Why did Vypari Bai die?

The Hindu, Sunday Magazine, January 23, 2011

THE OTHER HALF 

Women in rural India continue to die because of indifference and neglect by healthcare authorities...

Widespread anger: Adivasis protest Vypari Bai's

This is a public health warning. Do not express concern for the state of healthcare in this country. Do not express anger that women die because they are either denied care or help is delayed when they have complicated pregnancies. Do not demand that healthcare is an entitlement that the poor have a right to demand and that the government must deliver.

Chances are if you are too vocal about an issue like this, and if you happen to be working in an adivasis-dominated district anywhere in India, the district administration will hint that you have Maoist tendencies. And that alone is enough to land you in jail and even, as in the case of Dr. Binayak Sen who has spent a lifetime working as a doctor for the poorest, get you a life sentence for sedition under an antiquated law.

This is no exaggeration. On December 28, 2010, more than 500 adivasis demonstrated peacefully in front of the district hospital in Barwani, Madhya Pradesh. They were not demanding wages or forest rights. They were protesting the death of a 22-year-old pregnant adivasi woman, Vypari Bai, caused by callousness and negligence of the medical authorities.

Vypari Bai's story is not unusual. It is enacted hundreds of times in the poorer parts of this country. On November 27, Vypari Bai, who was eight months pregnant, developed high blood pressure and eclampsia, a life-threatening condition of pregnancy. She needed urgent medical help. From her village of Ban, her relatives carried her in a cloth sling for 10 km to the nearest Primary Health Centre at Bokarta. There she was told that the place was not equipped to deal with her condition. So she was sent to the Community Health Centre at Pati by ambulance. There again there was no help and the family was told to take her to the district hospital in Barwani.

Made to run around

The story did not end there. In Barwani, at the time of admission her blood pressure was high. The normal procedure in such situations is to try and normalise the blood pressure and induce labour. Although she was given some medication for the BP, nothing was done to induce labour. Instead, her relatives were asked to take her to a private hospital for an ultrasound in an auto rickshaw even though the facility existed in the hospital. The ultrasound confirmed that the foetus was still alive.

Yet, despite her relatives pleading for help, no doctor was ready to attend to Vypari Bai. Instead, they were advised to take her to Indore, 150 km away. For refusing to do so, they were asked to sign a statement that they took full responsibility for the consequences. By this stage, it would have required a miracle for this young woman to survive. She did not. On November 29, in the early hours of the morning, she died.

Her death has enraged the adivasis in Barwani district who have seen too much of this kind of callous neglect. A survey of maternal deaths in the district hospital from April to November 2010 revealed that there were 25 maternal deaths during this period, nine just in November.

A year earlier, in 2008, in a similar incident, a pregnant woman was turned away from the Primary Health Centre in Menimata in Barwani district when she had already begun labour because she would not pay. She was entitled to free treatment. As a result, she delivered her child literally on the road, outside the hospital. Those who expressed their disgust at this were charged by the district administration under various sections of the Indian Penal Code.

On December 28, the district administration once again slapped charges against some of those who demonstrated peacefully in front of the hospital and arrested Bachhiya Bhai on charges framed against him in 2008. He was finally released on bail after eight days. But the charges against him, under Section 146 IPC (unlawful assembly, rioting, armed with deadly weapon which when used is likely to cause death) and Section 186 IPC (obstructing public servant from discharge of public function) remain. Over 200 of those who participated in the December 28 demonstration have also been charged.

We know about Barwani because there is a group there, the Jagrit Adivasi Dalit Sangathan that is organising and working in the area. But there must be hundreds of similar stories from around the country.

The response of the district administration is shocking enough. What is worse is that this is happening five years after the National Rural Health Mission (NRHM) was launched to check precisely these kinds of incidents, where poor women are made to go from pillar to post for help when they develop complications during pregnancy. Institutional deliveries were seen as a way to bring down the unacceptably high maternal mortality rate. Yet, according to the National Family Health Survey – 3, only 13 per cent of births to the poorest women and 18 per cent of births to women with no education or who belong to the scheduled tribes are delivered in institutions. So no one will argue that increasing access to medical help when women need it most is an urgent need.

Only on paper

This need was supposed to have been addressed by the NRHM. Its guidelines state that every Community Health Centre — that comes between the Primary Health Centre and the District Hospital — is supposed to provide “24-hour delivery services including normal and assisted deliveries” and “Essential and Emergency Obstetric Care including surgical interventions like Caesarean Sections and other medical interventions”. Furthermore, specific districts have been selected in every state where the district hospital is designated as a Comprehensive Emergency Obstetric and Neonatal Care Centre (CEMONC). The Barwani district hospital is designated as such. Yet, despite a staff that includes four gynaecologists and two anaesthetists, no one was available to help Vypari Bai.

The real story of India's progress lies in the detail of how programmes like NRHM are implemented, or not implemented. It is a story that is not told often enough to make us angry. Occasionally, we pay attention to the needs of our children. But women like Vypari Bai, who die because no one cares, remain invisible, the ghosts of another India.

(To read the original, click on the link above)

IPL's bimbettes and him-bettes

SECOND TAKE Kalpana Sharma If you wanted an illustration of how private capital and media come together to sing the same tune, you only had to watch the IPL auction in Bangalore telecast live over two days, January 8 and 9. For two days, non-stop, the auction was covered by the main news channels. Nothing else mattered. Only the money. Once again, news television went overboard. We are a cricket-mad country. No one can deny that although many still question whether the IPL is really cricket. Still, the nature and the amount of coverage raise several questions. First, was this kind of election-style coverage necessary? How many people were really interested or even cared about the money being thrown about? Second, how did the channels decide to set aside regular news and spend a good part of the day giving a ball-by-ball account of the sale of cricketers? Did they conduct some kind of survey to assess viewer interest or did they just make a calculated guess? Third, did the certainty of a good part of the millions being talked about coming their way during the IPL fuel the decision? Were they ‘prompted’ to do this with actual financial support, another form of cheque-book journalism? Why do we ask these questions? Because the IPL is about big money as was evident from the size of the purses displayed during the auction. This is not small change; it is serious money. The team owners and the BCCI will only recover these sums if the IPL draws viewers and advertising support. How will this happen if the hype and excitement before the matches begin is not sufficiently pumped up? And who better to do it than television channels? The link is so obvious that one can be forgiven for jumping to the conclusion that there was more than just a ‘news-sense’ decision behind the full two-day coverage of the auction. Apart from the suspicion that the decision to given blanket coverage was prompted by promises of some of the lucre, it was extraordinary to see how the entire exercise seemed to erase recent memory of the seedy scandals surrounding the IPL and its chief promoter, Lalit Modi. The full story of that scandal has yet to be told. But on those two days, it was business as usual without the presence of Modi. As Anupam Mukherji wrote in his column Fake IPL Player in Mumbai Mirror (January 11, 2011), the auction “still had all the bearings of the Modi-era. The two new teams fit in well with the IPL culture by choosing hideously coloured outfits, Shilpa Shetty, who till the other day couldn’t tell the difference between swing and spin, was seen deciding team compositions.”  Cricket remains a man’s game even though Indian women’s cricket team, and that of other countries, plays the same game. You would never know that if you read our sports pages. But apart from that, some kind of ‘gender-balance’ is now the norm thanks to the induction of Mandira Bedi during the World Cup some years ago and the guaranteed media attention that she drew. Today Bedi has morphed into a commentator who seems to know her cricket; hence her presence during the IPL auction on Times Now. CNN-IBN had Latika Khaneja, who got noticed when everyone realized that she ‘managed’ Virendra Sehwag. Khaneja is serious about her business and knows it too. Yet, predictably, both women were asked to comment on the attire of two of the owners – Shilpa Shetty of the Rajasthan Royals and Preity Zinta of the Kings XI Punjab, the bimbettes if you will. Yet none of the men were asked to comment on the excessive gel on Siddharth Mallya’s hair or the bright orange Tshirts worn by the Kochi team, or what Ness Wadia wore – the ‘him’-bettes. A little bit of misogyny is probably par to the course in a game that has been designed to sell for its ‘sex appeal’ – via the cheer leaders, not the quality of the game. And significantly, neither the men nor the women on the panels were asked to comment on the other woman owner – Nita Ambani of the Mumbai Indians. Clearly, advertising clout zips up loose talk. Given the amount of useless chatter that filled those hours during the auction, it was amazing that everyone held off on commenting on Nita Ambani, on what she wore or how she functioned. Mukherji had no such qualms when he wrote, “Nita Ambani, after successfully buying Rohit Sharma, was congratulated via handshakes by a table full of lackeys as if she had coached the batsmen.” In fact, given the latest development from the house of Tatas, where an unwritten directive has gone to all Tata companies to avoid certain publications that featured the Niira Radia tapes and Ratan Tata, media houses must know how far they can go with the powerful.  Most striking of all was that there was not even a hint of anything critical being mentioned about the very fact of cricketers being auctioned. To get some perspective on this entire tamasha, read Sharda Ugra, well-known sports journalist who is now a Senior Editor with crickinfo.com. In her column titled, “The joke was on cricket”, Ugra fills us in on the background of auctions and how humans have never been auctioned, except of course when slavery still existed.  “Before the IPL turned up, the word ‘auction’ was understood to be ‘public sale’ of ‘goods’ or ‘property’ or ‘articles’ or ‘merchandise’. No dictionary contains the mention of people in an auction because in the history of mankind, the only human beings ever involved in public auctions were slaves.” Ugra also goes on to explain that no other sport in the world has anything resembling the IPL auction: “There is no respectable sport in the world whose athletes go up for auction. Not even in the richest professional leagues in the world. Not in European or North American football, not the NBA, not the NHL. The words, ‘franchise’, ‘commissioner’, ‘salary cap’ belong to American sport which is what inspired Lalit Modi to rework the idea into Indian cricket. So why abandon its steel frame: the league regulations, the minimum wage. Modi somehow thought nothing of borrowing and adapting into cricket the most common form of player hire in American leagues: the rookie drafts. (The BCCI thought the auction was a good idea.)” So what is about our media that it has stopped questioning and simply follows the money? ‘Paid news’ is clearly morphing into so many different forms that we will need a special commission to track it full-time.

(To read the original, click on the link above)

Saving India's children

The Hindu, Sunday Magazine, January 9, 2011

THE OTHER HALF

KALPANA SHARMA

Just under half of our children will grow up stunted because of malnutrition and hunger. How can we change this?

Photo: V. Sudershan 

Time to act:Aamir Khan, part of Citizens' Alliance, comprised of MPs across parties and NGOs, that aims to create social awareness of malnutrition among kids.

A year of scams and scandals is over. Can we expect 2011 to be different? If one had a wish list for 2011, topping mine would be a wish that the government make tackling child malnutrition in India one of its topmost priorities.

Everyone knows the glaring contrasts in India — between some of the richest men in the world and some of the poorest who also inhabit this country, between a high economic growth rate and increasing disparity and inequality, between unchecked consumption in our cities and the absence of basic survival needs of people in the villages and our forested areas.

What stands out as the worst statement about the state of India today is the fact that 46 per cent of our children are stunted because they simply do not get enough to eat. How can we accept this and at the same time boast about having moved up from the company of the poorest countries in the world into a middle-income country?

I began 2011 by looking again at the data on child malnutrition in India and it was like a cold shower. Sobering. Shocking.

India has more malnourished children than neighbouring Bangladesh which, until a decade back, was considered something of a basket case. Even African countries like the Congo, Lesotho, Tanzania and Rwanda are better placed than us.

Fundamental issue

Why be so concerned about this one issue? Because the very fact that almost one out of every two children in this country goes to bed on an empty stomach is shocking in itself. Malnutrition is the principal cause of child deaths. Half of all child deaths in India could be prevented if this one issue was tackled. Children die because malnutrition lowers a child's resistance to infection. As a result, they become vulnerable even when they have eminently treatable conditions like diarrhoea and respiratory infections.

What is worrying is not just the high percentage of children who are malnourished, but the fact that the rate is going down so slowly as to be virtually negligible. Between 1998-99 and 2005-06, the rate only came down by one per cent. At this rate, the challenge of cutting down on the prevalence of malnutrition in children by half by 2015, a part of the Millennium Development Goals, will be impossible.

So why is this happening in a country where there is an enviable economic growth rate? Development economist A.K. Shiva Kumar points out in a recent article that the belief that malnutrition automatically comes down if the per capita income improves is not necessarily true. He points out, for instance, that 28 out of 37 sub-Saharan African countries have a lower per capita income than India's and yet also have lower rates of malnutrition. Within India, Manipur has a per capita income of only Rs. 8,114 (1997-98), yet its child malnutrition rate is 28 per cent. By way of contrast, Gujarat has a per capita income of Rs. 16,251 and its child malnutrition rate is 45 per cent.

Dr. Shiva Kumar's contrasting data on two Indian states, Sikkim and Madhya Pradesh also brings out another important angle to malnutrition, that of gender.

Sikkim has 13 per cent children born with low birth weight; MP has 24 per cent. Sikkim has 11 per cent ever-married women with a BMI (Body Mass Index) of less that 18.5 (considered very low); MP has 38 per cent. The 0-6 years male female ratio in Sikkim is 986; in MP it is 929. The age of marriage for women in Sikkim is 22; in MP it is 19. Female literacy in Sikkim is 62 per cent; it is 50 per cent in MP. In Sikkim, 89 per cent of girls in the age group 6-17 years are in school; in MP it is 71 per cent.

Vital link

In other words, women in Sikkim marry later, are more educated and are in better health. As a result, there are fewer children born with a low birth weight. The link between women's status — both in terms of access to education and health — and under-nutrition in children is obvious. Women who are themselves malnourished, anaemic (56 per cent of women in India suffer from some form of anaemia), and become pregnant when young, give birth to low birth weight babies who never catch up.

Interestingly, the National Family Health Survey – 3 (2005-06) that gave the latest data of anaemia in women also shows that while 56 per cent women were found anaemic, only 24 per cent men had the same problem. Clearly, there is a gender dimension even to anaemia. Also, 47 per cent of girls in the age group 15-19 years are anaemic. Furthermore, 59 per cent of all pregnant women in India are anaemic.

These might seem like a set of numbers. But translate that the next time you read about children dying in a village, or even in a slum in your city. Last month, people in Mumbai woke up to the rude reality that living in a fast-moving metropolitan city in India does not mean that poor children have better chances of survival. The story of 15-month-old Sahil Salim from the Shivaji Nagar slum in Govandi, who weighed just 9 kg and died from “fever and cold”, was a stark illustration of how hunger haunts the poor in city and village. Indeed, although the rate of malnutrition in children in urban areas is better than in rural areas, it is still unacceptable — 32 per cent or one in three children.

This is not the India we like to think about. Yet the numbers tell us that this is the India in which half of our women are anaemic, where just under half of our children have diminished chances of survival.

What do we do to change this? The government has to make this a priority and look again at programmes like the Integrated Child Development Scheme (ICDS) that was designed to deal with this issue.

But we need more than that. The media has run campaigns to save the tiger. That is a valiant campaign. I would suggest that India's children are also endangered. That they too need an active campaign by media, schools, colleges, politicians, corporates, anyone who cares, to see that we break this circle of poverty and hunger.

(To read the original, click on the link above)