The Disgrace of India’s Women’s Health

A substandard health system devotes its resources to men

The Disgrace of India’s Women’s Health

By: Neeta Lal

Bindiya Kumari, 26, a farmer from Dumaria village, located 175 km from capital city Patna in India’s poorest state of Bihar, has had two miscarriages since her marriage in 2018. Her plight sadly is neither rare nor exceptional. She and millions like her are the victims of a grossly substandard health care system that seriously neglects women and whose defects have been tragically magnified by the second wave of the coronavirus that has been ripping through the country.

The nearest hospital in Dumaria is 20 km away, Kumari says, so each time her delivery date arrived, the arduous journey to a medical facility in a rickety bus caused excessive bleeding, resulting in the death of her two unborn children.

“My mother-in-law is always taunting me that despite three years of my marriage to her son, I’ve not been able to give her a grandchild,” Kumari said. “But is it my fault that we don’t have a good hospital in our village? None of the politicians who come rushing in at election time have bothered to focus on our health problems.”

Thousands of Indian villages are bearing the brunt of a rudimentary health care system characterized by lack of funds, skeletal medical staff, paucity of critical lifesaving equipment and bureaucratic apathy. In what many have termed as India’s “Covid Apocalypse,” millions of hapless patients and their families are scrambling to secure the most basic life-saving drugs and services. So far the virus has afflicted more than 22.6 million people, the second-worst total in the world after the United States, and killed more than 246,000 people.

The ramifications of the unprecedented crisis will be especially grim for women’s health, studies say. A recent Unicef report, Direct and Indirect Effects of COVID-19 Pandemic and Response in South Asia, estimates that pandemic-related disruptions will result in a dramatic spike in maternal and child deaths, unwanted pregnancies and disease-related mortality in women and adolescents. India is expected to record 154,000 child deaths while maternal deaths are expected to surge by 18 percent, stillbirths by 10 percent. Of the 3.5 million additional unintended pregnancies estimated due to lack of access to reproductive healthcare, three million are likely to be in India, according to Unicef.

Further research by the Foundation for Reproductive Health Services underlines how 26 million couples in India won’t have access to contraceptives due to the pandemic, resulting in an additional 2.4 million unintended pregnancies. Nearly two million people will be unable to access abortion services.

Clearly, the Indian government has learned nothing from the pandemic’s first wave, experts say, even though evidence from past epidemics, like Ebola and Zika, has demonstrated that in times of crisis, women’s health takes a back seat in governments’ priorities. That is because funds and health resources are diverted to other avenues, heightening the risk of unintended pregnancies, maternal health risks, and unsafe abortions.

Restrictions on mobility during the current pandemic have only made things worse.

“Lockdowns and fear of catching the dreaded coronavirus at hospitals are inhibiting families from visiting hospitals for maternal checkups, driving up pregnancy-related complications,” said Savitri Devi, an Accredited Social Health Activist (ASHA) employed under the government’s National Rural Health Mission. Devi is posted to a district hospital in NOIDA district in the northern state of Uttar Pradesh.

The pan-India nonprofit Population Foundation of India, which promotes and advocates gender-sensitive population policies and strategies, notes that women’s access to contraception, post-natal care services and institutional deliveries have plunged significantly in the pandemic year.

According to Poonam Muttreja, executive director of the foundation, India’s fragile healthcare sector is not equipped for the unprecedented rise in Covid-19 cases in this second wave. With only five hospital beds per 10,000 population and 8.6 physicians for every 10,000 people, the country lacks the requisite infrastructure for a crisis of this magnitude, she said.

The foundation’s own analysis of the first lockdown shows that women’s access to contraception, ante-natal care services and institutional deliveries have all been compromised as hospitals struggle to attend to critical patients. In backward states like Bihar, Rajasthan and Uttar Pradesh, adolescents reported an unmet need for reproductive health services, especially menstrual hygiene products.

Experts point out that the mess is a direct result of India’s undercapitalized health care system, a result of one of the world’s lowest spends on health. India spends only 1.3 percent of its GDP on health as compared to the OECD countries' average of 7.6 percent and other BRICS countries' average of 3.6 percent. India’s military spend, however, is 2.9 percent of GDP (China’s is lower at 1.7 percent).

By contrast, in its latest report, the Stockholm International Peace Research Institute revealed that India is the third highest spender on acquiring arms and its military expenditure grew by 2.1 percent since last year as against China’s more moderate 1.9 percent, a fact that has evoked sharp criticism at home.

Dr. Pratibha Khandelwal, Obstetrician and Gynecologist at Max Super Specialty Hospital, Saket, New Delhi, notes that another acute problem – inequitable distribution of health resources – bedevils much of rural India.

“Despite the authorities launching an array of targeted sexual and reproductive health interventions, our field studies reveal that they benefit 95 percent of economically empowered women as against 59 percent of the underprivileged,” she said.

Even the government’s flagship Beti Bachao Beti Padhao program, which focuses on women’s health and education, has facilitated only marginal improvements in enhancing the sex ratio at birth from 918 in 2014-15 to 934 in 2019-20, Khandelwal added. “Despite national campaigns emphasizing women’s free choice in opting for contraceptive methods, state governments continue to push female sterilization leading to coercion and risky substandard sterilization procedures, reflecting a patriarchal mindset.”

According to Unicef estimates, India would have the highest number of forecast births, at 20 million, in the nine-month period dating from when Covid-19 was first declared a pandemic. Also, of around seven million unwanted pregnancies globally, a little over two million will be in India alone. CARE International, in first-of-its-kind research across 40 countries, found that 27 percent of Indian women reported an increase in mental illnesses – compared to only 10 percent of men.

This skewed pattern paints a picture of missing political will, say health activists. When the will is present, they point out, much can be achieved, such as the improvement in India’s Maternal Mortality Rate, which plummeted from 122 in 2015-17 to 113 in 2016-18 through public sensitization campaigns. The rate of institutional deliveries surged from 18 percent in 2005 to 79 percent in 2016.

A gender-sensitive health framework with urgent attention from all stakeholders is the need of the hour, Khandelwal said. “The pandemic has been a wakeup call for the government to invest in public healthcare and prioritize the health of women, who make up almost half of India’s 1.3 billion population. It’ll be a shame if they don’t learn even now,” she concludes.

Source : Asia Sentinel More   

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Will Modi’s push for economic self-reliance succeed?

Author: Suman Bery, Wilson Center India has pursued two linked objectives since its independence and partition in 1947: to restore the country’s standing as one of the world’s major economies and to preserve geopolitical freedom of action, or ‘strategic autonomy’. Economic strength is both an end in itself — to lift millions out of deep […] The post Will Modi’s push for economic self-reliance succeed? first appeared on East Asia Forum.

Will Modi’s push for economic self-reliance succeed?

Author: Suman Bery, Wilson Center

India has pursued two linked objectives since its independence and partition in 1947: to restore the country’s standing as one of the world’s major economies and to preserve geopolitical freedom of action, or ‘strategic autonomy’. Economic strength is both an end in itself — to lift millions out of deep poverty — and indispensable for maintaining diplomatic freedom of action.

Over this period, India’s engagement with the outside world has evolved in response to domestic imperatives and to its external environment. India is engaged in a major reset at this time, moving from market-driven global integration to strategic trade and investment policy, what Prime Minister Narendra Modi has labelled self-reliance. What are the forces shaping India’s present external posture and what are the associated risks?

As the economist Pravin Krishna has observed, at its independence India inherited a relatively open trade regime and in 1948 was one of the 23 original ‘contracting parties’ to the General Agreement on Tariffs and Trade, the WTO’s predecessor. India’s turn inward was facilitated a decade later when the GATT permitted ‘special and differential treatment’ for its poorer members.

Policy was then reinforced by geopolitics. Indira Gandhi of the Congress party became prime minister in 1966 and increasingly sided with the USSR in the Cold War in reaction to US support of Pakistan and China under President Richard Nixon. The outcome was economic stagnation but ‘strategic autonomy’ was preserved.

India’s return to openness in 1991 also occurred on the watch of a Congress-led government. Elections in 1989 led to rejection of the ruling Congress party led by Indira Gandhi’s son, Rajiv Gandhi. The inexperienced coalition government that took office was not in a position to handle a fiscal and balance of payments crisis. The crisis was exacerbated by external events: the collapse of the Soviet Union, an important trade and defence partner, and the first Gulf War. In the 1991 election campaign, Rajiv Gandhi was assassinated, as his mother had been seven years earlier.

The electoral outcome was a Congress-led coalition government headed by PV Narasimha Rao, the first Congress prime minister from outside the Nehru–Gandhi family. Rao’s technocratic finance minister, Manmohan Singh, advised the prime minister to seek support from the IMF. The program submitted to the IMF included comprehensive reforms covering trade, public finance, the exchange rate regime and capital markets. While prime minister Rao provided valuable political cover for these reforms, he was not inclined to mount a frontal challenge to the party’s centre-left orthodoxy External integration remained a largely technocratic project that came to be known as ‘reform by stealth’ which is why it remains subject to reversal.

Though weak, this impetus to liberalisation survived for the next two decades till the global financial crisis. There was substantial reduction in average applied industrial tariffs, though agriculture remained very highly protected. Liberalisation was largely unilateral, driven by a desire to emulate the export-led manufacturing success of the economies of Asia.

India was an active but unconvinced participant in the WTO’s Doha round launched in 2001. India argued — with some justification — that a new round was premature as there was unfinished business from the earlier Uruguay Round to be dealt with, particularly where agricultural trade was concerned. Washington’s retreat from committed multilateralism towards preferential agreements — first with Canada and later including Mexico through the North American Free Trade Agreement (NAFTA) — and its support for China’s WTO accession, together with the steady expansion of the European Community, undermined India’s faith in the multilateral order in the 1990s and early 2000s.

India remains by instinct a multilateral trading power, preferring to trade under the GATT’s most-favoured-nation rules. It actively uses the flexibility afforded by the gap between applied and bound tariffs, as well as trade remedies such as anti-dumping and safeguard measures in order to manage domestic lobbies, despite the uncertainty that such interventions create for domestic and international investors. In the first decade of the new century, it began to flirt with relatively shallow bilateral preferential trade agreements with a range of partners. It also agreed to participate in negotiations on the Regional Comprehensive Partnership Agreement (RCEP) in 2012 but withdrew in 2019.

By the size of its economy, India is now a consequential, though still poor, middle power. However, the share of manufacturing value added in GDP, needed to accommodate its rapidly growing labour force, has remained stagnant. Instead, the services sector has boomed. While the overall balance of payments has remained comfortable, its structure has been closer to that of an advanced country, with a large deficit in manufacturing trade balanced by surpluses in agriculture and services. The concentration of the manufacturing deficit in India’s trade with China has added to bilateral political and diplomatic tensions.

As in the 1960s and 1990s, a combination of external and domestic forces has again prompted a re-evaluation of India’s external engagement. The economic, medical, humanitarian and political dimensions of the COVID-19 scourge have exposed and reinforced weaknesses in India’s development trajectory, and may have contributed to a setback to Modi’s party in important recent state-level elections. China’s long-term economic success and its current political assertiveness are now shaping both the regional and global economic order as well as its bilateral relations with India.

In its post-COVID-19 recovery, India will wish to consolidate market access for its export of services to rich countries and to make access to the country’s growing market most attractive for those willing to bring the latest technology. The risk is that more active government intervention will get hijacked by powerful domestic lobbies as happened before. India is also refocusing on trade with its South Asian neighbours and investing greater energy in links with Europe and the United States. By contrast, an early return to the RCEP negotiations seems unlikely.

Suman Bery is a Global Fellow at the Woodrow Wilson International Center for Scholars.

An extended version of this article appears in the most recent edition of East Asia Forum Quarterly, ‘Reinventing global trade’, Vol. 13, No 2.

The post Will Modi’s push for economic self-reliance succeed? first appeared on East Asia Forum.
Source : East Asia Forum More   

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