Hunger and malnutrition: Why is India in denial?

 

https://healthonair.in/columns/hunger-and-malnourishment-why-is-india-in-denial/

As per the UN’s Sustainable Development Goal (SDG) number two – ‘zero hunger’ – all forms of hunger and malnutrition in the world should end by 2030 so that no one suffers from ill health due to insufficient nutrition. The goal also requires addressing different forms of hunger and malnutrition, such as stunting and wasting among under-5 children, as well as anemia in adolescent girls, pregnant, and lactating women, and older persons, with a strong focus on improving their nutrition levels significantly by 2025. Stunting occurs when a child is too short for their age due to chronic malnutrition while wasting indicates low weight for their height, typically caused by acute malnutrition.

A key tool for measuring progress toward these goals is the Global Hunger Index (GHI) Report. Released recently, it revealed that India has the highest rate of child wasting globally, at 18.7 percent. It ranked India at 111th place out of 125 countries. However, India’s reaction to the report was characterized by denial and indifference. Minister of Women and Child Development of India, Smriti Irani, ridiculed and dismissed the report by calling its methodology “flawed”. What was never discussed by the government, however, was that if there was indeed no hunger or deprivation among people of this country, then why extend the Pradhan Mantri Garib Kalyan Anna Yojana (PMGKAY) for a period of five years with effect from 1st January, 2024?

The PMGKAY aims to provide free food to 81.35 crore people, which is more than half of the Indian population. Interestingly, this free provisioning of food for the next five years is not being presented as an acceptance of criticism of the government’s welfare schemes, but as a display of ‘sensitivity’ of the political leadership.

More recently, Minister of State for Health SP Singh Baghel said on the floor of the Parliament that not a single hunger-related death has occurred in the country in the last ten years. On another occasion, a minister from the Hemant Soren-led government in Jharkhand made a statement in the state assembly that there have been no starvation deaths in the state. Just within a matter of a few months of that statement in 2021, the Jharkhand High Court took suo moto cognizance of three alleged starvation deathsin the same family after the media reported the news. Following a court-mandated investigation by the Jharkhand State Legal Services Authority, it was revealed that individuals had to trek eight kilometres to obtain rations, while access to clean water and healthcare services remained scarce and challenging. The HC held up the state government for running welfare services ‘on paper’ and condemned starvation deaths as a matter of shame. Similarly, starvation deaths have recently been reported in various other states such as Odisha, and West Bengal among others.

The Ministry of Health and Family Welfare’s own NFHS-V data also points in the direction of overall poor nutritional indicators. For instance, it shows a dramatic rise in the number of children suffering from anemia when compared to data from NFHS-IV. More specifically, anemia has risen not just in children below six years of age, it has also increased among adolescent girls and boys, among women who are pregnant, and those in the age group of 15-49 years. Almost half of our population is anemic which is a matter of grave concern. Moreover, the prevalence of anemia among adolescent girls (59.1 percent) inevitably contributes to anemia among new mothers. This, in turn, serves as a contributing factor to anemia among newborns, maternal and infant mortality rates, and overall community morbidity due to iron deficiency. Unfortunately, the government will not be collecting data on prevalence of anemia in the sixth round of NFHS. Further, a more careful analysis of the NFHS-V data shows that stunting and severe wasting of under-5 children has actually increased in 11 and 13 out of 17 states respectively. The proportion of children who are underweight has also increased in 11 out of 17 states.

Following the GHI controversy, the Ministry of Women and Child Development issued a press release attributing the poor ranking to ‘malafide intent.’  The release spoke at length about India’s present nutrition-related programs – the Mission Saksham Anganwadi and Poshan 2.0, the Poshan Tracker, Pradhan Mantri Garib Kalyaan Anna Yojana and Antyodaya Anna Yojna etc. – and how India runs the world’s largest food security program and so on.

However, many public health and nutrition experts have already pointed out that irrespective of the size of the Indian food security programme, its basic flaws must be acknowledged and considered seriously if it is going to be implemented effectively and sustainably. First, the PDS system largely covers the poor and vulnerable population based on the outdated 2011 Census so a large number of households has been missed. The number of people who have increased within the existing households is still not officially counted as ‘beneficiaries’ yet. Besides, not all beneficiaries have a ration and/or aadhar card to be able to freely access the PDS. Secondly, our granaries overflow with food grains, they rot, get damaged in transit, and get exported but the intended beneficiaries from the poor and vulnerable sections of the population are unable to access and consume ration from the PDS conveniently, particularly women and girl children due to social and gender inequalities.

Adding nutritionally rich fruits and vegetables to the PDS system is also challenging due to storage issues for instance. Incorporating eggs in to midday meals has been a long-standing point of contention due to concerns about hurting religious sentiments. Only some states have been able to introduce daily eggintake for their high protein and vitamin content.

Moreover, the cereals provided within the PDS are usually wheat and rice, which are heavy on carbohydrate content. Focusing just on increasing and ensuring calorie intake will not make up for the other long-term nutritional deficiencies experienced by people. To cover up for this lacuna, nutritionally rich coarse grains (millets) have also been added to the PDS food basket by some states, and doing that has thrown its own set of challenges. In states where millets are included in the PDS, only a limited number of varieties are promoted for cultivation. This contrasts with the increasing prices of other millet species in urban markets, making them expensive even for city dwellers. Additionally, popular millet types like bajra, jowar, and ragiare being prioritized as major cash crops for export, which further limits their availability for domestic consumption.

The recent claims by Niti Aayog regarding poverty reduction just before elections seem to gloss over the persistent issues of chronic hunger and malnutrition in India. While Niti Aayog asserts significant poverty reduction and promising progress towards meeting SDG goal one (‘no poverty’) before time, experts have raised valid concerns about the accuracy of these claims. To address the persistent issues of hunger and malnutrition – which is SGD goal two, and is closely related with SDG goal one – we need to acknowledge their existence and interlinkages first. Unfortunately, what we often observe instead is a troubling silence and denial regarding these problems.

Till Death Do Us Apart

http://www.hardnewsmedia.com/2012/01/4298

How many more must die for love before it's curtain call for khaps and their feudal power?

Shaweta Anand Delhi

Even though the recent film Khap elicited lukewarm response at the box-office, it did ruffle feathers within khaps (unelected, caste panchayats) of Haryana who demanded an immediate ban on the film. They said the film misrepresented Indian culture as it 'portrayed them in bad light'.

Despite the poor response, the film did succeed in boldly highlighting the barbaric, feudal acts that khaps have perpetrated against couples-in-love for the first time on silver screen, even if it meant going against the powerful political class of Haryana that openly supports khaps.

With an eye on the electoral equations, he has given them a kind hearing whenever they held khap mahapanchayats (large gatherings of many khaps) and demanded from him an amendment to the Hindu Marriage Act 1955 to criminalise same-gotra (clan/sub-caste) marriages, otherwise legal in India. Om Prakash Chautala, ex-chief minister from the opposition party, too, has raised the same demand with the Union home ministry in order to appease the upper-caste vote bank. Haryana Chief Minister Bhupinder Singh Hooda had also tacitly backed the khaps.

Not far behind in regressive politicking is a representative of the younger generation, foreign-educated MP and industrialist from Kurukshetra, Naveen Jindal. Despite his exposure to a more liberal society, he had glorified the role of feudal khaps in society, arguing that they have been playing an important role in the settlement of village issues since generations, much before the formal legal system came into being. It was only when the Congress high command asked him for a clarification after he had attended a khap mahapanchayat, that he slightly backtracked from his stand.

'Honour' crimes, whether committed by organised upper-caste khaps (mostly Jats and Rajputs as reported by popular media), or individuals, comprise a broad range of acts from quiet murders passed off as suicides, to pre-mediated, long-drawn public humiliation and social boycott of those targeted for forming alliances across caste (for instance, between upper-caste girl and Dalit boy), religion, or for making swagotra alliances (ie, within the same gotra. Historically, people from same gotra are believed to be descendents of the same rishi/saint, hence siblings, according to Hinduism.)

Besides, family 'honour' sometimes also gets violated if girls refuse to follow 'acceptable' dress-codes, refuse forced arranged marriages, or engage in homosexual relationships, as all these are blindly denounced as blasphemous, 'un-Indian' activities influenced by Western culture.

According to the draft bill circulated by CPM's women's wing, All India Democratic Women's Association (AIDWA) — The Prevention of Crimes in the Name of 'Honour' and Tradition Bill, 2010 — crime in the name of 'honour' comprises a range of violent or abusive acts, including emotional, physical, sexual abuse and other coercive acts by caste/community groups or individuals. The bill was submitted to the Union law minister last year, but no action has been taken upon it yet.

Commenting on the oppressive nature of khaps, activist Ranjana Kumari said that a Taliban-like diktat was issued by a recently convened khap panchayat in Uttar Pradesh. "It was decided at that meeting that young girls and women shouldn't be allowed to wear jeans or carry mobile phones so that they can be prevented from 'going astray'." Kumari was speaking at a recent consultation in Delhi on 'the socio-legal implications of honour killing' jointly organised by Women Power Connect (WPC) and Jagori at Vishwa Yuvak Kendra. To ensure effective policing of village girls, at that very meeting, five-member all-women teams were constituted to 'keep an eye' on them as their western attire would supposedly give rise to social evils like 'vulgarity' and 'eve-teasing', besides 'provoking them to elope' with someone.

Honour’ crimes comprise a broad range of acts from quiet murders passed off as suicides, to pre-mediated, long-drawn public humiliation and social boycott of those targeted for forming alliances across caste, religion, or for making alliances within the same gotra.

It is, in fact, anti-women beliefs such as these that lead to crimes against women and those who support them – and this is often done in the name of safeguarding 'honour'. A large number of cases have been reported from rural and urban Haryana, western UP, Delhi and Punjab, with states like Jharkhand, Chhattisgarh, Andhra Pradesh and Tamil Nadu catching up fast.

Under public pressure and progressive directions by the Supreme Court, the central government appointed a Group of Ministers (GoM) last year to look into the legislative aspect of preventing 'honour' crimes. Nothing much has come of that exercise as the concerned states are not cooperating (Haryana, in particular), law and order being a state subject.

While acknowledging that feudal-minded groups or individuals take 'corrective' action against people who break traditional social norms, Anju Dubey Pandey, a participant at the WPC-Jagori consultation, urged people to use language more consciously as it is a potent tool of politics.

For instance, the term 'honour crime' reiterates the unfair, women-centric implication of the word 'honour'. 'Dishonour crime' and 'horror crime' (used by Kumari) bring out more accurately the insensitivity, intolerance and ruthlessness of acts of violence against women who resist customs, and the people who support them. In fact, usage of 'dishonour crime' was accepted at WPC's consultation last year as these crimes certainly bring dishonour to perpetrators than protect their honour in any way.

While taking slight offence to the words used by one of the panelists when she was passionately narrating an instance of a khap panchayat wrongly punishing a couple-in-love, "because they were found in a compromising position", Pandey urged everyone to be cautious of such regressive expressions that are often used in describing mutual acts between consenting adults, as the concerned adults were only exercising their human rights.

Elaborating further, she affirmed, "Dishonour crimes should be seen as a far greater violation of basic human rights (and, therefore, in that framework, invoke the entire law-and-order machinery to pro-actively respond) than anything that can possibly result from the breaking of social norms. Our framework informs our politics and the solutions we suggest for resolving issues." Pandey is associated with UN Women South Asia. She spoke with this reporter in an exclusive interview.

To ensure effective policing of village girls, five-member all-women teams were constituted to ‘keep an eye’ on them as their western attire would supposedly give rise to social evils like ‘vulgarity’ and ‘eve-teasing’, besides ‘provoking them to elope’ with someone.

Dr Jyotsna Chatterji, Director, Joint Women's Programme explained how the age-old practices that oppress women and the assertion of caste identity reinforce each other when khaps pronounce diktats against couples. She said, "This need to constantly establish one's caste identity is driven by deep-rooted patriarchal beliefs within groups, which in turn legitimises for them the domination by men and violence against women, including inciting or participating in dishonour crimes."

"Thus, efforts to preserve caste purity by khaps, and their justification for anti-women practices like controlling who they marry or live with, both go hand-in-hand. So to deal with one (casteism), one has to deal with the other (patriarchy) too," she elucidated.

A good illustration is the Supreme Court judgement on the Lata Singh case (2006) wherein the petitioner had married outside her caste against her brothers' wishes, who subsequently blatantly tormented her and her in-laws. The court categorically stated: "The caste system is a curse on the nation and the sooner it is destroyed the better. In fact, it is dividing the nation at a time when we have to be united to face challenges... Hence, inter-caste marriages are, in fact, in national interest as they will result in destroying the caste system."

The court rapped the police for not taking action against the erring brothers, upheld the inter-caste marriage of the petitioner, gave directions to institute criminal proceedings against the brothers, while simultaneously quashing the case of kidnapping and illegal confinement in Lucknow High Court, based on the FIR filed by Lata's brothers.

While the social punishment continues in the dishonour killing case of Manoj and Babli who were bludgeoned and drowned to death in 2007, their already traumatised families are still not allowed to lead normal lives. The psychological pain for Chandrapati (Manoj's mother) and Seema Kumari (his sister), who courageously went to Court against the khap, persists.

The torture was achieved by inflicting restrictions upon villagers. Soon after the couple was killed, a fine of Rs 25,000 was imposed on anyone who would interact with their family! Understandably, even the milkman discontinued engagement with them. Even though AIDWA has written to the Ministry of Home Affairs for their protection, threats to their safety abound as the family continues to oppose khaps.

"Unfortunately, the suffering of families that go against a handful of self-styled khap leaders is bound to happen as these are a powerful lot of men from higher caste and class, who command authority in the village and exploit the vulnerable as they please. Villagers are genuinely scared to go against their diktats," said Bharati Sud, Associate Professor at Satyawati College, DU, also a participant.

When it comes to asserting power and authority, many cases have been reported. Like the case of upper-caste men stopping Dalits from using well water in Jhajjar as their daughters 'ran away' with 'their' boy. The issue was 'resolved' only when the girls (one was with the boy, the other feared reprimand so escorted them) were brought back and duly butchered to retrieve 'family honour'.

Talking of instilling fear in villagers, even cops who marry outside caste have not been spared by khaps. Mewat-based khap attacked, boycotted and tried to break the marriage of a police officer-cum-champion wrestler from the Reserve Battalion, Bhondsi, who married within same gotra but as per Muslim tradition (to avoid complications). Despite legal action against them, his family still lives under constant threat.

Coming back to the Manoj-Babli case, even in death, what they achieved for couples-in-love was a landmark judgement by the Karnal district Court in 2010, when in a first-time conviction for 'honour' crimes, five people from Babli's family were awarded capital punishment, one was awarded life imprisonment and another, seven years in jail.

However, a recent Punjab and Haryana High Court judgement commuted death penalty to four convicts to life imprisonment and let go two others, including the main conspirator, Congress leader and head of khap, Ganga Ram. This has brought back shivers to the already ostracised family of Manoj, his mother and sister, who fear for their life and safety.

"What can one achieve if the judiciary is also patriarchal and either doesn't punish at all or gives reduced punishment in cases of dishonour crime," wondered Pandey, though not in particular reference to the Manoj-Babli case.

Most speakers on the panel agreed that dishonour crimes related to 'honour' reposed in women, who are primarily conceptualised as male possessions in a patriarchal world order. So when an 'unsuitable' match takes away the girl, it is a loss of 'honour' for that family. The family then fights back for its 'honour' by targeting, even killing the girl and her accomplices, as has often been reported.

" That women are not treated equal to men is clear from the high rates of female feticide, poor education and lack of opportunities for women," lamented Kumari. "In fact, women don't even get to participate in unilateral decisions that khaps take as they are not even allowed to step on their chabutara (raised platform). Though now, few women are made visible at some places to avoid the tag of khap panchayats being male-dominated institutions," she said.

Condemning all forms of violence against women, including dishonour crimes, Mamta Sharma, Chairperson, National Commission for Women, promised her solidarity with civil society organisations while urging them to engage with people in the villages and to generate awareness amongst them.

Promising support was Devika Singh Chauhan from the newly instituted National Mission for Empowerment for Women, which was inaugurated by the President of India Pratibha Patil last year.

The mission has a mandate to achieve inter-sectoral convergence for all pro-women programmes across various ministries of the government, including helping complainants who have been targets of dishonour crimes.

A point of debate was whether a stand-alone law was needed to deal with the issue at hand. Supreme Court advocate Meenakshi Lekhi was of the opinion that existing laws were sufficient and needed effective implementation.

She emphasised that feminists should behave like 'one caste of women' and not fight over whether or not to have a special law for dishonour killing. In reference to a recent Supreme Court judgment that terms 'honour' killing as 'rarest of the rare cases' deserving death penalty, she said, "We should try and get law-of-the-land enforced."

(Interestingly, Haryana CM Bhupinder Singh Hooda doesn't want a new law on 'honour' killing either. In his response to the specially appointed GoM for considering legislative measures regarding 'honour' crimes, he was of the opinion that new law was unnecessary as present laws were 'sufficient'.)

Ravi Kant, however, disagreed with this point. According to him, amendments in existing law were crucial for instance in the Special Marriage Act (to make marriage procedure less lengthy and painful for couples as it is an alliance between consenting adults) and the Indian Evidence Act (to put onus of proving innocence on the perpetrators), besides supporting a new legislation to tackle these crimes. Kant is also a Supreme Court advocate and is the Executive Director of Shakti Vahini.

"Just like there were laws made to deal with social malpractices like sati pratha (widow burning) and dowry, there should also be a well-defined legislation on dishonour crimes that stipulates the severest punishment to law-breakers," vouched Ranjana Kumari. "Since it is a specific social problem, we need a specific law to deal with it," she stressed.

The Law Commission, Ministry of Law and Justice, has come out in support of a special legislation to deal with 'honour' killings while turning down the proposal to amend IPC Section 300 (murder) by adding a clause defining 'honour' killing as that would 'create confusion and interpretational difficulties'.

The term ‘honour crime’ reiterates the unfair, women-centric implication of the word ‘honour’. ‘Dishonour crime’ and ‘horror crime’ bring out more accurately the insensitivity, intolerance and ruthlessness of acts of violence against women who resist customs, and the people who support them.

A recent draft bill on 'honour' killings titled 'The Endangerment of Life and Liberty (protection, prosecution and other measures) Act 2011', stipulates a three-five year imprisonment along with a fine of Rs 30,000 for caste-groups assembling with an intention of endangering lives or liberty of couples who want to marry. Those booked would face civil sanctions too; they would not be able to contest elections of hold public positions till five years of conviction.

Towards the concluding session of the WPC-Jagori meet, suggestions were discussed regarding future action. Smita Thakur of Jagori felt that all women need to start asserting themselves even at home for being able to ultimately stop dishonour killing – an anti-women act at its core. "We should promise ourselves that we will not tolerate dishonour crimes and resist them if they happen in front of us," she emphatically declared. 

There was a suggestion of social networking from the audience to unite people over this common cause, but again, as Sud argued, social networking is limited and can at best be a method of sharing information, but it is no substitute for real protests that happen in the streets. Tara Appachu Sharma, a gender consultant, suggested that there should be protests against dishonour crimes the same day all over the country to build a momentum and drive home the point. Lekhi said that 'flash protests' should be held at various places, especially outside the Delhi house of khap-supporting MP, Naveen Jindal to sensitise him.

Chatterji opined that to deal with the issue of dishonour crimes, one has to see them coming from a deeply casteist and patriarchal mindset of society. "Any changes will become effective only when they come from the bottom, after active engagement with people. Just law won't be enough," she said.

The Unbearable Immorality of Honour

http://www.hardnewsmedia.com/2012/01/4289

Albeena, Zicou and Jagmati address audience at a film screening organised by SFI at Koyna Hostel Mess/JNU

Even as songs of love are brutally silenced by khap panchayats, using marriage codes rooted in their history of denying women the right to natal property, a documentary celebrates stubborn resistance to this bloodlust of feudal authority
Shaweta Anand Delhi

Surprisingly, the night show was houseful. Despite the freezing temperature, a lot of people turned up for the screening of a documentary film 'Izzatnagari ki Asabhya Betiyaan' (Immoral Daughters in the Land of Honour) by Nakul Singh Sawhney. The protagonists in this 93-minute film were people targeted by khaps (unconstitutional, upper caste panchayats), who refused to be cowed down and continued to offer firm resistance despite the odds.

Through finely blended multiple narratives, the film captures the emotional loss faced by bereaved families of victims (mostly from socially and economically insecure backgrounds), on the one hand, while airing the views of khap leaders, on the other. The film also depicts the challenges faced by Jat women in the rural and urban/city settings, while acknowledging the significance of education and activism in their lives.

For instance, Seema, (late) Manoj's sister, who is determined to become a magistrate, shares in the film how their family continues to be threatened, boycotted and psychologically tortured after they challenged khaps in court. In 2007, Manoj and his wife Babli had been beaten to pulp for marrying within the same gotra (clan) as the khaps believed their relation to be incestuous. As a final punishment for violating family 'honour', their limbs were tied with ropes before sinking them in a canal, silencing their songs of love in a cold, watery grave. This happened despite the court's prior intervention and police protection to the legally married couple.

Mukesh, the other powerful protagonist in the film, decided to leave home for good and become a full-time women's rights activist in Haryana after she was being forced to opt for arranged marriage. Geetika and Anjali, Jat girls pursuing education in Delhi, spoke about their experience of opposing 'honour' crimes through the medium of street plays and academics respectively.

Gaurav Saini, whose wife Monika was forcefully taken away from him as their marriage was inter-caste, soulfully narrates his experiences of being tortured by Monika's family, and also what it means to live without one's partner of choice.

The film's highlight was candid interviews with khap leaders, some of whom got defensive and claimed they have "nothing to do with honour killing", while others, including a woman leader, audaciously proclaimed that honour crimes were bound to recur if such 'aberrations' (i.e., alliances between so-called siblings or inter-caste alliances) were allowed. According to them, it would "disturb social order" and "destroy society by promoting immorality".

"But now khaps are unable to wash their hands off this issue as more people associated with khapsare getting convicted for 'honour' crimes," said filmmaker Sawhney. He was speaking in the context of Ramdiya Banwala, a member of Banwala khap, who was convicted in the Ved Pal case of 2009. Pal, a medical practitioner, had been lynched by his wife Sonia's relatives for violating the norms ofbhaichara (brotherhood) as he had married a girl from the adjoining village.

As far as future strategy is concerned, Jagmati Sangwan, activist and head of the Women's Study Centre at Maharshi Dayanand University, Rohtak, said, "The two groups of people who are specifically targeted by khaps are the youth and the Dalits. We must work with them so that this scourge can be effectively dealt with." Sangwan participated in the making of the film and was present at the screening.

"As is well-known, all codes of marriage are rooted in regulation of women's sexuality and property. So the khaps' demand for a ban on sahgotra (same gotra) and bhaichara marriages is integrally linked to their history of denying women natal property rights. This link should not be forgotten," said Albeena Shakil from the All India Democratic Women's Association, also a participant.

Glamour Undone

http://www.hardnewsmedia.com/2011/04/3925

With a case in consumer court, a high-end beauty clinic is in the spotlight for irreversible damage caused to the eyesight, psyche and future of a young girl

For those of us who have studied Biology in school and dissected frogs in the laboratory, the following visual analogy might help. Preeti (name changed) had to lie face down on a bench, arms and feet spread out, so that the doctor could perform lumbar (spinal) puncture - a painful procedure involving surgical removal of excessive fluid from the spine to relieve the high fluid pressure that was blurring her vision. She screamed in pain but the operation was the only way to save her from going completely blind, thanks to a drug reaction.

In this procedure, a needle was used to extract a maximum of 25ml fluid to relieve her bulged out eye so that it could see better, and to treat severe headaches. This was the last resort after every other medical treatment to diagnose, treat or suppress her intense, intolerable pain had failed.

As was finally diagnosed by the neurophysician treating Preeti, the high fluid pressure was caused by a reaction to the minocycline drug prescribed to her at the high-end Kaya Skin Clinic for treatment of acne, rendering her 80 per cent blind at that time. Sadly, instead of stopping her from having more tablets, clinic staffers ensured she continued having them "to complete the medicine course".

Preeti underwent the spinal tap once and then another procedure - optic nerve fenestration - to save her failing eyesight, but is still left with permanent loss of peripheral (sideways) vision with blurry vision in one eye. She has acquired a hypo-allergic face skin that gets purple and blotchy under the sun, and so she will always have to use a special sunscreen or avoid sun exposure altogether.

It all started when Preeti complained of mild acne as an adolescent, which is a common complaint at that age. Impressed by advertisements, she wanted her pimples to be removed cosmetically and immediately. She could have also chosen a simple, healthy and balanced diet; but that perhaps would have taken much longer to work, compared to the quick-fix options offered by seductive, often brazenly unethical, ads.

"Since the time we contacted the Noida branch of Kaya Skin Clinic for treatment, our daughter has been traumatised. She has not stopped going to hospitals for one reason or another because of the reaction to the medicine they prescribed her," says her father, on condition of anonymity.

Among other things, Preeti was prescribed minox/minocycline 100 mg tablet daily, without any warning about probable side-effects that are well-established in medical literature. The consent form mentioned nothing to that effect either.

When contacted, Kaya representatives did not respond to this reporter's queries about the issue.

"Despite absence of proper legislation, the one thing that beauty clinics shouldn't be allowed to get away with is malpractice like this," says Dr Shehla Agarwal, consultant skin specialist, Mehak Skin Clinic, Delhi, who has hands-on experience of dealing with adolescents, anxious with skin problems.

"The consumer has to be more vigilant and should not get swayed by big media advertisements. They should ensure that people they go to for beauty treatment have the right qualification and are registered under the Medical Council Act," says Dr Shishu Bhushan Singh, a cosmetic surgeon at Dr Rekha Suman's Laser Cosmetic Surgery and Skin Clinic in Delhi.

Not only that, every clinic should maintain proper documentation of treatment they are giving. They should provide consumers with elaborate consent forms that clearly spell out the side-effects of medicines prescribed by their qualified doctors.

Doctors argue that people should understand how 'selling beauty' is big business because establishing and running such clinics in cities is not an easy job. Hence, demanding full information about the products and services they offer is the consumer's prerogative. Plus, none of the practitioners can claim to have magic wands for quick, short-cut, yet healthy treatments, as is misleadingly claimed in ads promoting beauty products and services endorsed by celebrities.

"Inexperienced medical graduates (fresh degree holders) should not be allowed to deal with patients in beauty clinics as the knowledge required to monitor the side-effects of medicines comes only with time," argues Dr Agarwal. "In many such clinics, there is this trend of different people dealing with the same patient each time s/he visits the clinic, thus breaking continuity in effective monitoring of the treatment."

"Yes, provision of services should be done ethically. The service provider should have full knowledge of the treatment s/he is giving. Another important factor is the quality of chemical products used during beauty treatments to avoid such chemical reactions. Today, every product in the market has a cheaper duplicate, from milk to garam masala. So when anyone goes for beauty treatment, s/he should also enquire about the quality of products used because beauty clinics commonly don't use original, good quality products so as to maximise their profit," says Karan, a senior make-up artist working with the Hindi film industry.

"Whatever the legislative weaknesses with regard to the beauty and cosmetic industry in our country, the fact remains that due to constant bombardment of the so-called ideal beauty images, especially targeting women, they have developed an inferiority complex and deep-seated insecurities about who they are and how they look," says Dr Rippon Sippy, a Delhi-based clinical psychologist. "I mean what is wrong with having acne sometimes? If you let it be, it goes away on its own."

In the contemporary anorexia-driven beauty business in metros and urban India, there is a constant comparison between bodily 'imperfections' vis-à-vis the artificial perfection of models and celebrities. Secretly or openly, the desire to possess a perfect skin, body, features, has been stimulated. Even youngsters, especially girls in their teens, face immense peer pressure, and suffer deep anxieties and insecurities. Like perhaps Preeti did.

Given that a section of women has more money to spare - it empowers but also creates an ironic decrease in self-worth - it is not surprising that many use products and services to alter their looks, points out Jessy K Philip, a sociology teacher at Delhi University. "In cities, fitting the beauty stereotype is something women are more obsessed with than in a village in Kerala, for instance, where women are also valued as workers."

As Naomi Wolf suggests in her book The Beauty Myth, why does this stereotypical notion of beauty - light coloured, fair, flawless, acne-less, hairless, smooth, young, tight skin and an hour-glass anorexic, almost famished, body shape - exclude women's inner qualities, integrity, resilience, achievements and talents? Why are educated, working women expected to conform to the mythical, antiseptic, market-driven, commercial body image, as if their acquired knowledge and professional skills are not enough?

"In my profession, if your face is not acne-free and your body weighs more than a prescribed standard, you'll be soon on your way out. This does cause stress, but it is part of our job to appear that way," says former air hostess Sanjam Jasuja.

Producer-anchor of a TV channel, Kajal Sharma, feels that for someone who appears on the TV screen every day, it becomes mandatory to constantly work towards a fair, smooth skin, wear make-up, have hair of a certain length, flaunt a certain kind of figure and look 'beautiful'. Just being intelligent and efficient is not enough.

Altering one's looks for 'job security' is one aspect of the problem women face, but changing one's appearance to feel valued as a person in relationships seems far more depressing. "One of the reasons why my marriage didn't work out was because I couldn't live up to the beauty norms prescribed in Punjabi families, which is different from what we learnt in Marathi culture. I remember growing up comfortably, like a tomboy, but today I use every product I must to make me look and feel feminine, and worthy of love," says Shruti (name changed), a JNU student in Delhi.

"I dress up conservatively and don't wear as much make-up in Delhi as I do when I am at home. This is because with people from the northeast, other stereotypes are associated. If we wear bright lipstick, we are thought of as women who are easily available. So then, this unfriendly city decides how beautiful I can look or how comfortable I can feel while I live here," says another student from JNU.

Celebrated feminist author-filmmaker Jean Kilbourne brings out similar, deeper concerns in her documentary Still Killing Us Softly, which is about beauty images that media propagates through ads. She says that ads sell not just products, but values, images and concepts such as love, sexuality and normalcy, defining who we should continuously aspire to be. Or else, you can feel left behind, incomplete, imperfect and guilty.

So, be it luxury creams or products to prevent aging, remove pregnancy marks, tighten the cleavage, soothe eyebrows, lighten skin colour and increase lip volume, or treatments for acne removal, facial wrinkles (botox) or body hair removal (waxing or laser), removal of 'ugly' fat (liposuction), breast augmentation, hair spa and so on: everything seems legitimate. However, the bitter realism might be different. "I doubt if women are dying to have body-altering treatments as most procedures are not physically comfortable, some involve painful sittings in beauty clinics with medical risks, some require multiple visits and cost a lot of money. Who would want to go through so much inconvenience unless there's some nagging compulsion inside," says Philip.

Uncannily, the UK has reported several cases of women who want 'vagina-cosmetic surgery' because their partners prefer younger-looking vaginas, similar to those advertised in adult magazines and films. This suggests the level of 'self-hate' and 'deep insecurity' women nurture under the guise of being successful, beautiful, rich and happy, argues Wolf.

In her film, Kilbourne also explains the stereotyped images of the 'perfect male'. In the Indian context, celebrities like Shahrukh Khan, Shahid Kapoor, John Abraham and cricketer MS Dhoni have endorsed fairness cream brands for men. In this racist worldview, to be 'fair' is to be handsome, successful and an achiever, with women chasing you.

The crux is that the concept of 'ideal beauty' is fake, fraudulent and false. It is driven by crass commerce with beauty clinics and products claiming to do the 'magical' transformation of the 'ugly' into the 'beautiful'. But when a silly acne-treatment fails and turns into infinite physical and emotional trauma, altering one's life into an abyss of despair, pain and tragedy (like that of Preeti), then it's time for a serious re-think.

From the print issue of Hardnews :

APRIL 2011

Ask the Women! (Story on injectable contraceptives)

http://www.hardnewsmedia.com/2011/01/3802
The introduction of contraceptive Depo Provera in India might spell health disaster for millions of women, especially rural and poor women. And if city women too get hooked, it might also spell an urban disaster.

Shaweta Anand Delhi

Two weeks before her term as Union health secretary ended in November 2010, Kanuru Sujatha Rao suggested to the Drug Technical Advisory Board (DTAB) to introduce Depo Provera (Depot medroxy progesterone acetate/DMPA or Depo) injectable contraceptive in the national Family Welfare Programme (FWP), previously called the Family Planning (read 'sterilise women only') Programme. The only exception to the women-only rule was the time when 'Sanjay Gandhi's totalitarianism' led to forced vasectomy (nasbandi) of men during the notorious Emergency (1975-77), among other widespread atrocities, including press censorship, torture and imprisonment of thousands.

No matter what the FWP is technically called, the government's main intention has been to curb population growth for it holds that as the basic cause of poverty. Thereby it intends to target women, officially or unofficially, especially poor women, in the name of either maternal and child health services or reproductive and child health programmes --- as if women's health, and their life itself, begins and ends strictly between the reproductive period of 15-45 years. Indeed, this uncanny conjecture implies that the only threat to their life and social condition is complication from childbirth.

Somehow, widespread nutritional deficiency, systemic misogyny since birth (high levels of foeticide, infanticide and domestic/work place violence) and lack of education, equal employment opportunities and equal wages, have never qualified to become areas of aggressive government interest or activism, unlike sterilising FWP targets, namely women.

This highlights the official fixation with birth control through the two-child norm strengthened by advocacy for birth control by women, including by the use of hazardous Depo Provera injectable contraceptive, according to Prof Mohan Rao of the Centre for Social Medicine and Community Health, Jawaharlal Nehru University (JNU), and member of the National Commission on Population. "Other than the Supreme Court upholding the Haryana government's law prohibiting a person from contesting or holding the post of a panch or sarpanch in Panchayati Raj Institutions (PRIs), if s/he has more than two children, there are more state governments like Andhra Pradesh, Madhya Pradesh, Rajasthan, Chhattisgarh and Orissa that also advocate the two-child norm by offering a battery of incentives and disincentives through their population policies," he told Hardnews.

In his note on 'Population policy and the two-child norm', Rao elaborates: "... (desperate to curb population at any cost,state governments are) restricting schooling in government schools to two children; restricting employment in public services to those with two children; linking financial assistance to PRIs for development activities and anti-poverty programmes with performance in family planning; linking assessment of public health staff to performance in family planning and so forth. Indeed, service rules for government employees have been altered in several states making a two-child norm mandatory." This implies that for all the above reasons, primarily a large number of poor women are being coerced to go through sterilisations as permanent contraception.

"The way things happen in our country, the government pressurises thepoor only for population control and therefore contraception. As women, we finally get cornered both by the government and our husbands, untilwe get the (sterilisation) operation done, no matter how physically sick or psychologically weak that makes us feel afterwards," said an old village woman interviewed in Deepa Dhanraj's documentary, Something Like a War.

Most poor women interviewed in this film made 15 years ago, on the subject of coerced family planning, said that pushed by the government's (mostly false) promises of money, some land or foodgrains, it's their husbands who finally decided that they 'need to' get operated. This makes them feeltotally powerless. This is quite the opposite of what promoters of new contraceptive technology claim, including promoters of quarterly injectable hormonal contraceptives like Depo.

Talking of losing control, women (or 'cases', as they were being referred to in the film by 'motivator' health workers and doctors),were brought in, their saris removed, and they were hastily mounted onthe operation table almost upside down for the doctor to easily perform the quick surgery - like an animal is pinned down fortests in a biology lab.

The doctor, while performing operations, simply could not control his boastful monologue, looking straight into the camera, jabbering about having performed 3,50,000 tubectomies (female sterilisations) in the past 12 years, with an efficiency rate of one procedure per minute. "In the interest of the nation," he said, while one of the woman he was "fixing" moaned in excruciating pain and hurled profanities at him.

Women came and women went while the doctor went on about his business of operating upon them most nonchalantly, "like the women were products being rolled out on a conveyor belt, who he is fixing," commented Abha Bhaiya of Jagori, a women's group which played an instrumental role in the making of this documentary. The attitude shows total lack of sensitivity towards women by family members, community workers and doctors. There are many similarities in the experiences of women who went through sterilisations in Dhanraj's film and those who got injectable contraceptive Depo Provera administered in a 'public hospital' setting in Delhi.

This, despite a recommendation against Depo's use in the FWP by the DTAB in 1995 after a Supreme Court direction, even though the injection continues to be available off-the-counter in certain local chemist shops. The 'hospital' had received a stock of injectables directly from Pharmacia and Upjohn, who made the drug before they were taken over by Pfizer, the current manufacturer of Depo.

'UNVEILED REALITIES', A study conducted by Sama - a Delhi-based resource group for women and health - involved recording in-depth experiences of women from a resettlement colony who were administered the injection. Sama also documented how ethically and within medical guidelines was this actually done in a public health set-up.

As in the documentary, this study also showed that men - either the husband/family or the doctor - were basically deciding about women's sexuality and reproduction, including the method and timing of contraception. It makes no difference whether this was 'new-age' -'liberating-the-woman-by-giving-her-another-contraceptive-choice' kindof technology - or a redundant one.

Most women's social identity and status is defined 'because of the father, husband or son' in the Indian context. As a corollary to that, men tend todecide on behalf of a majority of women; hence Depo is not having anyspecial liberating effect on female contraceptive users. In contrast, it is adversely affecting women's bodies and disrupting their lives with anxiety and illness.

On part of the service provider, the crucial issue concerns following ethical and medical safety guidelines, some of which are mentioned in the literature accompanying a Depo pack itself, before administration of the injection. One of the crucial considerations is to ensure 'informed choice' of the recipient before suggesting injectable contraceptives as 'the most effective' contraceptive compared to other methods that might actually suit the potential user better.

The doctor should ideally feel responsible and accountable to the patient if something goes wrong after taking the shot, and should do whatever is needed to put the woman's health and well being as his first priority, without worrying about discontinuation of the injection. As studies show, in most cases, the doctor takes upon a businessman's role, pushing aside the women's negative experience after using Depo and 'counseling' her to continue with the shot, no matter what be her expressed experience, helplessness, angst or anger.

As for compliance to guidelines, the Sama study reveals that the majority of poor women were suggested only Depo Provera injectable as the contraceptive they can opt for, a majority were not told about the probable short-and long-term side-effects, proving that their informed consent was not taken before administering them the injection, which could seriously jeopardise their future health prospects.

Majority of the respondents in the study were also not screened forall the tests before administering the injection. This includes documenting detailed personal and family medical history, menstrual history, blood pressure and weight, gynaecological examination to rule out pregnancy, and a pap smear test to rule out risk of infections. Majority of women showed contradictions (like history of heart disease or diabetes in the family, migraine, jaundice, hypertension, abnormal pregnancies), but were still given the injection, exposing them to grave danger as the hormonal contraceptive causes changes in the body's metabolism itself.

Not just that, Depo reduces the bone mineral density (BMD) irreversibly that has earned the injectable a black box warning in the past. It is the harshest warning of adverse effects caused by drugs issued by the US Food and Drug Administration. In its latest package insert, Pfizer acknowledges the issue of BMD, and that women who can use other birth control methods should not continue Depo for more than two years!

"As a Physician, I am saying that in the case of long-acting, hormonal contraceptives like Depo, adverse drug reactions - not 'just side effects' as Pfizer would like to put it - are a matter of grave concern. On administration of this injectable, healthy women have faced a disruption of their menstrual cycles, possibility of premature menopause accompanied by anxiety, depression and loss of libido, loss of bone density leading to weak, brittle bones, susceptibility to life-threatening blood clots and an increased possibility of HIV transmission, among other problems. All this can happen to normal, healthy women, who might just desire safe contraception, not sickness -inducing contraception, that will not only increase their suffering but also require additional treatment for disorders they never had earlier," argued Dr C Sathyamala, an epidemiologist. Many of these findings are documented in a research study: 'An epidemiological review of the injectable contraceptive, Depo Provera'.

The collective experiences of women reveal that Depo Provera has been administered to them in a highly unethical way that could endanger their lives. Plus, there is data to show that most women have eventually discontinued the injection due to adverse drug reactions,which service providers brush aside, calling them 'minor side-effects' while trying to cajole women into continuing with the contraceptive to meet population control targets. This has been the experienceof women world over, including in the US!

A related study, Introducing DMPA injectable contraceptives to private medical practitioners in urban Gujarat, by Population Council and others, recommends: "Obstetrics/gynecology specialists may be a more appropriate category of physicians (than generalists or MBBS) for reaching women", to administer the injection and for follow-up care. Indeed, India just does not have that kind of health set-up as yet.

However, after suggesting the inclusion of Depo Provera in FWP, Sujatha Rao had suggested that Accredited Social Health Activists (ASHAs) from the National Rural Health Mission could take up the task of administering the injectable, they being 'gaon ki beti' (daughter of the village) and trusted by villagers. "But the fact is that literacy not being their selection criteria, ASHAs may not be able to read even technical instructions on the Depo package regarding when to administer the injection, probable risks and adverse drug reactions involved, nor do they have much knowledge about a woman's internal bodily functioning like gynaecologists do, to watch out for complications or offer advice in case of ill effects to Depo users. ASHAs cannot do this. It will be like playing with the health of millions of women," said Kalpana Mehta from Saheli, a women's group.

"The injectable is hazardous to the woman and to her progeny irrespective of whether the government can find someone at the village level - trained or not - to persuade women, who trust them, that it is safe. Its use should be banned from the private sector too," urged Dr Sathyamala.

Indeed, its rampant misuse among young girls and women in the US has become an alarming cause of concern within the health sector. And if the trend catches up in 'unaccountable India', with girls and women also picking it up off the counter, without prescription, or corrupt doctors prescribing it, this might mark an epidemic with dangerous consequences. No wonder, the drug is in the midst of a deadly controversy with a dark, depressive narrative hidden behind its public claims.

SOS Call

http://www.hardnewsmedia.com/2010/10/3717

Recognising anganwadi workers as government employees will empower them and motivate them to work better

The Union Government's National Policy for Children acknowledged the dire needs of children way back in 1974. The result was the formulation of Integrated Child Development Services (ICDS) scheme in 1975 for holistic care of children of 0-6 years of age. Over 30 years into this national scheme, still a majority of our children continue to stay undernourished and uncared for. Who should be held responsible?

Statistics-wise almost half our children of age less than three years are underweight and about 80 per cent in the same age group are anaemic as per the third National Family Health Survey (NFHS) from 2005 to 2006.

The number of 'wasted' children who are too thin for height has increased from 16 per cent in 1990s to 19 per cent by the time of the last NFHS survey. Even if you look at under-nutrition statistics for children under five years at an international level, India stands at 48 per cent, much higher than Ethiopia (39 per cent) or Malawi (22 per cent)!

The ICDS scheme envisions simultaneous provisioning of health, nutrition and pre-school education for children below six years of age while also caring for nutrition and health education needs of pregnant, lactating mothers, and more recently, for an additional category of adolescent girls under the Kishori Shakti Yojana.

The original conceptualisation of ICDS was to run it as a long-term community-based programme, sustained by members of the community, especially women who benefit from this novel scheme. It gets operationalised through local Anganwadi Centres (AWCs), each with one part-time Anganwadi Worker (AWW) and a helper to carry out multiple tasks and record details of each task in registers daily. Though all the backbreaking work is part of their job profile, yet they're not recognised as government employees who get some facilities if not many.

However, higher level officials like supervisors or Child Development Project Officers (CDPOs) are recognised as government employees whose role is to make sure that 'work gets done' at the ground level. We can safely say that they ensure that registers get filled up with nutrition and health-related data by AWWs, whose accuracy or methodology of collection is not anyone's concern.

"When I first became an AWW in 1988, the ICDS system was much more effective than what it has become now," said Parvati (name changed). She works as an AWW in one of the anganwadis in Dakshinpuri, Delhi.

The main work of an AWW is to provide nutrition to small children, provide them pre-school education, record and refer cases of malnourished or ill children, pregnant or lactating mothers to the nearby medical facility, provide health and nutrition education to expecting mothers and adolescent girls, perform surveys related to mortality, pregnancy and ill-health in the community, cooperate with the Auxiliary Nurse Midwife (ANM) and Accredited Social Health Activist (ASHA) during immunisation drives, help them in other health related work etc, since she is well-known in the community and has all the data the government needs to run any of its programmes.

"Can you imagine this kind of workload on me and my helper, daily, even though we are supposedly part-time 'social workers' getting an honorarium for our services? We get no recognition for the worth of our work, no old-age benefits or security, not even minimum wages, but the blame is entirely ours when anything goes amiss. For instance, when food served at the anganwadi turns out to be of poor quality, we're held by the neck by everyone, including the media. But we don't cook the food here anymore like we used to earlier, so how can we be held responsible for its quality?" she asked desperately.

Showing the rusted and unsteady weighing machine she still uses to record weights of children - this is how levels of malnutrition are calculated - she admitted, "I know this machine cannot weigh correctly, still, I use it because I cannot afford to purchase a new one myself. Obviously the data calculated from readings I record in registers is fudged and won't show the real picture regarding health of people in the community. But I cannot help it as no one listens to me when I demand more facilities for children here."

"The government doesn't give us money for paying timely rent for the AWC, which is mostly a room in the house of the AWW, with no colourful charts or educational material, not even a silly board to identify the room as an AWC! We cannot hire a room for the measly amount of Rs 750 per month given by the government. Our own salary is no more than Rs 1,500 per month, and sometimes we get it only after six months. Who can work for the government like this forever?" she questioned.

"Some of us pay AWC rent from our own pockets and even for the data entry registers. Often, I end up entering government data in my children's notebooks since the registers and stationery given to us is inadequate," lamented Parvati.

In the 1980s, however, the scenario was drastically different. "We used to get paid on time even though the amount was a lot less than our current pay. There used to be timely provisioning of materials required for running the anganwadi. We got everything from phenyl, weighing machines, registers and utensils to pre-school education material for children like clay, wooden toys, colourful fruit and vegetable charts, drawing sheets, crayons, storage cupboards etc. That is how we could achieve at least some of the AWC's goals," she reminisced.

"Then, children used to spend quality time with us, learning and developing skills while also getting nutritious, freshly made food at regular intervals. Unlike today, we used to get raw food and the helper used to cook for the children on a daily basis. Today, the prepared food comes from somewhere far, perhaps from an NGO that has a private contract with the government. We don't know how stale or hygienic this food is, what quality of food material was used during preparation etc. We even had people complaining about cockroaches and worms till recently. Everyone avoids having this food anyway because it is neither tasty nor nutritious," she rued, fearfully exposing the current situation of her AWC in Dakshinpuri.

"Yahan poshan nahin shoshan ho raha hai. Netalog humare naam pe khub paisa kama rahe hain (There is no nutrition being given here, only misuse and exploitation of resources in the name of government schemes in which leaders end up making lots of money). Hummain kya milta hai yahan, sirf logon ka gussa (What do we get here, only public anger)?"

This situation is not unique to Delhi. "In terms of infrastructural provisioning, about 40 per cent of the AWCs in India still run under thatched roofs, huts or under trees instead of pucca government buildings. If the government cares for its children, it has to provide at least a decent roof over their head," said Kandikuppa Hemlata, general secretary of the All India Federation of Anganwadi Workers and Helpers in an interview with Hardnews.

"By the end of 2007, only 6.29 crore of the eligible 16.6 crore children were being covered by the ICDS," said Hemlata while explaining the rationale behind the Supreme Court's order to universalise the spread of anganwadis to every human habitation in India so that children and mothers, especially those who are poor and from the marginalised communities, can claim their right to food. This would lead to building more anganwadis to connect with more people and provide them with basic nutrition and health facilities.

Priya John, senior programme manager at the ICICI Centre for Child Health and Nutrition, said, "In Sunderpahari block, Godda district of Jharkhand, the AWW is usually more disempowered as is the case with most AWWs of north India when compared to those of south India."

"You can at least think of AWWs mobilising women in Delhi, but in the most backward interiors of the country, where households are also separated by vast distances, it is difficult to do any community activity with prejudices against AWW women, who are also tribal, playing out. Besides, the level of apathy and corruption among those administering the ICDS is very high, with probably everyone bribing everyone in a top-bottom chain." Even though the anganwadi scheme is very comprehensive and has great potential, it has to be administered properly all over the country, she said.

According to the 2007 report filed by the Working Group on Children under Six, only about one per cent of the Union budget is spent on children under six years of age - that is, those who genuinely need help from anganwadis don't get it. "Most children don't visit us at the AWC. Sometimes we also fail in our duty to reach out to them. This is especially true of the last few years because we feel highly demotivated and pressurised to fill registers despite knowing that the data being entered is not accurate," rued Parvati.

"In terms of physical infrastructure, about 17 lakh AWCs are needed to cover our entire population - 11 lakh more than what we currently have," said Dipa Sinha from the team of Commissioners to the Supreme Court (CWP 196/2001), recently appointed to ensure that apex court's order regarding universalisation of AWCs and right to food for all gets properly implemented.

"Further, the government should first get all the current vacancies in the existing AWCs filled by conducting exams and selecting capable candidates on a priority basis," said Hemlata. Data shows that there are 2,551 CDPO seats, 16,245 supervisor seats, 69,924 AWW seats and 1,21,896 anganwadi helper seats lying vacant at the end of 2009. "The government has to get proactive, advertise about vacancies and get them filled, besides setting up new AWCs," she added.

The Focus on Children under Six Report of 2006 (abridged) also highlights the fact that not only is there a need to make more AWCs available with adequate facilities like nutritious food, pre-school education material, drinking water, toilets, seating arrangement for children etc, but there is also a need to achieve universalisation of AWCs across the length and breadth of this country, but with quality services that are distributed with equity.

"The overworked AWW can be given some relief by appointing a second AWW, besides better remuneration. Coordination between the health workers and AWWs has to be improved, with full attention given to ensuring health rights of children, mothers and adolescents through the anganwadi," Sinha told Hardnews

"The AWW's salary should be increased to match the rising prices. One also has to reorient all the administrators, right from the top. All village-level workers, including AWWs and helpers, should be motivated again about the purpose of running an AWC. Consistent dialogue and communication at all levels are needed to understand the importance of caring about the health of women and children in the community," said Prof Ritupriya Mehrotra, Centre of Social Medicine and Community Health, Jawaharlal Nehru University.

"Just because the government didn't start such community processes earlier, it doesn't mean they cannot be put in place now. After all, ICDS is a very large, comprehensive public programme with huge potential and outreach, if administered conscientiously," she added.

G Dilip Diwakar, who is researching ICDS in Kancheepuram district of Tamil Nadu, said, "The state government has to be given credit for increasing the salary of AWWs and helpers, providing pension to workers who have completed 30 years of service, and giving AWCs all the required materials to run them effectively. Children and mothers are fed well with a rich diet of sathumavu (nutritious powder made of cereals and sugar), eggs and vegetables in different combinations on different days and in sufficient quantity. Tamil Nadu is a privileged state in this context."

This positive experience can be repeated in many other states if the government and the administrators show will-power and sensitivity towards women and children. There is a certain correlation between good nutrition, reduced morbidity and mortality rates that must not be forgotten.

From the print issue of Hardnews : OCTOBER 2010