Information & Communications Technologies (ICT): Telecentres Boon or Bane?

By M H Ahssan

Although telecentres have caught the imagination of government, their adoption is caught in a false pedagogy that treats entitlements as services and citizens as customers who pay service charges. The focus on putting a price on governance must be stemmed.

Over the past few years, there has been a lot of talk about Information and Communication Technologies (ICTs) as the next big thing for socio-economic development. This hope is based on the fact that ICTs can accelerate decentralisation, transparency and citizen-centric participation, and through these revitalise and rejuvenate democracy. Certainly ICTs possess a transformatory power, but to understand the potential vis a vis development needs, a closer examination is needed.

In this article, I examine the 'telecentre', which - as an amalgam of many different technologies - appears to have caught the imagination of government, development practitioners, funding agencies and corporates alike. A telecentre is a public place where people can access computers, the Internet, and other digital technologies that enable people to gather information, create, learn, and communicate with others while they develop essential 21st-century digital skills. While each telecentre is different, their common focus is on the use of digital technologies to support community, economic, educational, and social development-reducing isolation, bridging the digital divide, promoting health issues, creating economic opportunities, and reaching out to youth for example. The above definition of a telecentre by Wikipedia quite aptly captures its essence.

There are literally thousands of telecentre initiatives that dot the country, most of which are a mix of government pilot projects, NGO-driven initiatives and private for-profit projects. Now the Government of India is getting into the picture in a much more structured manner and is rolling out 100,000 'Common Service Centres' (CSCs) for 600,000 villages as part of its National E-Governance Programme (NeGP).

The potential of telecentres
A telecentre has the ability to forge together initiatives that weave disadvantaged communities into the mainstream, initiatives which bring together divergent needs of a community and create opportunities which lead to overall social and economic development. Typically, a telecentre would start out by providing a pool of development services, providing information related to best practices related to agriculture, health, education, livelihood opportunities & computer education. In addition to this, it would provide utility bill payment services.

By doing this the telecentre lays the groundwork for different sections of the community to come together and take part in government activities. While one might be inclined to dismiss these activities described above as trivial, it must be kept in mind that this is but the first step towards connecting citizens with government.

The next step involves the telecentre providing information regarding development schemes, social entitlements, and lists of project beneficiaries. In most cases, this information is available online i.e. most state governments digitise development information and put out the information on the Internet, which can be accessed in real time. This is an important change in India, where procuring any kind of information is almost always shrouded in secrecy and riddled with corruption, especially in rural areas. In this scenario, the telecentre then becomes that 'safe -haven' where citizens come to access all this information.

There are also initiatives by the government to make e-governance a two-way process. For instance, the government has started putting together draft policy papers on the Internet and invites inputs as part of various consultation processes. Communities which are directly affected by government plans and policies have a real chance to provide input, when such solicitations are brought to their attention. Also, in many cases, individual telecentre initiatives run by government at the district level have well established online grievance redressal systems which allow citizens to make complaints against erring government officials/public servants; complaints which are directly looked into by authorities at the highest level.

Not to sit and admire these accomplishments at the risk of losing sight of the larger picture, but the possibilities described above would have been very difficult to imagine and enforce even a few years ago. The ability of ICTs (in this case, telecentres) to bypass traditional encumbrances thus goes a long way toward bringing about citizen participation in governance.

Making the offline connection
Of course, participating in governance is quite different from shaping governance (being involved in the policy planning process from scratch). So far we've looked at citizens being able to access information on development services and the ability to talk back to government. This is only the beginning; going further, the ability for citizens to create and shape policy and the role played by telecentres in this regard is an area whose potential is only now unfolding.

A major development in this regard is the concept of 'community informatics'. While plenty of information can be made available at a telecentre, the validity of such information can vary greatly. How can this be tackled? Could citizens themselves validate - or even create - data using their local knowledge, so that its veracity is improved? The most likely answer to this question lies in community informatics (CI), which is a simple yet effective and participatory mechanism. CI refers to the process of information gathering being undertaken by communities in a bottom-up, participatory and collaborative manner so that this information directly complements and or authenticates institutional data, which then feeds into policy in that relevant domain.

CI also allows direct monitoring of government schemes by local communities. For instance, it is well known that the number of Below Poverty Line (BPL) families is often under-reported in government estimates, simply because governments are loath to be seen as presiding over great poverty. But under-counting doesn't eradicate poverty, and the sufferings of the uncounted are very real. CI can help them overcome such neglect; an enumeration process undertaken by the community itself would be more definitive in identifying BPL families, allowing it to challenge the empiricism of institutional data.

What role does the telecentre play in this process? While the actual data gathering and collation takes place offline, the telecentre is the space where the community (through volunteers) gathers and uploads the information on to computers. Where there is Internet connectivity and linkages to the government backbone network (State Wide Area Network), such data can directly feed into that system too, and be more representative than institutional data. Even if there is only intermittent connectivity, a printout of the data can be physically delivered to the government office where it gets processed and feeds into policy (Such work-arounds are being resorted to by quite a few pilot projects initiated by governments).

As governments move to a culture of e-governance, more and more data gets digitised and the opportunities for communities to participate in the overall development process increase exponentially. Once there is a certain regularity and comfort with this process, the telecentre becomes this space where people come to acquire information, hold community meetings, to an extent where government officials recognise this as an important platform and use it to interact with the community.

Thus, the telecentre acquires a certain credibility and legitimacy, by which it has the power to shape and change power equations within the community itself. In the Indian context, one gets to see pilot projects that have worked exactly this. There are specific projects which work exclusively with women's collectives, Dalits and other marginalised groups. By firmly keeping the ownership of telecentres with the constituencies they work with, many of the sponsor and volunteer organisations have managed to initiate a change in the power equations. And although there has been opposition from those sections of the community who are most likely to lose out, the changes are evident and sustainable.

A false pedagogy
At a very practical level, more development-domain departments (health, education) must be linked to telecentres in a way that citizens are in a position to benefit from entitlements that are met by these departments. This will go a long way in realising the potential of telecentres.

But there are shortcomings too. There is also an urgent need to challenge - and change - the 'efficiency' based pedagogy which is at play while describing the working of a telecentre. In the Indian context, telecentres (specifically those run by the government) have mainly been perceived as tools of e-governance. Some of the more famous initiatives are Akshaya (Kerala), Rural E-Seva (West Godavari- Andhra Pradesh) & Bangalore One (Bangalore). Telecentre functionaries describe these as 'one stop shops' where one accesses services like utility bill payment, procurement of digitized land ownership records and obtaining birth and death certificates (customers typically pay a service charge which is shared between the entrepreneur and the government department providing the service). Apart from the government functions, a telecentre may also run commercial functions like printing, photocopying etc.

The description of 'entitlements' as 'services', of 'citizens' as 'customers', and the notion of a 'service charge' are pointers towards this pedagogy. The focus of putting a price on governance is rather unfortunate and must be stemmed at the earliest. Telecentres should be thought of the same way as health centres, education facilities and roads - as public infrastructure.

What is most appalling is that nearly universally, the only kind of sustainability that ever gets talked about is that of financial sustainability - that the telecentre has to be in a position to fund itself in a matter of a year or two, and in this melee, concepts of community ownership, participation and social sustainability are thrown out the window. The 100,000 Common Service Centres the government is promoting through 'Public Private Partnership' model also suffer from this. The telecentres will be auctioned out to highest bidders, who in addition to providing government services can offer commercial services and in this way recover their investments. Clearly, that is an invitation to focus on the latter, although the purported purpose of the government in establishing the CSCs is the former.

Lessons from good telecentres
While successful efforts are sadly rare, a few telecentre initiatives have done good work in bridging the digital divide and have positively impacted disadvantaged communities.

In an earlier paragraphs I wrote about the potential of Information and Communication Technologies (ICTs) in development domains. I had specifically looked at the role that telecentres play in this regard. This article looks at existing telecentre initiatives that have done good work in bridging the digital divide and have positively impacted disadvantaged communities.

The good news regarding these initiatives is that they have clearly demonstrated extensive links between development sectors and technology. These initiatives have ensured that there is a sustained focus on development without being overawed by the technology. These initiatives refuse to see access to development services as a revenue generation activity. A key factor in these projects is that they are either run by the state administration or by NGOs (Non Governmental Organizations). The telecentres have extensive links with the community and hence address the all important question of decentralisation and accountability.

Sadly, such initiatives are few and far between and are not often highlighted. The good work done by three of these initiatives is described below.

The M S Swaminathan Research Foundation (MSSRF)
This project is amongst the oldest ICTD (ICT for Development) interventions in India. The MSSRF telecentre initiative was started in 1992 to provide technology impetus in development domains. Over the past decade or so, this initiative has extended beyond Pondicherry and Tamilnadu to other states such as Orissa and Maharashtra.

The foundation follows a 'hub and spoke' model for its telecentre initiative with a designated number of telecentres christened as Village Resource Centres - VRC (spokes). These spokes are linked to a centrally located Village Knowledge Centre - VKC (hub). A typical telecentre is run by knowledge workers who are usually drawn from the village itself. A knowledge centre provides information on government schemes, and broadcasts regular news bulletins.

Information about government schemes is available in the local language and in electronic form so people can get information for themselves. In case some piece of information is not available, the village knowledge workers try to procure that information from the village knowledge centre, where staff search for the information and relay it back to the resource centres. The centre also conducts computer training for villagers.

There is no formal setup between the information workers and the government regarding procurement of information regarding government schemes and services. Instead, an informal understanding between them allows the workers to get this information. Because the centre is a storehouse of information, it attracts people of the community, thus giving it legitimacy. The government also realises the importance of the centres and whenever the villagers need to be mobilised for any particular cause, the VRC becomes the space for doing so.

MSSRF is guided by several major principles, including:

Inclusion: Traditionally MSSRF sets up its telecentres in rural areas. They do this after consultations with different constituents of the community. One of the MSSRF's key focus areas is inclusion; they do not open telecentres in spaces that are seen to be exclusionary. In many cases, the telecentre is intentionally opened in areas inhabited by disadvantaged sections, forcing residents from the 'upper strata' of society to come to these places. This does help change the power equations, albeit slowly.

There have been cases in the past where the opening up of telecentres in areas dominated by uppers castes have resulted in restricted or no access to Dalits. Those telecentres have hence had to be discontinued. However, this was the case when the MSSRF initiative first started. Things have now changed such that inclusion of disadvantaged communities is a pre-requisite for the opening of a telecentre in any area.

Social Sustainability v/s financial sustainability: The real contribution of MSSRF in the entire telecentre debate has been in the aspect of financing. It is perhaps the first institution to explicitly state that financial sustainability is not the underlying or over-riding principle of telecentre initiatives. MSSRF clearly believes that a telecentre exists to serve the citizens and a price cannot be put on access to knowledge. This key principle has guided and continues to guide the working of MSSRF.

People do recognise that a dole-out approach won't work for long. When we ask people how the telecentres will survive if and when MSSRF withdraws, they chuckle and reply that they will get funding through the Panchayat, other village institutions or voluntary contributions if necessary. This will ensure funding for the knowledge workers and activities associated with the centre.

Community monitoring and ownership: The MSSRF initiative also addresses the all-important question of community monitoring and ownership. The monitoring and evaluation of the centre is undertaken by a joint committee comprising of MSSRF staff and people drawn from the village itself. This committee comes together every few months to discuss the current activities of the telecentre, areas that need to be strengthened and ways to strengthen them, and future activities.

With regard to ownership, MSSRF has been constantly training the information workers on the managerial aspects of running the telecentres. This gives them confidence so if and when MSSRF does withdraw, the trained workers can run the centres smoothly.

This initiative is one of those rare examples that successfully combines the issues of financing, community monitoring and ownership. This initiative thrives and will continue to do so because it caters to the information needs of the local people, gives them a sense of ownership of the initiative, and the chance to shape its running. This makes the centre indispensable to the lives of the community.

E-Gram - Gujarat
The E-Gram telecentre initiative is a relatively new one, having started in 2001 and piloted in one district of Gujarat. It has since then been extended to all districts of Gujarat. The project aims to digitise all the Panchayats in the state. An E-Gram centre is typically located in a public space, usually a Panchayat office. The centre has a computer with or without an internet connection, and a printer.

The centre is operated by a Village Computer Entrepreneur (VCE), typically a youth from the village who has technical knowledge. The centre offers services like printouts of land records, payment of electricity bills, issue of caste certificates, and information on government schemes. A certain amount is charged as user fees for availing these services, except for the provision of information on government schemes. The user fee is shared between the Panchayat and the VCE

While the aim of E-Gram was to digitise panchayats, it has achieved that and much more (which is why this initiative stands out and must be replicated):

Gram Mitras and E-Gram: As part of its mandate to bring in more decentralisation, the Gujarat government has also initiated a scheme which involves the appointment of 'Gram Mitras' (Friends of the village) in the areas of heath, education, agriculture, development & social justice. This scheme has close links with the E-Gram initiative. These Gram Mitras are not employees but are contracted, and their job is to go from house to house collecting details of a family's health, finances and so on. This information is compiled in the form of a family data sheet called a 'Kutumbh Patrak'.

Once this information is compiled, the Gram Mitras return to the E-Gram and in conjunction with the VCE, digitise this information. A printout is then taken and submitted to the taluk level office, which has a complete record of village level information. Through this data, families eligible for government entitlements are identified, and information regarding these entitlements is relayed back to them through the Gram Mitras.

While the current arrangement involves mostly offline links, there are plans to provide connectivity with the state wide area network. This will enable the VCE to enter the data on local computers, enabling the data to be automatically available to the administration at the taluk and the secretariat. Citizens on their part will be able to track their records and the entitlements available to them. Clearly, this aspect of the initiative is something that needs to be highlighted and replicated in other initiatives as well.

Outsourcing and E-Gram: Civil society groups contend that government must be held responsible for its actions and that outsourcing of any government work amounts to dereliction of duty. While this may be true, the E-gram case study presents a different side to this view, one which must be considered.

E-Gram operations are outsourced. A private technology company is responsible for the upkeep of the equipment and the supervision of the VLE. However, unlike the Common Service Centre Scheme (CSCs) where private companies own the telecentre and look upon it as a commercial venture, the example of E-Gram is refreshingly different.

The private company in charge of running the E-Gram only has the mandate of ensuring that the specified functions of the telecentre are being executed. The company has a representative at the taluk, district and secretariat level, and their performance is monitored by the district and state administration. The company is contracted for a certain time period and is paid accordingly; it is not expected to make money from citizens.

When we talk about PPP (Private Public Partnerships), this is the kind of partnerships that I would like to see, where the rein of control still lies in the hands of the government, and governance is not seen as a commercial venture. E-gram stands out in this respect. However, with the coming of CSCs with their accent on revenue generation, and the eventual merging of E-Gram into CSCs, one can only hope that the gains made by this initiative hold out against CSCs.

Akshaya - Kerala
The Akshaya telecentre project initiated by the Kerala administration has been much studied, and findings regarding this initiative have been varied. But two things regarding this project stand out:

This was probably the first project that brought together different government departments to provide a range of schemes/entitlements across a single counter.

The second and important point being that when the project was initially launched, there was a concerted effort to recruit those disadvantaged as telecentre entrepreneurs, including women and the youth.

A few years down the line, the results have been mixed with a few centres closing down, and some doing reasonably well. This result has not deterred the administration, which has reserved 33% of the centres for women during the expansion phase in the remaining districts.

Going forward ...
These are the stories of the few ICTD telecentre initiatives that continue to inspire hope. They demonstrate that development projects when implemented in the right way with the right technologies can bring about a tremendous difference in the lives of communities. They also demonstrate that ultimately, it is only political will that decides which way a project will turn out.

FEMALE INFANTICIDE: Think of the mother

By Kalpana Sharma

Even the most calculating and hard-hearted woman will not be indifferent to what happens to the child she has birthed. This is the reason that female infanticide remains a phenomenon restricted to only a few areas while sex selective abortions are rampant.

"Don't kill your daughter. The government will raise her," says Union Minister for Women and Child Development, Renuka Chowdhury. "It's a matter of international and national shame for us that India, with a growth of nine per cent, still kills its daughters," she adds.

Few will dispute the minister's sentiments or the concern that has prompted her to suggest the 'cradle scheme' to correct the skewed sex ratio in this country. She has appealed to women contemplating aborting female foetuses to instead bring them to full term and then hand them over.

Her concern about India's image is also not misplaced. At a time when the Indian media is full of stories of India's success in business, and prayers for its success in sports, the world media seems to have discovered precisely what Ms. Chowdhury speaks of — the fact that we also specialise in killing girls, or rather preventing them from being born. In the last month, leading newspapers in Britain and the U.S. have carried stories on this issue.

The 'cradle' idea has already been tried in Tamilnadu. The 'cradle baby scheme' was launched in 1992 to deal with the high incidence of female infanticide in some districts, namely Madurai, Salem and Dharmapuri. Women were encouraged to surrender their daughters rather than killing them. Over time, 188 reception centres for such babies were set up in primary heath centres and government hospitals across the state.

Mixed success
The scheme met with mixed success. While there appeared to be a drop in the incidence of female infanticide, it also became evident that women who had earlier killed their daughters now had the option of sex selective abortion. They managed to avoid giving birth to daughters altogether. So the need to kill them after birth did not arise. The scheme was unable to address the societal attitudes towards women that encourage and justify female infanticide.

This illustrates the problem that the current scheme is likely to face. It will not deal with the strong son-preference that lies at the root of the incidence of female infanticide or sex selective abortions. In fact, it changes little in terms of mindsets.

Also, while initially the plan might have worked in districts where female infanticide was prevalent, it will be far more difficult to implement in the hundreds of districts around India where sex selective abortions have skewed the sex ratio to such an extent that there are less than 800 girls to every 1,000 boys under the age of six in some of these districts. To persuade women to go through nine months of their pregnancy with a child they do not want, and then to abandon it, is expecting a lot. After all, so long as the pressure to produce sons remains, these women will have to continue trying. Does this mean, they have to go through multiple pregnancies to full term? Or does the minister hope that doing this once will cure the families of the urge to have a son? Women have always paid the price through their bodies for dominant social norms — such as the belief that only a son can be the rightful heir of property. This norm is so deeply ingrained that even a liberal education does not seem to alter it.

Expecting women to go through multiple pregnancies and abandon their girl children seems not just unrealistic but impossible. After all, even surrogate motherhood has faced innumerable problems as in the end, the women who conceive and give birth cannot bear to part with the infant after birth. Even the most calculating and hard-hearted of women will find it tough to go through the process of pregnancy and then be indifferent to what happens to the child she has birthed.

This is the reason that female infanticide remains a phenomenon restricted to only a few areas while sex selective abortions are rampant. Even though abortions also take a toll of women's health, they are rendered more impersonal because they happen within a few weeks of the pregnancy. Whereas killing or abandoning an infant after giving birth takes much greater physical and emotional toll on the mother.

Renuka Chowdhury must be commended for keeping the issue on the front burner. But she must be well aware that this kind of scheme, and the investment it will require, will not deal with the problem. Instead, the resources can be used to set up a machinery to ensure that the existing law, which prohibits sex selective abortion, is strictly implemented. Checking if all sonography machines have been registered could be one obvious way to start. In some places, where a vigilant bureaucrat has done this, there have been noticeable results.

Changing the mindset
But in the end, even the most strictly implemented law will not change the mindset, specially of the propertied classes who want sons to 'carry on' the family. This belief that the family is somehow not 'complete' unless there is a son has to somehow change. In the decade leading up to the 2001 census, it certainly did not change, as was evident from the Census statistics. We will now have to wait until the 2011 census to see if the multiple campaigns to promote the "girl child", to encourage parents to educate their daughters, to condemn the giving and taking of dowry and to expose those in the medical fraternity who knowingly transgress the law to facilitate sex selective abortions will have made a difference. These are social processes that cannot be assessed within a short period.

What is absolutely clear is that India cannot shine, or be poised to take off, if millions of girls are prevented from being born. This hateful reality must change if we are ever to consider ourselves a modern, democratic and just nation.

'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

Fate of AP and Thoughts on Kamma, Reddy and Kapu!

By Gudipoodi Srihari

Today you find every one conscious of the fate of A.P., making this issue a debate point, as to whether or not the state would be split into Telangana and Andhra. Some feel if it happens it is a retrograde step, going back to the early days of 1954, when Andhra State was first formed with Tanguturi Prakasam Pantulu as its first chief minister functioning from Kurnool as state Capital. We earned the statehood after the martyrdom of Potti Sriramulu, who laid his life for this cause, fasting unto death.

At that time other part of Andhra Pradesh was existing as Hyderabad state, with Burgula Ramakrishna Rao, as chief minister, after military action undertaken by the then central Home minister Sardar Patel, the Iron Man. He redeemed the state from the hands of the Sixth Nizam, a ruler then, ending the Muslim rule and uniting this with Indian Union.

That was also the time when the patriots in Telangana were struggling to realize this dream of retrieval of land of Telugus for Telugus. They included great names like Burgula, Madapati Hanumantha Rao, Jamalapuram Kesava Rao who was known as Telangana Kesari a la Andhra kesari -Tanguturi Prakasam and many more persons aspiring for this merger of Telugus of Telangana with Telugus of Andhra. At the same time, the Communist party of India was also craving for the formation of 'Visalaandhra', combining Telangana with main land of Andhra.

History of Telugus says that 'Andhra' is the original word found in 'puranas' too. Pt.Jawaharlal Nehru was convinced of the need of formation of states on linguistic basis. Accordingly the state of Andhra Pradesh was formed with Burgula, also a staunch linguist, acceding to the realization of this dream. Parts of Hyderabad state joined with Karnataka and Maharastra and states were formed on linguistic basis. Everything had settled down well, for good. This is the flashback before the formation of the State for Telugus called Andhra Pradesh on November 1, 1956. It was a real struggle for Andhras to get the state out of the hands of C.Rajagopalachari, who was working against the interest of re-organization of states on linguistic base. At that time, Andhrites were more in number in Madras city and hence demanded to make Madras as the capital of Andhra relinquishing the rights of Tamils on the city. But Rajagopalachari succeeded to keep the city of Madras with Madras state, later named as Tamilnadu. It was said that Andhra leaders preferred to forego the city in the interest of forming their own state of Andhra. Hence Kurnool became their capital.

The story repeats now. Some argue to keep Hyderabad independent state on the lines of New Delhi , administered by central government. This time the division is among the Telugus themselves. The issue now is not the language but the backwardness of Telangana, compared to Andhra. But few know the conditions in Telangana at the time of formation of A.P. Today's Telangana is much advanced, compared to the situation in fifties, some say. Most of the barren land in Telangana area came under cultivation purely because of the migration of farmers from Andhra area. Some of the enterprising men of Andhra area sold their properties there and settled in Telanagana parts in districts like Nizamabad, Khammam, Warangal and even Karimnagar. At the same time persons from the equally barren districts of Rayalaseema too migrated to these parts and launched industries and contributed to the industrialization of Telanagana.

A peep into history tells us that this backwardness in the Telangana was the result of the rule of Nizams and the domination of landlords, working for the Nizam, maintaining their fiefdom. But the large parts of Deccan and the coastal belt of Andhra was all nothing but Andhra, once called Trilinga Desam. Muslim rulers attacked Golconda and other areas and appropriated these lands, thus segregating from the rest of Andhra. They also invaded and appropriated some parts of Kannada and Maratha lands and finally they too added to the Hyderabad state, in the last Muslim rule of Nizam. This rule lasted almost three centuries till the rule of last Nizam. All this land also constitutes main Telugu land. Orugallu ( Warangal) was the birth place of pure Telugu (Achha Telugu), without any Sanskrit words in the sentence or verse. That was pure Telugu. Children were being taught verses and prose in this Achha Telugu, along with the Sanskritized Telugu. One should understand that invasion of the land called Telangana of Deccan plateau by Muslim rulers divided us, though our language and culture being the same. The changes in Telangana culture and language were due to the culture of the invaders. The end of the rule of last Nizam, paved way for the rule of Telugus for Telugus and by Telugus. The merger of Telangana with the rest of the Telugu land called Andhra which included Rayalaseema completed the map of Telugu Desam, that is Andhra Pradesh or 'Visalandhra', call it anyway you like.

Today Hyderabad has turned into a global city, purely because of the efforts put in by all Telugus and also people from other parts of the country. Like the way coastal Andhra and Rayalaseema are parts of Telugu land, Telangana too is part of same Telugu land. The Telugu and Telugu culture are binding factors. I am sure that majority people in Telangana too believe that the change in their lives and the progress they made in different walks of life are the result of this combined strength of Telugus.

Why then this demand for separate Telangana. - Not once but twice? This is not the demand of the people but of the hurt politicians – hurt because they were put away from the seat of power. Or felt belittled or ignored. The only way left for them to take revenge is by dividing the land, like the way children of the same mother demanding their share like the Amana brothers did. It is because of the aspirations of the politicians, who for one reason or the other raised the bogey of separation. The first agitation for a separate Telangana in 1969 was raised by persons who lost political power. They thought that if Telangana is separated, some of them could become the rulers of Telangana. It was power game but not special love for Telugus and Telugu land.

Now a new situation has developed. The eastern parts of Andhra, central coastal people and Rayalaseema too started demanding separate states. Every one of them is taking this as clue to the disgruntled Telugus of Andhra coastal belt those wanted their land ides to separate Telangana. Which means our state is seeking for breaking into four parts. This is surely an alarming situation, if they are really serious. Andhra Pradesh is now fifty years old. We celebrated its Silver Jubilee recently. Quit people belonging to other parts of the state those settled in Telangana and Hyderabad .

In Nizam days the government recognized a person as Hyderabadi, if he lived in Telnagana for a minimum of 15 years. Only then they were getting seats in educational institutions. Now you find many persons born and brought up here. Their elders contributed to the economy of these parts. The separate Telangana agitation and separate Andhra agitation met with natural death because of the wisdom shown by the rulers in the center and state. Jalagam Vengal Rao ruled the state almost at this time of jinx and set everything in order and implemented the six point formula announced by Indira Gandhi., besides taking other measures in trying to keep balance between these two parts - Andhra and Telangana. Andhra Pradesh state fell back to normalcy even during the long rule of Telugu Desam party.

Again the political ambitions of disgruntled politicians raised their heads. In his second term of rule, Chandrababu Naidu, appeared to have ignored the importance of Telangana leader K.Chandra Sekhara Rao and gave him an insignificant portfolio in his cabinet, like he did in his first term rule after he snatched the power from NTR. Rest is history unfolding before our eyes.

This time it was the turn of KCR to launch a separate Telangana Party with the name Telangana Rashtra Samiti and seek separation from Andhra.

The Telangana Rashtra Samithi and Congress joined hands shared seats and contested last General elections and defeated the ruling party- then TDP. The governments in state and centre brought some of the TRS leaders to power.

Meanwhile the BJP leader A.Narendra also tugged with KCR. Both were ministers in the center and some of TRS MLAs joined state cabinet. KCR and Narendra kept up the pressure on Sonia Gandhi to break the state. As a protest, the TRS ministers in Assembly first resigned. Later after some time, KCR and Narendra also resigned on pressure.

The language has changed into threats or hurling insults against Andhra leaders in public meetings. The incumbent Chief Minister is the main target, like Brahmananda Reddy in the first agitation held by Telangana Praja Samithi. Challenges and counter challenges between M.Satyanarayana Rao and KCR and again between K.Kesava Rao and KCR forced KCR to resign his MP seat and contest for Karimnagar seat raising the bogey of Separate Telangana. He became a hero overnight after winning the seat with huge majority.

There were examples of many other leaders winning parliamentary seat with bigger majority without any promises. P.V.Narasimha Rio was one. If this bait of 'every vote you give me is for separate Telangana' was not there the result would have been different, some say. Yet this winning with stunning majority has now become an issue to claim that entire Telangana people seek separation. This time the coastal and Rayalaseema Telugus reacted fast. Now every region in Andhra Pradesh wants separation. What is wrong in asking for it, says KCR. This means the bread of Andhra Pradesh should be cut into four parts – Telangana, east Andhra, Central Andhra and Rayalaseema.

How funny the entire theme is reduced to! This is slowly gaining farcical look. Funnier is the way, like the stock market, the real estate market goes up and down in these areas, according to the news they receive about the formation or no formation of Separate Telangana state. Those who hold huge properties in Andhra area change sides and seek separate Andhra. And those who have huge properties in Telangana area express their opposition for the division of Andhra Pradesh. There is no leader to lead Andhras in coastal area. Therefore Chiranjeevi's name is kicked up as possible contender launching his own party, which still continues to be no more than a rumor. Even the Telangana men in congress began playing double game, thinking that KCR would simply walk away with Telangana.

What is the role of people in this whole drama? They are all silent voters. For one who witnessed many elections, one realizes that the wind of change comes not by judging the rule of the party but by a wind of sentiment. Presently people think that Telangana sentiment is working. If this emotion dies down and elections are held after a big gap giving enough time for the people's mind settles down, you will find different results. No wonder the wish of the Telangana people might also tilt in favor of united Telugu land, after assessing their living standards and growing opportunities in Andhra Pradesh. Better everybody keeps silence for some time and allow the formation of second SRC. There is talk of rising of Kapu power if Chiranjeevi gets into politics. The Kammas too aspire for power. So are Rayalaseema's Reddy rulers. Otherwise, why this talk of too many separate states in A.P emerge? The two earlier agitations took a toll of big life. It is time for the UPA in the center to take strong decisions, with pragmatic outlook.

Telangana People's struggle

Under the British, India was ruled basically by two types of rulers: (a) the British administered provinces of India The Provinces of India were those portions of India ruled directly by officials of the British East India Company and, from 1858 to Indian independence in 1947, by Great Britain. known as British IndiaBritish India



The part of the Indian subcontinent under direct British administration until India's independence in 1947.



.......and (b) 'princely India' or those state governed by princes, maharajas, rajas, and nababs. Among them, Hydarabad was the largest one, which was under the Nizam prince, and Telangana is one out of three linguistic regions--Telagu, Marathwada and Kannada--of Hydarabad. The Telangana revolt began in the middle of 1946 and lasted for five years. It was an armed resistance of women and men to the feudal oppression or against the princely state A princely state is any state under the reign of a prince and is thus a principality taken in the broad sense. The term refers not only to sovereign nations ruled by monarchs but also to lower polities ruled by various high nobles (often vassals in a feudal system). in Telangana. It was a struggle against the autocratic rule of Nizam and the Zamindari system. (1) There were three types of land holding systems--sarf-e-khas (the land controlled by Nizam and his family from where revenues collected were used for their personal expenses) and Jagirs (the land which has given to Jagirdars) and diwani or government land. Jagirdars were those who were loyal to the Nizam enjoying their own police, revenue, civil and criminal systems. They had received Jagirs and become revenue officers or generals in the army. They also had right over forest and fisheries fisheries. From earliest times and in practically all countries, fisheries have been of industrial and commercial importance. In the large N Atlantic fishing grounds off Newfoundland and Labrador, for example, European and North American fishing fleets have long , and exercised police and judicial functions. Having all the power they compelled people to various illegal exactions and forced labours. The peoples' conditions of Jagir areas were far more oppressed a people who were oppressed by tyranny.



2. than in the sarf-e-khas lands; the jagirdars and their agents were free to collect a variety of illegal taxes from the actual cultivators. Jagir lands were even above the jurisdiction of civil courts. There was also the Vetti (free services (O.Eng. Law) such feudal services as were not unbecoming the character of a soldier or a freemen to perform; as, to serve under his lord in war, to pay a sum of money, etc.



See also: Free to the proprietors) system. Every peasant was compelled to contribute Vetti to the Zamindar zam·in·dar also zem·in·dar

n.

1. An official in precolonial India assigned to collect the land taxes of his district.



2. . Only after completing operations on the landlord's fields, peasants and labourers could work for themselves. A tenant and his family had a compulsion COMPULSION. The forcible inducement to au act.

2. Compulsion may be lawful or unlawful. 1. When a man is compelled by lawful authority to do that which be ought to do, that compulsion does not affect the validity of the act; as for example, when a court of to leave food in their plate and go to the landlord whenever called.



Women were more suppressed under this rule. Women were not allowed to feed their babies while working in the landlord's field. Women were repressed re·pressed

adj.

Being subjected to or characterized by repression. , not only in the field of free work or Vetti, but also sexually harassed and exploited. There were many examples of such suppression; if the landlord fancied a woman, she was taken as a consort. Sleeping with the landlord on the first night was a compulsion to newly married women. It was the landlords' prerogative An exclusive privilege. The special power or peculiar right possessed by an official by virtue of his or her office. In English Law, a discretionary power that exceeds and is unaffected by any other power; the special preeminence that the monarch has over and above all others, . So, peasant women, along with men, came into the Andra Maha Sabha (AMS AMS - Andrew Message System ) and started an armed struggle against the 'oppressive feudal system and the fundamentalist fundamentalist



An investor who selects securities to buy and sell on the basis of fundamental analysis. Compare technician. militia of the Nizam--the Razkars".



In 1928, people established Andhra Maha Sabha converting it from the Andhra Jana Sangam For other uses of Sangam see Sangam (disambiguation).



Sangams were Tamil academies, which according to Tamil legends, enabled poets and authors to gather periodically to publish their work.[1]. , which was established in 1921 with the objectives of social and cultural uplift of the Telugu people Telugu people are an ethnic group primarily located in the state of Andhra Pradesh in India and neighbouring areas such as Pondicherry, Tamilnadu, Karnataka, Maharashtra, Chattisgarh and Orissa (the areas bordering Andhra Pradesh). . It changed not only the name but also the objectives from socio-cultural to political activity. Earlier, it was common organization to all--The RSS (Really Simple Syndication) A syndication format that was developed by Netscape in 1999 and became very popular for aggregating updates to blogs and the news sites. RSS has also stood for "Rich Site Summary" and "RDF Site Summary. , Congress and even to the nonpolitical--who wanted change in society. In 1930, the Andra Mahila Sabha and, in 1937, the Mahila Nay Jivan Mandal had formed in co-ordination with AMS. These organizations are credited to bring women into the movement. During 1940-42, some important leaders of the AMS went under the communist leadership and assumed AMS into the character of a mass organization. AMS went into an armed struggle with decision made in November 1946. The struggle was extended form of grass root level resistance, using local weapons to resist against the regime. The movement was also considered in which "the Mao's thought was first put into practice out of China" (Louis 2002:49). The first struggle took place to support Ailimma, a women who was threatened by landlord's Goondas, taking up of local arms e.g. lathis, slings and stones for volunteers and pounding sticks and chilly powder for the women as well. Later, volunteer squads were not only formed but also trained in using these kinds of weapons. They started to make local weapons professionally. They even used modern weapons. Several struggles took place between squads and Nizam's supporters. The rebels seized arms 'raiding police stations and landlord's houses'. But women did not leave their strategy to use local means to defend themselves against the police. Women used to attack the police with pots full of chilly powder.



Ruler's oppression was not a single cause of women's participation in the revolt. Women-oriented programmes of Sanghams were other reasons; when such women's issues like wife-beating, early marriage of child age come up, the Shangam immediately called the people concerned, held debates and resolved the matters. Misbehaviour MISBEHAVIOUR. Improper or unlawful conduct. See 2 Mart. N. S. 683.

2. A party guilty of misbehaviour; as, for example, to threaten to do injury to another, may be bound to his good behaviour and thus restrained. See Good Behaviour.

3. to the women was started to be severely punished. These rules were practiced even in their organization which attracted women to join the Shangam. For instance, Shankar, a member of organization was accused of raping and mismanaging the party funds, and faced the firing squad. According to according to

prep.

1. As stated or indicated by; on the authority of: according to historians.



2. In keeping with: according to instructions.



3. them, these punishments were declared by the people themselves as the correct line of action.



"Large number of peasants spontaneously participated in the struggle directed against the government, landlords and their agents. The insurgents Insurgents, in U.S. history, the Republican Senators and Representatives who in 1909–10 rose against the Republican standpatters controlling Congress, to oppose the Payne-Aldrich tariff and the dictatorial power of House speaker Joseph G. Cannon. had neither firearms This is an extensive list of small arms — pistol, machine gun, grenade launcher, anti-tank rifle — that includes variants.



: Top - 0–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z



A



A-91 (Russia - Compact Assault Rifle - 5.

nor training but were required to use them. A few volunteers' corps had come into existence, which were not so much well organized guerrilla squads, but ad hoc For this purpose. Meaning "to this" in Latin, it refers to dealing with special situations as they occur rather than functions that are repeated on a regular basis. See ad hoc query and ad hoc mode. formation in response to the situation. Initially the revolt was spasmodic spasmodic /spas·mod·ic/ (spaz-mod´ik) of the nature of a spasm; occurring in spasms.

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spas·mod·ic

adj.

1. Relating to, affected by, or having the character of a spasm; convulsive. " (Dhanaghare 1983: 195) and later it became regular and usual between the people and state security forces when the rebellion received support from all, especially the women. By such enthusiastic participation both men and women, they were able to carry some social transformations in the society. They ousted several police stations from the village, Vetti was abolished and thousands of acres of land distributed, debts to be paid were dismissed. The struggle could not reached in the aim of the organizer; when the Indian union armies were deployed against the Nizam, the movement also started to face lots of troubles. After the Nizam surrender in September 1948 to the Indian Army, the communists and the movement became the target of the Indian Union Army. Then, the party and its cadre (company) CADRE - The US software engineering vendor which merged with Bachman Information Systems to form Cayenne Software in July 1996. were compelled to leave the villages. Party tried to organize the tribal people for fighting against the local governmental institutions e.g. forest officials and moneylenders "who subjected them to exploitation". However, it was not an alternative to continue emergency. The politburo politburo, the former central policy-making and governing body of the Communist party of the Soviet Union and, with minor variations, of other Communist parties. of the party, finally, took the decision on 21 October 1951 to call off the struggle citing "the increased repression by the Indian union army."



The Maoists Movement in Nepal



The Maoist insurgency in·sur·gen·cy

n. pl. in·sur·gen·cies

1. The quality or circumstance of being rebellious.



2. An instance of rebellion; an insurgence.





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insurgency, insurgence

1. , for the last ten years, spread all over the country. Some 15,000 people have already lost their lives since 13 February 1996. The cost of reconstruction of development infrastructure, until 2003, that was destroyed by the Maoists, is estimated to be NRs. 200 billion (2). Developmentalists argue that the Maoist insurgency 'is basically a social and economic issue and is produced and sustained by failed development' (Pandey 1999:12). It is true that the epicenter and heartland of the Maoist insurgency is Mid-west hill districts--Rolpa, Rukum, Salyan, Dailekh, Jajarkot etc.--which the Human Development index categorizes as the lowest rank districts of the country (NESAC NESAC National Electronic Switching Assistance Center (AT&T) 1998: 264-65). Not only this but also some political exclusions and brutal human rights violations are also fostering factors for the insurgency.



The involvement of women in the People's War People's War (Chinese language: 人民战争), also called protracted people's war, is a military-political strategy invented by Mao Zedong. The basic concept behind People's War is to maintain the support of the population and draw the enemy deep into (PW) lacks reliable data to determine the actual%age of women in different roles within the organization. Even statistics given by the Maoists are different from leader to leader. Hisila Yami Hisila Yami, alias Parvati (born June 25 1959 in Gorkha District), is a Nepalese politician and architect. She is a politburo member of Communist Party of Nepal (Maoist) and a former president of the All Nepal Womens Association (Revolutionary). , the central committee member of the Maoists, has given tentative data by writing, "the participation of the women in people's liberation army People's Liberation Army



Unified organization of China's land, sea, and air forces. It is one of the largest military forces in the world. The People's Liberation Army traces its roots to the 1927 Nanchang Uprising of the communists against the Nationalists. are from 30 to 40 per cent" (Yami 2006: 66). For Sapana, company commander, more than 40 per cent are women in the People's Liberation Army (Mulyankan, Bhadra 2061: 14), and for Uma Bhujel, a central member who broke Gorkha jail and came back under open sky, the ratio is approximately 40 per cent in army and more than 50 per cent in other field (Ibid: 16). This is more closer to the number of figures in party and militia comprising approximately 40 per cent and in autonomous government and in industries, the number is above 50 per cent (Janadesh 2006: 8).



Here, a question must be raised about the causes, which inspired or compelled Nepali women to join the movement. It is said that some women are forced to join the Maoist movement by the Maoist and some are compelled to join by misbehaviour of the security forces. For example, Ganga and Sobha Thapa, who were 16 years old each and studying in grade nine in Satakhana School of Surkhet district Surkhet district, a part of Bheri zone, is one of the seventy-five districts of Nepal, a landlocked country of South Asia. The district, with Birendranagar as its district headquarters, covers an area of 2,451 km² and has a population (2001) of 288,527. , were abducted abducted Distal angulation of an extremity away from the midline of the body in a transverse plane and away from a sagittal plane passing through the proximal aspect of the foot or part, or away from some other specified reference point by the Maoist on 29 September, 2005 (3). Shanti

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Shanti (from Sanskrit शािन्‍त śāntiḥ) can mean:

Inner peace

Ksanti, is one of the paramitas of Buddhism



16, Resmi 16 and Binita 15 are the examples of how the security personnel irritated ir·ri·tate

v. ir·ri·tat·ed, ir·ri·tat·ing, ir·ri·tates



v.tr.

1. To rouse to impatience or anger; annoy: a loud bossy voice that irritates listeners. the students and general people. (4) Brutal suppressions of security forces have also encouraged young girls to join the militia either for their own security or for taking revenge. Being revengeful after the murder of their relatives by the security forces, women have participated in the Maoist organization. Sarita is a perfect example to support the argument. She took gun after her innocent brother was killed by the army (Paudel,2004:14). For the sake of revenge, she joined the movement. Low success in school leaving certificate The School Leaving Certificate is the final exam in Nepal secondary school system and is commonly called the School Leaving Certificate (SLC) Examination. Every student must appear in this exam after they complete grade 10th of their study before they join the higher examination and lack of training options for engaging students failing their school level examination is another main factor for their joining the Maoist movement in order to escape idleness and frustration (Karki and Bhattarai 2003:5)



Apart from that, propaganda of women's liberation Women's Liberation

Noun



a movement promoting the removal of inequalities based upon the assumption that men are superior to women Also called: (women's lib) , equality in the Maoists organization in opportunity, in award and promotion, the hope of all kinds of emancipation, and on-going women related social reform programmes like anti-alcohol, anti-gambling campaigns, anti-sexual violence programmes, anti-women exploitation programmes are the main attractions for women participate and support the movement. Some are there only for "romance, pleasure, and luxury". But, there is a consensus that the credit has to be given to the Maoists for "widespread women's awareness in the Nepalese history" (Mulyankan, August-September 2004: 13).



Slogans about 'progressive education' rather than 'bourgeois education' and love/ courtship courtship



paying attention to a member of the opposite sex with a view to mating; occurs in farm animals but is not highly developed other than estral display by the female and seeking by the male, activities that are rather more pragmatic than implied in the definition. is also a vital factor for women's attraction. Orthodox social system towards the widow is another cause for compelling women to join. In Nepal, generally, girls are not allowed to choose their own partners and to decide her marriage; still the society does not tolerate love marriage easily. If the love affair is inter-caste, acceptance is difficult by both, the parents and the society. Increment To add a number to another number. Incrementing a counter means adding 1 to its current value. of Widow population and the unchanged social perception on widow marriage seems another factor, which led women to join the movement. After Maoist movement, 15,000 people are killed; most of them are male leaving behind young widows in the society. However, the society does not accept a widow-marriage easily. In a patriarchal society in Nepal, if people are involved in these activities, a female have to face social degradation in comparison to their male counterparts. In such a situation, the Maoist movement became accommodative to socially mistreated women. It is said that a majority of women in the movement are "influenced by superficial factors (Bhool Bhulaiya) than deep knowledge and understanding of state affairs, political process, gender exploitation, women rights etc" (Adhikari 2006, an unpublished paper). Denying these factors, Hisila Yami, a senior woman Maoists leader said that the women are not recruited for party's "contemporary advantages" but hired because of "their double resistance capacity than man" (Mulyankan, August-September, 2004: 12-18).



To sum up the social reality, which promoted women to join the Maoists movement, we can agree with the argument made by a political scientist Kapil shrestha. He argues, "after democracy in 1990 some positive changes towards women participation in politics has appeared, but sociologically speaking most of the Nepalese women politicians belong to 'the small upper strata of urban, middle class, upper caste caste [Port., casta=basket], ranked groups based on heredity within rigid systems of social stratification, especially those that constitute Hindu India. Some scholars, in fact, deny that true caste systems are found outside India. and educated elite background not from the rural, grassroots or low caste background" (Shrestha 2001).



Comparison



We can compare both struggles on the basis of its objectives, goals and achievements. Apart from that, the paper tried to examine validities and reliabilities by observing available narratives, and data of both the movement. First, the Telengana movement was declared against the Nizam's oppression. The Telengana struggle supported to abolish the Nizam feudalism feudalism (fy`dəlĭzəm), form of political and social organization typical of Western Europe from the dissolution of Charlemagne's empire to the rise of the absolute monarchies. from Telengana. It seemed that the Telengana struggle was more focused on democracy and freedom. However, the Maoist Movement in Nepal has been launched after the restoration of democracy in 1990, which provisioned, at least, freedom to the people. Abolishing the monarchy and establishing the "Democratic Republic" were the said specific objectives of the Maoists of Nepal.



Second, the Telengana movement had supported the independent struggle of India from British colony. If such a disturbance had not occurred in several parts of India, Britain could have taken the independent struggle at face value and they could have tried to use more force against the struggle. People were able to raise slogan against the feudal and brutal regime and able to abolish not only local principality but also it's backbone--the colonial power. Ultimately, the Nizam principality was abolished after the departure of the British from India.



Although the Maoists have shown their eagerness to join the "competitive democracy" and signed different agreements (12-point agreements in November 2005 and Eight points agreements in June 2005) with seven party alliance (SPA), their earlier targets were SPA cadres in the villages undermining democracy. The Maoists killed, injured in·jure

tr.v. in·jured, in·jur·ing, in·jures

1. To cause physical harm to; hurt.



2. To cause damage to; impair.



3. and compelled people to leave the village, who were believed to be at least progressive than any feudal regimes. The SPA cadres were not only tortured but also banned from launching political activities in the Maoists-influenced-areas. Apart from such 'undemocratic' behaviours against the democratic forces, the Maoists claimed that they had a "tacit understanding" with King Birendra. These activities of the Maoists compelled the people to be skeptical. The doubt of the people was 'the objectives of the Maoists movement was not to strengthen the freedom and democracy but to support the undemocratic and feudal regime'. The suspicion of the people over the Maoists was obvious because the monarchy itself has been considered as "the main obstacle for strengthening the democracy in Nepal".



The doubt of the people over the Maoists increased, when both Maoists and the king trapped democratic forces or parliamentary parties, in Nepal. On the one hand, as mentioned earlier, the Maoists banned the movements of the parliamentary parties in the countryside, which made the government unable for holding of the parliamentary and local elections. On the other, the king started ruling the country blaming the democratic government for its' 'incompetence' to holding the election and for maintaining the peace and security in the country. It is said that the democratic process was initially disturbed by rampant violent activities of the Maoists; even the democratically elected government was triggered to impose the state of emergency and termed the Maoists as 'terrorists'. The Maoist activities became major 'trump card' for the king to be used in asking support for his autocratic regime.



As a consequence more than forty thousand women's representation in different democratic agencies was directly hit antagonizing them. However, the Maoists defended such antagonism antagonism /an·tag·o·nism/ (an-tag´o-nizm) opposition or contrariety between similar things, as between muscles, medicines, or organisms; cf. antibiosis.

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an·tag·o·nism

n. as the initial compulsion when they were weak. Prachanda, in an interview defended it and said such strategy was there only for "extended political disclose to establish the ideology and to preserve the power when the party was overall weak in ideology, politics, organization and physical power". Now, according to him, they are trying to bring all possible force together because they are now "strong and reached near the strategic aim" (Prachanda in Janadesh 2006: 15-16).



Third, both the struggles, the Maoist movement and Telengana movement have definitely empowered women, sometimes knowingly and sometimes unknowingly. Although the Telangana struggle was called off without success, it has has brought some qualitative changes in women and in their life. After 40 years of the unsuccessful struggle, women still have no guilty feeling for the struggle but they took pride on it. Somaka of Vimpati who participated in Telangana struggle says, "in those days, could we sit and talk to you like this? Today we can do that. If we dressed up well, if we put kumkum The introduction to this article provides insufficient context for those unfamiliar with the subject matter.

Please help [ improve the introduction] to meet Wikipedia's layout standards. You can discuss the issue on the talk page. they used to say, what does she think herself?" (Sangathana 1989: 16). For her, that sort of empowerment was gained by the struggle, although the entire problems were not solved. Another woman participant Kausila was also satisfied by the achieved things. She says, "we didn't know what was behind this wall. We could never go out. Now we go out and look to our agricultural works (Ibid: 16)."



One question may be raised about how the women are empowered by the Maoist's movement. Some direct and indirect factors created by the movement, however, have led the women to be empowered. The Maoists' conflict compelled majority of the male members to leave their home into urban area or escape to the jungle to join the Maoist guerrilla force Noun 1. guerrilla force - an irregular armed force that fights by sabotage and harassment; often rural and organized in large groups

guerilla force . Women have thus been 'compelled to take the responsibility of running households. They have compulsion to go and take part to express their opinion in front of mass and so on. Women were compelled even to plough the field to feed their family members, which was restricted earlier. Engaging more in the public life than ever before, they have become more vocal in community activities.



On the other hand, the active involvement of women in both political and military organizations of the Maoist party has boosted the confidence of the Nepali women as a whole. This has indeed produced a wide-ranging impact on the Nepali state. Now, the government itself has started to recruit women into the Royal Nepal Army. The parliamentary forces also have realized the need to launch more progressive and reformist programmes to increase the role of women in the political participation.



Taking all these factors into consideration, we can conclude that women were sensitized sensitized /sen·si·tized/ (sen´si-tizd) rendered sensitive.

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sensitized



rendered sensitive.



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sensitized cells

see sensitization (2). and made aware about their role in the society. On the other hand, they are affected badly by the ongoing conflict. Women have become double victim due to the People's War. First, they are the direct victims of the security force as they are participants, relatives, wives, daughters and mothers of the rebels. They are continuously threatened, tortured and harassed in the name of inquiry as well as raped, killed, and disappeared as suspects, rebellion and also relatives of rebels. Second, the Maoists also demand lodging, food, money and sex from women any time and any day. Rapes by the Maoists have been frequently reported in the press and field work reports, conducted by individual visitors and human rights groups. The Maoists are also following the security forces' footstep to torture people suspecting them as informers, opponents and class enemies. Third, women are compelled to bear the double burden because of absence of their male members who are either killed or are compelled to flee from their domicile domicile (dŏm`əsīl'), one's legal residence. This may or may not be the place where one actually resides at any one time. The domicile is the permanent home to which one is presumed to have the intention of returning whenever the purpose .



Although, the Maoist claims itself as a radical party but it is also not far from being feudal towards the issue of women. Only two women members--Hisila Yami and Pampha Bhusal--are among the 27 Politburo members. The same women members of the Politburo are also in the 39--member Central Committee. In the case of female leaders, only two women--Pampha Bhusal and Hisila Yami--among the 40% women representation in the Maoist movement--have represented in politburo and central level. In the military wing, there is no single woman in the division commander where most decisions are made. But We have to say that the issue of gender is highlighted and sensitized in the Nepali society.



After having a look on Latchampas elaboration, we can conclude that the women in Telangana struggle faced same problem whatever Nepali women are facing now; the fear of rape and sexual harassment sexual harassment, in law, verbal or physical behavior of a sexual nature, aimed at a particular person or group of people, especially in the workplace or in academic or other institutional settings, that is actionable, as in tort or under equal-opportunity statutes. , torture etc. They kept secrets and protected other party workers especially the male by facing all the troubles of the state security (5). But they blamed the party for not being able to evolve any policy regarding the women. The charges over the party by women is not only about its policy towards women in the organization, their main grievances are that the party initially appreciated and welcomed women's support in the movement by wooing, and later it distressed them in the way without any alternatives. Some of them left their husbands, kids and home in the name of 'emancipation', but they got nothing but more trouble. Reminding Party's promise to women thwarted thwart

tr.v. thwart·ed, thwart·ing, thwarts

1. To prevent the occurrence, realization, or attainment of: They thwarted her plans.



2. their involvement in the struggle, Mallu Swaraj, who commanded a guerrilla squad and was a legend in the Telangana, says:

In the party, they will see only what the movement needs ... So

when struggle was withdrawn they told us to go and marry ... we

fought with them. We said that even if the forms of struggle had

changed we should be given some work (Sangathana 1989: 271-272).







But when the movement was called off, the party had not fulfilled its promise by giving work to women. They themselves, who spent their whole active life in the movement, often felt suppressed when the party withdrew the struggle and asked the women to go back and marry. Women are mentally tortured by such an immature decision of party. Priyamvada who spent years in the struggle said that "she often felt like committing suicide" (Sangathana 1989:272)." Sugunamma's observation is an example how they got frustrated frus·trate

tr.v. frus·trat·ed, frus·trat·ing, frus·trates

1.

a. To prevent from accomplishing a purpose or fulfilling a desire; thwart: after party's order to women "go back and marry". She says:

They have used us so long and now they say go stay at home. How

could they even understand what the situation was at home? What

mental torture--I was really upset. That was my first taste of

suffering (ibid).







Kamalama and Salama are the examples of exploitation by the party where Kamalama, now, is begging in her village to feed her children and is carrying "liquor and worked as a wage labor to bring up her sons" (Ibid). They themselves are in doubt whether they got some achievements or not because, according to Pesara Sattemma (Sangathana 1989: 221-227), the struggle's initial aim was for land ownership and against the Vetti. Vetti was abolished but women were not successful in getting land on their own name. Women considered that situation as big blow and insult to them. Priyambada, another women participant in the struggle, explained struggle as failed action to address the agenda of women. She says, "after the parliamentary election and police action, these dreams This article or section needs copy editing for grammar, style, cohesion, tone and/or spelling.

You can assist by [ editing it] now. were--smashed-crushed like an egg. What a blow it was, after the elections, do we know where we were? Like a proverbial pro·ver·bi·al

adj.

1. Of the nature of a proverb.



2. Expressed in a proverb.



3. Widely referred to, as if the subject of a proverb; famous. rug ... lying exactly where it was through" (Sangathana 1989) Ultimately, when the movement was ended, women neither got land, nor enjoyed other sort of settlement. The slogan 'all sorts of emancipation' remained a fantasy.



Everyone who knows the situation of women after calling off the Telengana struggle has always raised the question, fearing whether the Maoist movement will also go the same way as that of Telengana struggle? The fear is real because there were no women participation at the decision-making level in Telengana movement. The condition remains the same in the Maoists movement because only two women members--Hisila Yami and Pampha Bhusal--were among the 27 Politburo members. No women are there in standing committee, which is the supreme body of the party. And, only three (two representing in politburo also, and another was Uma Bhujel) members are in the 39--Member Central Committee. Now, the Maoist party has dissolved the standing committee and the politburo; all the power has been centralized cen·tral·ize

v. cen·tral·ized, cen·tral·iz·ing, cen·tral·iz·es



v.tr.

1. To draw into or toward a center; consolidate.



2. , which according to them, is because of their forth-coming general convention. In the military wing, there is only a single woman, Sapana is the company commander where they claim 40-50 per cent women's are working under them. The party and its women are still eager to raise the agenda of women participation in all the sectors.



After the Janaandolan II (Peoples' movement), the reinstated parliament has unanimously provisioned 33 per cent reservation to women in Nepal. The concern of the people is how this decision of the parliament would be implemented. The decision of 33 per cent reservation to the women seems unique and progressive in South Asia This article is about the geopolitical region in Asia. For geophysical treatments, see Indian subcontinent.



South Asia, also known as Southern Asia . People are having a doubt over its' implementation because of the traditional thinking of all the political forces over women in Nepal; till date, every party has offered the opportunities to the women for fulfilling the quotas. Recently after the Janaandolan II also, the position of the parties on the issues of women remained unchanged. Only a state ministerial portfolio has been given to the women; neither the Maoists nor the SPA sent any women in their dialogue teams, and in the interim constitution drafting committee.



After reading the narratives of the participants of the Telengana struggle, the research has concluded that radical agendas would be harmful for society, if the agendas were raised just to woo the people. It will not only be harmful to the organizer, but also to the individual or participants making them frustrated. Such frustration may possibly direct another revolt. The Telangana movement should be taken as a guide in which the CPI (1) (Characters Per Inch) The measurement of the density of characters per inch on tape or paper. A printer's CPI button switches character pitch.



(2) (Counts Per I called off the movement in 1951 but the party was not able to control its' activists to join another revolt. Those who were not satisfied by both, the achievement and the party's decision to end the struggle, tried to reorganize re·or·gan·ize

v. re·or·gan·ized, re·or·gan·iz·ing, re·or·gan·iz·es



v.tr.

To organize again or anew.



v.intr.

To undergo or effect changes in organization. such a struggle. After being unable to resume revolt by the same party, they tried to form an alternate party Alternate party diversion is an optional feature of telephone services, where a call may be routed to a different number based on time-out and precedence schemes set up by the customer. . Ultimately, in 1964, the split took place in the CPI and CPI (M) was created in the initiation of those dissatisfied members, which again continued armed struggle against the Andhra rulers in 1969 demanding "separate Telangana state" (Mohanty 2005:11-15). So, one can conclude that if some one takes weapon, s(he) rarely will quit the weapons before reaching to his target. Experiences show that all revolutionary parties and their accountable leaders can analyze the entire situation and decide to compromise by suspending and even giving up the armed struggle but applying such theory in cadres and followers followers



see dairy herd. , who took weapons after suppressed and marginalized feeling, has not succeed properly. For them, 'do continue the revolt and die in the battle field' is better than being back before getting something. The leader of the Maoists must think to prevent such possibility, and hopefully that may be the signal of thinking over it by the Maoists supreme commander when he realized that "whatever has supported for successful development of the people's war, it is the both, main possibility and main threat."



It is the desperate need of time to Nepali Maoists leaders to think and rethink about the hindrances those hindrances felt long before by Priyamvada, Sugunamma, Kamalama and Sattemma, and that group which split and re-organized the revolt after the wind up of the Telengana people's struggle. Every top-level leaders of the groups including the Maoists, which raised the radical agendas, must learn lesson from Telengana before they take any step forward.