharatiya Janata Party’s (BJP) election manifesto claims to have achieved 100 per cent enrolment in primary schools and reduced the overall dropout rate by 2 per cent. United Nations Development Programme (UNDP) statistics show that Gujarat ranks 18th when it comes to success in keeping children in schools. The school life expectancy of children in Kerala (which ranks first) is 11.33 years, while that of children in Gujarat is 8.79 years. The State also ranks seventh among 15 major States in terms of literacy rates.
UNICEF said the quality of education needed to be improved, with less than half the students being able to read, write and understand mathematics at levels appropriate for their age. Rather than improving the existing government educational infrastructure and thereby making education accessible to all, the government is leaning more towards private educational institutions. This trend was apparent at the January 2013 Vibrant Gujarat summit, where Modi proposed setting up a global forum for forging partnerships between universities across the world.
A marginal decrease in rural poverty put to rest Modi’s election boast of being a development-oriented Chief Minister. On the whole his government has a poor record of poverty reduction measures. Statistics of the NSSO show that the percentage of reduction of poverty between 2004 and 2010 was the highest in Odisha at 20.2 per cent, and the lowest in Gujarat, at 8.6 per cent.
The Gujarat government’s inattentiveness towards poverty reduction is all the more apparent when it is compared with Odisha, whose GDP growth is lower than that of Gujarat. Much-publicised handouts in the form of various benefits (with names like Garib Kalyan mela) were quite common in Modi’s last term, but an active anti-poverty programme was missing.
Low employment, low wages and high prices—the formula is one of despair. Indeed, food, fuel, clothing and housing in rural and urban Gujarat are the eighth most expensive in the country. This means that even though the per capita income is higher than the national average, the per capita monthly expenditure in both rural and urban areas is low when compared with other States and the national average. While the percentage of the population below the poverty line in Gujarat seems better than in some States, Planning Commission data show that the percentage of poverty reduction in a seven-year period between 2004 and 2010 was not creditable. In a comparison of percentages of poverty reduction in seven States, Maharashtra fares the best, West Bengal the worst, and Gujarat is fifth.
Water and sanitation
According to Census 2011, 43 per cent of the rural households in Gujarat get water supply on their premises and 16.7 per cent get treated water from a common tap. In urban households, the corresponding percentages are 84 per cent and 69 per cent.
The data show that 67 per cent of rural households in the State have no access to toilets and members of more than 65 per cent of the households defecate in the open, very often polluting common water sources. Waste collection and disposal are matters practically unheard of.
The larger issue of the environment is also severely neglected. Despite the Modi government’s pride in the economic boom brought on by the industrial clusters of south Gujarat, these are actually environmentally dead zones. The levels of air, land and water pollution are measured to arrive at what is called the Comprehensive Environmental Pollution Index (CEPI). Anything over 70 on this index is considered to have crossed critical levels, that is, the pollution exceeds the capacity of the environment to handle it and it becomes a dangerous health hazard. According to statistics from the Central Pollution Control Board, Ankleshwar and Vapi in Gujarat top the list of 88 severely polluted industrial areas in India. Ankleshwar has a CEPI rating of 88.50 while Vapi’s is 88.09. Of the 88 areas, eight are in Gujarat. Even Dhanbad in Jharkhand, with its intensive coal mining and a longer history of pollution than the Gujarat centres, ranks only 13th on the list.
In the race to be seen as a State where growth (read industrialisation) is on the fast lane, Gujarat has forgotten human development. A former member of the administration told Frontline: “Modi runs Gujarat like a shopkeeper. Profits and losses are measured only in economic and monetary terms. The larger picture of human development, and I include the environment in this, is completely ignored. Not neglected, mind you. It is wilfully ignored.”
When the BJP released its election manifesto on December 3 last year, the party billed the document as a sankalp patra, or a pledge to the people. In it, the Gujarat government applauded itself and the “all-round development” it had created in the State. The reality is that this development has been one-sided and socially exclusionary. The State government’s claims are nothing but a mirage.

The Indian Academy of Paediatrics (IAP)’s reforms: transformative or cosmetic? #medicalethics


Rema Nagarajan
25 February 2013, 08:14 PM IST, TNN

The Indian Academy of Paediatrics (IAP)’s has dismantled its Committee on Immunisation which recommends vaccines to be included in the annual immunization schedule. It is being reconstituted as IAP Advisory Committee on Vaccines and Immunisation Practices. (ACVIP).

The IAPCOI, which was almost entirely funded by vaccine manufacturers, was under a cloud following criticism about issues of conflict of interest.

In IAP’s new committee on immunization members have to abide by a very strict code of conduct and also have to sign a pretty exhaustive declaration of conflict of interest stating whether they, their employer or their immediate family members have received any money or travel grant or favour from a commercial business, industry association or research association or other enterprises with an interest related to the subject of the meeting or work. The declaration also includes statements about research support including grants, collaborations, sponsorships and other funding the person or his department or research unit might have received. It also includes non-monetary support for research such as equipment, research assistants, facilities, paid travel to meetings, investments such  as stocks, bonds, securities, in a commercial and so on. Plus, the members have to have undergone some training in the field of immunization and vaccines.

The brand name Rotarix is prominently displayed inside the hall of the PEDICON conference held last month, though IAP claims it does not promote brands

The brands Synflorix and Rotarix of GSK, a major sponsor of the conference displayed prominently all over the conference venue

Doctors thronging the stalls put up by various pharma companies especially vaccine manufacturers

Secretary general of IAP Dr Sailesh Gupta pointed out that all doctors’ associations take money, whether it is gynaecology association or the cardiology association of India, as they cannot conduct training without pharma support.

“Why only pharma? There should be concern about us taking funding from WHO or the UNICEF. Even they have an agenda. For example, UNICEF also promotes food products for children. So, even with these international agencies they will want to promote a particular food product they are using in say Africa. So, we need to be careful with them also,” said Dr Gupta. He added that there were very few organisations which were doing something about conflict of interest like the IAP.

Dr Gupta said that Medical Council of India (MCI) was not responsive to doctors’ concerns. “MCI never responds to any letter we send. Sometime back we were organising two conferences which were being funded by pharma companies. We wrote to the MCI seeking clarification regarding this. We got no response from them. Finally, we hired a lawyer specialised in MCI regulations who assured us that there was nothing amiss in conducting the conference. If MCI clarifies that organisations cannot take funds at all from pharma we will abide by that.”

He further explains: “We understand that the public has concerns about conflict of interest in us taking funding from pharma. But when we make recommendations we give an entire armament of medication for a condition and not by brand name. We ensure that pharma does not advertise inside the area where the programme is taking place even when a company is funding a session or workshop or training. We only use generic names and the only credit is to say that the programme is supported by so and so company. We are very careful about conflict of interest.”

While it is true that IAP is making efforts to address conflict of interest in its immunisation committee, it is not entirely true that IAP does not promote brands or that they do not allow advertising inside where programmes take place. A few photos from IAP’s annual conference Pedicon held just last month, show that industry particularly vaccine industry was visible everywhere and even during sessions their advertisements were being projected. Members were also being given gifts by companies at their stalls.

Is this a case of more things change, the more they remain the same? Or, is there a genuine effort to change illegal funding practices and address conflict of interest issues?

Dalit women pledge to snatch their rights from oppressive social structures #empowerment


MOHAMMAD ALI

NEW DELHI, December 5, 2012, The Hindu

Sunita Devi couldn’t take her Class IX final exams because the date clashed with the day of her marriage. Nine years on, she has not only completed her BA, but also teaches other Dalit women who couldn’t continue their studies after marriage. The resident of Baghpat in western Uttar Pradesh was recounting her story to a large number of Dalit women who had gathered here on Tuesday as part of the first national conference of Dalit women to debate and outline a National Dalit Development Agenda. The agenda is to focus on the access of Dalits to essential services like Integrated Child Development Schemes (ICDS), Mid-day Meal Scheme (MDM) and the Public Distribution Scheme (PDS).

“After marriage I told my husband that at any cost I would continue my studies. I challenged the social norms prevailing in Baghpat because somebody has to take the courage to break the social structures. If you won’t then nobody will,” Sunita told the cheering crowd.

Sunita was joined by Laxmi Bagri, a field worker on Dalit issues in Haryana. She narrated her story of fighting against a casteist and patriarchal society. “I raised my voice against sexual violence on fellow Dalit women and took the matter up with the police. The victims got justice because of the solidarity shown by the Dalit rights activists and groups,” she said.

“The bottom line is that it is high time we say no to all kinds of violence by any body and every body,” Laxmi , adding, “We need to take our every legitimate right from the self appointed guardians of the society.”

The occasion saw eminent feminist and women’s leader Kamla Bhasin singing empowering songs about not getting bogged down by patriarchal dictates and fulfilling one’s every wish and aspiration.

“Let’s take a pledge not to be defeated by patriarchal onslaught. All that it takes is courage on our part,” said Ms. Bhasin.

During the public hearing, the Dalit women talked about how they faced discrimination while accessing food programmes like PDS, ICDS and MDM and demanded that ICDS centres and PDS shops be opened in Dalit villages. They also demanded that the cooking staff should be appointed from among the SC/ST to “eliminate the notions of purity, pollution and untouchability.”

On this occasion, Ashok Bharti from the National Confederation of Dalit Organisation, a coalition of several Dalit rights groups, underscored that at present the PDS, ICDS, and the MDM were arguably the strongest available tools with which the poor and marginalised could actualise their Right to Food.

“But the biggest roadblock is the considerable disadvantage faced by Dalits while accessing these schemes which has finally resulted in poor nutritional indicators of the majority of the SC/ST communities,” he added.

A recent UNICEF study showed that 37 per cent of reported maternal deaths were from the Scheduled Castes, said Mr. Bharti, adding that children from SC/ST communities were more likely to be underweight and malnourished.

“It shows that there is some thing seriously wrong with our nutritional policies,” he said, demanding the National Nutrition Policy be redesigned and a National Nutrition Authority be established with substantial presence from the SC/ST communities. He also asked the Government to make the social audit of all food and nutritional schemes mandatory.

 

Trapped after being forced to say ‘I do’


ARUNA KASHYAP

Child brides are not criminals. They cannot be compared to children accused of committing crimes. Anyone who hears a story of a girl forced into marriage before she turned 18 will tell you that she had little choice in the matter. In fact, under Indian law, children convicted as juveniles cannot be disqualified from having access to any benefits or legal entitlements on the basis of their conviction. So why punish children who were forced to marry by closing the door on them?

 

The case of Ratnashri Pandey

Take the example of Ratnashri Pandey from Madhya Pradesh. Her family pressured her to marry soon after she passed her class nine examinations. Pandey told Human Rights Watch, “I didn’t want to be married, but a girl’s wishes are not respected. Everyone said I should get married…I got married.” Pandey never set eyes on the groom; not even his photograph. “I told my nana (mother’s father) I wanted to study after marriage.”

She described her struggle to continue her education — juggling household work, fighting with her husband and in-laws to delay pregnancy, and enduring insults and beatings because of her decisions. She separated from her husband because he started beating their young daughter, and eventually divorced him.

She completed her master’s degree and worked as a teacher. But because the income was not enough to support both her and her children, Pandey dreamed of becoming a civil servant. Leaving her children in her parents’ care, she went to another city, moved into a women’s hostel, and started preparing for the State civil services examinations. Her parents spent nearly Rs.300,000 to help. She passed the preliminary examination in 2006. But State policy stopped her in her tracks a month before she was to sit the main examination.

The Madhya Pradesh authorities informed Pandey that she was ineligible to take the exam because she was married as a child, she said. She filed a case in the Madhya Pradesh High Court, which granted her permission to write the examination pending a decision on the merits of the case. She did not pass the first time. After another round of litigation, she sat the exam again in 2009. “I spent more time in courts than with my books,” she said. The Madhya Pradesh High Court upheld the government rule disqualifying applicants who had married as children. She appealed to the Supreme Court, and awaits the verdict.

Violates 2006 Act

India prohibits marriage for girls under 18 and boys under 21, and should do everything possible to prevent child marriages. But when children (usually girls) marry and prevention strategies fail, punitive measures aimed at “discouraging” child marriages victimise girls yet again. This approach contravenes a key principle of the Prohibition of Child Marriage Act, 2006: no penalty for girls forced into marriages.

There is almost no information on how many such small rules are embedded in regulations or other programmes throughout the country. But there is enough information to show that such an approach is not an aberration.

Central programmes

During the second Universal Periodic Review (UPR) — which is the review of each country’s human rights progress every four years before the U.N. Human Rights Council — India earned high praise for its commitment to education. Other countries urged India to tackle the issue of child marriages and to advance opportunities for education and work for women. Reiterating its commitment to protecting the rights of women and children, India stated that its authorities exercised “greater consciousness” to integrate human rights concerns in every ministry’s policies and programmes. The need for “greater consciousness” in responding to child marriages in the country is dire.

It’s clear that what goes on even at the national level, excluding the victims of child marriages, goes well beyond Pandey’s case. Indian health rights experts have documented at least two other well-known examples. The Janani Suraksha Yojana (JSY) programme — sponsored by the Central government — provides conditional cash transfers to women giving birth in health facilities and is linked to prenatal, in-hospital, and post-natal services.

In many States with better health indicators, though, the benefits exclude girls below 19 who are not from Scheduled Castes or Tribes and where the Central government limits the benefits to two live births. The impact of this discriminatory treatment is likely to be mitigated by the Janani-Shishu Suraksha Karyakram (Mother and Child Protection Programme), another new scheme that promises free in-hospital and referral services to all pregnant women. But it is too early to tell.

UNICEF report

The Indira Gandhi Matritva Sahayog Yojana, which is the Central government’s cash assistance programme to supplement pregnant and lactating women’s nutrition and double up as maternity benefit, has identical restrictions. And weigh all this against stark data in a recent UNICEF report which says that 47 per cent of India’s adolescent girls are underweight and 56 per cent of girls from ages 15 to 19 are anaemic. UNICEF calls this a “severe public health problem.”

In April, UNICEF released its world report card on adolescents. It showed that India has 243 million adolescents (ages 10 to 19) — the highest number in the world. Another UNICEF report this year found that 47 per cent of women surveyed in India were married or in unions by age 18.

When the law against child marriages protects the mother and her child, it is appalling that key health and nutrition schemes for pregnant women leave out adolescent pregnant girls, affecting them and their newborns.

To be fair, the Central and State governments have dozens of schemes that “promote” girls, many of which are aimed at delaying marriage. But this is not enough.

Indian officials should develop a holistic response to tackle child marriages — a rights-based approach to Central and State government action. Punitive measures against girls and women forced into child marriages should find no place in government policies, programmes, and practices. Central and State governments should adopt a clear policy of non-discrimination that includes married adolescents in all welfare, higher education, and employment efforts. Without such a coherent response, India will fail its child brides. It’s time India’s approach to child marriages moved beyond this punitive phase and matured.

(Aruna Kashyap is Asia researcher in the Women’s Rights Division of Human Rights Watch.)

How Biriya delivered safely


Kounteya Sinha | February 11, 2012

A unique project in MP ensures that even women who live in remote tribal villages are only a phone call away from safe childbirth.

ON HAND: Call centre numbers for Janani Express are plastered on the walls of village homes

Scenario 1

Time: 1. 40 am February 6

Deepak Tiwari, posted at Mandla district hospital’s 24X7 call centre, receives a call informing him that Biriyabai from the tribal village of Sarra has gone into labour. He immediately dispatches an ambulance. At 2. 30 am, Biriya arrives at the Nainpur community health centre (CHC), 32 km from her home, and safely delivers a baby girl.

Scenario 2

Time: 1. 05 am February 4

Shiv Kali Maravi from Bamnigaon is in labour. Her family calls Rameshwar Khudape who is now manning the same call center. An ambulance is dispatched. At 2. 16 am, the patient reaches the CHC at Niwas, 33 km away. Soon after, Maravi gives birth to a baby boy.

While new born babies continue to die in hospitals across West Bengal – a tragedy that chief minister Mamata Banerjee calls “fictional, ” drama of a different kind is being played out in Madhya Padesh’s remote villages – one that can teach Banerjee a lot.
A fleet of 669 ambulances and 176 staffers in 48 call centres across 50 districts of Madhya Pradesh are working 24×7 to maximise institutional deliveries in distant tribal villages of the state. Jointly run by the state government in association with Unicef, Janani Express is now a major success story in the field of public health. The results talk for themselves.

More than 7, 00, 000 pregnant women have been transported free of charge across the state between January 2008 and December 11, 2011. Fewer children in the state are now being delivered outside hospitals. While the number of Janani Express beneficiaries was 2, 691 in 2007, it has steadily increased to 23, 545 in 2008, 35, 076 in 2009 and over 1. 7 lakh in 2010. In 2011, 4. 81 lakh pregnant women have delivered in hospital settings while 10, 000 new born children have benefited from it.
Each district in the state now has a call centre with a dedicated phone number. Around 22 vehicles are placed at different delivery points. “Somebody in a village has to have a phone. A single call now ensures a mother’s safety, ” says Dr Gagan Gupta, Unicef health specialist.

The infant mortality rate in Madhya Pradesh saw a fall of five points in 2010 – from 67 per 1, 000 to 62 per 1, 000 – the highest such fall recorded in the state. This is also the most dramatic fall documented in a year in the last decade, according to the registrar general’s latest data. “The analysis of two pilot call centres from Guna and Shivpuri for 50, 000 pregnant women transported from 2008-2011 revealed that half of the beneficiaries belonged to scheduled castes and tribes and half of the women were transported in the night hours between 8 pm and 8 am. In addition, 90 per cent of patients were transported within two hours of a call to a health facility, ” says Dr Gupta.

So how did the scheme start? In order to promote institutional delivery of children, the Union health ministry started the Janani Surakhsha Yojna (JSY) scheme which entitled all wouldbe mothers to free delivery, including a Caesarean section, in hospitals. They would be entitled to free transport from their homes to government health facilities and between facilities in case they are referred on account of complications. They would also be offered free drop back to their homes soon after.

This initiative was estimated to benefit more than one crore would-be mothers and newborns every year in both urban and rural areas. Under the scheme, accredited social health activists (ASHAs) were given Rs 250 as transportation charge for bringing pregnant women on the verge of delivering to the closest health facility. But an analysis showed that the lack of organised transport in the hinterland meant that it was hard for ASHAs to reach pregnant women to health facilities in time. Often they would be transported in lorries and on bike pillions.

Using a public-private partnership model, MP then decided to tie up with a private transport company – chosen through a tender – to start the Janani Express. “The cost of hiring of the vehicles is met from the Rs 250 marked for transportation under JSY funds. These funds are pooled based on number of institutional deliveries and provided to chief medical officers to make payments to the hired agency, ” says Dr Gupta.

The first call centre was set up in Guna in 2006. Each centre is manned by four people. Says Tania Goldner, chief of UNICEF Madhya Pradesh of the project: “Such 24×7 call centres, the Janani Express, strengthening of health sub-centres and cash linked maternity benefits, are part of the continuum of care for pregnant women and contributed to a significant increase in institutional deliveries in MP and progressive decrease of the maternal mortality ratio for the state. ”

Dr Archana Mishra, deputy director, maternal health at that state directorate of health services, says the state is committed towards reduction of high maternal mortality rate and maternal deaths caused by the shortage of referral transport facilities.
“The scheme is providing free referral transport facilities to pregnant women coming for delivery. Nearly 50 per cent of pregnant women going for institutional delivery are availing the free services under the scheme. These facilities are available to both the mother and the new born after discharge from the government health institutions, ” says Dr Mishra.

North South Dialogue IV (Conference On Inclusion of Disabled)- Goa 19-23 Feb


There are over 100 million disabled Indians who have no access to services. Despite legislation only 2% disabled have so far been covered. The North South Dialogue (NSD) was conceptualized by Dr. Mithu Alur and ADAPT – Able Disable All People Together (formerly SSI – Spastic Society of India) to explore models of reaching out to these people, strive for inclusive education and use the dialogue to build partnerships between Indian and global organization, learning from one another, exchanging ideas and supporting one another in the journey for inclusion.

In the past 11 years of its existence and 3 previous versions (2001, 2003 and 2005), NSD has done these and much more. It has seen global speakers from countries like UK, Canada, USA, Germany, Brazil, Ireland, Russia, Hong Kong, South Africa, Australia, Bangladesh, Nepal, Indonesia, Mongolia, Cambodia, Vietnam, Tajikistan, Tibet etc. Representatives of organizations as diverse as the governments of various countries, to those of World Bank, UNESCO, UNICEF, CIDA, civil society orgs, individual activists have participated and exchanged experiences from diverse cultures, contexts, resources and policies.

Overall the conference has not only been successful in generating innovative ideas for the disabled and their inclusion, but in also pushing forward disabled friendly policy and consciousness in the Indian sub-continent. The concrete steps have helped impact the lives of millions of disabled in a positive manner.

A fountainhead of ideas, it has become a must attend event for government officials at state and central level, NGO’s, activists and those providing services to the disabled, family members who want to do more, practitioners, academicians etc. not just from India and the Indian subcontinent, but also from the rest of the world who want to understand the Indian condition and share experiences from their own culture.

The 4th conference entitled ‘Implementing Tools of Change for Inclusion’ will be held in Goa between 19th and 23rd February. With 200 participants and speakers, it is expected to be a veritable mix of learning and inspiration, networking and interaction with participation from countries like UK, Germany, USA, Brazil, Canada, Australia, Ireland, Bangladesh, Nepal, Indonesia, Mongolia, Cambodia, Vietnam, Tajikistan, Tibet and of course, India.

Those interested in participating and knowing more about the conference, its purpose, costs etc. can contact: Mrs. Diane Saldanha, Conference Co-ordinator, ADAPT, K C Marg, Bandra Reclamation, Bandra (West), Mumbai – 400050. India. You can email nsd4.adapt@gmail.com or call +91-22-26443666/88 or fax: +91-22-26436848.

 

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