Sunday, October 30, 2011

Skewed health coverage

The Hoot

The health of the Indian media is supposedly robust but the state of healthcare coverage in the Indian media is almost comatose. It snaps out of that coma only when ‘health’ and ‘wealth’ meet.  Is it not the media's job to cover broader health issues than those related to the health of their readers, asks KALPANA SHARMA
Posted/Updated Wednesday, Oct 26 15:08:54, 2011

Kalpana Sharma
The health of the Indian media is supposedly robust compared to the media in many other countries, particularly the West. But the state of healthcare coverage in the Indian media is far from that; in fact it would appear its condition is critical, almost comatose. Occasionally, it snaps out of that coma – when ‘health’ and ‘wealth’ meet.
If that sounds a bit obtuse, let me explain. Anyone can do a spot check of five or six leading daily newspapers. Count the stories related to health. The stories receiving a large amount of space will be: a disease that has afflicted a celebrity, eg pancreatic cancer after Steve Jobs succumbed to it; lifestyle diseases and the extent of their occurrence in urban areas, eg diabetes and hypertension and obesity; an unusual condition afflicting a celebrity, eg some years ago excruciating details on something called‘diverticulitis’ because Amitabh Bachchan was struck down with it. Apart from this, the health coverage includes chapter and verse on a disease for which a particular day has been chosen, such as Breast Cancer day or TB Day, etc. Apart from these, there are literally “seasons” of health stories – usually linked to funding and fellowships. So you might get a spurt in articles on TB, or on HIV/AIDS, or on tobacco-related illnesses. And of course, one must not forget the “health” reporting of politicians arrested for corruption who regularly require hospitalization.
But what of the diseases that strike and kill thousands of our poor? The latest such example is Japanese encephalitis (JE) which has killed nearly 500 children in eastern UP. The media has only just woken up to this fact – well over a month after the first deaths occurred. CNN-IBN did a special programme on October 11. Predictably, NDTV followed suit a few days later. And as a result of this media spotlight, the Union Health Minister Ghulam Nabi Azad hotfooted it to the afflicted area, Gorakhpur in UP. And since then, the print media has taken note and several editorials decrying the pathetic state of health care have appeared in major newspapers.
Encephalitis in UP, or Bihar and Assam, is not a new disease. It has been around for decades. And it occurs every year. Children die, or survive with severe afflictions. There is always talk about doing something about it. But the plans are not implemented, or action is taken when it is too late to save children from dying. Much of what needs to be done is preventive – the fairly unglamorous process of dealing with sanitation, providing clean water supply, ensuring that the Culex mosquito does not get easy breeding grounds, providing protection by way of vaccines and treated mosquito nets to the vulnerable population etc. This is not high drama. It is difficult to picturise this process on film. But it can be done. And it can certainly be written about. To write would mean doing considerable legwork over a period of time. And the story might not make it to a prominent position. In any case, newspapers are now clear that they only write for their readers, who are middle class and urban. So encephalitis in deepest darkest UP is simply not sexy enough. 
Health coverage in the media in many ways is a litmus test of the relevance of media in turning the spotlight on the dark corners in our country. With the media increasingly rendering invisible much of India, the news of tragedies, such as the encephalitis occurrence in UP, only come into the limelight when many avoidable deaths have occurred. Why should that be so? Is it not the task of the media to cover issues that are not directly related to the health of their readers but are essential to the health of the nation?

Women and the Arab Spring

The Hindu, Sunday Magazine, October 30, 2011

The cusp of change: Exercising the choice democracy brings. Photo: AP
The cusp of change: Exercising the choice democracy brings. Photo: AP
As change sweeps through the Arab world and dictatorships are toppled, will women's rights be forgotten as it happened in Iran?
As the Arab Spring moves through the Arab Autumn towards winter, there is hope but also anxiety and apprehension about the future. The elections in Tunisia — with a record 90 per cent turnout — have triggered the hope that countries like Egypt and Yemen and now Libya, will also witness a peaceful transition to a democracy they have never known. But the grounds for apprehension are abundant.
As the world watches, a key question that is being raised is that of women's rights in the new political arrangements emerging in these countries. Arab women have spoken out, emphasising that a guarantee of their human rights is a prerequisite to a just society. But in the noise of the celebrations as dictators get toppled, these voices are sometimes being drowned out.
Arab voices
I was privileged to attend a fascinating discussion on the future of women in the Arab world at a recent conference in France. The Women's Forum for Society and the Economy 2011 drew together over a thousand women from around the world. But what turned out to be the most riveting session was the one where women from Egypt, Tunisia and Yemen and the renowned human rights activist and 2003 Nobel Peace Award winner Shirin Ebadi from Iran discussed how the future of Arab women would emerge following the Arab Spring. It threw up a relevant discourse on religion, secularism and law.
If women's rights are also human rights, then should societies fighting for the reassertion of human rights also first guarantee women their rights? Is it possible to allow religion to dictate law if the interpretation of that religion is left to men? Are rights that women have won, even in a dictatorship, still valid even after the overthrow of the dictator? Is it possible to have a ‘ secular' constitution and still respect religion and religious laws?
These were some of the questions that wove their way through the remarks made by the participants. Moushira Mahmoud Khattab, an impressive woman from Egypt who has been a diplomat and a Minister for Family and Population and is now a human rights activist, pointed out that even under Hosni Mubarak, women had won many rights. In fact, she was one of those central to bringing in laws to criminalise female genital mutilation (FGM) that is widespread in Egypt and other north African countries, raise the minimum age of marriage to 18, give women the right to initiate divorce, give women the right to custody of their children after divorce and allow children born outside wedlock to be registered. But now, after the January 25 uprising that led to the overthrow of Mubarak, she says there are voices that have been raised against these rights calling them “Suzanne's laws”. Suzanne was Mubarak's wife and all these changes were initiated in her name. But, asked Ms. Khattab, why should rights that women had won after a struggle be negated just because they had been initiated during a hated dictatorship? The role of women in the January 25 revolution was crucial, she said. Women challenged tradition when they went out and protested and even spent nights out in Tahrir square. Yet, today in Egypt, women's rights are being questioned.
Nadwa Al Dawsari is a young activist from Yemen. She has spent many days in Freedom Square in the Yemeni capital of Sana'a with this year's Nobel Peace Prize winner Tawakkul Karman, who lives in a tent in the square. Ms. Dawsari said there was an assumption that in tribal societies, like the one in Yemen, women had no rights. Yet, over 30 per cent of the protestors in Freedom Square were women. The young people of Yemen wanted a civil state, not an Islamic state, she said. She insisted that what was important now was to get the dictator to leave Yemen and for free elections to be held. Other issues could be tackled later, even if the election brought the Islamists to power.
Tunisian women, however, are not as confident as Ms. Dawsari about the Islamists coming to power. In fact, many have gone on record to say they fear for the future if the Islamist party, al Nahda, wins the elections. But what primarily concerned Amira Yahyaoui, a young blogger and militant human rights activist from Tunisia, was that women's rights in Tunisia ought not be compared to other Arab countries but to those where women are better off. “We want women and men to have real equality. Women need to be considered not as women but as human beings. What we have at present is not enough,” she said. Currently, although Tunisian women have more rights than their counterparts in some other Arab countries, they do not have equal rights of inheritance. They also cannot marry non-Muslims.
Ms. Yahyaoui was also not confident that women would have enough of a say in the process of constitution-making in Tunisia. Under the list system of proportional representation, women did not stand a chance of winning in substantial numbers as political parties tended to push male candidates to the top of their lists.
After listening to the young women from Tunisia and Yemen, Shirin Ebadi spoke. “Look at Iran”, she told them, “Do not repeat our mistakes.” When she saw images of the protestors in Syria, Yemen, Tunisia, she saw them demanding democracy. “Did anyone say we are against polygamy? That we want divorce rights? That we are human beings and need equal rights? You are making the same mistake Iranian women made. We thought we could demand women's rights after the revolution”, she said.
Ms. Ebadi said that the Iranian women who participated in the 1979 revolution that overthrew the Shah of Iran, knew what they did not want. They wanted an end to dictatorship. What they did not demand and insist upon were the rights that they did want. They did not go on the streets and demand an end to polygamy, or the right to divorce. It was taken for granted that these rights could be negotiated later.
Biased interpretation
“I am a practising Muslim woman”, said Ms. Ebadi, “but when a government is based on Sharia law, it can be interpreted in different ways.” She said that she did not believe that Sharia law was against human rights and democracy. But when it is left to men within a patriarchal system to interpret that law, inevitably the suppression of women's rights is justified. The best way to prevent that, she advised her Arab sisters, was to push for women's rights during the struggle. “Don't wait for the victory. Choose your allies. Dictate these conditions before the alliance”, she said.
She reminded the Tunisian about a recent incident where a TV channel was attacked for telecasting the film “Persepolis”, an animated feature film about women's rights in Iran. The director of the channel had to give a public apology. “These are not good signs”, she said. Ms. Ebadi said that although Iranian women had succeeded, even under a fundamentalist regime, in wresting many rights, these were not enough. “We are expecting a bigger victory. Aim for complete equality between the rights of women and men”, she said.
As the Arab world goes through a political churning, the voices of these women need to be heard, and heeded.

Monday, October 17, 2011

Citizens, not 'naukranis'

The Hindu, Sunday Magazine, October 16, 2011

They deserve better... Photo: K.K. Mustafah

Domestic workers are not servants, they have a right to fair wages and working conditions…
This Deepavali, will the woman who cleans your house and cooks for you be able to celebrate the festival with her family, or will she be cooking and washing dishes as you celebrate with your family and friends? Rarely does this question cross the minds of the majority of people who employ domestic help. Yet, the 3,000 domestic workers who gathered for a public hearing in Jaipur last month reminded us about precisely this reality: “We run two homes, yours and ours”, they said. “Can any of you in society do without our labour?” How easily we forget that these women also have their own homes to run even as they manage ours.
The women who gathered in Jaipur also demanded that they be recognised as workers. “We are not ‘naukranis', we are workers in a free India,” they asserted. Yet, the majority of the people who employ them rarely think of them as ‘workers'. As a result, there is no accepted standard of what they should be paid, how that payment should be calculated — per day, per hour, per month or according to the number of tasks performed. The rate at which they are paid depends on the demand and supply of domestic workers. In big cities like Mumbai, for instance, where demand often outstrips supply, these women — and the majority are women and girls — can negotiate a higher wage. In places where there is a surplus, they are forced to settle for next to nothing. For, if they demand more, there are always others willing to work for less.
The rights of domestic workers can no longer be ignored. For many poor women who have to manage their own households, part-time work in several households is the ideal way to earn money. The skills they use in their homes are precisely the skills required in their jobs. Yet, because this is paid labour, it ought to come with a clear set of rights that the employer recognises and respects. Nothing of this kind happens.
“She is like a member of the family”, some say about their domestic help. Yet the woman will not be allowed to use the toilet the family uses, sometimes not even to drink or eat out of the same utensils that everyone uses. And there is no question of time off, either during the day or one day in a week. So how can she be a “member of the family”?
Across the world, the issue of domestic workers, their rights, their wages has been a raging controversy. It has been particularly acute in the case of migrant workers engaged as domestic help in some countries. The most notorious cases of abuse, including sexual abuse, have emerged from Saudi Arabia. In June this year, an Indonesian maid was beheaded in Saudi Arabia after she was convicted for having killed her employer. The reason she was driven to do this was a history of abuse and torture. What she experienced is not the exception; testimonies from scores of domestic workers from the Philippines, Indonesia and Sri Lanka who work in Saudi Arabia indicate just how widespread is such treatment. Graphically documented in a report by the New York-based Human Rights Watch titled, “As if I am not human: Abuses against Asian Domestic Workers in Saudi Arabia”, this is grim reading as dozens of women speak of being repeatedly raped, tortured, abused and forcibly confined so that they cannot escape and report the abuse. These stories have seen the light of day because a few did manage to escape. Tragically, even those that did escape did not find a happy ending. Their tormentors, their former employers, often got away under Saudi law while the women were left with no money to show for the years they had worked and had to face deportation.
Initial steps
These stories and the campaigns by those concerned about migrant domestic workers, particularly in the Gulf countries, finally prompted the International Labour Organisation (ILO) to pass a Convention Covering Decent Work for Domestic Workers in May this year. All countries, barring Swaziland, endorsed the Convention. It will become operational only once the parliaments of the individual countries ratify it.
The Convention sets out steps to protect the human rights of domestic workers, allow them freedom of association, eliminate forced or compulsory employment, abolish child labour, protect them against all forms of abuse and violence and provide decent working conditions. It also touches on the way remuneration is calculated — by the tasks done or the number of hours worked, their right to annual paid leave, weekly offs, daily rest periods and terms and conditions regarding termination of employment. In other words, a structure similar to that of workers employed in the formal sector where these things are stated and not assumed. A director of the ILO, Manuela Tomei stated that the new standards established by this Convention, “make clear that domestic workers are neither servants, nor ‘members of the family' but workers. And after today they can no longer be considered second-class workers.”
The problem in India is that domestics are not even considered ‘ workers', leave alone ‘second-class workers'. This is the crux of the problem. Until we acknowledge that however informal the arrangement, this is also work, we will continue to exploit the crucial service provided by the 50 lakhs and more domestic workers in India. In some states, notably Tamil Nadu, the first steps towards fixing a minimum hourly wage is being discussed. In countries around the world, where domestic workers are engaged, the payment is worked out on an hourly basis. As a result, whether a worker finds employment directly, or through an agency, she is guaranteed a set wage.
Uphill task
Although there are many efforts being made to organise domestic workers, particularly in some of the bigger cities, it is an uphill task because of the nature of the work, and the constant flow of people willing to work. Yet, just as the ILO has intervened on the international level, surely the government in India has to take some steps. If there is any genuine concern in government circles, it is not entirely evident. A law drafted in 2008 on domestic workers has not seen the light of day. Worse still, domestic workers have been excluded from the Protection of Women Against Sexual Harassment at Workplace Bill, 2010, an area where there is urgent need for intervention. And even though the government has extended the Rashtriya Swasthya Bima Yojana to provide health insurance to ‘ registered' domestic workers between the ages of 18-59, there is no clarity on how this will be implemented if the majority of these workers remain unregistered.
The lights that will shine in many homes this Deepavali must now shine on these dark corners of our homes, where unfair practices and exploitative wages are allowed to continue.

Sunday, October 02, 2011

Beating violence, not men

The Hindu, Sunday Magazine, October 2, 2011

Violence against women, both inside homes and in the public space, needs to be treated with the seriousness it deserves…
Violence against women is no laughing matter. Yet, in Andhra Pradesh, the state Minor Irrigation Minister, Mr. T. G. Venkatesh seems to think it is something that can be treated as a joke. According to a front page news item in the Deccan Herald (September 25, 2011) headlined: “Cashing thrashing: Pati, Patni and ten thousand”, Mr. Venkatesh is reported to be offering a new scheme that he thinks will deal with abusive husbands.
“Beat your drunken husband if he touches you. The government will pay you a Rs. 1,000 reward. The more you beat him, the better as you can get up to Rs. 10,000”, he is reported to have told a women's meeting in Kurnool. The Minister apparently advised women to beat up their drunken and/or abusive husbands on the street so that everyone can see what they are doing. “Once you do this and you get rewarded, your husband will stop harassing you”, he reportedly stated. And went on to say that the scheme could be called “Pati, Patni and Rs. 10,000 scheme”. How simple life would be if we could remove alcoholism and domestic violence by beating up drunken men and stop murders by enforcing capital punishment!
Complex phenomenon
Dealing with violence against women is not such a simple matter. For one, most of the violence takes place within the home. Second, given the way women are socialised, the majority accepts domestic violence as an essential part of the deal of being married.
Yet, even though so few report it, the highest number of crimes categorised by the National Crime Records Bureau (NCRB) as ‘ crimes against women' is under the head, ‘cruelty by husbands and relatives'. In 2009, out of 2,03,804 recorded ‘crimes against women', 89,546 were those of ‘cruelty by husbands and relatives'. And incidentally, Andhra Pradesh topped the list of states accounting for 12.5 per cent of the total crimes against women in the country (NCRB 2009) followed by West Bengal.
So perhaps Mr. Venkatesh thought, given his state's leading position in this category, he needed to devise a scheme to deal with violence against women. But his solution, if indeed the idea is a serious one and not a joke, mocks at the seriousness of the issue. The women at the receiving end of domestic violence are rarely if ever in a position to fight back. There is a strong body of evidence and documentation over the years in India that shows that even educated women bear the daily humiliation and physical violence rather than go public with it, or report it to the police. Many of them blame themselves. Others fear that they will be left destitute, a fate they believe is worse than suffering the violence.
Vital support
Of course women should resist and fight back. And the Domestic Violence Act enacted in 2005 is an important step to help them to do that. But before they can pick up the courage to do so, they need support, including places like shelter homes if they have no option but to physically get away from their abuser and report the violence. Unless such backing is available, there is little likelihood of an abused woman risking more violence by fighting back.
The section in the NCRB on crimes against women does not include rape, which is categorised separately under ‘violent crimes'. We know this is one crime that is grossly under-reported. Yet the growth in the incidence of rape in the NCRB data is stark. It seems to double every decade between 1971 and 1991. Between 2001 and 2009 the incidence grew from 16,075 reported cases to 21,397. And although 94.2 per cent of these reported cases were charge-sheeted, there were only 26.9 per cent convictions. This is obviously a major reason why women do not persist with rape cases, even after having overcome the hesitation to report them, and often withdraw the case when they realize how long it will take and how difficult it is to get a conviction.
In this connection, a small study by the Centre for Social Research (CSR) on rape cases in Delhi brings out another important aspect of crimes against women. The CSR study looked at 58 FIRs on rape filed between 2009 and 2011. The study deflated several popular hypotheses about rape. For instance, when there is a hue and cry about the rising incidence of rape, police officials are quick to advise women not to venture out after dark. It is assumed that women only get raped at night. Yet the CSR study data shows that seven rapes had occurred between 6 am and 12 noon, 17 between 12 and 6 pm and 14 between 6 pm and 12 midnight. In other words, more rapes took place in the daytime than either early in the morning or late in the evening.
Damning facts
Linked to this theory about a dangerous public space is the belief that women are ‘secure' in their homes. Yet, nine of the 58 incidents studied took place in the victim's home. And the majority of the rapes were by men known to the women. In fact, out of the 58 cases studied, 51 of the accused were relatives, neighbours, friends, teachers or acquaintances. Worse still, the majority of the victims were under 20 years old and of them 22 per cent were less than 10 years old. Thus, women are as unsafe in their homes as outside; they are as likely to be raped by men they know as by strangers and the age of a woman, even if she is a small child, is no bar to being raped.
Violence against women is a bad joke, not something we can laugh about.
(To read the original, click on the link above)