Madhya Pradesh: The Undiscovered Polity Of Indian Face

By Parsa Venkatesh (Guest Writer)

Madhya Pradesh is an understated state in the country. It has a rich history to rival that of any other state but there seems to be no great fanaticism about its past. The past lives on quietly with a quiet present. More importantly, it has a natural grandeur of forest, hill, dale, plain, rivers, rivulets, lakes that is not to be found in the better-known scenic parts of the country. 

The state is also relatively under-populated, though the residents of Indore may complain that their city is getting overcrowded and that traffic snarls are worse than those of Mumbai. Madhya Pradesh reminds one of almost a virgin country, which can absorb immigrants in large numbers and this can be done without destroying the forests, without choking the rivers and lakes — as it has begun to partly in Bhopal — and keeping intact the sense of the expanse of the land.

Editorial: It's now Bijli, Sadak, Pani and Terror

By M H Ahssan

Driving through Madhya Pradesh and Rajasthan, just a few days before the terrorist attack in Mumbai, one got the distinct impression that bijli, sadak and pani (BSP) firmly remained the key issues impacting the assembly elections in both states.

More importantly, terrorism was not even remotely seen as an issue with the electorate, even though the BJP’s central leaders had tried their best to politicise the Malegaon terror episode. This may have changed after the Mumbai attacks. It is now emphatically bijli, sadak, pani and terrorism (BSPT), not necessarily in that order.

Congress party leaders admit privately that the terrorist strike could have instantly given the BJP the extra advantage in crucial states such as Madhya Pradesh, Rajasthan and Delhi which voted just after the black Wednesday. Of course, the full debate on terrorism will play out at the general elections five months from now.

By then things may look a bit different as some distance from the event brings greater perspective. The Congress still has time to demonstrate its seriousness in tackling the growing threat of terror. Five months, after all, is a long time in politics.

The BJP will also try to appropriate, as much as possible, the issue of national security in the context of terrorism. It will be somewhat constrained by the unwieldy manner in which it sought to communalise the terror issue — though L K Advani is now correcting his course saying that he was merely on the issue of how the Maharashtra ATS had tortured the sadhvi allegedly involved in the Malegaon bomb blasts.

The BJP is already going through its own contortions to explain away its earlier stand on Maharashtra ATS chief Karkare, who fell to the terrorist’s bullet.

There will be a much more nuanced play of the terror issue in the months ahead. Meanwhile, the results of Madhya Pradesh, Rajasthan and Delhi will help in gauging how the Congress and BJP would evolve their campaign strategy for general elections.

Barely three days before the Mumbai terror attack, Madhya Pradesh chief minister Shivraj Chouhan candidly admitted to some journalists who met him at his Bhopal residence that there was a lot of anti-incumbency working at the constituency level. He also conceded that national level issues such as terrorism were not a factor at all at that time.

However, the chief minister felt confident that his positive image, linked with a larger vision for the state would beat the anti-incumbency at the level of MLAs. The biggest factor working against the BJP at the MLA level was the absence of bijli and pani, the very slogan which helped the party throw the Congress out of power five years ago. On an average, across Madhya Pradesh, villages are getting electricity just about five hours a day. Sans power, farmers are unable to pump up ground water.

Chouhan was honest enough to admit that part of the failure was caused by the dependence of the state on hydel power from Narmada river which did not have much water this year due to low rainfall. “What was supposed to generate 2,200MW is now only giving 800MW”, Chouhan said.

Despite the odds, Chouhan is seen as a winning horse because of what many see as his ability to connect with the poor in the state. Put simply, he is a 24x7 grassroots politician.

Does Congress have one in Madhya Pradesh? It is interesting to note that Chouhan tries to model himself as a strong regional leader like Narendra Modi, who is seen as having a finger on the pulse of the people. One also saw in Madhya Pradesh shades of Modi’s Gujarat strategy. For instance, Chouhan has fielded a large number of fresh faces to beat anti-incumbency at the local level.

Of course, the Congress’s major criticism against the chief minister is that he has promised a lot and done little. Even if that were true, it might be difficult for the Congress to cover the massive deficit in the total vote share it suffered in the last assembly elections.

In 2003, the BJP cornered 42% of the total votes polled in Madhya Pradesh, with the Congress bagging only 31%. Other things remaining the same, the Congress needs a 5% plus swing away from the BJP to cover the vote deficit, which seems like a tall order. The terrorist strike in Mumbai a day before the polling in the state may have made things even more difficult for the Congress.

The Congress, it would appear, has a much better chance of exploiting the anti-incumbency factor in Rajasthan where it lags behind the BJP in vote share by just 3%. It needs a 1.5% plus swing in its favour to challenge the BJP chief minister Vasundhara Raje Scindia, who seems to be banking largely on her personal charisma, with not much help from the rest of the BJP leadership either at the state or central level. The party apparatus does not seem to have backed her to the hilt.

The Congress is somewhat better organised in Rajasthan this time and Vasundhara’s distance from her party leadership could help swing the state away from the BJP. Again, it is not clear how the issue of terrorism will play out in Rajasthan whose capital has been a target of major terror strikes in recent times. The voter turnout in Rajasthan, though, was quite high.

In Delhi, it seemed very clear that the sudden surge in voting after the Mumbai attack clearly reflected some anxiety among the urban middle class over the issue of national security. So, terrorism will certainly impact the outcome of the assembly polls.

The real test for India’s major political parties will come during the 2009 general elections. In many ways the Mumbai terror attacks may have already changed the discourse of national politics. Until recently, the view espoused by many political observers seemed to be that both the Congress and the BJP were in disarray and that a reinvented third front could emerge with Mayawati playing a key role.

The third front becomes a strong possibility if the Congress and BJP together fall well below the half way mark in the 545-seat Lok Sabha. At present the two main parties are a little above the half-way mark of 273 seats.

However, as national security and terrorism gain centre stage, as they are most likely to do, in the Lok Sabha elections, the electorate might prefer a coalition that is led by a stronger national party. This is an opportunity for both the BJP and the Congress. The contest to appropriate the national security plank should be quite engaging.

Editorial: It's now Bijli, Sadak, Pani and Terror

By M H Ahssan

Driving through Madhya Pradesh and Rajasthan, just a few days before the terrorist attack in Mumbai, one got the distinct impression that bijli, sadak and pani (BSP) firmly remained the key issues impacting the assembly elections in both states.

More importantly, terrorism was not even remotely seen as an issue with the electorate, even though the BJP’s central leaders had tried their best to politicise the Malegaon terror episode. This may have changed after the Mumbai attacks. It is now emphatically bijli, sadak, pani and terrorism (BSPT), not necessarily in that order.

Congress party leaders admit privately that the terrorist strike could have instantly given the BJP the extra advantage in crucial states such as Madhya Pradesh, Rajasthan and Delhi which voted just after the black Wednesday. Of course, the full debate on terrorism will play out at the general elections five months from now.

By then things may look a bit different as some distance from the event brings greater perspective. The Congress still has time to demonstrate its seriousness in tackling the growing threat of terror. Five months, after all, is a long time in politics.

The BJP will also try to appropriate, as much as possible, the issue of national security in the context of terrorism. It will be somewhat constrained by the unwieldy manner in which it sought to communalise the terror issue — though L K Advani is now correcting his course saying that he was merely on the issue of how the Maharashtra ATS had tortured the sadhvi allegedly involved in the Malegaon bomb blasts.

The BJP is already going through its own contortions to explain away its earlier stand on Maharashtra ATS chief Karkare, who fell to the terrorist’s bullet.

There will be a much more nuanced play of the terror issue in the months ahead. Meanwhile, the results of Madhya Pradesh, Rajasthan and Delhi will help in gauging how the Congress and BJP would evolve their campaign strategy for general elections.

Barely three days before the Mumbai terror attack, Madhya Pradesh chief minister Shivraj Chouhan candidly admitted to some journalists who met him at his Bhopal residence that there was a lot of anti-incumbency working at the constituency level. He also conceded that national level issues such as terrorism were not a factor at all at that time.

However, the chief minister felt confident that his positive image, linked with a larger vision for the state would beat the anti-incumbency at the level of MLAs. The biggest factor working against the BJP at the MLA level was the absence of bijli and pani, the very slogan which helped the party throw the Congress out of power five years ago. On an average, across Madhya Pradesh, villages are getting electricity just about five hours a day. Sans power, farmers are unable to pump up ground water.

Chouhan was honest enough to admit that part of the failure was caused by the dependence of the state on hydel power from Narmada river which did not have much water this year due to low rainfall. “What was supposed to generate 2,200MW is now only giving 800MW”, Chouhan said.

Despite the odds, Chouhan is seen as a winning horse because of what many see as his ability to connect with the poor in the state. Put simply, he is a 24x7 grassroots politician.

Does Congress have one in Madhya Pradesh? It is interesting to note that Chouhan tries to model himself as a strong regional leader like Narendra Modi, who is seen as having a finger on the pulse of the people. One also saw in Madhya Pradesh shades of Modi’s Gujarat strategy. For instance, Chouhan has fielded a large number of fresh faces to beat anti-incumbency at the local level.

Of course, the Congress’s major criticism against the chief minister is that he has promised a lot and done little. Even if that were true, it might be difficult for the Congress to cover the massive deficit in the total vote share it suffered in the last assembly elections.

In 2003, the BJP cornered 42% of the total votes polled in Madhya Pradesh, with the Congress bagging only 31%. Other things remaining the same, the Congress needs a 5% plus swing away from the BJP to cover the vote deficit, which seems like a tall order. The terrorist strike in Mumbai a day before the polling in the state may have made things even more difficult for the Congress.

The Congress, it would appear, has a much better chance of exploiting the anti-incumbency factor in Rajasthan where it lags behind the BJP in vote share by just 3%. It needs a 1.5% plus swing in its favour to challenge the BJP chief minister Vasundhara Raje Scindia, who seems to be banking largely on her personal charisma, with not much help from the rest of the BJP leadership either at the state or central level. The party apparatus does not seem to have backed her to the hilt.

The Congress is somewhat better organised in Rajasthan this time and Vasundhara’s distance from her party leadership could help swing the state away from the BJP. Again, it is not clear how the issue of terrorism will play out in Rajasthan whose capital has been a target of major terror strikes in recent times. The voter turnout in Rajasthan, though, was quite high.

In Delhi, it seemed very clear that the sudden surge in voting after the Mumbai attack clearly reflected some anxiety among the urban middle class over the issue of national security. So, terrorism will certainly impact the outcome of the assembly polls.

The real test for India’s major political parties will come during the 2009 general elections. In many ways the Mumbai terror attacks may have already changed the discourse of national politics. Until recently, the view espoused by many political observers seemed to be that both the Congress and the BJP were in disarray and that a reinvented third front could emerge with Mayawati playing a key role.

The third front becomes a strong possibility if the Congress and BJP together fall well below the half way mark in the 545-seat Lok Sabha. At present the two main parties are a little above the half-way mark of 273 seats.

However, as national security and terrorism gain centre stage, as they are most likely to do, in the Lok Sabha elections, the electorate might prefer a coalition that is led by a stronger national party. This is an opportunity for both the BJP and the Congress. The contest to appropriate the national security plank should be quite engaging.

MGNREGA In Madhya Pradesh: 'A Tale Of Ghost Beneficieries'

Out of 1.20 crore MGNREGA job cards in Madhya Pradesh, 53 lakh are fake. Now look at the other numbers. The state has been receiving around Rs 3,000 crore from the Centre every year since 2006. It means, a huge portion of this has gone to bogus beneficiaries. Add up all the money they siphoned off in the last six years. If it is a record in corruption, it is some record indeed.

The state government has woken up to the problem rather late. It has ordered the cancellation of all the fake cards and taken strong punitive action against several officials besides ordering recovery of about Rs 5 crore from them. But all this clearly is a case of too little, too late.

Sixty percent of the money under the Centre’s flagship programme goes toward paying for human labour. That explains 53 lakh fake job cards. The rest goes towards construction material and other heads.  As fake as the job cards or the beneficiaries, are the jobs undertaken. Construction, road-cutting and digging jobs done under MGNREGA happens only on paper. For the record, the state’s expenditure towards the flagship central programme was Rs 1,863 crore in 2006-07, Rs 3,000 crore in 2007-08, more than Rs 3,500 crore in 2008-09, Rs 4,000 crore in 2009-10, Rs 3,640 crore in 2011-12 and over Rs 1,900 crore in 2012-13.

Ajay Dubey, an RTI activist who has been waging a constant battle against corruption in MGNREGA across multiple districts since 2006, says, “Madhya Pradesh tops every other state of India where corruption in MGNREGA is concerned. Whether it is the amount bungled or the number of cases caught and reported, no other state can match the corruption happening, even now, in Madhya Pradesh.”

According to him, “Lack of transparency and accountability is the root of all corruption. It is like government functionaries from rural areas have been left with huge amounts of money to spend as they please. The scenario, quite predictably, is pure mayhem. There have been inquiries conducted upon MNREGA irregularities, on the state government’s behest by IIM Indore, IIFM Bhopal, and a research study was carried out by Mahila Chetna Manch, Bhopal. But none of the reports were made public by the department. I have myself reported massive irregularities in different districts, but those reports too just gather dust, and the officials turn a deaf ear, as there is nobody interested to clear the mess.”

Time and again the state and national media have taken their viewers and readers to spots supposed to have been lakes, ponds and other water bodies dug or roads constructed by MGNREGA beneficiaries as MGNREGA job. While the team has shown government records on paper proving the ‘jobs completed’ and the labour and costs paid for, they could not, however, show any physical evidence whatsoever of a road or a water-body existing on land.

Allegations are multi-pronged and numerous. A scheme targeted at the down-trodden class, i.e. dalits, Schedule Castes, below-poverty-line individuals, and those who were on the brink of abandoning their homes and state for want of livelihood, as reports suggest,  leaves out these very people from the payrolls. If they have been included, they have not been paid the full amount or not paid at all.

Veteran journalist LS Hardenia, says, “Powerful and prosperous men from villages, team up with administrative functionaries and place their own manpower on MGNREGA payrolls and use their labour for their field-work. This saves the rich money, and deprives actual needy dalits and adivasis of the benefits of a scheme made initially for them.”

He cites the cumulative case of village Naregaon, tehsil Gadarwara, of Narsinghpur district. “In this village, since February 2012, the lower caste villagers are being treated as outcastes. Their fault – they refused to dispose of the dead cattle of the upper caste villagers.”

“Now these were the people who actually needed MGNREGA. But not one job has gone to them. All the beneficiaries are from the upper caste villagers and labourers working for upper class and rich farmers of Naregaon,” he said adding, a fallout of this is that here the smaller farmers who need labour for their moderate farming needs, suffer. They cannot use bigger machines and are dependent upon labour from the village, which is now working for richer farmers at the cost of MGNREGA.

As per the findings of an inquiry conducted by the state government, 91 officers, including the then Collectors and the then CEO of Janpad Panchayat, have been found committing irregularities. Action was not taken against the high-ranking officials, two of which belong to the cocooned IAS clan.

Leader of Opposition in the MP Assembly, Congress MLA, Ajay Singh says, “There is rampant corruption in the scheme all over the state. But a Collector of a district, who is directly involved in, and responsible, is yet to be held responsible for the corruption, or punished. Action will continue to be taken against the small fry but no higher-up would be brought to the book.” Singh added that the state government and the CM were openly shielding IAS officers and CEOs. “This could point to the fact that politicians and high-ranking bureaucrats too are the beneficiaries of the MGNREGA pie,” he said.

The government, while accepting that irregularities have taken place, won’t agree that it is as rampant as it is being made out to be. “Since the time of its inception in the year 2006, the government has carried out 14 lakh MGNREGA jobs in the state. We have received complaints of irregularities against just three thousand jobs. That is not even 0.5 percent of total jobs done. If 99.5 percent jobs have been done satisfactorily, and if the state government is taking action against wrong-doers in the remaining 0.5 percent, how can you call the scheme a failure in Madhya Pradesh?” asked additional chief secretary, Aruna Sharma.

She added that taking action against the wrongdoers was the government’s priority. However, since it’s a procedural issue and involves in-depth inquiry, it takes time. “If allegations of corruption against Collectors and CEOs are proved correct, action will be taken against them too,” she said.

However, the larger issue remains unanswered yet. Most of those punished are engineers, who are directly responsible for the schemes. Who monitors them? Retired IAS officer Nirmala Buch, ex-chief secretary of Madhya Pradesh and the Head of Mahila Chetna Manch, Bhopal, the organisation that did a research study on MGNREGA for the Madhya Pradesh government in 2012, told INN that MGNREGA is a scheme with major design defects. The implementation had to be carried out extremely carefully in such schemes and the jobs undertaken must be need-driven.

“For example, water bodies have to be dug only at places where water shortage is at its worst. What it has ended up being is a scheme taken up by different Collectors, CEOs, Janpad functionaries, as it suited them, need or no need. District officials and Janpad functionaries decide the budget, the beneficiaries and their own interests. No practical guidance, no supervision and no monitoring have led to many jobs not done,” she said.

Recently, Madhya Pradesh Lokayukta has appointed retired judicial officials, retired IAS officers, chief engineers, IFS and state administrative officers as MGNREGA Lokpals.

How effective would retired officers be in monitoring construction jobs done in far-flung rural areas of Madhya Pradesh, is a question many would wonder about.

MGNREGA, in many instances in Madhya Pradesh has ended in jobs not done, in genuine beneficiaries not benefitting, and in money reaching the coffers of the rich and the powerful. What is required is speedy action against all those who have done extensive misappropriation of government funds and recovery of money from them.

This, however, looks like a tall order.

Editorial: What 2013 Results Mean For Poll 2014 Scenario?

By M H Ahssan | INN Live

The results of the 2013 assembly elections in Chhattisgarh, Delhi, Madhya Pradesh and Rajasthan are out but those looking for clear pointers towards how the next general election will play out are likely to be left scratching their heads.

The Bharatiya Janata Party turned in a spectacular performance in Rajasthan and wrested the state from the Congress. It has retained Chhattisgarh and Madhya Pradesh, the latter with a significant increase in its seat share. But in Delhi, the BJP failed to properly ride the wave of anti-Congress sentiment, yielding crucial political space to the Aam Aadmi Party and falling short of a clear-cut majority.

Telangana: Inevitable And Desirable

The HNN has argued editorially that a just and sustainable solution to the Telangana issue can be found within an undivided Andhra Pradesh. 

In the winter of 1953, the Fazal Ali Commission was set up to reorganise the States of the Indian Republic. Its recommendation to go about creating States on linguistic lines, indirectly paved the way for the creation of Andhra Pradesh. Andhra was formed from the northern districts of the erstwhile Madras state and the southern districts of the erstwhile Hyderabad state — though the committee itself did not advocate such a merger and was against it.

Fifty-six winters later, the very concept of the creation of States based on linguistic lines has become passé. We need to look for fresh parameters for the creation of States, and that has to be based on holistic development on economic and social lines for better administration and management. This fact has been proven with the creation of Chhattisgarh from Madhya Pradesh, Jharkhand from Bihar and Uttaranchal from Uttar Pradesh.

Two issues that seem to be at the centre of the contention between the two regions of Andhra Pradesh is the future of Hyderabad and the repercussions in terms of the sharing of river waters from the completed and planned irrigation projects after the division of the State. Any entity, political or otherwise, that is able to find pragmatic solutions to this conundrum would not only earn the respect of the people of the State but also help set a precedent in the matter of contentious State divisions in the future.

Economics of small States
The case for small States can be argued with two parameters of macroeconomic statistics from the Ministry of Statistics and Programme Implementation. The first parameter is the percentage increase in Gross Domestic Product for States between 1999-2000, when the smaller States were created, and 2007-2008. India’s overall GDP increased by 75 per cent during this time period. During the same period, Jharkhand, Chhattisgarh and Uttaranchal recorded more than 100 per cent, 150 per cent and 180 per cent increase respectively. These rates were much above the rate at which national GDP increased. This clearly indicates that the recent creation of smaller States was a step in the right direction.

Experts have often argued that the creation of smaller States has been at the expense of the States they were created from. For all its lack of governance, Uttar Pradesh grew by more than 21 per cent of the national average during this time period.

The second parameter, the percentage contribution of States to national GDP, helps negate the myth of smaller States growing at the expense of the States they are created from. Uttar Pradesh, Bihar and Madhya Pradesh each contributed the same amount to national GDP. While the contributions of Bihar and Madhya Pradesh increased by 0.01 per cent and 0.06 per cent respectively, Uttar Pradesh’s contribution to national GDP increased by 1.2 per cent during the same time period. This is more than Chhattisgarh’s percentage increase in the contribution of 0.64 per cent to national GDP, the highest increase among the three newly created smaller States.

Capital politics
Hyderabad is an integral part of Telangana and a Telangana State without Hyderabad as the capital is inconceivable. However, the militant rhetoric of some political parties has made people of other areas feel unwelcome, creating an air of mistrust among the Telugu-speaking people of various regions. This is not only constitutionally illegal but also extremely foolish as it affects the image of Brand Hyderabad. Everybody who has come to Hyderabad in search of a better quality of life must be protected. Rhetorical slogans such as Telangana waalon jaago, Andhra waalon bhago gives the impression of an exclusionist movement that forces people of the non-Telangana region of Andhra Pradesh out of Hyderabad rather than a movement where the people of Telangana want greater autonomy for their region. 

Significantly, when Maharashtra and Gujarat were created from the then Bombay state on the recommendation of the States Reorganisation Commission, there was fear about Mumbai losing its importance as a financial nerve-centre as a lot of investment in Mumbai had been made by Gujarati business people. The creation of two separate States did not halt Mumbai’s rapid development. In fact, it additionally paved the way for the development of Ahmedabad and Surat as alternative financial centres. Hyderabad can emulate the same model. As in the past 400 years, the city can continue to welcome people with open arms rather than close its gates to fresh talent and creative ideas.

The people of the Andhra and Rayalaseema regions feel that the benefits reaped from Hyderabad must be accessible to all those who have been equal stakeholders in the city’s development. The solution to this is not alternative models such as according Hyderabad the status of a Union Territory or making Hyderabad a joint capital for the States carved out of present-day Andhra Pradesh. These solutions are just not practical. A better approach would be to plan a special financial package for the development of a new State capital for the non-Telangana region. Pragmatism would dictate that the special package be funded through some form of cess on the city of Hyderabad for a limited period rather than running to large financial institutions for loans, as has been proposed by some political entities.

Social dynamics of water
About 70 per cent of the catchment area of the Krishna and close to 80 per cent of the catchment area of the Godavari is located in the Telangana region. Across the world, water distribution and sharing schemes between two areas is calculated on the basis of the percentage of the catchment area that lies in the region. Other factors that influence water-sharing accords is the population of a given region, the projected usage of water for industry and the domestic population, and the physical contours of the region through which the river flows.

Take the instance of the Godavari, where the areas planned for large dams in the Telangana have not been found feasible for various reasons. As the Sriramsagar project on the Godavari already exists, it is not feasible to build another large dam on the Godavari until after the Pranahitha tributary joins the Godavari. There is not enough water to be harnessed on a continuous basis for the project to be economically feasible if the dam is built before the Pranahitha joins the main river. The Inchampally project, a national project whose benefits are to be shared between the States of Andhra Pradesh, Maharashtra and Chhattisgarh, was one such large project that was proposed. Though the project was conceived a long time ago, it has run into typical issues that are usually associated with projects that have multiple States as stakeholders. 

Though Andhra Pradesh, by large, is the main beneficiary of the project, the project plan estimates more forest land being submerged in Maharashtra (47.7 per cent) than in Andhra Pradesh (29.9 per cent; all land in Telangana). An equal amount of cultivable land will be submerged in Chhattisgarh (41.8 per cent) and Andhra Pradesh (42.2 per cent; all land in Telangana). And, more villages that belong to Maharashtra (100) will be submerged as compared to Andhra Pradesh (65). This has obviously made the other States reluctant to move as quickly as Andhra Pradesh on this project.

The link canal that has been planned between Inchampally and Nagarjuna Sagar that is proposed to irrigate the regions of Telangana in between also involves prohibitive costs as a result of the 107-metre lift that is required for the water to reach the Nagarjuna Sagar. The lift itself will require a separate hydro-electric power project for the project to be feasible. Commonsense and pragmatism would have ensured that a project in Kanthamapalli or Kaleswaram be pursued. Additionally, three smaller step- dams between Yellampalli and Sriramsagar must be devised with a realistic State-level river-interlinking plan. Inchampally is not an exception, but the trend in how political leaders across the aisle in Telangana have been caught up in the big-projects-to-line-my-pockets mentality at the cost of the development of the region by looking at smaller, realistic projects to execute.

The finale
The Telangana agitation is the only such movement in India that involves a capital city located in the region that is fighting for separation from the main State. This clearly reflects on the lack of governance and civic administration in this area as the benefits of having a State capital in the hinterland have not trickled down to other areas in that region.

Smaller States still need a good and vibrant administration to be recipes for success. Chhattisgarh is a fine example of how an effective administration could turn around a State in all aspects of development. The development that has happened in the Chhattisgarh region from Independence till 2000 has in fact been less than the development that has taken place from the time a new State was created in 2000 till now. The first Telangana Chief Minister would have done a great service to the infant State should he take a prescription from Chhattisgarh’s most famous Ayurvedic doctor.

Prespective Of 'Vyapam Scam': After Rapid Political Rise, CM Chouhan May Sink In Cash-For-Jobs Scandal

By Newscop
Group Managing Editor

Once seen as a prime ministerial candidate, the Madhya Pradesh chief minster is now trying just to survive the crisis.

The cash-for-jobs, or Vyapam, scam surfaced four months before a moment of glory for Madhya Pradesh’s Bharatiya Janata Party chief minister, Shivraj Singh Chouhan. Already eight years in office, the chief minister was hailed as the hero of a spectacular electoral victory in the state assembly election of 2013.

Sporadic cases of ineligible candidates being granted admission to the state’s six medical colleges had been surfacing in the media for many years. The public also had a sense of the longstanding nexus between Madhya Pradesh’s professional examination officials and admission touts.

Why Congress Is Likely To Lose Battle For Middle India?

By Ankit Trivedi / INN Live

The Congress should have been riding the anti-incumbency wave to power. INN Live travel across central India to discover why the party is floundering. The analysis of INN Live tour shows the anti-Congress wave is dominated in central India states while Bharatiya Janata Party (BJP) puts its strong hold with a strong leadership and enormous public support despite Congress party's public services. BJP's main agenda is to expose the scandals of Congress regime and show the party's grass-root public work towards minorities and rural people. Congress mostly works in urban areas to populate its populist schemes and utterly failed to reach rural India in these regions. INN Live minutely analysed the entire situations and sketched as following state-wise sequences.

Netas' Sons, Daughters Contesting Above 50 Seat In India

By M H Ahssan | INNLIVE

ELECTIONS 2014 At least 50 parliamentary constituencies will be contested by 'sons and daughters' of politicians. From President Pranab Mukherjee’s son Abhijit to Rahul and Varun Gandhi, at least 50 parliamentary constituencies will be contested by ‘sons and daughters’ of politicians of various parties during the upcoming Lok Sabha polls. Of these, a majority of candidates have been fielded from the ruling Congress party.

Abhijit Mukherjee, a sitting MP, is contesting on a Congress ticket from his present Jangipur (West Bengal) constituency while Rahul Gandhi and Varun Gandhi are fighting from Amethi and Pilibhit constituencies in Uttar Pradesh, respectively.

Revealed: Multi-Crore MPPEB Scam Trail Traced To Saifai?

By Sofia Razzack | Bhopal

The Madhya Pradesh Professional Examination Board (MPPEB) scam trail can be traced to Samajwadi Party (SP) supremo Mulayam Singh Yadav's ancestral village in Saifai district of Etawah district. In a revelation, a teenage prodigy and internet activist has leaked information pertaining to the exam scam in Madhya Pradesh, said reports.

This comes days after Lokayukta sleuths raided the house of former controller of examinations, Dr Pankaj Trivedi, the key accused in the Madhya Pradesh Professional Examination Board (MPPEB) scam.

Fake Federalism: How 'National Parties' Turned The Concept Of 'Rajya' In Rajya Sabha Into A Farce?

By NEWSCOP | INNLIVE 

The upper House of Parliament, literally a Council of States, was meant to be a federal chamber to look out for the interests of the states.

The continued abuse of the idea of the Rajya Sabha – or the Council of States – by the so-called national parties continues with the upcoming round of Rajya Sabha elections.

Clinical Trials: Storm in the Medicine Chest

Why the regulatory turmoil in India’s pharmaceutical establishment is good.

In 2005, Rajkumar Tiwari, a clerk at a transport company in Indore, had a son. The mother and child were doing well, and Tiwari was happy. At the end of the first month, his wife took the baby to Chacha Nehru Bal Chikitsalaya, a children’s hospital attached to Indore’s largest public hospital, for what they thought was a routine inoculation. She was made to sign a few papers, after which the baby was given two injections on his heel by paediatrician Dr Hemant Jain. Within 24 hours, their child was dead.

Ashish Jatav was luckier. A day after his son was born, the embroidery worker received a call from the same hospital asking him to bring the child. His wife and mother took the child there, where he was given what Jatav thinks was “some kind of polio vaccine” by Dr Jain. In all, the child received “either three or four” doses. That was in 2008.

Tiwari put his son’s death down to fate. “I didn’t even try to contact the hospital,” he says. And Jatav didn’t make any further enquiries about the vaccine his son had received.

That’s where matters would have rested had it not been for a question on clinical trials that cropped up in the Madhya Pradesh Assembly in late 2010. In response, the health department submitted a list of 81 people who had been enrolled in clinical trials between 2006 and 2010. That, shockingly, is how Tiwari and Jatav realised that their children had been used as guinea pigs in clinical trials.

The papers their illiterate wives had been made to sign had been passed off as the ‘informed consent’ that is required from participants in clinical trials. They had been given no verbal explanations, nor were they given copies of the documents they had signed. They had trusted the doctors of Chacha Nehru Bal Chikitsalaya, the city’s largest public children’s hospital.

Investigations by the state government and RTI requests from activists revealed that Dr Jain was conducting these trials for Panacea Biotec, a large Delhi-based pharmaceutical company. Jatav’s son was given drops of an untested polio vaccine, and according to PD Karan of Panacea, Tiwari’s son got the Haemophilus influenzae type B conjugate vaccine.

In its defence, Panacea claims that all participants in their trials were given consent forms in Hindi, which were subsequently approved by the hospital’s ethics committee.

The company says that of the 640 children involved, three died during the trials. Panacea claims that none of the deaths was related directly to the trials.

However, Panacea was not the only company for which Dr Jain was running trials. According to a report by the Madhya Pradesh government’s Economic Offences Wing, he conducted clinical trials on 2,500 patients for a number of different companies between 2006 and 2010. There were 18 deaths during the course of these trials, none of which was investigated by any independent agency.

Dr Jain, a government doctor, was paid Rs 1.7 crore for the trials. Not a penny of that went to the hospital. Dr Jain says he is “not interested in answering any questions”.

“We might be poor,” says Tiwari angrily, “but even the poorest wouldn’t subject their children to a trial vaccine.”

India emerged as a global pharma destination in 2005 when it amended patent laws to recognise product patents. Also amended were the rules that required foreign companies to conduct clinical trials in India only after they had successfully completed trials abroad. Now, companies could conduct trials in India concurrently and use clinical trial data generated in India for their patent applications abroad.

The clinical trial market burgeoned, growing from almost non-existent to one that the Boston Consulting Group estimates is now worth $400 million a year.

However, India’s regulatory infrastructure and the laws governing the pharma sector had not changed significantly. They were completely inadequate to control an industry that had been growing at over 20 percent every year.

As new details emerged in Madhya Pradesh, the issue simmered. Anand Rai of Indore-based NGO Swasth Samarpan Seva Samiti tried to get in touch with all the 81 participants, and filed RTI requests to unearth more details about the trials.

Then, last January, Swasthya Adhikar Manch, another Indore-based NGO, filed a case in the Supreme Court alleging that the Madhya Pradesh government had allowed completely unregulated, large-scale clinical trials of a whole array of drugs. In a writ petition, it alleged that many other states had done the same. It wanted the Union health ministry to provide details about the number of people enrolled in clinical trials, the number of deaths and the compensation given.

And that cracked open the anarchic can of worms that the pharma establishment in India (both government and private) had become. It was going to be a year of more revelations and indictments. What happened in Madhya Pradesh had also happened in Uttar Pradesh, Rajasthan and many other states.

The chaos in clinical trials, it emerged, was mirrored by regulatory laxity in drug control and the government’s tacit submission to various vested interests on intellectual property issues.

The blowback was swift. The furore on clinical trials was followed by a scathing Parliamentary Committee report on the functioning of the Central Drugs Standard Control Organisation (CDSCO), the apex body for drug approval and the regulation of clinical trials in the country.

At the same time, the Indian Patent Office rejected a number of major patent applications of pharma MNCs, and issued the first compulsory licence for the manufacture of a drug in India. This lead to a drastic reduction in the prices of critical drugs used to treat diseases like cancer.

The government also took a conservative stand on FDI in pharma, unlike what it was doing in most other sectors. The Department of Pharmaceuticals introduced a new drug price control system, the first amendment since 1994.

In the meantime, the Planning Commission was working on a broader canvas, suggesting changes that would refocus India’s health policy in the 12th Five Year Plan period (2012-17) on public health. The individual regulatory processes had started earlier, but in 2012, the strands coalesced into what will hopefully become a comprehensive net.

Everyone in the pharma industry has been affected. In a departure from the norm, the three government departments that handle pharma issues — the ministries of health; chemicals and fertilisers; and commerce — have spurred into action.

Pressure from civil society and the SC’s intervention has set into motion a series of regulatory changes in the pharma establishment that will have far-reaching consequences, determining the path of the industry over the next decade.

“It was the year when drugs took centrestage,” says Dr Ranjit Roy Chaudhury, who has worked with the government, the WHO and a number of private research organisations on health policy. “Public consciousness has been raised, and today more than ever before, there is demand for better control and availability of medicines and the rational use of drugs.”

But greater government regulation has meant reduced profits for the pharma industry, and that has not gone down well. So rattled is the industry that Tapan Ray, the head of the Organisation of Pharmaceutical Producers of India, hopes that “what happened in 2012 will not be a general trend in the future”.

Unfortunately for him, the ball has already been set rolling. What started last year is gathering pace, and will be refined by a series of reports and court orders that are expected. It’s leading to greater transparency and accountability in the government’s health regulation and in the private medical and pharma industry.

When Rai filed an RTI request with the Drugs Controller General of India (DCGI) asking for data on clinical trials, he was first stonewalled. Then emerged a smorgasbord of conflicting data. All of it seemed to point in one direction.

Not only did the apex drug control body (of which the DCGI is the head) not maintain a central database of clinical trial deaths, but there was little monitoring of trials or the compensation paid to victims who suffered serious adverse drug reactions. This was despite the fact that all clinical trials post 2009 are required to be registered on the Clinical Trials Registry.

That the monitoring of clinical trials had been almost non-existent became obvious by the end of 2012, as the government pulled out different, often conflicting data.

According to the DCGI, there had been 2,031 deaths during clinical trials between 2008 and 2011. 668 of these had taken place in 2010, of which 22 were directly related to clinical trials. In these cases, the companies conducting the trials had paid varying compensations, but the DCGI was not aware of the amounts.

The ethics committees overseeing clinical trials were responsible for deciding whether a death was related directly to it. In a clear conflict of interest, these committees were, according to Rai, “composed of members from the institutions where the trials were being held”.

The DCGI did not furnish data for the other years. “The data of respective trial sites and their respective states is not maintained by this directorate,” it averred. No action has been taken against the drug companies, clinical trial research organisations or the hospitals involved.

In the meantime, other data emerged in an answer given by Union Health Minister Ghulam Nabi Azad in response to a question in Parliament. According to him, there were 16 deaths each in 2009 and 2011. Compensation had been paid in all cases that occurred in 2011.

The government had no rules on compensation to the victims of clinical trails, therefore the money doled out by the companies in all these cases had been at their discretion.

Yet more data emerged from the case filed by Swasthya Adhikar Manch in the SC. In an affidavit filed on 3 January by R Chandarashekar of CDSCO, the government claimed that between 1 January 2005 and 30 June 2012, there had been 2,644 deaths during clinical trials. Of these, 80 were directly due to the trials. Compensation had been paid in the 40 cases that occurred in 2008-11; and the agency was “now ascertaining the status of such cases pertaining to the year 2005 onwards”.

The figures from all the sources above were at variance. Azad’s reply in Parliament put the deaths in 2009-11 at 54, whereas the CDSCO affidavit put it at 40 for a longer period!

A similar state of confusion prevailed when it came to the number of patients enrolled in clinical trials across India.

Those who had suffered serious adverse reactions were completely ignored. The CDSCO affidavit put their numbers at 11,972 (for the same period), of which it stated that 506 were related to clinical trials. The CDSCO was not aware if any compensation had been paid in these cases.

Matters only got murkier.

Not only did the drug controller not have any reliable data on clinical trials, Azad’s reply revealed that it had conducted only 23 inspections of trial sites and companies in 2008-12. Shockingly, during this period, the same agency had allowed the clinical trials of 1,544 drugs.

All this had worked in favour of the growing clinical trial industry with clinical trials of drugs that Mira Shiva of the All India Drug Action Network says are “largely irrelevant to India”.

India was a cheap destination for pharma MNCs to conduct clinical trials (for drugs to be marketed abroad), and there was a huge pool of people to be used.

Ironically, while on the one hand these clinical trials were growing, the drug control agency was increasingly letting pharma firms introduce new drugs in India without conducting mandatory clinical trials.

In a May 2012 report, which Dr Chaudhury calls “remarkable” and “unprecedented” for its brutal honesty, a Parliamentary Standing Committee pointed out these glaring violations.

Randomly scrutinising the approval of 42 new drugs given by CDSCO, the committee found that files for three controversial drugs were untraceable.

Of the remaining 39 for which the files did exist, 11 drugs were not put through mandatory phase III trials. Thirteen drugs were not approved for sale in any major developed country (including Buclizine, a controversial appetite stimulant for children) and had no “special relevance to India”. For 25 drugs, approval had not been taken from medical experts.

In all, the regulator had waived the mandatory clinical trial requirement for 31 drugs between January 2008 and October 2010. This included Ambrisentan, a hypertension medication manufactured by GlaxoSmithKline, and Colistimethate, an antibiotic made by Cipla, which were likely to be used widely.

More worryingly, it pointed out that most of “expert opinions” justifying the waivers were “written by the invisible hands of drug manufacturers and experts merely obliged by putting their signatures”.

“The clinical trial system was a complete mess,” says Sakthivel Selvaraj, a health economist at the New Delhi-based Public Health Foundation of India.

As these revelations emerged, the government was forced to act. The CDSCO put out guidelines regulating the ethics committees overseeing clinical trials. The guidelines stipulate that the committees should have at least seven members, including some who are independent of the institution conducting the trial, besides one layperson (not from the medical establishment). It also required the committees to be registered with the state or central licensing authority.

There were also guidelines for the compensation for injuries and deaths related to clinical trials. These took into account the patient’s age, earning capacity and the extent of injury.

The onus of proving that an injury or death was not due to the clinical trial was transferred to the sponsor, and a time frame stipulated within which the victim was to be compensated. Ethics committees were now required to report all adverse reactions to the regulator.

A whole slew of New Drug Advisory Committees were also constituted to advise the CDSCO on the approval of clinical trials and new drugs. Clinical trials of new drugs would now have to be approved by a separate committee controlled by the Indian Council for Medical Research (ICMR).

In its order on 3 January, the SC was even more restrictive, directing that all clinical trial applications be temporarily approved by the health ministry secretary.

A government panel set up to look into the Parliamentary Standing Committee’s allegations on the approval of new drugs has submitted its report, which is yet to be made public. VM Katoch, head of this committee and director-general of ICMR, did not respond to emails and phone calls.

Predictably, the pharma and clinical trial industry is worried. Anil Raghavan, head of the Indian operations of Quintiles, a large MNC contract research and clinical trial company, finds these changes disturbing. “These are knee-jerk solutions to societal concerns,” he says. “They have caused confusion and concern in the industry about the intent and direction of government policy.”

A report from PricewaterhouseCoopers and the Confederation of Indian Industries reiterates this stating that as a result of these changes and the consequent delays in clinical trial approvals “some contract research organisations are looking to increase focus on other geographies”.

That wouldn’t be cause for concern in the case of clinical trials of drugs that are not relevant to India, but it could lead to significant delays in the introduction of important drugs manufactured by MNCs.

In the long run, this regulatory churn seems inevitable, almost overdue. It’s the first step to a more radical and comprehensive overhaul. “Making these changes in our system is very difficult,” says Chaudhury, “this is the start of a process that will play out across the next decade.”

NEGLECTING INDIAN FORESTS - 1 : 'MISSING TIMBER FOR WOOD'

INN will run a special series of reporting from different forests across the country on neglected and dis-functional forests. INN reports the actual findings. This is the first story of this series.

As the demand-supply gap for timber widens in India, it is time to exploit the potential of private plantations and government-managed forests in a sustainable manner.

For the past five years, Rambharos Kamedia, a farmer in Madhya Pradesh, has been receiving a lot of attention. A dense teak forest he raised on his farm near Satwas village in Devas district is visited by the who’s who of the forestry circle. The state government projects it as one of the success stories of its much acclaimed Lok Vaniki scheme. Kamedia, however, is no more amused. Rather, he feels cheated.

Why Kerala Is like Kuwait & Madhya Pradesh Is Like Haiti?

For its level of income, India, as well as many of its states, could do a much better job in taking care of their most vulnerable people.

American poet Walt Whitman’s “Song of Myself”—“Do I contradict myself/ Very well then I contradict myself/I am large, I contain multitudes”—seems tailor-made for India. Which country can India be compared to, in economic terms? Is India’s level of economic development more or less like Vietnam’s, because their per capita incomes, in international dollars and in purchasing power parity terms, are almost the same?

Exclusive: Are Indian 'Chief Ministers' Safe In Next Polls?

By M H Ahssan / INN Live

Seems that incumbent chief ministers in the states of Madhya Pradesh, Rajasthan, Chhattisgarh and Delhi are safe in the forthcoming Assembly polls with the opposing political parties not succeeding enough to create a ground to dislodge them even from their constituencies.

Anti-incumbency is visible in the election-going states of Madhya Pradesh, Rajasthan, Chhattisgarh and Delhi, but not against incumbent chief ministers.

'They Still Die in Labor Room'

By Samiya Anwar & M H Ahssan

Taj Mahal- One of the seven wonders of the world, One of the Greatest monuments, dedicated to the memory of the Queen Mumtaz , by her husband Emperor Sahajahan, is a testimony and a grim reminder of the tragedy of maternal mortality, that can befall any women in childbirth. The probability of an Indian mother dying during childbirth is roughly 10 times that of her Chinese counterpart. Reducing the Maternal Mortality Ratio (MMR) by three-quarters in 10 years is now a Millennium Development Goal. Why is MMR in India so high and how far are we from the goal? HNN unravels the many challenges to saving mothers' lives.

Maternal Death - A Tragic Reality
Women, undoubtedly is the most beautiful piece of creation. She is not just a female, she is more than it. She is definitely a special handiwork of God. That is why she is wanted, she is loved. Men love women. Isn’t so and why not they are always surrounded by women. First it is a woman, to whom they are born. Then they grow with women as sisters. They are married to women. And also women are the one who reproduces the generations. Yes, because women are the reason for the offspring and growth of society.

But the same women are put to menace for procreation of mankind. They are often treated as reproducing machines. Not cared, left as scraps or doormats at homes women die anonymously especially the poor. For women it is a joyful start to a life as the mother and for a child a whole new life. It is really indecent that there is no man or women who take care of them or good medical facilities when the women are in need of special care and attention during and after pregnancy. Hence they either develop complications in the womb or die soon after child birth. Lack of education and short of medical facilities would be the cause. Many stories of women dying with maternal deaths are largely untold and unheard.

This is a social issue and heeds attention. Thanks to the television channels for wonderfully presenting the shows on social problems. Balika Vadhu, is such a social serial on Colors, which had so far portrayed the maternal deaths of young women. It is a mirror of Indian Society. The Indian Government estimates that 301 women die annually for every 100,000 live births. In some states the maternal mortality ratio is even higher -- 358 in Orissa, 371 in Bihar, and 379 in Madhya Pradesh. It is also estimated that few rural women chooses to remain passive. Laajwanti (name changed) a rural girl barely 16 has no complaints; however, she says “It’s a woman’s duty to produce as many children she can. They are God’s gift.” It is been observed that the maternal mortality rate has risen faster as there is pressure on girls to produce as soon they reach puberty. It is a shame to our country which is developing but not the people. We’re still backward. Right!

As the new data analysis tool reveals an estimated 80,000 pregnant women or new mothers die each year in India often from preventable causes including hemorrhage, eclampsia, sepsis and anemia. Since many deaths happen in the anonymity of women's homes or on the way to seek help at a medical facility, they often go unrecorded. It is absurd because we know about such practices, we have heard it, we have also listen to the news channels and read in several newspapers but still there is no official complaint.

Over 67% of maternal deaths in eight districts in Orissa were among SC/ST groups. Illiteracy is as much a factor as lack of primary health care. After achieving so many laurels in academics, still we’re not fully educated. Though the enrolment in schools has risen from past, our country yet suffers from problems due to lack of information and knowledge. Also in Purulia, West Bengal, 48% of the women who had died had no formal schooling. That’s a real embarrassment. In Bihar’s Vaishali, we can see 42% of the deaths occurred due to Haemorrhage, the most common cause of delivery-related deaths, with almost all hemorrhages occurring after delivery. Many women who delivered at home also died from postpartum hemorrhage. Eclampsia, a serious complication during pregnancy that is attributed to under-developed arteries in the placenta, was the second most common cause of death (17% in Dholpur, 19% in Purulia, and 27% in Guna/Shivpuri). However, the standard treatment for eclampsia, magnesium sulfate, was often not available in these places. These are the shocking findings of an ongoing survey across six states being conducted in co-ordination with the United Nations Childrens’ Fund (Unicef). India is still quite far from achieving the Millennium Development Goal of reducing maternal mortality rate (MMR) by three quarters by 2015. On an average, there are at least 301 women dying annually for every 100,000 live births. In some states the MMR is even higher—358 in Orissa, 371 in Bihar and 379 in Madhya Pradesh.

Causes may be:
- Early marriage,Hidden pregnancy, history of abortion, etc
- Financial disasters, No medical facilities
- Smoking, drinking and drugs (urban women)
- Lack of knowledge (like the example I gave about Laajwanti above)

Maternal death is a sensitive issue of human race. We need to curb the social ailments from the society. It is like terrorism killing the number of innocent lives in the dark of ignorance. Though it is hard to eliminate fully from the society we can generate proper awareness about the loss of humanity with every mother dying during and post pregnancy.

Maternal mortality: This India story is a shame!
Over 67% of maternal deaths in eight districts in Orissa were among SC/ST groups. Illiteracy is as much a factor as lack of primary health care. In Purulia, West Bengal , 48% of the women who had died had no formal schooling.

Haemorrhage is the most common cause of delivery-related deaths, with almost all haemorrhages occurring after delivery. In Bihar’s Vaishali, 42% of the deaths occurred due to this. Many women who delivered at home also died from postpartum haemorrhage.

Eclampsia, a serious complication during pregnancy that is attributed to under-developed arteries in the placenta, was the second most common cause of death (17% in Dholpur, 19% in Purulia, and 27% in Guna/Shivpuri). However, the standard treatment for eclampsia, magnesium sulfate, was often not available in these places.

These are the shocking findings of an ongoing survey across six states being conducted in co-ordination with the United Nations Childrens’ Fund (Unicef). India is still quite far from achieving the Millennium Development Goal of reducing maternal mortality rate (MMR) by three quarters by 2015. On an average, there are at least 301 women dying annually for every 100,000 live births. In some states the MMR is even higher—358 in Orissa, 371 in Bihar and 379 in Madhya Pradesh.

A new tool, Maternal and Perinatal Death Inquiry and Response (MAPEDIR), has been developed to analyse the underlying medical and social reasons behind maternal death and is being used across 16 districts in Rajasthan, Madhya Pradesh, West Bengal, Jharkhand, Orissa and Bihar providing an ongoing, systematic collection of data to reconstruct and analyse the cases of 1,600 women—the highest number of audited maternal deaths in the world. MAPEDIR also informs health officials about the challenges local women face in accessing reproductive health care.

“The tragic reality is that too often maternal deaths are not visible. They don’t leave any trace behind, and their deaths are not accounted for. Unicef is committed to continue working with the National Rural Health Mission to promote surveillance as a key strategy to lower maternal and child mortality,” Chris Hirabayashi, Unicef India deputy director of programmes, said at a meeting with health officials from the six states who are using MAPEDIR.

“Unless we know the main reasons for maternal deaths we cannot take effective measures to tackle them. The traditional system did not deal with the issues adequately. Now using MAPEDIR, we can know if the death are due to delays in decision making at household level or lack of transport or delay at the facility or a cumulative of all three,” S P Yadav, director of medical and health services in Rajasthan said.

A team made up of state government health and nutriti on officials and NGO members, headed by a member of the local village council or Panchayati Raj Institution, conducts interviews with surviving family members at community-level with technical support from Unicef and funds from the United Kingdom’s department of international development (DFID) work under MAPEDIR.

Social and economic factors like the low status of women in communities, the poor understanding of families on when to seek care, lack of transport, poor roads, the cost of seeking care, multiple referrals to different health facilities and a delay in life-saving measures in rural areas have been listed out by Unicef as the reasons behind the high MMR.

Many of these deaths happen in the anonymity of women’s homes or on the way to a medical facility and so they often go unrecorded. An estimated 80,000 pregnant women or new mothers die each year in India often from preventable causes including hemorrhage, eclampsia, sepsis and anemia.

Who cries when mothers die?
Munna was nine months pregnant. She did experience pains few days back, when her husband and mother-in-law rushed her to the nearest primary health centre in Kushwai of the District Shahdol in the State of Madhya Pradesh in India. They had to make her travel by bus from their village, and then in pain Munna had to walk, which she could barely to reach the health centre.

But unfortunately the kushwai health centre, where they had come with lot of hopes, did not had a medical doctor for last one and half years. One male health worker mans the centre. Though, he puts in his best but that may not be enough for women like Munna and others who need medical support.

Inspite of reaching the primary health centre, she did not get any help. She has to travel another eight kilometers to Burhar, the place where there is a community health centre. The centre is fortunately newly built and has facilities for delivery. Munna did develop some complications during the delivery but fortunately survived to see her new born.

She was lucky but thousands of women which die in the state are not. App 10,000 women die every year in Madhya Pradesh during pregnancy or within 42 days after pregnancy. Majority of these could be prevented. Medically these deaths may be due to hemorrhage, infection, eclampsia or unsafe abortion or any of three delays. But fact is there exists a yawning gap in our health system which stands in between life and death of women in the state. This gap has linkage to availability and access to health services, infrastructure, awareness among communities of not only the services but even recognizing danger signs, issue of how where they can access the services etc. Studies also tells us that for every maternal death in India, 20 more women suffer from the impaired health.

But if the situation at ground is like this, and has been there. What is the state’s response to an issue like this? Does it impact the political leaders, their discourse? Does issue of women dying in the state is debated in discussions where funds are allocated or decisions are made? Does state’s machinery care for it? Does civil society raise its concern?

To answer some of these questions a dip stick assessment was done in year 2004 at various levels within civil society, debates in the state assembly, media analysis. Outcomes were revealing. First of all the issue concerned only few in health department. There were only handful of civil society partners, and their major role was to support service delivery system. As such there was no push or urgency to bring change. Interestingly, the issue had never being debated on the floor of the state assembly, a place where elected representatives ‘of the people, for the people and by the people’ decide. It did not impact them, many of them were not even aware of the fact that state has this high number of maternal deaths? An issue like this was never raised by the political leaders in the debates which happen there – an issue of total neglect at the highest political body. Media covered ‘event news’ around the safe motherhood day, probably they never got the right information too.

That was a starting point, but nevertheless situation has changed today. Today state recognizes it as a major issue when it comes to women and children. State calls for an action. It is on high priority list of the political head of the state, state party is being questioned on the number of deaths, gaps on the infrastructure and many related points. Today more than 150 civil society organizations are raising concern on the issue and demanding urgency and urgency of action in the state.

How it happened and what does it impact and what strengths does it generate? Movements don't just happen; the energy that underlies them must be marshaled, channeled, and focused. The principal means by which this is achieved in our society, and within our political tradition, is through advocacy networks and coalitions.

Networks like Madhya Pradesh Voluntary Health Association, Madhya Pradesh Jan Adhikar Manch and Collective for advocacy, resource and training, Madhya Pradesh Samaj Sewa Sanstha, Mahila Chetna Manch, and many others have not only contributed to help bring the issue at an individual level but as a part of informal collation added to that force which helped bringing the agenda on political normative framework. Some of the strengths which this informal network helped bring were the numbers of civil society partners raising concern on the issue spread across different regions of the state. From a handful few now it is more than 150 civil society partners in the state working in all divisions to bring the issue to forefront. The turn around is also in their way of working from being a service delivery partners or a social mobilization partners in supportive and submissive role in a new avatar of advocacy partner. In this new role civil society speaks on the issue of right to health, its violation, demands state’s accountability to provide for safemotherhood. In this new business influencing people who make decisions which impact human lives is the key.

The primary target of the civil society was to bring the issues which impact lives of women at the villages, blocks and districts to the agenda of the people who make or influence decisions, i.e. state assembly debates, political leaders, members of legislative assembly, ministers, media, rights commission etc. They had been to some part successful. ex-pression of this concern was undertaken by directly meeting and sensitizing political leaders. The evidences highlighting gap were shared with political leaders, urging them to rise above politics and give a strong call for action. These non governmental organizations wrote memorandums, shared information and collected evidences for the same purpose. Media engagement also supported by providing an enabling environment for change. Strong evidences i.e. case of maternal deaths which can be presented, health system gaps were highlighted which added pressure on the state and the leaders to react. Resultant of this solid gains achieved. Today questions on maternal mortality are being raised in the state assembly, the highest policy making body of the state. It is not just few many voices are being publicly heard on the issue. There is a increased concern within media.

From nowhere it came to a point where state publicly acknowledge the problem, and its commitment to act. Many new polices and schemes have been announced and that too in the rapid succession. This amount of concern and even expressed publicly by leaders had never been seen earlier in the state on the issue of maternal mortality. But that is not enough today empowered civil society and media is always looking with eagle’s eye on the new measures of the state and vocally points out the gaps This is a positive sign, where people are voicing their opinion. But it is not easy as said. Political leaders have started picking up real cases of deaths, gaps in infrastructure in the state, violation of rights, gaps in policies and seeking answers to what is being done by the state to response to the situation.

Advocacy experts tell us that ‘people centered advocacy’ is the best, i.e. position when people who suffer can speak for themselves. A step has been taken in the same direction by the engaged networks. Madhya Pradesh Jan Adhikar Manch in their work with communities helped to bring the issue to debate in various gram sabhas which were held by panchayats in Gwalior – Chambal division. Similarly women who had participated in various women conventions hosted by Madhya Pradesh Samaj Sewa Sanstha came forward and wrote about the problems women face in rural areas when it comes to issue of safemotherhood and why do women die in their villages while giving birth. As per sources of Madhya Pradesh Samaj Sewa Sanstha more than 200 women have written to the Chief Minister. On a simple fifty paise post card, they wrote by theselves and it was send to the Chief Minister. It looks simple but powerful, if it gets to his eyes. Recently a large number of women from villages across Madhya Pradesh have joined a signature (or thumb-impression) campaign to press for their right to health and to call upon the Government to ensure that the dream of safe motherhood becomes a reality. As a part of a special drive to raise concern on this crucial issue, more than 20,000 women from different villages of the State are now in the process of signing (or placing their thumb impression) on a various banners demanding the right to health and calling upon the State to ensure that the dream of safe motherhood becomes a reality. Madhya Pradesh Voluntary Health Association, Madhya Pradesh Samaj Sewa Sanstha are the civil society partners who are collecting these signatures/thumb impressions of women. They say that they do so after they are adequately sensitizing them on the issue of maternal mortality. Then if they feel that some concrete action is needed to improve the situation, they come and sign. Plan is to present the banners with their signatures to policy makers.

One might say that this is good effort, which indeed it is to bring the agenda of maternal mortality on to the political and action framework but it is still a long way to go. This is true. But if one looks back one and half years where there was hardly any concern, hardly anyone called for action, except few that too ‘within the box’. The focus was limited. From nowhere it has come somewhere, which is an important achievement by any means. Need of the day is to provide possible answers to the state, which is willing to listen. Answers which can help deliver results, within the context of the field realties and socio – cultural aspects – a new call to many!


Lhamu, a mother of twelve, lives in a remote village in Western Tibet. Three of her children died within a month of birth and the four year old strapped to her back looked as small as a one year old. She gave birth all alone, at home, all twelve times. But Lhamu was lucky. She didn't die. One in 33 women dies during childbirth in Tibet. Malnutrition, abject poverty and lack of any health care – however basic—plagues Lhamu's family, as it does much of Tibet. Tibet – vast lonely stretches of dead habit with nary a creature on its harsh plains and no economy to speak of. It can't be as bad here in new economy India, right?

Think again.

One in 48 women in India is at risk of dying during childbirth. The Maternal Mortality Ratio (MMR) in India is a high 407 per 100,000 live births, according to the National Health Policy 2002. Other sources put the MMR at a higher 540 (NHFS and UNICEF data, 2000). Reducing the Maternal Mortality Ratio (MMR) by three-quarters by 2015 is a Millennium Development Goal (MDG) for all countries including India. Achieving this means reducing the MMR to 100 by 2015. Part of the problem is this measurement – MMR data is just not there and if it is, it varies widely depending on what method was used to get it.

Studies show MMR among scheduled tribes (652) and scheduled castes (584) is higher than in women of other castes (516, according to one study). It is higher among illiterate women (574) than those having completed middle school (484). The key determinant seems to be access to healthcare. Less-developed villages had a significantly higher MMR (646) than moderately or well-developed villages (501 and 488 deaths, respectively).

"It is very sad that the numbers are so high even 57 years after independence," avers Dr H Sudarshan who is Vigilance Director (Health) of the anti-corruption body Karnataka Lokayukta. "Not only are the numbers from the Sample Registration System (SRS) high, they are also incomplete. We do not know how many mothers actually died during childbirth and why. Underreporting is rampant and people hide MMR numbers in fear of repercussions. We need state-wise and within states, district-wise data," says Sudarshan who was also Chairman of the Karnataka Health Task Force which made wide-ranging recommendations based on a 2-3 year detailed study conducted in the state. Regardless, the UN MMR numbers for India (540) are several times higher than those for other developing countries like China (56), Brazil (260), Thailand (44), Mexico (83) or even Sri Lanka (92).

Medical reasons
So what exactly leads to such a high MMR? The main reasons for maternal deaths related to pregnancy are anaemia, post-partum bleeding and septic abortions with anaemia being the most rampant. "Antenatal care is most important," declares Sudarshan, "and that is just not being done. This kind of care checks for high risk pregnancies."

Public health advocate Dr Mira Shiva agrees, "Hypertension and the toxemias of pregnancy can only be detected with antenatal care. There is a total neglect of a mother's health in India. [The situation] is disgusting because a big chunk of all this is preventable. The medical establishment is busy with micronutrients but that is not the answer. Giving one iron tablet to a woman during her pregnancy is too late." Shiva is coordinator of the All India Drug Action Network (AIDAN) and one of the founding members of the People’s Health Movement (PHM). Striking out at a more endemic problem, she says, "The real problem is food. It is all about food, the cost of food and the nutrition content therein. These pregnant women have to fetch the water, make fuel, work the buffaloes, etc., all on the measly amount of food they can afford. How can the nutritive intake be enough? It becomes a negative calorie balance. In short, what is needed goes beyond a medical solution."

Sudarshan echoes Shiva's sentiment, "We need to move from a medical model to a social model. Nutrition for pregnant mothers is very important and the ICDS Anganwadi scheme has clearly not achieved the hoped results." Where antenatal care is good, the results are good as well. Kerala and Tamilnadu have good antenatal care and correspondingly have two of the lowest MMRs in India. In Assam and Bihar where antenatal care is almost zero, the MMRs are among the highest. India has the lowest percentage of antenatal coverage (60%) among countries like China, Brazil, Mexico, Thailand and Sri Lanka which are all in the high 86-95% range.

While antenatal care is paramount in the prevention of pregnancy-related deaths, septic abortions are more insidious. What is worse, the latter tends to go unreported due to the nature and circumstances surrounding it. In many rural areas couples do not use any spacing methods and women conceive within 7 months of having given birth. Dr Leena Joshi of Family Planning Association of India (FPAI) is familiar with this scenario. Her voice drops with concern when she mentions abortion rates in the remote reaches of Maharashtra. "The abortion rate in these areas is just so high. With it comes hidden mortality from septic abortion deaths. Since the PHCs do not have MTP methods, the abortions are performed by quacks. And even if the PHCs or district hospitals have MTP methods, the people opt for local help." Why? "It saves them money. These are very poor people and transport costs and medical costs can be saved by walking to a local quack." As a result there are a high number of abortion-related deaths which do not get reported under maternal mortality. Dr. Joshi laments that everybody only talks about deaths during the childbirth process. "But since there are so many septic abortion cases it all goes unreported."

The problem of unsafe abortion is something that Shiva worries about as well. "Abortion (MTP) being legal in India, no one is turned away. Second trimester abortion is a big reason for rising MMRs." People come late for the abortions and complications ensue. And apparently these are not only driven by spacing problems. "Contraceptives are used only by women and failure of these is common," says Joshi. Of course, abortion of female fetuses is routine and it goes on until the woman conceives a male child. The whole scenario makes one shudder.

But all this seems to be not even half the story.

Take malaria, for example. Orissa has a high incidence and accounted for 28.6% of detected cases of malaria -- 41% of falciparum -- and 62.8% of all material deaths in India (1998). Malaria and pregnancy form a sinister synergistic pair. Falciparum malaria leads to abortion and still births in the gravid woman and can severely compound anaemia. Coincidentally, Orissa has a high incidence of sickle cell anaemia. The combination is lethal. The haemoglobin in pregnant women could drop to 1gm/dL (healthy levels are between 12-16gms/dL). While drugs are available to treat the malaria, the treatment requires a high degree of awareness and care in administration. For example, the common primaquine and tetracycline are absolute no-nos during any stage of pregnancy. But chloroquine and quinine are allowed. "But mistakes occur and are lethal," says Shiva. Acting fast and carefully is paramount and any deaths due to these infections are primarily due to gross neglect or ignorance. Orissa has one of the highest rates of MMR in India at 738.

Another key reason for deaths during pregnancy is post-partum bleeding or haemorrhage. The need for blood in such cases is imperative and access is less than ideal. Both Sudarshan and Shiva worry about the blood bank policy in India. Heavily driven by the HIV/AIDS lobby, they feel that somewhere the important issue of access to blood has been sacrificed for quality and safety since the policy makers are looking at it all from the AIDS perspective. Says Sudarshan,"The policy says you have to keep the blood in an air-conditioned room. But in Coorg, for example, you don't need it. HIV awareness is good, but blood banks need to be demystified and access and availability improved." Shiva adds, "It is imperative in case of complications during pregnancy to have blood available. But no. NACO only sees blood banks from their perspective and only in an emergency are you allowed to take blood from the banks. It is a major concern." When it comes to donation, Shiva points to an endemic problem. The strange connection between men, caring for women, and giving blood. "If the men have to pay a lot of money and go far to get blood for their wives, they just won't. And men will never give blood. They think a 100 drops of blood equals one drop of semen and thus, giving blood is related to potency. And so many times, when women need blood, it is not available."

Organisational reasons
Early diagnosis of high-risk pregnancies and complications and quick referrals are of paramount importance. But is institutionalising deliveries the answer? By requiring 100% institutional deliveries, the World Bank supported vertical program Reproductive Child Health 1 (RCH1) resulted in the abolishing of the dais (Traditional Birth Attendants), and Sudarshan believes, probably increased MMR. Subsequently, following a public uproar, the program was amended to advocate "training" TBAs into Skilled Birth Attendants. "Institutional support will bring down MMR, yes, but what type of institution is important," says Sudarshan. "The so called Primary Health Care units are so dirty that infection will probably increase because of them." "In Bihar, for example," explains Sudarshan, "80% of the deliveries happen at home. In Karnataka it is 70%." Joshi concurs with this high degree of preference. "In the Bhandara area almost 100% prefer home deliveries. And if there are complications, it means there are inevitable delays in getting more sophisticated care."

Now, if there were a skilled birth attendant (SBA) at the time of each delivery or for antenatal checkups for each pregnancy, he or she can recognize a high-risk pregnancy or a potential complication and refer the mother to a district hospital or closest emergency care unit. The incidence of death from complications would be reduced. Countries like Malaysia have employed this strategy to bring down MMR to less than 100. In India only 43% of deliveries are attended by an SBA compared to between 86% and 99% in Mexico, China, Sri Lanka, Brazil and Thailand.

Sudarshan himself is involved in training tribal girls in the Soliga communities of Karnataka to be auxiliary nurse midwives (ANMs). For a population of 3000, there is a sub-centre and for every 5 or 6 sub-centres, there is a primary health care unit. Sudarshan's team trains the tribal girls in each village so that the few ANMs posted do not have to walk the 20 kms between the 4-5 villages this program covers. Joshi's team in Bhandara also trained 25 local dais or Traditional Birth Attendants (TBAs) to recognize complications and give basic medicines and obstetric care in the villages, one to each village. They also conduct antenatal checkups every month in about 10 villages. But funds for such programs are scant primarily because maternal health is not recognized as a priority issue in India. "The awareness that a pregnant woman should be taken care of is just not there," says Joshi. "If a woman is not delivering, the attitude used to be, let's wait and see, maybe tomorrow morning she will deliver. Now with our training, the dais can recognize complications but the money to shift the patient to a hospital is still not there."

This brings us to the next obstacle. So say the SBA refers to patient to an emergency obstetric care unit (EOC) and let's assume that we have one of those for every few villages. How would the patient reach the EOC? "Transport is a big issue. It is appalling that we do not have EMS (emergency medical services) that is efficient and well staffed," Sudarshan states categorically. He is working on building one for Karnataka with a coordinating body at district level which has jeeps, ambulances, even tractors available for responding to emergency calls. "We have to strengthen the PHC and an EMS is an integral part of that," he says. Bhandara is not so lucky. "Vehicles are available in 50% of the cases. But they are expensive. In the day, people can use buses, but not at nights. There are several rivers in this area and the buses are not allowed to travel over these at night," says Joshi.

Suppose the patient does reach the first referral unit (FRU) with complications that say, require a C-section. Is that a guarantee for a safe delivery? Sadly, no. Few FRUs run 24 hours. Joshi's hospital has 2-3 gynaecologists where the recommended number for the population of that area is 5-6. "All the C-sections and hysterectomies are carried out by these 2-3 gynaecologists. In the PHC in the villages, there is one doctor and 2-3 sisters (nurses), but they are only graduates, not post graduates or MBBS. So they cannot even do a complicated normal delivery, let alone C-sections."

Even in Karnataka, the FRUs are woefully understaffed and in some cases dangerously mismatched. "In one case," says Sudarshan with an ironic smile, "an orthopedist was posted where an obstetrician was required. With bribes, these so-called doctors can get posted to any area they want regardless of what is actually required there." And then there is the big problem of anaesthetists. At the Taluka level there is an acute shortage of them. Anaesthetists are required during complications and surgeries. When Sudarshan's team proposed that nurse obstetricians and other doctors also get trained in anaesthetics, the proposal was shot down by the medical lobby. Human resource management in the health sector seems to be a big issue. Shiva echoed the sentiment saying, "We need trained people in PHCs. And people with the right training. There is no point sending patients who require C-sections to where there is no anaesthetist or ob-gyn."

Government
Now, if we had fully staffed and functioning FRUs, would that bring down the mortality rate? Unfortunately, there is still one more layer that mothers have to contend with.

Shanta lives in a slum in Bangalore. When she was expecting her second child, she had the good fortune of being close to a government hospital where care would be free. Or so she thought. When she reached there, she realized that she had to 'buy' a bed or sleep on the floor. She also had to 'buy' food. So much so that she even had to 'buy' washing services or wear soiled clothes. And when it was time to "push" during delivery, she was just too weak, and the nurses slapped her. Left and right, again and again. They abused and cursed. "Is that the way to treat a patient?" Shanta queries in puzzlement. "My mother's house where I had my first born was better," she declared. Her sister-in-law Prema now laughs as she describes her own run-in with a local PHC outside Mysore. "They wouldn't give me my child until I paid up. Luckily I had saved all year, knowing this would be the case. The nurse was actually someone I grew up with. I thought she would be fair, but no. Everyone wants money." As soon as they got their money, she was sent home -– the same day -- with no medicines or follow-up monitoring either for her or her baby.

Corruption is not a new problem. "Even if the most sophisticated PHC is right across the road the ward boy needs to be bribed with Rs 150 to wheel the mother into the operation theatre and another Rs 300 to wheel her to the ward and most cannot afford that," declares a grave Sudarshan. In his opinion this final layer is the most important and toughest one to correct. "Bad governance. The real problem is not technological care but simply what I call the epidemic of corruption in the health services. And this is not just in the public healthcare sector, the private is just as bad," he says. "Doctors in Arunachal Pradesh take their pay checks but never show up. There is rampant corruption in procurement where, in one case, 123 spurious drugs were identified but bribes were taken and they were not reported. Dialysis machines which cost 5 lakhs are bought at 12.5 lakhs. Poor people end up spending huge amounts due to over-prescription of medicines that should be free to them. This is the real problem and no amount of infrastructure improvement will bring down MMR if governance is not improved," warns Sudarshan.

Shiva adds, "The private hospitals are mercenaries too. They perform unwanted C-sections and hysterectomies where none is required simply because there is big money in these procedures." Sudarshan, who sits in the anti-corruption cell of the Karnataka Government has presented strong recommendations to the Karnataka government regarding this issue. He stresses that good accreditation, accountability, good monitoring, and honest reporting are the only things that will actually bring down MMR, given the other necessities are taken care of.

And where will the money for the necessary infrastructure come from? Prime Minister Manmohan Singh has promised that the government spending on public healthcare -- which currently stands at an abysmal 0.9% of GDP (one of the five lowest in the world) -- will be increased to 2-3% of GDP which Sudarshan finds heartening, but tempers his optimism with caution. "It is great that there will be three times the amount available today for a sector that needs it badly, but one must plug the holes first. No point pouring all that money into a leaky vessel," he quips.

So, can it be done? Can MMR be brought down under 100 by 2015?

Sudarshan thinks so, but he will give it not 10, but 15 years. "It all comes down to political will. Sri Lanka, in spite of the civil war showed tremendous political will in tackling IMR and MMR and setting goals for themselves. Tamilnadu has a Deputy Commissioner (DC) monitor maternal mortality himself." This has increased the accountability and responsibility of the people in charge and has achieved good results. In Kerala, awareness about maternal health issues is high and the citizens demand more. Literacy plays a key role in keeping the MMR low. Kerala leads the way in successfully reducing MMR and Tamilnadu is close behind. While people like Sudarshan are doing everything to make sure it happens in Karnataka, the awareness and more importantly, recognition of this as an issue is lacking in other parts of India. In Uttar Pradesh, Madhya Pradesh, Bihar, Rajasthan, Assam and Orissa where the MMRs are well above the national average, it will require serious political will and accountability to change status quo.

The Ministry of Health and Family Welfare puts plans in place with the best of intentions (see here), but until governance and administration is addressed, people like Prema will still have no guarantees of care without paying beyond their means to like other pockets. But whether we will make progress will also be determined by when the Ministry recognizes MMR itself one of the key "Health and Population Indicators." Today, they do not. (See here.)

Both Shiva and Sudarshan agree that what India does not require is yet another vertical program to tackle maternal mortality. Verticals tend to be donor driven and cost intensive. MMR is not a disease unto itself. Clearly, high MMR is a symptom of a larger and wider problem in healthcare, namely the overall health of the woman, and should be treated as such and across verticals. Tackling a lot of the broader issues of governance and infrastructure should bring down the MMR. The National Rural Health Mission aims to reach across verticals to integrate services and by appointing an Accredited Social Health Activist (ASHA) at the community level provides decentralized first contact care. Shiva was part of one of the Task Forces of the NRHM and lauds its efforts as broadening the RCH program. But in order that the NRHM succeed, we come back to the need for evaluation methods and strong accountability.

The health of mothers is directly related to a child's health and without due attention to the causes behind high maternal mortality ratios, we are ignoring an important determinant of the health of our nation. In doing so, we may be running the risk of damaging our chances for all-encompassing prosperity.

Ways to tackle maternal mortality
To check the maternal mortality rate in India, health experts have stressed on changing the traditional treatment and delivery system being practised in most villages.

At the 52th All-India Congress of Obstetrics & Gynaecology, the annual meeting of The Federation of Obstetric & Gynaecological Societies of India (FOGSI), gynaecologists from across the globe advocated the need to adopt advanced strategies practised in some of the countries in Africa.

“Lack of access and inadequate utilisation of healthcare facilities are responsible for maternal deaths in India. Countries like Mozambique have made good progress in reducing maternal mortality ratio (MMR),” explained Staffan Bergstrom, from Sweden.

Bergstrom added that the healthcare facilities in remote areas of countries like India are virtually absent, with no specialist doctors and advanced treatment facilities.

“In a number of countries with low per capita income, there is a scarcity of specialist doctors. Non-specialist doctors do major surgeries and fail to diagnose complications. Besides, many medical and clinical officers are being trained to perform surgeries in remote places, where specialists are not available. This is very risky,” Bergstrom explained.

“We should remember that children’s health is directly related to mother’s health. The MMR reflect the health of our nation. So, we should introduce advanced facilities in our villages,” said Gita Ganguly Mukherjee, former head of obstetrics and gynaecology, RG Kar Medical College and Hospital.

In India, one of 48 expecting mothers is at risk of dying during childbirth. According to the data of National Health Policy 2002, the MMR in India is as high as 407 per 100,000 live births. Other sources have put the MMR as high as 540 (NHFS and Unicef data, 2000).

“The chances of death of an Indian mother during childbirth is roughly 10 times more than that of her Chinese counterpart,” said Bergstrom.

India and other Third World countries have set a goal to reduce the MMR by three-quarters by 2015.

Also Read:

Motherhood Cursed Bliss in India

Obstetrical Interventions and Maternal Mortality

Death in Birth

The Heartbrake