Chasing The Poll Stars

By M H Ahssan

Come elections, no politician is immune to the pull of the planets. A huge industry rests in the space between reason and unreason.

SIXTY YEARS after independence, why have India and Pakistan – siblings born merely a day apart — led such remarkably different lives? Astrologers have a delightful explanation. The answer, they say, lies in the countries’ respective janam kundlis. A country’s kundli is determined by its birth time and place and astrologers had dutifully warned India’s first prime minister that August 14 wasn’t an auspicious birth date for a country. Sadly for Pakistan, half-anhour made all the difference: Nehru signed the dotted line at midnight on August 15.

If this story is believable, it is not much of a leap of imagination to understand why a few months before every general election the glassy image of modern India turns over on its head. Politicians invoke the divine with unmatched fervour. Astrologers are in epic demand. The gods become India’s most wooed constituency.

This year too, as India laces up for its fifteenth general election, goats are being sacrificed to the sound of clanking cymbals; 1,000 people are sitting in precise groups of 11, chanting in unison and blowing into rising flames; somewhere, an unassuming blind man is being handed a brown chappal; and an inconspicuous alleyway is blotted a bright red with all the red donations being showered upon it. An electoral aspirant is turning herself and the nomination box to face the sun. Elaborate rituals are being supervised outside peeling government offices; anxious candidates are turning to a strapped watch on their arm, waiting for the exact minute when the universe suggests they should file their nomination papers. (BJP Opposition leader LK Advani chose 12:39 pm because it is said that is when Ram killed Ravan.) A politician is secretly slipping an extra “a” into her name, hoping no one will notice her changed signature. Hordes of India’s poor are being ushered into manicured lawns for sudden propitiating banquets. In the temples of Lord Bhairon and Kali, alcohol is being offered to the deities, then fed to beggars as prasad. Suddenly, everywhere, politicians have turned into puppets, lifting a designated leg as they enter shrine or office, at the command of their master stargazer.

Dressed in a bright orange kurta, a long tika running up his forehead, Acharya Raj Jyotishi Shukla is emerging from the Congress office at 24 Akbar Road in Delhi. It’s a surprise to see him there, for Shukla says he was officially appointed BJP’s raj guru in 2006 at the behest of Sanjay Joshi, former BJP general secretary. “People in the BJP liked me because I talked about kattar Hindutva. They appointed me the upholder of Hindu religion and asked me to make sure it is never wiped out,” he says. But now he doesn’t restrict his consultation to just the BJP: he has risen above the political divide. “No politician knows where else I go,” he winks. In the last two months, Shukla says he has performed 40 poojas for 40 MPs, each lasting anywhere between two to 12 hours. The scale of each pooja depends on the particular disjunction between the planetary positions and the candidates’ desires. One can only wonder what impact the varying monetary value of each pooja will have on different candidates’ fortunes.

Politicians might be loath to disclose their particular position on the Richter scale of faith and superstition, but suffice it to say that according to a Business India story in 2004, the astrology industry in India adds up to a whopping Rs 40,000 crore. At election time, it apparently jumps by another Rs 600 crore.

UNIVERSAL ADULT franchise obviously brings many dreams, crises and fears for the ‘futures’ doctors to tend to. What follows is only a small recounting of epic pleas and epic interventions:

• Apparently, Trinamool Congress President Mamata Banerjee recently had her assistant call the popular numerologist Swetta Jumaani for tips on how to get an edge over the CPI(M). Jumaani advised her to change her spelling from ‘Mamta’ to ‘Mamata’. If events in Bengal are anything to go by, the Reds are reeling under the onslaught of that extra ‘a’.

• During the nuclear deal stand-off in Parliament last year, much to the horror of animal rights activists, Kishore Samrite, a Samajwadi party legislator, sacrificed 302 goats and 17 buffaloes to seek a divine boost for the Congress-led vote on July 22. Aided by some horse trading, the goats seem to have worked.

• Where there is a crowd, there must be a leader. Jalandhari Baba, now dead, or as his followers put it, “who has now taken leave of his body but left his rose fragrance behind” — was once one of the most sought after gurus in Delhi and had several politicians flocking to him. If you connected with Baba at a personal level, his devotees say, you didn’t even need to tell him what you wanted: your energies just spoke for themselves. In that tacit speaking line were some pretty powerful names. Pranab Mukherjee and LK Advani, apparently, visited Jalandari Baba on several occasions. PDP leader Mehbooba Mufti sought his help to extend her father’s term as Chief Minister of Jammu and Kashmir and NCP President Sharad Pawar asked for a cure for his cancer.

• In the hyper-surreal landscape of Tamil Nadu politics, short of a written diktat from AIADMK party chief Jayalalithaa, astrology enjoys an official place in all party affairs (see box on page 54). A senior party leader told TEHELKA that all those who wanted to contest the Lok Sabha polls this year had submitted a copy of their horoscope along with their application. “When candidates are shortlisted for a particular constituency, the horoscope of the candidates may help the party chief in taking the final decision,” he said. Adds R Balasubramaniam, a political commentator, “Jayalalithaa makes no bones about her belief in astrology.” Apparently, it is mandatory for AIADMK politicians to file their nominations exactly at 12.32 pm. Jayalalithaa herself is a stickler for the colour green. Before she leaves her Poes Garden residence, her car must face a small temple of Lord Venkateswara next to her home. Once, on her way to address supporters, she was horrified to find a temple to her left and the crowds to her right. A complete U-turn was made to have the temple on her right and the crowds on her left. Relieved that the planets were realigned, she continued with her speech.

• Elsewhere, Shiv Sena leader Gajanan Kirtikar, who has been indicted for his role in the Mumbai riots of 1992, turned to an astrologer to pick the choicest full moon day for filing his nomination from the Mumbai northwest constituency. One hopes he didn’t suffer the fate of Rajkumar Patel, a Congress candidate from Madhya Pradesh. Patel was told by his ace consultant to file his nomination for the Vidisha seat at the last hour for the most auspicious impact. Unfortunately, a technical slip required him to go home for additional papers. By the time he returned, the deadline for filing his nominations was past. Perhaps Sushma Swaraj’s spiritual contacts were better because with Patel disqualified, she has no serious contender in Vidisha.

• In Gujarat, a key minister has asked Asaram Bapu for help with a particular yagna, which will be performed at the candidate’s home on April 30. Perhaps the minister is taking a leaf out of his leader Narendra Modi’s book, because the story goes that at the height of the pogrom of Gujarat 2002, the controversial chief minister had a band of 17 priests performing the all-powerful Rudravishek prayers to invoke Lord Shiva.

“They are all into it but many won’t own up to it on paper,” says Hemang Arun Pandit, CEO of Ganeshspeaks.com, the portal that handles the backroom operations of top astrologer, Bejan Daruwalla. “They all come to me almost everyday from across the country asking for the right dates to file nominations,” says Daruwalla. In 2000, ex-Prime Minister Atal Bihari Vajpayee had called Daruwalla to strategise about the prospects of the NDA. “They also want to know what suggestions their rival candidates have taken from me,” Daruwalla adds. Some ambitious politicians go a step further and take the kundlis of political rivals to astrologers. “A rival party in UP asked me to read Mayawati’s kundli,” UP-based astrologer Pandit Padmesh Dubey told HNN.

RIVALRY, VULNERABILITY, ambition, greed, faith, intrigue, counterintrigue, and at the end of that manic cycle, unkept electoral promises and the intractable, faceless Indian voter. What can a politician do but turn to the stars?

“They are all eager to win and are at their most vulnerable before an election,” says senior astrologer Ajai Bhambi, who has been so inundated with calls before election 2009 that he has cancelled all out-of-station tours. He gets the largest number of calls before tickets are to be handed out. “Once I had my terrace full of candidates for rival parties, embarrassed to see each other at my door,” says Bhambi. Some clients who have offers from two different parties ask him to read the party’s kundli and the party leaders’ kundli to decide which party would gel better with their own kundlis! (Yes, even parties have kundlis, based on the day and time of their birth. Sometimes a leader’s individual kundli could have led the party to a win, but because it is also influenced by the party’s collective kundli, the candidate ends up losing.)

Bhambi is a staunch believer of kismat (whatever is written in your kundli will happen) and refuses to embark on machinations to alter the divine plan. This is not necessarily a good strategy. Says Acharya Kishore, another pandit operating within political circles, “I looked at [former Congress leader] Madhav Rao Scindia’s kundli and told him he would never be the PM.

His wife immediately took me aside and said, ‘Don’t talk like this, he will get angry.’”

Some like Bhambi and Acharya Kishore stop at predictions. Others conduct yagnas. But there is a fast growing group of ‘futures’ traders who stop at nothing, readily venturing into the dark underbelly of astrology — the tantric jaal, rituals usually performed at night to destroy one’s enemies. A client can choose from four lethal options — turn the enemy in your favour, destabilise the enemy, make the enemy go berserk, and kill the enemy. “Politicians don’t just want prayers. They want their planetary positions to change. We tell them this is not possible from us. Naturally, most of them turn to occult practitioners,” says Hemang Pandit.

No surprise then that a week ago, in the interiors of Orissa, the state’s Finance Minister Prafulla Chandra Ghadei had conducted a special ritual at the dead of night at a Biroja temple meant for women. Even before he could complete his special prayers, Ghadei had to flee the spot after tribals, armed with bows and arrows, attacked him and the priest, protesting against the occult ritual.

BUT IT is probably the powerful and tantra-surcharged Kamakhya temple in Guwahati that is India’s premier enemy warding-off institution. Visit before election 2009 and one finds that yellow is the pervading colour at the temple of Bogola Devi, one of the 10 forms of Kamakhya Devi. A little girl selling yellow flowers at the bottom of the steep stairs that lead to the temple yells, “Come and buy some flowers for the goddess. All the big ministers buy flowers from my stall.” If you talk to her, she will tell you that all of them come late at night. There is a popular belief that Bogola Devi vanquishes enemies. Politicians come to ask her for help far from the public gaze. Rajiv Sarma of Kamakhya Debuttar Board says openly that Kamakhya Mandir is not an abode of astrologers but that of tantricism. “But most of the politicians who turn up to offer prayers here do so at the advice of astrologers,” he says.

The head priest of the Bogola Devi temple, Pankaj Sarma confirms that politicians of all parties come there to ask for more power and that many perform rituals after midnight, but he refuses to name anyone. Other sources, however, tell TEHELKA that controversial Congress candidate Mani Kumar Subba is a staunch devotee of Kamakhya Devi. His farmhouse in Delhi has a temple with a permanent astrologer and he regularly goes to Rishikesh and Haridwar for consultations with others.

Others choose milder routes. The Ajmer Sharif dargah in Rajasthan has always been a pilgrimage spot and a tourist attraction, but during peak election season, it draws a wide range of politicians too. “Many politicians call me, email me, and ask me to offer a dua for them,” says Qutubuddin Saki, the chief maulvi. If they cannot go themselves, they send their wives and children. Visitors who come to the dargah tie a thread around a revered pillar and ask for divine blessing. If their wishes are fulfilled, they are supposed to return and untie the thread. In the past, the seekers have included Govinda, Sanjay Dutt, and Rajasthan Chief Minister Ashok Gehlot who came months before the assembly elections and returned 15 days after his win to untie the thread. Other politicians who visited recently include Mulayam Singh Yadav, who came six months ago, Vasundhara Raje, Shri Prakash Jaiswal, Shahnawaz Hussain and Sachin Pilot, all of whom have visited in the last two months. Saki is now waiting to see which among these returns to open the blessed thread and thank the influence wielded by the Ajmer dargah.

Meanwhile, in Mumbai, priests and security guards at the city’s famous Siddhivinayak temple are already having sleepless nights as they brace themselves for the onslaught of politicians from across the country, who visit at peak hours. Congress MP Priya Dutt, who took over the mantle of the constituency after her father Sunil Dutt passed away, may not be a very religious person, but the prospect of retaining her father’s seat seems to have ignited a newfound spirituality. Before filing her nomination, Dutt made a marathon trip to the key religious shrines in the city, including the Siddhivinayak temple, the Mount Mary church and the Haji Ali dargah. After all, one never knows which religion the planets may favour on judgment day.

But Dutt is not the only new believer on the horizon. NCP top boss and prime minister aspirant Sharad Pawar, a known atheist and a key figure in the socialist movement of the 1970s shocked many when he paid a visit to the Tulza Bhavani temple in Osmanabad district before filing his nomination last month. In fact, almost every political leader in Maharashtra has visited this temple to pay obeisance before the elections.

IN KOLKATA, the Kalighat temple lies close to a rivulet that many say was the original Ganges. After the clock struck twelve and brought in another Bengali new year last week, Trinamool Congress leader Mamata Banerjee apparently slipped into the temple quietly with two of her trusted aides for a special prayer. The next morning, a handful of her supporters sacrificed 50 goats for a neighbourhood feast. “Didi must win,” they chanted to thundering cymbals. Even Kolkata’s CPM leader Mohammed Saleem is said to have visited a Hanuman temple to request a divine shield.

Back in Delhi, astrologer RB Dhawan sits with long sheets of star patterns and web kundlis flashing on his laptop. “The energy of action can influence the auras around,” he says. Through what astrologers call “upayas” — action to negate or please dominant planetary influences — bad times can be delayed, good times advanced, and planetary alignments reworked. It is no coincidence, says Dhawan, that the BJP has made illegal money from Swiss banks an election issue. The current planetary alignment shows a connection between Rahu (a moon-dependent phase), Jupiter and Saturn. Rahu stands for darkness and anything black, Saturn signifies foreign travel. And Jupiter is the king of money. Also, of religion. A shrewd astrologer would know that a party associated with religion would benefit from turning this divine alignment in its favour. Sources say Advani has at least five astrologers, picked from across India for their varying specialties. Dhawan suspects they had something to do with Advani’s sudden interest in Swiss banks.

Her son Varun’s planetary alignments might be askew but Maneka Gandhi is luckier. She doesn’t have rely on orbits or engage a troop of astrologers to make laborious calculations. She has only to think about Jalandhari Baba. Once, an eager supporter told her he had bet an acre of land that she would win from her UP seat with at least 1 lakh votes. Once the counting was over, she did win, but with a margin of 80,000. Travelling back from Barielly to Delhi, Maneka silently cursed Jalandhari Baba. He had allowed a man to lose a precious acre of land because of her. “Why did guruji let this happen?” she asked herself over and over again. Before she left the UP border, her cell phone rang with unexpected news. There had been a recounting of votes. Maneka had won by a precise margin of 1 lakh!

It’s easy to be dismissive of politicians’ extreme reliance on their attendant soothsayers. But this proclivity is of a piece with the average Indian’s deep religiosity and his enduring belief in the illogical. Transpose all that into the high tension atmosphere of imminent elections in one of the most populous countries in the world, that also happens to be striding towards modernity, and it isn’t difficult to understand why politicians clutch at whichever supernatural straws they can.

Perhaps, it is this dichotomy that best explains our continuing passion for astrology and that of our elected representatives too.

A Famished Franchise

What is a vote to a starving man? What does the world’s largest election mean to the world’s largest group of forsaken people? HNN finds out.

A VOTE IS often a product of mixed motives — the result of generations of unshakeable loyalty, or the last-minute epiphany of a frustrated finger hovering over multiple EVM buttons. A vote sometimes rewards jobs provided, children schooled, identities recognised. Other times, it punishes pleas unheard, bulbs unlit, bruised faiths. It is a bargaining chip that negotiates a better life for you.

But what if you were forgotten? Even in the shower of attention that elections bring, what if the convoy drove past your village for the nth time? What is a vote to you, if for the third time, a child in your family was dying of hunger, and you had no hospital to take her to, and no earnings to buy her food with? From places that governments have long ignored come shocking stories of the complete failure of government and unbelievable deprivation. Not a morsel to eat, not a drop safe to drink. What does the world’s biggest election mean to the largest group of forsaken people in that country? What is a vote to a starving man?

It takes a stinging swarm of mosquitoes to wake little Maya from her tired sleep. Immediately, she bursts into tears. She thrashes her bony legs; her ribs visible under her skin. There are angry rashes and bleeding sores all over her body. Exhausted from crying, Maya’s eyes shut again. The wailing is now soundless, the tears flow quietly.

Maya looks about one year old, but is actually three. “She doesn’t seem to grow,” says Rasali, her mother. “She hasn’t been able to walk or crawl and most of the time, just lies in an unconscious sleep.” Maya has Grade-4 malnutrition, the severest degree, which means that she has only a few months left to live. She is from Nichikhori village in Madhya Pradesh’s Sheopur district, where locals recognise villages not by name, but by the number of children that have starved to death there in the past few months. Nichikhori is known by the number 6. Not one of the children here who stare at us shyly from behind walls and trees looks well, let alone well-fed. Without exception, they are underweight and have distended abdomens, reed-thin limbs, bulging eyes. Almost all have had a sibling starve to death.

Every four minutes, a child is born dead in Madhya Pradesh. Of those that survive, over 14 per cent die before they turn six. In the seven months from July 2008 to January 2009, 676 children died here of malnourishment. That’s three a day. Empty kitchens, leafless trees and ration shops that are as barren as the landscape are visible proof that there is precious little to eat in northern MP. A chronic, pervasive hunger that lay hidden till a few years ago now screams for attention in newspaper headlines. It is not surprising that, in December 2008, the BJP’s Shivraj Singh Chauhan became Chief Minister against a poll promise of subsidised rice. With no actual food to be had, the mere hope of food is what people subsist on. Lok Sabha aspirants have realised that here, the promise of food security is a profitable one to make and a convenient one to break.

RN Rawat, a Congress MLA from Shivpuri is contesting the Morena Lok Sabha seat, with “eradicating starvation deaths” as his primary agenda. When asked why he did not raise the issue in the years he was an MLA, Rawat says, “I may be raising this just before elections, but someone has to do it sometime.” The MP administration denied reports of malnutrition until 2007, when a wave of hungerrelated deaths brought criticism from across the world. Today, Central and state governments recognise the problem, but underplay its scale. Nutrition and Rehabilitation Centres (NRCs) were started to treat malnourished children in remote villages, but they admit only severely malnourished children, who are already too sick to respond to treatment. The other hungry children are left to the Centre’s anganwadis, which are supposed to provide a daily meal to children under six. In Shivpuri district, however, women say these meals come only once a week.

“Why do these people depend on the government for everything?” asks Ganesh Singh, the BJP parliamentarian from Satna, who is contesting the seat again this year. “The government helps those who help themselves,” he declares.

In Singh’s constituency, long years of drought have forced many families to mortgage their land to moneylenders for food. Non-agricultural jobs are scarce and pay poorly. Entire villages bear insurmountable debts but still have no food. It is at this point that people look to the government. And when even children die of starvation, it is usually a sign of the most abysmal hunger.

Hari Singh, a labourer in Sheopur, lost his one-year-old son three weeks ago. “Sonu was always very weak,” says Singh. “When he was just over 14 months, he suddenly got boils all over his body and his skin started peeling. He became sookha (dry). He couldn’t even digest breast milk and then got diarrhoea. Towards the end, a rotting smell came from his body. That’s when I knew it was over.” The experience left Hari blaming himself. But what it reveals is an absolute breakdown of government welfare schemes.

IF THERE is food from anywhere, the child is sure to be fed. Universally, parents feed their child first,” says Sachin Jain, a member of the Right to Food campaign in Madhya Pradesh. “If children are starving, it means the entire community is on the brink.”

Starvation deaths are often downplayed by governments as transient aberrations, ones that might merit a cure but never prevention; aberrations that can be dealt with after they occur. The Mizoram government, for instance, has camouflaged chronic hunger among its other anti-famine measures. The state witnesses a unique phenomenon called mautam, literally, ‘bamboo death’. Every 48 years, a particular species of tropical bamboo flowers. A temporary surfeit of rich bamboo seeds leads to an explosion in the population of rats, which soon overrun paddy fields, causing a famine. The last famine was in 1959, and it took on political colour as it became the genesis for the militant Mizoram National Famine Front.

Since late 2004, Mizoram has been going through another devastating famine. There are clear manifestations of the onset of famine in eight districts. It seems bizarre that an entire people live perennially on the verge of starvation, but mautam remains a non-issue this election. CL Ruala, the Congress candidate says that the famine does not feature in the party manifesto because its repercussions are limited. C Rokhuma, founder of the Anti-Famine Campaign Organization, believes that Mizoram is a victim of politicised and badly tackled hunger. “The 2007 mautam was manipulated by politicians,” he says. “They let people starve and then brought rice for them from outside, so as to be seen as solving their problem.”

The snag in approaching hunger as a famine-like phenomenon is that the solution is often short-sighted. The Central government accumulates an emergency stock of food grains by buying directly from farmers, a cache meant for famine relief. It has been hoarding this for so long that it now has four times the required stock. As development economist Jean Dréze puts it, if these sacks of grain were lined up in a row, that array of futile, wasted food would stretch for more than a million kilometres, to the moon and back. Grotesquely, though India has the largest unused stocks of food in the world, it also has more people suffering from hunger than any other country.

ALOOK AT the states that have lost the most people to starvation — Madhya Pradesh, Jharkhand, Rajasthan, Mizoram and Orissa — reveals a more silent and misunderstood killer: chronic hunger, the kind that is caused by an utter disability to buy any food. With no land to grow food on and no earnings to buy even subsidised food, families grow hungrier by the generation.

Kalahandi in Orissa has become an icon of Indian poverty. Visited repeatedly by Congress bigwigs and development journalists, the district still remains an unfortunate, living stereotype. A ricesurplus district, yet a district with one of the highest mortality rates (140 per thousand) in the country. The poorest state, yet one voting for 27 crorepati candidates, seven of them from the hungriest Kalahandi-Bolangir-Koraput region.

When the residents of Pengdusi village in Kalahandi are asked what they do for a living, one man bursts out laughing, “We’re boatmakers, fishermen or farmers. At least until we become patients.” In September 2007, 16 people died of diarrhoea here in just 15 days, most of them adults. No one was taken to the hospital because it is 45km away, and there was no bus, no ambulance, and no road. “If you fell sick in this village, you died,” says 30-year-old Madan Nayak, who lost his wife and, one day later, his one-month-old daughter. Diarrhoea is the most common symptom of hunger death — a body’s final rejection of any food or water, an inability to digest anything because of being unfed for too long. Even today, the Primary Health sub-Centre set up 5km from the village following media and NGO pressure, lies locked, with no doctor or health worker appointed. Two years after people died of neglect, no lessons have been learnt.

Yet, instead of despondence, there is still talk of political change. “We all campaigned for Pushpendra Singh of the BJD in the 2004 assembly elections, because we thought he would help us get our BPL cards,” says Haladar Majhi, “But after he won, when we went to remind him of his promise, he asked us who we were.” This year, the popular parliamentary candidate seems to be the Congress’ Bhakta Charan Das, the first politician to visit the village at its worst time in 2007. “He came on a motorcycle, with a doctor riding pillion,” says Haladar, “He ensured that the road is paved. He responds to us, at least for now.”

NEARBY, PREDOMINANTLY tribal Kashipur has been facing the wrath of failed crops. Everyone seems to be at work in lush paddy fields for most of the day, but in their homes, there is commonly just half a pot of dilute rice gruel for a family of five for three days. It is a simple difference between the haves and the have nots. In the last 50 years in Orissa, big farmers have been buying fertile land and cheap labour for throwaway prices. Adivasis work for foodgrains on lands they once owned. When there is no harvest in the rainy season between May and October, they find themselves jobless and too poor to buy even the Rs 2 rice from ration shops. Those with a few acres of land manage for a month or two before hunger strikes them too. Everyone seems to have an NREGA card, but instead of a guaranteed 100 days a year, people in Kashipur get an average of 20 days’ work. Most of that is unpaid.

The staple diet is mango kernels, which lie drying in front of every house. They will be ground and eaten, even though it was these very poisonous fungus- ridden kernels that caused rampant diarrhoea a year ago. “We know this isn’t very good for us,” admits Kaluna, who now raises four children belonging to her sister who died of starvation last year in Kashipur. “But there’s not enough farm produce,” she says. “We need something to quieten the growling stomach.”

The still-robust will to vote among the most neglected is striking. “In the absence of food, land, work, and good health, my vote is the only privilege I have left,” says the 67-year-old Dhiru Kaka, who lost his son, daughter-in-law and wife to starvation last year in Kashipur, Orissa. Playing with his voter ID card is his 2-year-old grandson, the only family he has left. When Dhiru Kaka made the trip to the polling booth on April 16, it was to cast his vote for the 17th time. “At least for a few months after the election, the winning politician will bring us food,” he says, hugging his grandson. “That is the best we can ever expect.”

Offer Valid Till Votes Last!

Hawala money. Benami deals. Cash for votes. Corporate payoffs. Everyone knows it is happening, even the Election Commission cannot control it. HNN maps the invisible funding of Indian elections.

FEROZESHAH ROAD is a quiet, tree-lined boulevard, in the heart of the Indian capital. Considered — by any standard — one of the finest addresses in the city, it houses political leaders and has a few select multi-storied buildings. Not the kind of place one expects surveillance to happen. But last week, intelligence officials — after a tip-off — kept watch on a third-floor flat at 34, Ferozeshah Road. They had reliable information that the occupants of the apartment were in the process of laundering — through hawala — a staggering Rs 380 crore from an undisclosed destination in south-east Asia (read: Singapore). The money, say intelligence officials, was meant for spending in the upcoming general election. Intelligence sources said that those involved included a wealthy businessman from Kolkata and his associate, a wellknown figure in Delhi’s illegal foreign liquor racket.

It may be the world’s largest democratic exercise, what the British weekly The Economist called India’s “jumbo election”. But it’s also one of the most expensive shows on earth. An Indian parliamentary general election is the ultimate political spending spree. And the fuel powering this frenetic activity is almost all black money. Like the proverbial iceberg, the official statistics of what candidates are spending — and therefore, announcing to the Election Commission (EC) — is just the tip. Nine-tenths of it lies beneath, silent, but powerful.

On the surface, everyone, candidates and political parties alike, toe the official code of the Election Commission. While submitting individual details, they offer proof that they are not crossing the commission’s stipulated limit of Rs 25 lakh per candidate.

Not that the commission is fooled, however. The presence of black money in the political arteries of the Indian economy is so overwhelming that the EC knows it plays a powerful role in an election. It has actually admitted it cannot control the deluge of money in election season. Election Commissioner SY Quraishi sounded exasperated when he told a television news channel in Delhi recently, “No, we have little control over money that flows underhand in the elections.” The next week, his office noted breaking news on television that an estimated Rs 10 lakh was found from the drawers of the offices of filmmaker Prakash Jha, who is contesting elections from Bettiah, Bihar on a Lok Janshakti Party (LJP) ticket. “The cash was meant to be distributed among the voters,” Bettiah superintendent of police KS Anupam told reporters.

WHETHER THE charge will be substantiated or not is to be seen. There’s no proof and the clout money has in an election is so routine, it’s accepted. “I am currently in Chennai and my conservative estimate for just three constituencies in Madurai alone is Rs 700 crores. The spending in South India is always higher than in North India,” former Finance Secretary S Narayan told TEHELKA this week. The Bharatiya Janata Party (BJP) held a twoday opinion poll in Gujarat on black money stashed by Indians in banks abroad in early April. Ordinarily the EC would have been expected to raise objections to this sort of grandstanding. The quiet joke in the capital was that the the hardworking election watchdog would have preferred to come to grips with the money political parties spend during the polls, estimated at over Rs 50,000 crore ($10 billion) by those entrenched in the electioneering proces. That figure, incidentally, is almost one fifth of the figure arrived at by a recent national survey.

The survey conducted by Centre for Media Studies (CMS), a Delhi-based think-tank, says that across the country, one-fifth of voters have said politicians or party workers offered them money to vote in the past decade. In some states like Karnataka, Tripura, West Bengal, Kerala, Tamil Nadu and Andhra Pradesh, says CMS, nearly half say they have been bribed. Even in the Indian capital, 25 percent of voters received money for their votes.

The organisation estimates that onequarter of the actual election budget is directed towards illicit activity. “For political parties in India, the main objective is to win at any cost. As a result, parties are opening up their purse strings for the polls,” says Jagdeep Chokkar, a former Indian Institute of Management (IIM) professor.

Raymond Baker, author of Dirty Money and How to Renew the Free Market, writes that, since 1970, at least $5 trillion has moved out of poorer countries to the banking systems of the West. But a portion of this black money comes back to India — election time. That the entire process is unofficial is certain: the transactions, both back and forth, involve hawala operators, sale of benami properties and bagloads of cash ferried to the party faithful for redistribution. And this money transfer operates more efficiently than India's official economy channels.

Informed sources told HNN that an estimated Rs 10-15,000 crores ($2-3 billion) has been earmarked by political parties for “unofficial” purchases of individual votes. Besides this, politicians in their effort to squeeze every last vote out of the world’s largest electorate — are criss-crossing the country’s 2.97 million square kilometre land mass, running up crores in air transport bills. With campaign costs virtually doubling every election, political observers feel the country’s democratic process is being hijacked by the kind of spendingpower politics that is more often associated with the US elections. Worse, it’s without the level of transparency in both collection and spending that is also associated with the US.

That the EC is troubled is understandable . The bulk of the money is transferred to the states even before the stringent EC code comes into force; more than 60 percent of corporate funding to all political parties is in the form of black money; on an average, a candidate spends anywhere between Rs 3-15 crore in a single constituency. Recently, Chandrababu Naidu, former Chief Minister of Andhra Pradesh, was admonished by the EC for handing out colour televisions and announcing a ‘special’ cash scheme for voters. Code violations such as Naidu’s — cash distributed at rallies or offerings of gold chains or similiar bribes — are merely the infringements that are caught out. Most of the infringements happen before the EC code kicks in.

AS A result, odd stories float around the offices of political parties in Delhi: the capital is the hub for receiving funds from which payments are radiated to state units. Sources say a television channel received nearly Rs 200 crore for slanted publicity; that a top corporate chief visited the offices of the Left brigade with an offer of support to the Third Front with the explicit condition that a leading woman aspirant not become the prime minister; that the UP-based owners of tobaccolaced chewable products have become the conduits for money transfers to state units because of their huge cash reserves. Top Mumbai-based companies are now funding elections in states where they have big business interests.

“Perhaps this will be the election that will see an all-India display of money power as never before. It is only in the urban and better-educated areas — and if the younger people turn out to vote in large numbers — that one can see some hope for transparency, clean voting and genuine democratic selection,” said former Finance Secretary S Narayan in a newspaper column.

Insiders say receipts and payments have been at record levels for the last two months. A number of kickbacks offered by brokers in various deals have slowly found their way to the coffers of the parties in power in each state. “You will find nothing on paper but it is true that a portion of government tenders, running into thousands of crores, is routinely channelled back to the funds of the party in power,” says a corporate insider. He adds that there is also a serious drive in the states to pick up money through various means the moment elections are announced. It is unofficially called the Chief Minister’s slush fund. The fund takes care of the cash transactions of the state and — if required — sends to the party’s centralised funds for distribution to states where the party is not in power. “Besides Delhi, there are certain pockets that take care of the regions. It is like Maharashtra funding Gujarat and Andhra Pradesh unit of the party funding Karnataka, (where it is not in power)” adds the insider.

CONSIDER THE case of the general managers working in the Rural Road Development Agency (RRDA) in Madhya Pradesh districts who received calls from the offices of a minister, demanding Rs 5 lakh. Tired of the calls, they complained to the EC in writing last week. It will be interesting to see how the EC reacts to the complaint. Those in the know say the demands such as the ones faced by the RRDA managers are routine in almost all states. In fact, the Samajwadi Party made four campaign films about Bahujan Samaj Party (BSP) supremo Mayawati, that portrayed the Dalit leader as having a penchant for erecting her own statues and demanding money from bureaucrats in her state. The EC rejected the films, but most people seem to agree with the content, ostensibly because similar reports have routinely filled the media about the UP chief minister and her way of operation.

State-owned companies are hardly the only ones tapped for funding — the country’s top corporate houses say the pressure from political parties for money is high indeed. Corporations want an immediate overhaul of the system, to bring in transparency to political funding. The issue cropped up during a Confederation of Indian Industry annual session meant to discuss the country’s troubled job market. Tata Communications chairman Subodh Bhargava and Bajaj Auto chairman Rahul Bajaj, also a Rajya Sabha MP, moaned about black money flowing into elections. “Clean money makes a difference. Currently, as much as 60 percent of companies are financing political parties with black money,” an enraged Bajaj told reporters.

Federation of Indian Chambers of Commerce and Industry (FICCI) secretary- general Amit Mitra says the problem is not the politicians or industrialists. “We must fund elections and take a call on how much an individual can donate. India could either go the US way (of capping corporate contributions) or follow the European model and allow elections to be completely funded by the government,” he says.

Both suggestions are sound, legislatively speaking, but the question is whether any legislation can bring change to a system in which funds are both collected in the form of off-the-book payments and then paid out in silent backhanders.

Conglomerates like the Birlas and the Tatas have separate electoral trusts, through which they donate money to political parties. The Tata Electoral Trust does not distribute funds to individual candidates but to registered political parties, based on their number of elected members to the Lok Sabha. “I think there is obviously a case for laying down procedures for funding as it is at the heart of Indian democracy,” says Communist Party of India (CPI) deputy general secretary Sudhakar Reddy, who is trying to raise the issue of Indian deposits topping the list in secret Swiss Bank accounts. “Companies who fund political parties obviously see returns if the supported party comes to power,” he adds.

IT’S THE return on investment that fuels corporate funding of elections. But even for political parties, the need to increase spending exponentially with every election has become imperative. “Politics is actually a big game of money. Those spending heavily are doing so only as an investment and expect a ten-fold return on their money,” says Anil Bairwal, chief coordinator of the Association of Democratic Reforms. It’s an umbrella group of NGOs that launched the National Election Watch to keep an eye on party and individual campaign budgets and spending.

Bairwal says that in the past, candidates and parties organised mega events such as mass weddings, and handed out money there in return for votes, but patterns are constantly changing in the country’s political landscape. “From Rs 100 for a vote more than a decade ago, the rate has gone up to Rs 1,500-2,000 a vote. In fact, the cash-for-vote often works as a hit-and-miss syndrome in India because booth capturing is out and you actually do not know who’s doing what,” he told HNN.

The EC is aware of the money movement. “Our emphasis will be on controlling the money power in elections,” outgoing chief election commissioner N Gopalaswamy told reporters last week. He added that the EC has also deployed 2,000 observers — many of them senior tax revenue officials — with a special brief to keep tabs on all pollrelated spending.

IT’S A daunting task, because of the sheer numbers involved — both the number of candidates and the size of their funds. Very conservative estimates say the Congress will officially spend approximately Rs 1,500 crore — one expense is its Rs 1 crore ($200,000) blowout to acquire the rights to the Oscar-winning Slumdog Millionaire song Jai Ho from its copyright holder, T-Series. The BJP’s official budget is estimated to be about Rs 1,000 crore: this includes a Rs 200 crore advertising fund.

The BSP has a kitty of Rs 700 crore, similar to that of the Nationalist Congress Party. The Dravida Munnetra Kazhagam (DMK) — thanks to some recent fund-raising drives by Union Communications Minister A Raja — has a kitty of Rs 400 crores. The official budget of the All India Anna Dravida Munnetra Kazhagam (AIADMK) is close to Rs 300 crores. The CPM and its allies have a more modest Rs 250 crore budget.

Of course, not every outlay is about glad-handing and buying votes. Many of the expenses are legal though one could question the extravagance. One such is the cost of hiring choppers and executive jets by political parties. For this election the number of helicopters and small jets hired by the political parties have doubled since the last polls in 2004. Currently, political parties have hired an estimated 45 to 50 choppers — half of them from abroad — and 22 small jets. (Most are sixseater jets while some are 13-seaters.)

“The demand is sky-rocketing and political parties do not mind the cost,” says R Puri, who heads Air Charters India, which has rented out its entire fleet of helicopters and jets at prices that range between Rs 75,000 and Rs 1.5 lakh per hour. Hi Flying Aviation, India’s oldest air charter firm, also finds its order book full. Operators like the stateowned Pawan Hans have large fleets which are not allowed to rent out to political parties. However, the political companies are allowed to borrow Pawan Hans helicopters leased to corporations. During the elections, almost anyone and everyone pushes their choppers and planes towards the politicians.

And there are 16 private helicopter owners — read big corporate houses and five star hotel chains — who could spare a chopper to a friendly politico, of course with no financial consideration involved as per rules. In short, it means the favours would be asked for later. And finally, there are 17 state government choppers that can be used for campaigning purposes, in accordance with EC norms.

But flying high costs money. For India’s political leaders, who aim to fly very high indeed, the money to do so, it seems, is easily forthcoming.

Waning Motherhood - The Cursed Bliss in India

By Sheena Shafia

"Mothers Reflect God's loving presence on earth."

Motherhood is such a blessing in woman's life, that as a loving mother, she forgets her own self for the tender love of her dear ones and trains her children to virtue. The bond between a mother and her child is a powerful component in a child's life.

But mothers who die during childbirth or before the birth of a baby leave behind their never ending stories, their children and families and numerous reasons as to why their lives ended so early.

Every time a woman in the third world becomes pregnant, her risk of dying is 200 times higher than the risk run by a woman in the developed world. Approximately 30 million women in India experience pregnancy annually, and 27 million have live births. In India every one woman dies every 5 minutes from a pregnancy-related cause.

Maternal mortality is generally defined as the death of a woman during pregnancy or delivery, or within 42 days of the end of pregnancy from a pregnancy-related cause.

The maternal mortality ratio is nothing but the maternal death per 100,000 live births in one year. The maternal mortality ratio in India is somehow near about 267 (Urban estimation), rising to 619 in rural areas where as the developed countries in contrast have a maternal mortality ratio of around 20 per 100,000 live births.

Given the high maternal mortality rate in India, the women who lose their lives as a result of pregnancy and childbirth remain invisible in general. Therefore, reliable estimates of maternal mortality in India are not available. However, WHO estimates show that out of the 529,000 maternal deaths globally each year, 136,000(25.7%) are contributed by India, most of which can be prevented. This is the highest burden for any single country.

The indirect estimate done by Bhat (Maternal mortality in India: An update. Studies in Family planning, 2002) shows that MMR is higher in eastern and central regions and is lower in north-western and southern region. Similar picture is also shown by data collected under Sample registration system by Registrar General of India in 1997.

States with high maternal mortality include Rajasthan, Madhya Pradesh, Jharkhand, Orissa, Uttar Pradesh and Bihar.

The most common responsible causes of maternal deaths are hemorrhage (ante partum or post partum), eclampsia, pre-eclampsia, infection, obstructed and prolonged labour, complications of abortion, disorders related to high blood pressure and anaemia.
Causes of maternal death (%)

Haemorrhage 30
Anaemia 19
Sepsis 16
Obstructed labor 10
Abortion 8
Toxemia 8
Others 9

MAJOR CAUSE: Anaemia is one of the major causes of maternal mortality in India. It is noted painfully that after 61 years of independence India leads iron deficiency anaemia cases in the world and more than 90% of Indian women, adolescent girls and children are anaemic. Everyone is aware that anaemia results in physical weakness, mental shortcomings, low intelligence and increased vulnerability to a number of diseases and causes adverse pregnancy outcomes and even death of expectant mother. The anaemic mothers also bear anaemic children. The Ninth Plan envisaged universal screening for anaemia in pregnant women and appropriate use of IFA tablets is also indicated .But just like other plans and policies the programme had not been operationalised fully. In none of the states were services for anaemia included as a component of antenatal care. Data from Rapid Household Survey indicated that even iron folic acid consumption is still very Low. The target during the Tenth Plan was to make every effort to fully operationalise the Ninth Plan strategy for prevention and management of anaemia. But still now it has not faced much success. Only 22.3% of pregnant women consume Iron and Folic Acid supplementation for 90 days and the percentage is less than 10% among the non-educated women compared to 50% among the well-educated. Also the disparity between rural and urban areas is significant (18% and 34.5% respectively).

OTHER CAUSE: There are various other causes of maternal mortality. Eclampsia is one of them, which is a fallout of pregnancy-induced hypertension. This usually happens due to improper antenatal care. Hypertension during the course of pregnancy can ultimately culminate in convulsions. Eclampsia if not treated with care in time may lead to the death of the mother.

Another reason of maternal death is Haemorrhage. This may once again be caused by poor antenatal care, anaemia during pregnancies or during operative deliveries.

Obstructed or prolonged labour occurs when the foetus does not deliver in the anticipated time. This may be due to the wrong position of the foetus, if it is a too large a baby or if the pelvis of the mother is narrow. In urban India, obstructed labour is generally not among the primary causes of maternal deaths anymore but in rural India, due to lack of interest in institutional delivery it is still a cause of maternal deaths. Till now, in India only 43% of deliveries involve a skilled birth attendant compared to between 86% and 99% in Mexico, China, Sri Lanka, Brazil and Thailand.

Sepsis, another major cause of maternal deaths, may arise from infections, unsafe abortions, anaemia and improper care during pregnancy. Women who do not eat nutritious food during pregnancies are susceptible to infection. In rural, India this is one of the commonest causes of maternal deaths.

INTERMEDIATE CAUSE: They include the low social status of women, lack of awareness and knowledge at the household level, inadequate resources to seek care, and poor access to quality health care. Other causes are untimely diagnosis and treatment, poor skills and training of care providers, and prolonged waiting time at the facility due to lack of trained personnel, equipment and blood. The other prominent dark chapters of our society are the early age of marriage and child bearing, child spacing, family size and fertility patterns, literacy, socio-economic status and the and the customs and beliefs.

Under the Reproductive and child health (RCH)care programme efforts were made to improve the coverage, content and quality of antenatal care in order to achieve substantial reduction in maternal and perinatal morbidity and mortality.

In the ninth plan the antenatal and intra partum care contained features like,

* Early registration of pregnancy (12 - 16 weeks);
* Minimum three Ante-Natal Check-ups;
* Screening all pregnant women for major health, nutritional and obstetric problems;
* Identification of women with health problems/complications, providing prompt and effective treatment including referral wherever required;
* Universal coverage of all pregnant women with TT immunization;
* Screening for anaemia and providing IFA tablets to prevent anaemia;
* Advice on food, nutrition and rest;
* Promotion of institutional delivery / Safe deliveries by trained personnel etc.

But according to the Household Survey 1998-99 the actual scenario was something different. A ntenatal coverage in states with poor health indices such as UP, Bihar, MP was very low. Whereas in the southern states antenatal coverage was quite good.

The main problem areas of antenatal checkups lie herewith:

* Inadequate coverage; lack of trained health personnel in antenatal screening, risk identification and referral services;
* Over crowding in PHCs/hospitals
* Lack of Emergency Obstetric services etc
One of the major goals of Government of India's Department of Health and Family Welfare is to reduce maternal mortality and morbidity. The focus has shifted from individualized interventions to attention to the reproductive health care, which includes skilled attendance at birth, operationalising Referral Units and 24 hours delivery services at Primary Health Centres and initiation of Janani Suraksha Yojna (National Maternity Benefit Scheme).

Not only that, improving women's health require a strong and sustained government commitment, a favourable policy environment, and well-targeted resources. The government's strategy should include extended care to women whom government programs do not reach. The government of India has been making policy and programmatic statements time to time and setting goals of reducing maternal mortality.

Major policy and program goals in MM ( Maternal Mortality)

1983
Health policy statement by Govt of India
MMR reduction by 200-300 by 1990 and below 200 by the year 2000

2000
National population policy
MMR reduction to less than 100 by 2010

2002
National health policy
MMR reduction to less than 100 by 2010

2002-007
Tenth Five year plan
MMR reduction to less than 200 by 2007

The challenge for the government is to help direct and improve privately provided services through appropriate regulatory arrangements and by encouraging an expansion of their scope to include promotion and prevention, in addition to curative care.
The link between pregnancy-related care and maternal mortality is well established. National programmes and plans have already stressed on the need for universal screening of pregnant women and operationalising essential and emergency obstetric care. Focused antenatal care, birth preparedness and complication readiness, skilled attendance at birth, and access to emergency obstetric care are factors that can help reduce maternal mortality.

The mind boggling high maternal mortality rate in India can be reduced by following the strategies enumerated below:

* Effective initiative from the government is required in terms of proper allocation of resources to all the health institutions specially Primary Health Centers. Even more important is to ensure that the funds actually reach the users whenever it is needed.

* Early registration of antenatal cases and effective health education of couples to make them understand the importance of antenatal check ups, hospital deliveries and small family norms.

* Local dais / birth attendants and female health workers should be imparted periodic training to update themselves with improved techniques and be incorporated as an integral part of health care system. The importance of observing proper aseptic measures while conducting deliveries should be emphasized to them.

* Prevention and early treatment of infection, ante partum and postpartum hemorrhage.

* Wide spread availability / supply of Iron – Folic acid tablets and nutritious food to the poor and remotest corners of the country.

* Treatment of illnesses like diabetes, tuberculosis and malaria during pregnancy should be ensured.

* Construction of better roads and transport facilities is required especially in the rural areas and urban slums to make the health care facilities more available and accessible to people in need.

* Providing facilities for hospital deliveries for high risk cases like severe anaemia, hypertension, diabetes and heart disease.

In conclusion it can be said that, a maternal death is often not only a result of technical incompetence or negligence, but is also caused by ineffective health system and limited knowledge, social attitudes and poor health and midwife practices by the family and community itself. Since 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 simply ignoring an important determinant of the health of our nation. In doing so, maybe we are running the risk of damaging our chances for all-encompassing prosperity in future.

'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

Junk debt - or a rubbish rating?

By Kunal Kumar Kundu

United States-based rating firm Standard & Poor's downgraded its outlook for India's sovereign debt from stable to negative on February 24, while retaining the country's BBB- rating - the lowest investment grade. In essence, India's sovereign debt is just a step away from being declared junk. Not only does that indicate that the economy is in a perilous state - it drives up the cost of borrowing.

The last time India was downgraded to junk was in 1991. Are we saying that India is currently on the edge of the precipice and is about to hurtle down the abyss, as it did then, when, if memory serves me right, inflation ruled at 16.7% in August 1991. India's foreign currency assets were worth a measly US$1.1 billion on June 30, 1991, just good enough to cover the country's import bill for a fortnight.

That year, the government leased 20 tonnes of gold to the State Bank of India (SBI) for sale abroad, with an option to repurchase it after six months. The government also asked the Reserve Bank of India (RBI) in July 1991, to ship 47 tonnes of gold to the Bank of England to raise $600 million.

Agreed, India's current fiscal situation is a cause for concern. This is purported to be the background for the current downgrade, along with external vulnerability, given the rising current account deficit. But before we go into the depth of the issue, it is important remember that in the interim, during 2001-2004, there was a strong debate on same issue, when global rating agencies downgraded India in view of a rising fiscal deficit.

In January 2004, Professor Nouriel Roubini (RGE Monitor) and Richard Hemming (senior advisor at the Fiscal Affairs Department of the International Monetary Fund) in their paper "A Balance Sheet Crisis in India?", drawing on their and India's experience of the previous crisis in 1991, concluded by highlighting several vulnerabilities that India was on the verge of another crisis. In retrospect, however, these risks never materialized. India recorded 8%-plus annual gross domestic product (GDP) growth for the next few years thereafter and everything was under control.

Now, the specter of a high deficit is again looming large. India's estimated fiscal deficit for the financial year 2008-09 is 6%, and if one takes into account the state government deficits, the total fiscal deficit should be in the region on 9% to 10%. However, the uptick in the deficit has as much to do with rising expenditure as it has to do with falling revenues as growth momentum slows, following the contagion effect of the global crisis.

It is important to note that the fiscal deficit rose despite a sharp fall in private spending. Hence the rise in the fiscal deficit has not been caused by private spending. Even the external (im)balance that is of concern to the rating agency has a lot to do with the global financial crisis. In fact, with domestic demand shrinking and commodity prices falling (and unlikely to improve much even next year or the next given the general recessionary trend), India's external balance will be much under control going forward.

Given the demand contraction (both domestic and external), India will be lucky to record even 6% GDP growth in 2008-09. It is not expected to be much better than 6.5% even by 2009-10. Thereafter, India will record much higher GDP growth. Clearly the fiscal vulnerability that is being talked about is more cyclical than structural and hence is a lesser cause for worry.

Seemingly, for the the rating agency economists, these are issues not important enough to dwell on, and hence they have decided to sound alarm bells by simply going by the macro-indicators and their past experience, failing to take congniscance of the fact that the business environment changes and a much more holistic view needs to be taken.

In the case of India, 1991 was different. Since then, India has seen many structural changes and, as an economy, the country is in a much better shape. Because of prudent practices, India has managed to avoid the financial contagion that many developed economies, with their cutting-edge policies and regulations, have fallen into.

A major part of the blame for the implosion of the global financial market has to do to with the credit rating agencies themselves, for their miserable failure to predict a crisis that was possibly one of the most predictable ever to hit the global financial system. Agencies that pour their energies into studying company data day in and day out could not predict the collapse of the US housing bubble, despite every data indicating that big trouble was brewing. Not only that, they went ahead and boldly gave a high investment grade rating to various structured products that abounded with junk, leading to the problem being exacerbated.

A scorecard released recently by Credit Suisse detailing the vulnerability of various countries repays study. (Click here for table.)

Credit Suisse ranked countries with regard to their vulnerability by taking into account various factors, the lowest ranking being more vulnerable. The table highlights the ratings given to the East European countries. As we all know, this region has the ability to have a severe impact on even the developed European economies. The S&P rating column shows that only one East European country, Latvia, had a BBB- rating similar to that of India. All others have higher rating than that of India, at times substantially higher.

Yet consider that fact that Hungary, Ukraine and Romania have already gone to the International Monetary Fund (IMF) for a bailout. In contrast, India is talking of making contributions to the IMF's coffers to finance these bailouts. India's ranking is 25, that is, it is a country considered to be much less vulnerable than others. More importantly, consider Iceland, now a poster boy of doom because of its reckless policies. Iceland was rated similarly to India. Clearly, S&P even failed to predict Iceland's tremendous fall from grace.

Given the current situation, Keynesianism - with government spending seeking to take up the slump in the private sector - is the way out of the present crisis for most countries. Given the contraction in domestic demand, India needs to do the same.

Similarly for the US. The forecast fiscal deficit for the US in the current year is higher than that of even India. It is quite likely that, if S&P or another such rating agencies were handed the relevant data for the US without the information to which country it referred, the sovereign rating that would result for the world's biggest economy could well be "junk".