Indianama

The ill-health of Bharat mata requires another, more urgent surgical strike

Can India feel secure about its future without taking care of the Indian women's health?

After absorbing the views of those far more learned, let me sum up my interpretation of the process of reducing 86% of India’s currency to scrap paper (technically, this isn’t demonetisation, it’s “old for new”, as Praveen Chakravarty, explains here): To spite our nose, we’re cutting off our head.

Of course, this extreme method – more scorched-earth than surgical strike – should not be a cause for concern, because we can also always affix a new head, a technique India has been famous for since prehistory, as the prime minister himself once said, with regard to the elephant head on Ganesha.

But this column does not concern itself with India’s head or crown or other contentious upper extremities or issues that invite extreme reactions. I would like to focus your attention on a topic that is of far greater importance than the currency imbroglio but mostly attracts disinterest. I refer to the Indian body – our collective health.

To illustrate how it is a crisis that needs our utmost attention, I will sharp focus on the health of the Indian mother – Bharat Mata, to use a nationalist label and metaphor. Because the Indian woman is a keystone species, her health is a precursor to the health of the new generation, the same generation that will grow up and determine the health of everything the government currently propagates: Make in India, Skill India and every other great idea to transform India.

This is not to say that there has been no progress on health. Much has improved, as we shall see, but India lags so far behind its peers in the emerging nations – and, in some cases, poorer countries – and has invested so little on health, sanitation and women that no more than a radical new approach will suffice.

My colleagues at IndiaSpend regularly track various health-related data sets, and their regular stories – which I have drawn from for this column – make clear the depth of the crisis. To begin with, unless we can secure the two stages of the Indian woman’s life, it is a fallacy to believe that India can feel secure about its future.

Childbirth. Bilaspur, 1675-1700, Mughal painting.
Childbirth. Bilaspur, 1675-1700, Mughal painting.

Stage 1: Birth and childhood

Being born is the first hurdle that the Indian woman faces. India’s child sex ratio – the number of girls per 1,000 boys aged 0-6 years – has never been worse in 60 years. It tells us that girls continue to be aborted, killed or die because they are deprived of medical services and nutrition.

Once she gives birth, the Indian woman not only has an unacceptably high chance of dying – maternal mortality has almost halved over 12 years to 2013, but it is still six times higher than Sri Lanka and worse than Cambodia – but may produce a malnourished child, as a result of her own poor health and lack of access to poor sanitation, water and food. There are other indicators of malnourishment, but let’s consider stunting, children who are short for their age.

In June this year, the president of the World Bank, Jim Yong Kim, came to Delhi and drew India’s attention to its stunting problem, an indication that children were not getting healthcare, adequate and proper nourishment. “This is the bottom line,” said Kim, “If you walk into the future economy with 40% of your workforce having been stunted as children, you are simply not going to be able to compete.”

In general, children who are stunted are more likely to have reduced cognitive skills; spend less time in school; have lower test scores; be sicklier, less literate and poorer. For women in particular, the effects of childhood stunting is correlated with being younger mothers, having more children and, to complete the depressing circle, a greater chance of those children being malnourished.

In 1997, 46% of India’s children were stunted. That figure fell to 39% by 2013, which is not enough of an improvement (the global average is 24%). In 1997, 60% of Bangladesh’s children were stunted, but today 36% are, which means our poorer, eastern neighbour has done better than us. India has the highest stunting rate among Brazil, Russia, India, China and South Africa. Of our neighbours, Pakistan (45%) and Nepal (41%) do worse. In parts of Maharashtra, India’s richest state, more than 47% of all children are stunted.

“Childhood stunting is one of the most significant impediments to human development,” noted a World Health Organisation policy brief. “Stunting has long-term effects on individuals and societies, including: diminished cognitive and physical development, reduced productive capacity and poor health, and an increased risk of degenerative diseases such as diabetes.”

Not surprisingly, India’s healthiest children happen to be in states that provide the best maternal healthcare.

In 1974, 37% of Brazil’s children were stunted, almost the same rate as India’s nearly 40 years later. Brazil’s stunting rate today is about 7%. What Brazil did is what India urgently needs to do – focus on making women more literate, make maternal and child health services widely available, grow wealth through cash transfers, get small farms to grow more nutritious food and expand water and sanitation services.

Of these interventions, Narendra Modi has attracted welcome attention to sanitation, but experts and workers on the ground will tell you that while the programme is good on promises, slogans and construction, it is short on mindset change and details.

Amrita Sher-Gil/ Bride's Toilet, 1937
Amrita Sher-Gil/ Bride's Toilet, 1937

Stage 2: Adolescence and motherhood

If India continues to discriminate against the birth of its girls, over the next 14 years, 23 million of them will not be born.

Of those who are being born currently, it is true that greater numbers will be educated and marry later than ever before. But these women will, still, find it hard to escape early marriage and motherhood. Over 20 years to 2011, the female literacy rate rose by 26%, but women could extend their average age of marriage by only 1.9 years to 21.2. This improvement also hides the fact that 61% of women are married before 16. Women who marry early, as we already know, are likely to produce sicklier children.

It does not help that a failing healthcare system does not allow women to space their children. “More than 10 million women terminate their pregnancies in the privacy of their homes, reflecting the government’s failure to adequately address family planning needs, endangering mothers and keeping India more populated than it might be if women had access to, and knowledge of, contraceptives,” my colleague Charu Bahri wrote earlier this month.

As more children are born in poor families without access to proper healthcare, these children are more likely to be neglected and even more sickly. This is particularly worrisome because the public health systems in the poorest states, where the vast bulk of Indians live, are worse than inadequate. In Bihar, for instance, up to a fourth of children who suffer “severe acute” malnourishment – meaning, they are at risk of death – are likely to face a relapse because the state’s specialised nutrition rehabilitation centres can only treat 0.3% of such children. It is little girls, as this Thomson-Reuters foundation story details, who bear the brunt of “India’s vicious cycle of malnutrition”.

The lack of access to health systems for Indian women is now starkly evident even at death, with a new census report revealing that a larger proportion of men (63%) were likely to be with a medical professional at death than women (38%).

Amrita Sher-Gil/ Resting
Amrita Sher-Gil/ Resting

Women suffer most, but healthcare is in crisis

Although the number of medical colleges and seats almost doubled over the past decade, India is short of about half a million doctors and even in the most prosperous states, particularly in the south, home to the majority of India’s private medical colleges, a doctor may serve more than 1,000 people (in poorer northern states, that number may go up to 25,000).

The shortage of doctors is particularly evident in India’s rural areas, where the frontline of the public healthcare system – the primary health centres – is short of more than 3,000 doctors, the scarcity rising three times over 10 years. In Uttar Pradesh, India’s most populous state with 200 million people, these centres decreased 8% over 15 years to 2015, a period when the state’s population increased by more than 25%.

With government-run healthcare scarce or unreliable, 89.2% of the health expenditure in India is out-of-pocket, which means it is met by individuals, according to World Bank data. Out-of-pocket expenses are an indicator of the health of the public healthcare system. In India, an additional 39 million people fall back into poverty every year because of health-related spending, as this Lancet paper reported. Yet, the proportion of out-of-pocket expenses greatly exceeds that of comparable and poorer countries, such as Brazil (47.2%), Botswana (12.7%) and Liberia (44.8%).

Although it is four time costlier, on average, than public healthcare, and 15 times more than the average monthly expenditure of the poorest 20% of Indians, more than half of Indians living in rural areas use private healthcare. To access reliable healthcare, Indians make great journeys, often staying in thousands – including on footpaths, for months – outside premier medical centres, such as the Tata Memorial Hospital for cancer care in Mumbai and the All India Institute of Medical Sciences in Delhi. Nearly 48% of overnight trips made by Indians from rural areas, and 25% from urban areas, are not for tourism but for medical reasons, according to National Sample Survey Office data.

The data that my colleagues gather are endlessly revealing in general but what they show is that women always bear the brunt and play a central part in numerous vicious circles:

  • The proportion of anaemic, pregnant women dropped 12% over a decade in 2015, but India still has more anaemic women than any other country. An anaemic, pregnant woman is more likely to die or deliver a baby lighter than normal. That means the baby is at greater risk of death.
  • Nearly eight in 10 Indian babies are now delivered in hospitals but 343 healthcare institutions surveyed by WaterAid India across six states often lacked basic hygiene, toilets, clean water and waste disposal. In Madhya Pradesh, a state with a higher maternal mortality rate than war-ravaged Syria, half the post-natal wards of primary healthcare centres lacked toilets, as did 60% of larger community health centres.
  • Up to 62% of government hospitals don’t have a gynaecologist on staff and an estimated 22% of sub-centres are short of auxiliary nurse midwives. Gynaecologists and nurse midwives comprise the frontline of the battle against infant and maternal mortality.
Amrita Sher-Gil/ Woman on charpai
Amrita Sher-Gil/ Woman on charpai

Funding is certainly an issue. For instance, although the budget for the centrally funded National Rural Health Mission rose 67% over a decade to Rs 11,196 crore in 2015-16, such investments have fallen behind requirements, at a time when a tide of ill-health and disease is rising. As a share of gross domestic product, India’s health expenditure has never reached 1.5% over the last two decades. That is among the lowest levels in the world, according to World Bank data, comparing unfavourably with not just Cuba (10.6%), Brazil (3.8%), China (3.1%) and South Africa (4.2%), but even Ethiopia (2.9%), Tanzania (2.6%) and sub-Saharan Africa (2.3%).

With Delhi handing over more responsibilities and money to the states, their share of central tax revenue has risen to 42% from 32%, but this has resulted in a spending cut on social programmes, specifically affecting health and education financing. In conjunction with education, which, as noted above, is an important factor in making mothers more empowered, healthcare affects the wellbeing of Indians from cradle to death, the circle beginning with its women.

The bottom line: India ignores its collapsing healthcare system at its immense peril. If the Prime Minister really wants to do the best by India and the women he often eulogises (“Mothers and sisters are partners in our development journey,” he said this year), he should take the states along and consider his next surgical strike against the healthcare system. Nothing could be less controversial and more beneficial.

Samar Halarnkar is editor, IndiaSpend.org, a data-driven, public-interest journalism non-profit.

We welcome your comments at letters@scroll.in.
Sponsored Content BY 

Top picks, best deals and all that you need to know for the Amazon Great Indian Festival

We’ve done the hard work so you can get right to what you want amongst the 40,000+ offers across 4 days.

The Great Indian Festival (21st-24th September) by Amazon is back and it’s more tempting than ever. This edition will cater to everyone, with offers on a range of products from electronics, home appliances, apparel for men and women, personal care, toys, pet products, gourmet foods, gardening accessories and more. With such overwhelming choice of products and a dozen types of offers, it’s not the easiest to find the best deals in time to buy before your find gets sold out. You need a strategy to make sure you avail the best deals. Here’s your guide on how to make the most out of the Great Indian Festival:

Make use of the Amazon trio – Amazon Prime, Amazon Pay and Amazon app

Though the festival officially starts on 21st, Amazon Prime members will have early access starting at 12 noon on 20th September itself, enabling them to grab the best deals first. Sign up for an Amazon Prime account to not miss out on exclusive deals and products. Throughout the festival, Prime members will 30-minute early access to top deals before non-Prime members. At Rs 499/- a year, the Prime membership also brings unlimited Amazon Prime video streaming and quick delivery benefits.

Load your Amazon pay wallet; there’s assured 10% cashback (up to Rs 500). Amazon will also offer incremental cashbacks over and above bank cashbacks on select brands as a part of its Amazon Pay Offers. Shopping from the app would bring to you a whole world of benefits not available to non-app shoppers. App-only deals include flat Rs 1,250 off on hotels on shopping for more than Rs 500, and flat Rs 1,000 off on flights on a roundtrip booking of Rs 5,000 booking from Yatra. Ten lucky shoppers can also win one year of free travel worth Rs 1.5 lakhs.

Plan your shopping

The Great Indian Sale has a wide range of products, offers, flash sales and lightning deals. To make sure you don’t miss out on the best deals, or lose your mind, plan first. Make a list of things you really need or have been putting off buying. If you plan to buy electronics or appliances, do your research on the specs and shortlist the models or features you prefer. Even better, add them to your wishlist so you’re better able to track your preferred products.

Track the deals

There will be lightning deals and golden hour deals throughout the festival period. Keep track to avail the best of them. Golden-hour deals will be active on the Amazon app from 9.00pm-12.00am, while Prime users will have access to exclusive lightning deals. For example, Prime-only flash sales for Redmi 4 will start at 2.00pm and Redmi 4A at 6.00pm on 20th, while Nokia 6 will be available at Rs 1,000 off. There will be BOGO Offers (Buy One Get One free) and Bundle Offers (helping customers convert their TVs to Smart TVs at a fraction of the cost by using Fire TV Stick). Expect exclusive product launches from brands like Xiaomi (Mi Band 2 HRX 32 GB), HP (HP Sprocket Printer) and other launches from Samsung and Apple. The Half-Price Electronics Store (minimum 50% off) and stores offering minimum Rs 15,000 off will allow deal seekers to discover the top discounts.

Big discounts and top picks

The Great Indian Festival is especially a bonanza for those looking to buy electronics and home appliances. Consumers can enjoy a minimum of 25% off on washing machines, 20% off on refrigerators and 20% off on microwaves, besides deals on other appliances. Expect up to 40% off on TVs, along with No-Cost EMI and up to Rs 20,000 off on exchange.

Home Appliances

Our top picks for washing machines are Haier 5.8 Kg Fully Automatic Top Loading at 32% off, and Bosch Fully Automatic Front Loading 6 Kg and 7 Kg, both available at 27% discount. Morphy Richards 20 L Microwave Oven will be available at a discount of 38%.

Our favorite pick on refrigerators is the large-sized Samsung 545 L at 26% off so you can save Rs 22,710.

There are big savings to be made on UV water purifiers as well (up to 35% off), while several 5-star ACs from big brands will be available at greater than 30% discount. Our top pick is the Carrier 1.5 Ton 5-star split AC at 32% off.

Also those looking to upgrade their TV to a smart one can get Rs. 20,000 off by exchanging it for the Sony Bravia 108cm Android TV.

Personal Electronics

There’s good news for Apple fans. The Apple MacBook Air 13.3-inch Laptop 2017 will be available at Rs 55,990, while the iPad will be available at 20% off. Laptops from Lenovo, Dell and HP will be available in the discount range of 20% to 26%. Top deals are Lenovo Tab3 and Yoga Tab at 41% to 38% off. Apple fans wishing to upgrade to the latest in wearable technology can enjoy Rs 8,000 off on the Apple Watch series 2 smartwatch.

If you’re looking for mobile phones, our top deal pick is the LG V20 at Rs 24,999, more than Rs 5000 off from its pre-sale price.

Power banks always come in handy. Check out the Lenovo 13000 mAh power bank at 30% off.

Home printers are a good investment for frequent flyers and those with kids at home. The discounted prices of home printers at the festival means you will never worry about boarding passes and ID documents again. The HP Deskjet basic printer will be available for Rs 1,579 at 40% off and multi-function (printer/ scanner/ Wi-Fi enabled) printers from HP Deskjet and Canon will also available at 33% off.

The sale is a great time to buy Amazon’s native products. Kindle E-readers and Fire TV Stick will be on sale with offers worth Rs 5,000 and Rs 1,000 respectively.

The Amazon Fire Stick
The Amazon Fire Stick

For those of you who have a bottomless collection of movies, music and photos, there is up to 60% off on hard drives and other storage devices. Our top picks are Rs 15,000 and Rs 12,000 off on Seagate Slim 5TB and 4TB hard drives respectively, available from 8.00am to 4.00pm on 21st September.

The sale will see great discounts of up to 60% off on headphones and speakers from the top brands. The 40% off on Bose QC 25 Headphones is our favourite. Top deals are on Logitech speakers with Logitech Z506 Surround Sound 5.1 multimedia Speakers at 60% off and the super compact JBL Go Portable Speaker at 56% off!

Other noteworthy deals

Cameras (up to 55% off) and camera accessories such as tripods, flash lights etc. are available at a good discount. Home surveillance cameras too will be cheaper. These include bullet cameras, dome cameras, simulated cameras, spy cameras and trail and game cameras.

For home medical supplies and equipment, keep an eye on the grooming and personal care section. Weighing scales, blood pressure monitors, glucometers, body fat monitors etc. will be available at a cheaper price.

The sale is also a good time to invest in home and kitchen supplies. Mixer-grinders and juicers could see lightning deals. Don’t ignore essentials like floor mops with wheels, rotating mop replacements, utensils, crockery etc. Tupperware sets, for example, will be more affordable. There are attractive discounts on bags, especially laptop bags, backpacks, diaper bags and luggage carriers.

Interesting finds

While Amazon is extremely convenient for need-based shopping and daily essentials, it is also full of hidden treasures. During the festival, you can find deals on telescopes, polaroid cameras, smoothie makers, gym equipment, gaming consoles and more. So you’ll be able to allow yourself some indulgences!

Small shopping

If you have children, the festival is good time to stock up on gifts for Diwali, Christmas, return gifts etc. On offer are gaming gadgets such as Xbox, dough sets, Touching Tom Cat, Barbies, classic board games such as Life and more. There are also some products that you don’t really need, but kind of do too, such as smartphone and tablet holders, magnetic car mounts for smartphones and mobile charging station wall stands. If you’re looking for enhanced functionality in daily life, do take a look at the Amazon Basics page. On it you’ll find USB cables, kitchen shears, HDMI cables, notebooks, travel cases and other useful things you don’t realise you need.

Check-out process and payment options

Amazon is also offering an entire ecosystem to make shopping more convenient and hassle-free. For the festival duration, Amazon is offering No-Cost EMIs (zero interest EMIs) on consumer durables, appliances and smartphones, plus exchange schemes and easy installation services in 65 cities. HDFC card holders can avail additional 10% cashback on HDFC credit and debit cards. Customers will also get to “Buy Now and Pay in 2018” with HDFC Credit Cards, as the bank offers a 3 Month EMI Holiday during the days of the sale. Use Amazon Pay balance for fast and easy checkouts, quicker refunds and a secured shopping experience.

Sales are fun and with The Great Indian Festival offering big deals on big brands, it definitely calls for at least window shopping. There’s so much more than the above categories, like minimum 50% off on American Tourister luggage! To start the treasure hunt, click here.

This article was produced by the Scroll marketing team on behalf of Amazon.in and not by the Scroll editorial team.