Showing posts sorted by relevance for query Tamilnadu. Sort by date Show all posts
Showing posts sorted by relevance for query Tamilnadu. Sort by date Show all posts

Tuesday, June 23, 2009

TAMILNADU'S PARADOX - Alarming malnutrition pushing children out of school - I

By M H Ahssan

Tamilnadu leads the country in nutritional interventions and yet has alarming levels of hunger in children. Research indicates that is a very likely cause of poor schooling achievement and drop-out rates.

Despite several schemes, chronic malnutrition persists in Tamilnadu and this is very likely a major cause for continuing poor performance and high dropout rates of children in Tamilnadu’s government schools. Ironically, the state leads the country in nutritional interventions and has improved its standing in comparison to other states in the last two decades since the scaling up of nutrition schemes. Yet, nutritional status have only marginally improved and in some cases like the anaemia count going up, perplexing activists, policy researchers, and funding organisations.

The state is a study in contradictions: It gave the country its direct nutrition intervention in the form of the Noon-meal Programme (NMP), and yet has alarming levels of hunger, according to the International Food Policy Research Institute's India State Hunger Index (ISHI) of 2008. The index gave the state this rating from a choice of: low, moderate, serious (6 states), alarming (10 states including TN), extremely alarming (Madhya Pradesh). The ratings are based on the prevalence of calorie-energy deficiency, child mortality and the number of children below the age of 5 who are underweight.

One out of every three persons ate less than 1,632 calories a day (much lower than the national Below Poverty Line cutoff of 2,100 calories) in Tamilnadu. Every third child below the age of 5 in the state is underweight (low weight for age) and the under 5 mortality rate of is 3.5 per 100 births.

The National Family Health Survey data of 2008 show a similar trend: Almost one-third (31 per cent) of children under age five in Tamilnadu are stunted, or too short for their age, which indicates that they have been undernourished for some time; 22 percent are wasted, or too thin for their height, which may result from inadequate recent food intake or recent illness and 30 per cent are underweight, which takes into account both chronic and acute undernutrition.

Seven out of every 10 children below the age of 5 have iron-deficiency anaemia (IDA) according to the NFHS. IDA has actually increased from 69 to 73 percent in the 0-3 age group from the last survey of 1998. Only 40 per cent of the households have access to adequately iodised salt and Vitamin A deficiency persisted despite prevention programmes.

The effects of such acute and chronic undernutrition are well established. Increased mortality, poor cognitive and motor development and other impairments in function as fallout of undernutrition, show Dr Stuart Gillespie and Dr Lawrence J Haddad of IFPRI in their book The Double Burden of Malnutrition: Causes, Consequences and Solution. “Children who have been severely undernourished in early childhood suffer a later reduction in IQ by as many as 15 points (Martorell 1996), significantly affecting schooling achievement and increasing the risks of drop-out or repeat grades.”

Impact of stopping noon meals for over-14
Activists of Right to Food (Tamilnadu) also chalk up a higher drop out rate of close to 40 per cent in the higher classes also to the cessation of noon meal schemes after the age of 14. S Kanniyan, RTF-TN convenor, says with decrease in agricultural work in the villages, more and more women have taken up contract work in construction industry. “Many children no longer have breakfast because their mothers need to be at work early in the day. Classroom hunger is a serious cause of concern. When the child comes hungry to school, her learning is going to be impacted. Often teachers do not understand the reasons for poor scholastic achievements and instead punish the students; which only pushes the child into dropping out,” he said.

The noon meal is made available in higher secondary classes only to students belonging to MBC, SC/ST castes. Often older children are ashamed of the caste and socio-economic status identification their noon meal plates accord them and prefer to skip the meal altogether, says Aruna Rathnam, Education specialist, UNICEF. “Younger children are more enthusiastic about noon meals, especially since the introduction of eggs two times a week, because of hunger. For adolescents, the lunch hour becomes a question of peer acceptance and socialisation. Many students prefer to eat packaged food of poor nutritive value to the prepared meals in schools," she says.

Even in the below 14 category, the efficiency has come under question. A review of Tamilnadu's Noon-meal programme (NMP) implementation shows that the per-day-per-child expenditure is 35 paise, for vegetable, condiments and salt. TN FORCES, an NGO that works throughout the state with day cares and crèches, says vegetables or oil or other seasoning are often not present in the Anganwadi centres. Sometimes even salt is brought from the home of the beneficiaries. TN FORCES is the state wing of Delhi-based FORCES.

K Shanmughavelayutham, TN FORCES convenor says that only two-thirds of children who are eligible for the nutritious meal scheme get coverage. Despite that, the nutrition schemes are unable to meet the needs and the government should commit at least 3 percent of the budget for nutrition, he says.

Both Right To Food and TN FORCES have been seeking an improvement in infrastructure and quality of food given to children. “After the death of a child in Melvalampettai Higher Secondary School after a vessel holding hot sambar toppled onto him, we sought improvements to NMP kitchens in schools. A committee that inquired into the incident that happened in 2006, said NMP urgently needed upgraded, smokeless kitchen and a safe serving/eating area. The improvements have been slow in coming.

“Nutritionally too, the scheme needs a re-think. Rice that is used is from the Civil Supplies department and is so heavily processed that it is shorn of all nutrients other than starch. The only other food children get is red gram (masoor dhal) in the sambar, not even oil. The meal, though supposedly provides one third the calorie need of the child, does little else in the form of minerals or vitamins," they say.

Tackling the challenge of Anaemia
Another issue that has the child health organisations worried is that of iron deficiency anaemia (IDA). According to NFHS-3, in the below 5 years group, a majority -- 64 percent – is anaemic. This includes 27 percent who are mildly anaemic, 35 percent moderately anaemic, and 3 percent with severe anaemia. Children of mothers who have anaemia are much more likely to be anaemic themselves. And in the state, those numbers are also of concern: various health surveys put that between 53 and 69 percent for pregnant women.

Dr Devashish Dutta, Specialist in charge of Health, UNICEF office for Tamilnadu and Kerala says maternal anaemia impacts maternal mortality. It could also lead to pre-term deliveries, abortions and growth retardation with nutrition to the unborn baby being less than sufficient, he says. “Anaemia reduces the capacity of the baby to survive, through diminished immunity, poor growth and development. Poor immunity leads to the child falling ill often, which in turn impacts her nutritional status leading to further reduced growth and immunity, and hence more illness and so on. When the child grows up to have children, the vicious cycle of anaemia leading to low birth weight, poor immunity, frequent illnesses, retarded growth, development and malnutrition is repeated," says Dr Dutta.

Gillespie and Goddad, in their book, further aver: “Infants with low birth weight are born with low iron stores, depleted by two to three months. Because breast milk cannot meet their iron requirements, it should be supplemented with iron starting at two months of age....

"Iron supplementation of anaemic preschoolers improves their cognitive and physical development.”

Unfortunately, the under-five group is outside the purview of the IDA prevention programme in Tamilnadu, that focus on adolescent girls and pregnant women. Nor have issues like links between poor iron absorption and Vitamin A deficiency and worm infestation been integrated into the scheme.

“Protein deficiency in the diet can also cause anaemia, given that iron binds with a protein called globulin. Often more than one deficiency co-exists indicating that the nature and quantity of food available or feeding practices were poor," says Dr Dutta.

Even in the case of adolescent girls who receive the weekly supplementation of Iron and Folic Acid tablets, activists are not happy. A daily supplementation dose will not have as many side-effects as the weekly dosing, which are often accompanied by black stools, gastro-intestinal discomfort, and malaise. “Ideally, the supplement is had in the night after dinner with another food with vitamin C like lime juice or sweet oranges. But the government has asked us to ensure that the IFA is taken in our presence, so we give it with the noon meals. Occasionally, some girls feel nauseous or vomit after taking the tablets. Then encouraging others to consume it becomes an issue," says S Tamilazhagi (name changed to protect identity), an Anganwadi supervisor in St Thomas Mount Panchayat union, that abuts Chennai Metropolitan area to the west.

Some anganwadi workers who are involved in distributing IFA tablets in neighbouring Kancheepuram and Thiruvallur districts say the supply has been erratic over the past two years and others allege that after initial testing of haemoglobin levels in 2005-2006, the government has subsequently failed to study the impact of the programme.

“The distribution of tablets or testing for haemoglobin levels depend on the initiative of the VHNs and Anganwadi workers. Often the service delivery is interrupted because of government chooses to implement other non-nutrition related schemes through us. For example, we are also to talk to the adolescent group about nutrition, reproductive health, menstrual hygiene and entrepreneurship development," says N Gomathi, a leader in the TN VHN Association.

(Click here to read - Part - 2)

Saturday, May 25, 2013


By M H Ahssan / Hyderabad

Television news in the southern part of the country has largely become the preserve of the various political dynasties, with a glut of channels acting as mouthpieces of the owners rather than objective news broadcasters. INN brings us the true picture. 

A joke in Tamilnadu one has heard several times is about how Tamilians ensure they get the right news.

Monday, June 15, 2009

Price of rice, price of power

By M H Ahssan

Most governments that stressed welfarist measures gained in last month's elections. Food prices and cheap rice are crucial, though not the sole issues.

Now that we have a Cabinet whose assets total close to Rs.5 billion on its own declaration, with Ministers worth over Rs.75 million each on average, it will be worth watching how it rises to the challenge of identifying with the poor and the hungry. That Rs.5 billion figure, painstakingly compiled by the National Election Watch, a coalition of over 1200 civil society organisations working across India, covers 64 of the 79 Ministers. The other 15 are Rajya Sabha members whose updated assets are yet to be computed.

True, these figures are skewed by the fact that the top five Ministers alone are worth Rs. 2 billion. However, as the NEW points out, the rest are not destitute. In all, 47 of the 64 are crorepatis. And the remaining 15 won't harm the score too much when their totals come in.

Together, they will preside over the destiny of, amongst others, 836 million Indians who "get by with less than Rs.20 a day" (National Commission for Enterprises in the Unorganised Sector report, August 2007). This challenge will unfold in a Lok Sabha where the average worth of an MP is Rs.51 million. Again, this average too, is skewed by a chunk of 60-70 MPs of the 543 whose asset worth is relatively very low. On the other hand, many have notched up large gains in wealth during their first term as MPs.

In a complex and layered verdict driven by many factors, one seems clear: most governments that stressed welfarist measures - particularly cheap rice and employment - gained in last month's election results. This was regardless of which party was leading them - the Congress, the BJP, the BJD, the DMK or any other. Some of these measures might not have led to large numbers of people going out to vote for those governments. But they at least lowered hostility levels amongst the voters in a hungry nation. As Madhura Swaminathan points out, the FAO data confirm that "no country comes close to India in terms of the absolute number of people living in chronic hunger."

The hungry have had it pretty bad. The rise in food prices was extremely steep over the last five years, one of our more adverse periods in decades. Between just 2004 and 2008, the price of rice rose by over 45 per cent and of wheat by more than 60 per cent. Atta, edible oils, dals, milk and even salt saw rises of between 30 and 40 per cent. Lower or near-zero inflation has seen no drop in food prices. That the media never saw hunger and cheap food as a major poll factor says more about them than the issue.

The DMK's colour television set giveaway - the focus of much derisory media attention - was never a fraction as important as its provision of 20 kg of rice per family at Rs.1 a kg since September 2008. That too, for anyone with a ration card, without dividing people into the APL or BPL groups. Tamilnadu had already been providing rice at Rs.2 a kg for some years. It also took the NREGA seriously. The State government gained on both counts.

In Andhra Pradesh, like in Tamilnadu, the Congress government of Y S Rajasekhara Reddy was helped by the presence of a third party - Chiranjeevi's Praja Rajyam - which drew a lot of anti-Congress votes, crippling the rival Telugu Desam Party. But YSR's was also a government which in its first year restored lakhs of cancelled BPL cards and issued lakhs of new ones. (The Hindu, Sept. 29, 2005) In nine years, Chandrababu Naidu's government issued no BPL card till the period just before the elections. That in a State where hunger and food have been huge issues even in urban areas.

Andhra Pradesh was where rice at Rs.2 a kg began with Naidu's father-in-law, then Chief Minister N.T. Rama Rao. NTR's charisma was never in question - but rice at Rs.2 a kg helped, more than any other factor, to convert it into votes. Chief Minister Rajasekhara Reddy in fact stole the TDP's clothes when in April 2008 he brought back the Rs.2 a kg rice scheme - a year before the national polls. This was at 4 kg per person (or 20 kg per family of five). An earlier generation of Congress leaders had trashed NTR's pet project as a "costly gimmick." But Dr. Reddy took a more sensible line and gained from it.

During Mr. Naidu's years in power, so lavishly praised in the media for his reforms, the public was repeatedly hit by massive hikes in power charges, water rates, food prices and other costs. He has not managed to live down his record or regain credibility in 2009.

His adversary ran a decent NREGA programme. In the backward Mahbubnagar district, distress migrations fell as many found work under the NREGA. This at a time when food prices were biting. So much so that people in their 70s turned up at NREG sites for work - their Rs.200-a-month pensions blown away by the rise in food prices. Even on that front, though, the Andhra Pradesh government earned some credit. When it assumed power, there were 1.8 million people in the State getting old-age, widow and disability pensions - a paltry Rs.75 each. This was raised to Rs.500 for disabled people and Rs.200 for the rest. Hardly enough - but a lot more than before. And the number of people getting these pensions rose four-fold to 7.2 million. The State also has one of the country's better pension schemes for women.

In Orissa, Naveen Patnaik played his cards most effectively, gutting the BJP and corralling the Congress. But he also gained hugely from giving people cheap rice. In the burning hunger zones of Kalahandi-Bolangir-Koraput, 25 kg of rice had been offered to all families at Rs.2 a kg since mid-2008. In the rest of the State, this was restricted to BPL families. The government also gave out 10 kg of free rice to the poorest families in the KBK districts. This had a major impact in curbing starvation deaths. Mr. Patnaik also increased the numbers of those coming under pension schemes - and housing projects for the poor - quite significantly. (At the same time, he implemented the Sixth Pay Commission recommendations before the polls, sewing up the middle classes as well).

Sure, these were not the only issues on which people voted, but they played a big role (In the case of YSR and Mr. Patnaik, there was another factor that helped this along. The positive measures in both States were present and visible. The negatives - and they are explosive, like massive human displacement, SEZs, dangerous mining projects - are in the pipeline. Disasters waiting to happen but which will take two or three years to do so. Unless, of course, those policies change.)

In Chhattisgarh, however repugnant the ways of that government in many spheres, Chief Minister Raman Singh took a personal interest in declaring 35 kg per family at Rs.3 a kg. His government then unilaterally "increased" the number of people below the poverty line to almost 15 million - in a population of 20.8 million (2001 census). That is, close to 70 per cent of the population was "declared" BPL. This was done several months before the 2008 Assembly elections. It helped the government in both the State and national polls.

The Left Front in West Bengal failed on both fronts. The State saw rioting at ration shops last year as the Centre cut allocations of grain sharply. Yet West Bengal, which tops the States in rice production, moved towards provision of cheaper rice only early this year. Too reluctantly and too late. Its performance in the NREGS was also very poor. Hunger was a factor in the rout of the Left Front.

So what should those in power read into the poll results? That they have a mandate for more liberalisation, privatisation, high prices and other such reforms? Or that the price of rice could be the price of power? That jobs and security are vital? Food prices and cheap rice are crucial, though not the sole issues. Governments cannot bank on such moves already made to bring them perpetual gains. But the whole process is a step ahead and has raised the bar on public expectations. Sharp reversals could prove suicidal.

Tuesday, June 25, 2013

Poverty Forced Her To Live On Brick Bites In Tamilnadu

By Selvanatham / Chennai

Born into a poor family with no means for two square meals a day, an octogenarian and her family members had no option but to subsist on pieces of bricks, mud and ash for a long time — and now she has become addicted to it. “I was born in a poor family and at times we had nothing to eat. We used to eat pieces of bricks, mud and ash. Even after my marriage to a daily wage earner, the situation did not change,” said Saraswathi, a resident of Vishwapuram in Thoothukudi in Tamilnadu, who works as a domestic help at several houses in Muthammal Nagar.

Tuesday, October 11, 2011

J. Jayalalitha - The Iron Lady of Tamil Nadu

Birth Name: J. Jayalalitha

Informal names :
Ammu, Puratchi Thalaivi

Actor turned Politician

Birth on Feb-24-1948 at Mysore

Father � Jeyaram, Mother - Sandya


Bishop cotton Girls High School, Bangalore.
Church Park Convent, Chennai.

Awards and Achievements
1972- Kalaimamani award from the government of Tamilnadu.
1991- Was conferred the Degree of Doctor of Literature(D.Litt) by the University of Madras.
1992- Dr MGR Medical University conferred the degree of Doctor of Science.
1993-Madurai Kamaraj University conferred the degree of Doctor of Letters.
2003-Tamil Nadu Agricultural University conferred the degree of Doctor of Science.
2003-Bharathidasan University conferred the degree of Doctor of Letters (Honoris Causa)

Fine arts:
As a dancer well versed in Bharata Natyam, Mohini Attam, Kathak,Manipuri.

Influential persons in her life
Mother Celine(school head mistress)
Her mother for her career in films.
Dr. M.G.R for her career in politics.

Has a large private library with a huge collection of books. Likes to watch old tamil, hindi and english movies. Once mentioned that she was impressed by the book "Wild Swans".

Debut movie:
Kannada film:'Chinnada Gombe'
Telugu film: 'Manushulu Mamathalu'
Tamil film : 'vennira aadai '
With MGR: "Aayirarhthil Oruvan"
With Shivaji: 'Galaata Kalyaanam'

Political Entry :
First as the Secretary of the AIADMK, then was nominated to the Rajya Sabha.

Chief Minister
First Tenure: 24-06-1991 to 12-05-1996,
Second Tenure: 14-05-2001 to 21-09-2001
Third Tenure: 02-03-2002 to -12-05-2006
Fourth Tenure: May 2011

Portfolio's handled by her as C.M. Public, General Administration, Indian Administrative Service, Indian Police Service, other All India Services, District Revenue Officers, Home, Police and Minorities Welfare.

Schemes for the welfare of women
Cradle baby scheme.
All women police station.
Personal Highs
In 1982 when she gave her maiden speech about 'pennin perumai' which was applauded by Dr. M.G.R and In 1984 her Rajya sabha maiden speech which impressed Mrs.Indira Gandhi

Other Facts and controversies
After completion of Matriculation in 1964, she won a scholarship from Government of India for higher studies but did not accept it as she took up a career in films.

Played 'herself' as a politician/chief minister in the movie 'Neenga Nalla Erukkanum'

The first Woman Leader of the Opposition in the Tamil Nadu Legislative Assembly.
She was elected from Andipatti Assembly constituency in February 2002 to become the Chief Minister of Tamilnadu.

About her life
"One-third of my life was dominated by my mother, the other part - a major one - was dominated by MGR. Two-third of my life is thus over. One third remains and this part of my life remains for myself but there are some responsibilities and duties to be fulfilled".                             

Saturday, March 22, 2014

Political Twists & Turns In Tamilnadu: Perfecting The Art Of Switching Sides To Stay Afloat In Power Pool Settlements

By Sujata Pillai | INNLIVE

TAMILNADU POLITICS The birth of new alliances in Tamil Nadu this election once again proves that politicians don’t hesitate to find strange bedfellows at will. Ever since smaller regional parties began to flaunt their distinct vote banks in 1998, ideology has taken a backseat during polls.

The PMK, which consolidated its base in the Vanniyars belt in the north and north-west regions has the reputation of hopping camps almost in every election since 1998, barring the 2006 Assembly election when it remained in the DMK camp.

Monday, March 18, 2013

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Saturday, April 20, 2013


By Shreya Reddy / Hyderabad

By scrapping the Bayyaram mining leases in Khammam district and announcing a decision to hand them over to the Visakhapatnam Steel Plant, Chief Minister N Kiran Kumar Reddy queered the pitch for the Telangana Rashtra Samithi and the Telugu Desam Party (TDP).

In fact, the TDP, which has been crying hoarse over the allocation of Bayyaram mining leases for quite sometime, was caught napping when the State Government announced its decision. Aside from this, the State Government announced that it would insist the Rashtriya Ispat Nigam Ltd (RINL), the public sector company that runs the Vizag Steel Plant, to establish a benification plant and also a steel plant in Khammam district.

Monday, April 27, 2009

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.

Friday, September 06, 2013

Agri-Innovation: The Wonder Climber For Areca Nut Trees

By Srikrishna D / Bangalore

A new mechanical device that makes areca nut harvesting less labour-intensive and hence affordable could solve one of the major problems faced by farmers of the crop. 

In recent years, labour scarcity has emerged as one of the foremost challenges in farming. One crop that has been most affected by this is the supari, or areca nut. Areca nut trees attain a height of about 60-70 feet. It is mandatory to climb the trees a minimum of five times a year for a successful harvest - twice for the preventive spray against fungal disease, and thrice to harvest the areca bunches. The spraying is done in monsoon, while harvest time is typically in summer.

Only skilled labourers can carry out these farming operations. They have to climb the trees using muscle power. In an acre that has 550 trees, a labourer has to climb a minimum of 100 to 150 trees.

Tuesday, October 25, 2011

The Fermenting India

India these days seems to be in ferment. If one picks up a newspaper one gets hit by headlines that certainly do not bode well for the country, at least, not in its immediate future. While one can discern a severe churning taking place in the country’s social, political and economic life, the government, at the same time, is largely perceived to be drifting along.

Protests against governmental actions/inactions both, at the Centre and in some states have been raging for months. Tamilnadu in the South has witnessed an agitation against the Koodankulam nuclear power plant that is only few months away from attaining criticality. The pathetic fate of far-away Fukushima in Japan and its ill-fated victims have justifiably induced fear in the surrounding villages of Koodankulam. People in general have become resistant to the idea of nuclear power and fearful of the nuclear power plants.

Another anti-nuclear protest by villagers earlier this year in the idyllic Konkan region in Maharashtra’s Ratnagiri District against a mega Nuclear Power Park had boiled over for weeks and had even become violent. Acquisitions of fertile lands under an antique law for mining, industry and power – thermal or nuclear – in pursuit of double-digit GDP growth gave rise to agitations of farmers and tribal communities in several states. The government has been hard put to subdue them.

The country has also seen protests in the North-East, in Arunachal Pradesh and Assam, as also in the Himalayan states of Himachal and Uttarakhand against construction of dams for irrigation and generating hydro-power. While people, especially rural and tribal communities, have become more alert about safeguarding their rights and livelihoods, the governments, both at the Centre and in the states have been tardy in shedding their autocratic attitudes and have failed to take people into confidence before conceiving projects that impinge on their wellbeing.

Today, with information being available at the remotest of outposts ordinarily people refuse to be taken for granted by governments and their functionaries. A decades-old movement for creation of the Telangana state (to be carved out of the southern state of Andhra Pradesh) has gathered strength and is continuing now for months with no solution in sight. The Congress Party which had merged the region with the then newly-created Andhra Pradesh more than half a century ago against the wishes of the locals and against its own better judgement has now been facing the music. With passions running high, life in the state and its capital, Hyderabad, is paralysed with considerable impact on it administration and economy.

The social activist Anna Hazare’s two successive fasts, with unprecedented country-wide support, for enactment of a strong “Janlokpal” (anti-corruption ombudsman) law and later the government’s capitulation are recent history. India Against Corruption (IAC), led by Hazare and his team, are still hitting headlines. It has decided to canvass against Congress candidates at the 2012 state polls if the Parliament reneged from its commitments given during its last session for legislating for a strong “Lokpal” – the reasoning being the Congress leads the coalition at the Centre.

Although the context might be different, IAC’s efforts of swinging elections away from the Congress remind one of the campaigns of The Tea Party in the US during the 2010 Congressional elections. The United Progressive Alliance (UPA) government’s first tenure appeared sedate until, of course, the Prime Minister, Manmohan Singh, insisted on signing the Indo-US Nuclear Deal even at the cost of losing support of one of his important allies – the Left – risking his government’s survival. The government did survive and win the “Confidence vote” only after the “cash-for-votes” scam exploded in the Parliament in 2008. The Congress-led ruling combine’s brazen efforts to soft-pedal investigations into the scandal invited a scorcher from the apex court. And yet, the trial that was hurriedly commenced, based on seemingly skewed investigations, appear to be farcical as none from among the beneficiaries – the Congress-led UPA government – of the scam has so far been hauled up. After IAC’s massive anti-corruption movement the government’s attitude appears somewhat brassy.

UPA I’s survival by dubious means has come to haunt it in its second avatar. All the scams that are currently hogging the headlines are of UPA I-vintage. The biggest of them all – allotment of 2G spectrum – saw a cabinet minister, a member of parliament (both of a southern ally) and a few corporate honchos into the jail, besides embarrassing the Prime Minister who tried to hide behind the nebulous “coalition compulsions”. He was, nonetheless, forced to act by an aggressive Supreme Court. Later, even the Comptroller & Auditor General (CAG) got into the act, putting the finger at the loss of incredible hundreds of thousands of billion rupees.

The relentless media exposes of scams of another few hundred thousand billion rupees during the run up to the Commonwealth Games in 2010 forced the Prime Minister into action to have it investigated by a former CAG. Having shot himself in the foot, he lost credibility. And, it led to a curious crisis of confidence that stalled governance and induced a policy-paralysis even as sycophants of Sonia Gandhi undermined his stature by repeated assertions about eligibility of her son to occupy the highest executive position.

Today, the busiest organisations are the courts, especially the Supreme Court, and investigative agencies like the Central Bureau of Investigation and other police outfits. While virtually every day there are reports of court orders pulling up a public organisation or an individual, every new day brings also the news of a big wig either being put in the coup or refused bail. A large number of politicians of different hues are in Delhi’s infamous Tihar Jail. While the Law Minister, strangely, feared for drop in investments with so many corporate heads in jail, the apex court was taken aback when warned by a government lawyer of destabilisation of the government if it went after high functionaries like the home minister, a case for whose prosecution contributing to the 2-G scam is also currently being heard.

A recent headline spoke of “scams, graft (are) hitting growth”. Indeed, GDP growth has slowed down. Scams and graft could well have been very important reasons. No less important has been the reason of inflation which has been biting the industry and the common man, the very aam aadmi, whom the UPA swore by. The prices have gone through the roof and what hurts the most is the food inflation that has moved beyond 10%. The declining value of the rupee has pushed a few more millions below the poverty line. And yet, the government unmindfully has sought to peg the poverty line at a ridiculous Rs. 32 .00 and Rs. 26.00 per day in urban and rural areas, respectively, fuelling fresh controversy.

None in the government seems to have bothered to enforce checks on the inflated prices of essentials like vegetables and food grains. While the prices of agricultural produce rule high squeezing the common man the farmers commit suicide and, ironically, the cartels and middlemen make their piles. Even, the middle classes have got the wrong end of the stick with repeated hikes in interest rates to combat the prevailing inflation, pushing, inter alia, housing and automobiles out of the reach of many.

Economic growth has, on one hand, been accompanied by growth in numbers of billionaires, enriched ministers and MPs/MLAs, rising numbers of private aircraft, luxury yachts and high-end luxury cars on the roads and, on the other, by huge numbers of discontented and resentful poverty-stricken, malnourished and hungry – by some estimates around 60 million (77% by the reckoning of the late economist Arjun Sengupta) – in rural and urban India. Jobs remaining scarce, petty and other crimes have shown an inordinate rise. Snatchings, thievery, rapine, kidnappings etc. have become common. Worse, while mafias stalk the honest and whistleblowers, murder and rape have registered a sharp rise. Security of life and property has become tenuous.

Polarisation in politics has bred acute intolerance for a contrarian view. Two prominent IAC activists were assaulted – one was beaten up on camera for holding views on Kashmir disagreeable to the extreme right and the other for canvassing votes against the Congress if it did not fulfil its commitment of legislating for a strong Lokpal. While unbridled pursuit of economic growth has made only the rich and the unscrupulous prosperous and happy, it has spread unhappiness and misery among a very large section of the people. At the same time, it has demolished the anchors of Indian society in a mad rush for money; the get-rich-quick syndrome is eating into its moral fibre. Ethical life in India today has been shoved on to, no, not the back seat, but the boot. Reversing this now well-established unholy trend might well be an impossible proposition.

Tuesday, April 09, 2013

Kudankulam Nuclear Plant: Ready To Produce Power?

Will the Kudankulam nuclear power plant finally become operational this month as assured by the Prime Minister? INN takes an in-depth look at the long history of delays and conflicts that has plagued the project since its inception. 

Almost 11 years after concrete had first been poured in the Kudankulam Nuclear Power Project (KKNPP) in March 2001, India still awaits the 2000 MW electricity that the plant could generate. Six months after nuclear fuel-enriched Uranium was loaded into the core of the plant, with repeated tests being run to satisfy all safety parameters, Kudankulam is still on the brink. For the nuclear protesters that brink denotes a lurking disaster while for India's nuclear establishment, it is the power that could relieve a crippling shortage that has come in the way of growth.

The stalled project had seen its share of delays right from the beginning. A product of the Indo-USSR pact in 1988, the first hurdle came in the form of collapse of the USSR. Clearances, in line with the laws of those days, were obtained in 1989 and land acquisition completed by the 1980s. The plant had to be renegotiated with Russia in 1997.

But a different set of rules for environment safety were in place in 1997, under the Ministry of Environment and Forest. Any project that cost over Rs 50 crore needed to go through an Environmental Impact Assessment (EIA) and a Public Hearing, after the copy of the EIA was given to the public/panchayats (local body governance) of the village in which the project was to come up. The notification mandated any expansion and modernisation of existing projects and new ones should go through a process of EIA by an expert committee chosen by the Ministry of Environment and Forest. The report had to be placed before the State Pollution Control Board, which would then convene a public hearing to find out objections to the project. Schedule I of the notification included nuclear plants and allied industries.

The Nuclear Power Corporation of India Ltd, the Indian company that is implementing the project, had also proposed four more plants in the site. A fresh inter-Government agreement was signed in 2008. While the two plants for which permissions were already in place did not have to go through additional processes, the other four proposed plants had to. Permissions for those four plants had come only in 2012 after much deliberation and changes in the safety plan, after EIA and public hearing.

Home-grown industry and its safety
The civilian nuclear energy programme in India is 62 years old with one of the safest records in the world. There have been no Chernobyl-like or Three Mile Island-like accidents, events that were believed to be caused by human factor. India also collaborated with the likes of Canada, France, USA. However with the Smiling Buddha operation in 1974, the country faced a nuclear apartheid. Countries that had then helped India set up reactors backed out of their commitments, setting back many projects. The fast breeder reactors, for which India was working with France, were delayed. A smaller test breeder reactor has been in operation for almost 30 years now, but the 500 MW Prototype Fast Breeder Reactor (PFBR) is yet to go on stream, the nuclear establishment attributing this delay to the manufacturing of a first-of-its-type equipment.

Since then the nuclear energy programme has been almost entirely home-grown and has often been praised elsewhere for the ingenuity and experimental facilities that is matched only by Russia. In that sense, Kudankulam then would come to mean a collaboration between two of the best in the world.

But then the project attracted so much opposition that it was almost derailed twice, and while the last rounds have come very close to commissioning, it has not reached that state. The residents of Idinthakarai, a village 6 km outside the 5 km sterilisation zone, have called for the project to be abandoned. In September 2011, the anti-nuclear movement started gaining momentum, forcing the State of Tamilnadu to call for a suspension of works in a ready-to-be commissioned project.

Summer of discontent
Tamil Nadu was going through an unprecedented power shortage, with an installed capacity of 11,640 MW including from Central projects like Neyveli Lignite Corporation through power sharing agreements, and the state experiencing a 4,460 MW deficiency. The demand from the Power Utility was projected at 13,450 MW for 2013-14.

The Tamil Nadu Generation and Transmission Company – TANGEDCO – had to resort to extensive power cuts throughout 2012, some extending up to 12 hours in rural areas to manage the crisis. The crisis continues in 2013, with the state being energy-starved this summer also.

There has been little capacity addition since 2000 in the state and opposition to projects like the 1600 MW Jayamkondan Lignite Power Project had meant that the state quickly went from energy surplus to buying power from the North Eastern States. Demand had increased from 6000 MW in early 2000 to 12000 MW within a decade. Many of the thermal plants are operating only at 50 percent capacity and dwindling resources at Neyveli Lignite Corporation poses its own problems. The state needed to add capacity and add it quickly.

This prompted the Chief Minister to do a volte-face on her stand that KKNPP can only be commissioned after allaying the fears of the locals and seeking immediate consent. The consent came a day after parliamentary by-elections to Sankarankoil constituency, in the district of Tirunelveli, the same as Kudankulam in March 2012. It was an election fought over the poor management of power crisis. The AIADMK-government leveraged its victory to give consent to the project. It also upped its ante by demanding all of the 2000 MW for the state, negating the original power-sharing contract.

Both the AIADMK and its bitter enemy the DMK had contributed to the power crisis, by not adding capacity and by distributing freebies promised during elections like TVs, blenders, grinders and fans (and where fans were redundant induction stoves). These energy intensive appliances added another requirement of 250 MW per day, according to some TANGEDCO estimates. But with the by-elections won, the AIADMK government put the ball firmly in the centre's court.

Expert group struggles to win over
The centre was urged to win over the support of locals after allaying fears. Well-respected scientists including the former President of India Dr A P J Abdul Kalam were part of that effort. An Expert Group that went into safety aspects presented its report to the State Government. 

That report addressed how the Fukushima meltdown happened and how the design of the Kudankulam plant does not allow for that kind of events to happen. The Japanese plant was shut down when the 9.03 Richter scale temblor hit the North Eastern Japanese island; the six tsunami waves that followed cut off power supply to the plant that resulted in a level-7 meltdown. The earthquake was so powerful that it moved the entire main island of Japan, Honshu, by 8 ft and shifted the earth on its axis. Of note is the fact that entire Japan sits on seismic zone 5, while Indian authorities says Kudankulam sits on zone 2, the least prone to earthquakes.

When the Boxing Day tsunami, caused by a 9.1-earthquake off Sumatra, Indonesia, struck the Eastern Coasts of the Indian peninsula, two nuclear establishments saw some flooding. The Madras Atomic Power Station (MAPS) at Kalpakkam (70 km from Madras) was minimally affected. Water entered one of the 220 MW plants, which had been manually shut down safely. The residential colonies for the workers fared worse with five employees of the Madras Atomic Power Station drowning..

Kudankulam plant also saw tsunami water entering its incomplete premises. Kudankulam's neighbouring fishing villages were minimally affected by the tsunami.

The Expert Committee then pointed out the low seismicity of the region, the plant safety features including the higher elevation of the building and diesel generator to cool, double containment, measures to prevent explosions caused by release of hydrogen gas, like those that happened in Fukushima, to prove their point that Kudankulam is no Fukushima waiting-to-happen. The Nuclear Establishment has also agreed to implement the safety plan that the International Atomic Energy Agency proposed. Yet, these assurances were not good enough for the protesters.

The activists still demanded that the project be scrapped and even sought that the blueprint of the reactor be made public, an unprecedented step. This time around they also wanted it scrapped on the basis that it went against public sentiment. Their rhetoric revolves around nationalistic sentiments of Tamils and has received widespread support among parties that have espoused those values. After the main parties of Tamil Nadu, the ruling AIADMK and the DMK, toed the line of the expert group report, the Tamil Nationalistic PMK and the MDMK have extended support. This movement has also attracted the attention of supremacist elements involved in the Tamil separatist movement, like Naam Thamizhar Iyakkam.

Close to commissioning
While the Nuclear Establishment was looking at an October 2012 commissioning, the residents, organised under the umbrella of People's Movement Against Nuclear Energy (PMANE), filed a case in the High Court seeking the scrapping of the project. When that case was thrown out, they went to the Supreme Court to stop the loading of fuel into the plant. The court refused to stop the loading, but reserved its order pending the satisfaction of safety norms.

The residents then resorted to a sea siege. There were many incidents of disturbances of law and order, including a charge against peacefully protesting villagers. The atmosphere around Kudankulam continued to be rife with rumours.

With the plant expected to be commissioned by the following month, local media started reporting leakage of radiation claiming 40 lives. Those reports were then rescinded the next day and apologies issued. Sri Lankan anti-nuclear groups became involved at this stage claiming leaks and the Sri Lankan Atomic Energy Authority, which has radiation detectors installed near the Indian coast, had to issue a denial.

Moving toward transparency
In the last decade, India has signed the 123 Indo-US Nuclear Treaty with the USA, which mandates it to separate civil and military nuclear facilities and to open up its civil facilities to scrutiny by the IAEA.

As a last step of activating the pact, the government had to legislate The Civil Liability for Nuclear Damage Act, 2010. With these steps the Nuclear Establishment of India hoped it could work toward removing some of the cynicism about its safety record and accusation of secrecy. These measures, however, have not even been recognised by the anti-nuclear movements in the country that quote the example of Germany and wants India to stop all civil nuclear energy efforts.

Those for nuclear energy have also demanded greater transparency in the working of the Nuclear Establishment. Most of the officials from the regulatory body, AERB, are from the nuclear establishments themselves. That expertise on nuclear energy does not exist outside the realms of the Department of Atomic Energy has been a concern. Many of the dialogues between the establishment and anti-nuclear activists have therefore been trenchantly inimical - a rather technical “he said-she said” than ones trying to move towards consensus building. And the one catastrophe that Kudankulam has already left us with is that of public relations.

For instance, the first ever nuclear project to have undergone a public hearing was the Prototype Fast Breeder Reactor in 2001. When the public hearing was on in the presence of the Kancheepuram district Collector, the anti-nuclear groups organised residents to complain of the incidence of congenital deformities, believed to have been caused by radiation. These were listed by Doctors for Safer Environment. The then Collector, also a medical doctor, had requested that these be documented instead of blanket accusations being levelled. However, when this reporter spoke to those doctors and asked why the report was not published in a peer-reviewed journal, instead of being presented to journalists first, they were reluctant to answer questions.

On the other hand, the Nuclear Establishment maintains that radiation levels in Kalpakkam were much below those minimum requirements mandated by the AERB and that they are much below background radiation already present.

In recent times, the anti-nuclear protesters have also called into question the design/safety criteria that were taken into account during the design process.  Most reactors were designed taking into account storm surges, given that the east coast is prone to cyclones. But that the entire region is considered to be low-seismicity zone and not tsunami prone, unlike the Pacific Ocean, is pointed out as a poor design factor. Protesters have also put forth the view that a scientific body like the DAE and its constituents cannot afford to pick its safety concerns. It is true that these contentions of theirs have not been sufficiently addressed by the establishment.

Since the fuel loading in October 2012, NPCIL has run many tests and has submitted their results to AERB. The AERB has also called for many tests to be done in thoroughness. People who are observing the process see it as strategies to assuage the Supreme Court, where a PIL against the KKNPP filed by Prashant Bhushan in September 2012 is still pending. The Supreme Court had observed that the plant could be put on hold at this stage - when it is about to be commissioned - if it is not satisfied with the safety measures.

In all of this, the commissioning of the plant has simply been pushed beyond one deadline to another; The AERB has been periodically stating that the plant would be commissioned shortly; now, the latest assurance comes from Prime Minister Manmohan Singh who has promised Russian president Vladimir Putin that the plant will be operational this month.  However, given the long history of roadblocks, and the fact that the verdict of the Supreme Court in the case against the power plant is still pending, one can only wait to see when the assurance becomes reality.

Monday, December 15, 2008

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.

Monday, April 21, 2014

Editorial: Is Arvind Kejriwal Dangerous For Indian Politics?

By M H Ahssan | INNLIVE

Who is more dangerous for India – Arvind Kejriwal or Narendra Modi? This is a question that India needs to answer. But a recent article titled ‘Arvind Kejriwal: The Most Dangerous Man In Indian Politics’ has ventured to supply a one-sided answer to this question. The title is as catchy as it is misleading if not subversive. 

The ensuing ‘analysis’ is sadly not borne out by facts but relies on obfuscation and rhetoric. The tragic outcome is that many pertinent facts have been buried beneath the rubble of unsubstantiated allegations and sinister accusations. On the whole the article is an anti-Kejriwal diatribe disguised as an intellectual treatise.

While conferring on Modi the respectable halo of a “firebrand Hindu nationalist”, the writer goes on to indulge in pure speculation and sweeping generalizations about Kejriwal and other AAP leaders.

Sunday, April 21, 2013


By M H Ahssan / Chennai

Tamilnadu has a history of mixing politics and food. With Jayalalita’s Re 1-idli scheme becoming a hit with even the middle class, has she perfected the art of food bank politics?

At 8am, the sun shines bright over Sant home High Road which leads to the panoramic Marina beach in Chennai. A newly painted small stucco building on this road is making waves. A long queue is weaving out of the verandah of the two roomed building and if you walk past it and step into the kitchen, the smell of freshly cooked idlis and sambar, the staple Tamil breakfast, assails you.

Saturday, April 25, 2009

'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."

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