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.

Dharna for a just and comprehensive National Food Security Act

From RTF updates:

Announcement

Dharna at Jantar Mantar, outside Parliament on 25th and 26th November 2010, 10am onwards

Be there to raise your voice in support of a just and comprehensive National Food Security Act!

After an agonising four months of discussions, the final recommendations of the NAC for the National Food Security Bill are extremely disappointing. The enactment of the NFSA could have helped the country overcome the gravest problem facing us today – that of declining food availability and an agrarian crisis. The recommendations however essentially deal only with a cereal-based targeted PDS and are a far cry from the comprehensive approach required to truly ensure food security for all. While the proposed child and maternal entitlements are minimalistic, social security pensions for the destitute have been kept out of the Bill.

We are shocked that the expansion of food entitlements for all is not even being considered. Arguments of lack of resources cannot be accepted where on the other hand the same government provides tax exemptions and rebates of over Rs. 5 lakh crores (in 2009-2010) majorly to the corporate sector.

The working group on food security of the NAC will now be drafting the National Food Security Bill based on these final recommendations and the bill will then be tabled in the Parliament. Hence, it's immensely important that we all get our hands together and raise our voice asking for a just and comprehensive food security act.

A dharna has been planned outside Parliament at Jantar Mantar on 25th and 26th November. We request all of you to be there to extend your full support.

Summary of our demands:

· An overarching obligation to protect everyone from hunger;

· Promotion of sustainable and equitable food production ensuring adequate food availability in all locations at all times;

· Protection against forcible diversion of land, water and forests from food production;

· Protection of food sovereignty and elimination of the entry of corporate interests and private contractors in food production, distribution and governance;

· Promotion of decentralized food production, procurement and distribution systems;

· Protection of interests of small farmers especially ensuring that farmers are given remunerative prices for food items.

· A Universal Public Distribution System providing at least 14 kgs of grain per adult per month as well as 1.5 kgs of pulses and 800 gms of oil, with comparable quantities for children;

· Special food and cash entitlements for households (including an expanded Antyodaya programme for single women, old, dalits, Tribals, Disabled, Transgender, landless and marginal farmers, daily wagers, slum dwellers, migrants etc.);

· No use of technology for identification purpose which can violate the civil liberties and human rights of the people.

· Consolidation of all entitlements created by recent Supreme Court orders (e.g. cooked mid-day meals in primary schools and universalization of ICDS);

· Support for effective breastfeeding (including skilled counselling, maternity entitlements and crèches);

· Immediate moratorium on genetically modified (GM) seeds, GM food imports, and use of GM food in government food schemes.

· Universalisation with quality of the ICDS, crèches for young children, universal and unconditional maternity entitlements and cooked mid day meals for school children.

· Elimination of all social discrimination in food–related matters;

· Safeguards against cash transfers replacing food transfers under any nutrition-related scheme;

· Provisioning of Ration cards in the name of women.

· Strong accountability and grievance redressal provisions, including mandatory penalties for any violation of the Act and compensation for those whose entitlements have been denied.

There will be dharnas at Jantar Mantar on the 22nd, 23rd and 24th of November as well regarding the Land Acquisition (Amendment) Act, Resettlement and Rehabilitation Bill, Special Economic Zone Act, Forest Rights Act, Coastal Regulation Zone etc.

We are,

The Steering group of the Right to Food Campaign,

Anjali Bhardwaj, Nikhil Dey, Ankita Anand (National Campaign for People’s Right to Information), Annie Raja (National Federation for Indian Women), Anuradha Talwar, Gautam Modi and Madhuri Krishnaswamy (New Trade Union Initiative), Arun Gupta and Radha Holla (Breast Feeding Promotion Network of India), Arundhati Dhuru and Ulka Mahajan (National People’s Movement of India), Asha Mishra and Vinod Raina (Bharat Gyan Vigyan Samiti), Ashok Bharti and Anup Srivastava (National Conference of Dalit Organizations), Colin Gonsalves (Human Rights Law Network), G V Ramanjaneyulu (Alliance for Sustainable and Holistic Agriculture), Kavita Srivastava and Binayak Sen (People’s Union for Civil Liberties), Lali Dhakar and Meera Paliwal (Ekal Nari Shakti Sangathan), Mira Shiva and Vandana Prasad (Jan Swasthya Abhiyan), Paul Divakar and Asha Kowtal (National Campaign for Dalit Human Rights), Prahlad Ray and Anand Malakar (Rashtriya Viklang Manch), Subhash Bhatnagar (National Campaign Committee for Unorganized Sector workers)

Secretariat - Right to Food Campaign

C/o PHRN, 5 A, Jungi House, Shahpur Jat, New Delhi 110049. India

Email: righttofood@gmail.com

Phone - 91 -11 -2649 9563

Website: http://www.righttofoodindia.org/

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Some photos from dharna

JalSamvaad's photo exhibition opposing Delhi govt. for poor flood management and 'beautifying' city for CWGs by evicting the 'ugly looking' poor

Happy 12th Birthday CHILDLINE Delhi!

Volunteers paint children's hands for printing on canvas as part of birthday celebration activities. Yes, there were birthday balloons and lots of cake for everyone to feast on too!

Childline directors shake a leg while children let their hair down 

There were smiles everywhere as the DJ played popular dance numbers in Don Bosco School's playground. In my view, this was a big-time 'mainstreaming' exercise for children, who dialed 1098 and were subsequently rescued from dangerous situations.

 Their excitement in front of camera was tangible and infectious :)

For more photos, click here.

Pahar Ganj main bazaar

The photo was clicked during participation in the City Walk programme organised by Salaam Baalak Trust, Delhi. For more photos, click here.

'Happy' Diwali

Have been exchanging Diwali wishes since the last few days. But that day has arrived where one can think of hiding under the bed in a room, whose doors and windows have been tightly latched from the inside. This is a strategy of saving myself from inhaling tonnes of smoke released by Diwali crackers without even knowing 'how much' actually went inside. Earlier it was only the birds, asthmatics, or the old and ailing who couldn't bear smoke and noise from crackers. I am neither a harmless bird, nor an asthmatic or an ailing person (not in any way that I know of), but I cannot seem to tolerate the warm, yet poisonous, blanket of smoke that'll gradually wrap me up from the inside tonight, especially gripping the lungs to reduce their oxygen breathing capacity...

Was chatting with a friend from Maharashtra who said that her state had just witnessed a string of 'festivals of pollution' like Ganapati, Navaratri and Dussehra, where the river bodies choked. But, one can conveniently close ones eyes to that and pretend that those are 'just far-away rivers'. However, aquatic plants and animals would disagree as rivers comprise their complete life source so they cannot take their own gagging lightly. Maybe if living creatures of water could speak with living creatures of the land, and in a language they understood, maybe the latter could have considered finding ecologically healthier ways of appeasing-Gods-at-any-cost. I don't think any 'real' Gods would appreciate so much killing to boost their own ego annually, i.e. just once a year.

   

Anyway, between the two realities i.e. river choking and subsequent dying of aquatic life in Maharashtra and direct, almost inevitable, human-lung-choking during Diwali in Delhi, the latter seemed like a much more immediate concern for me. Just when I was convinced about the importance of what I was thinking, Aruna Roy's group Diwali message beeped on the mobile phone. It said: "Join us on 5th November at 5pm at Statue Circle, Jaipur, with unlit diyas to celebrate kali diwali and demand payment of minimum wages in MNREGA."

(Source: http://www.activityvillage.co.uk/diya-collage-card.htm)

Meeting Tellis

I finally met Dr Ashley Tellis for lunch yesterday at Mamu dhaba in JNU. He is forever surrounded by people, and yesterday, I was one of them. We were a mix of researchers from different centres of JNU (one was from IIT), straight and gay people, basically ‘feminists’ at heart. What was supposed to be a pure luncheon turned out to be the first meeting of a group called a ‘good idea’ (might have to check that again). Though I am cynical with on-campus groups since in the last few years one has only witnessed a declining level of discourse and politics on campus, still I kept my opinion to myself for then. Anyway, coming back to yesterday’s meeting with Tellis.

I have been circulating his petition for days now (http://www.ipetitions.com/petition/ashelytellis/; more than 800 signatures in 4-5 days means overwhelming support for him) and found it rather amusing to be meeting him after already sticking my neck out for him, his politics, whatever I have managed to perceive of it till now. His razor-sharp logic can tear apart any thought and give it dimensions that the speaker, who could be anyone, never thought of before opening his/her oral cavity. In that sense, the unplanned visit to Mamu’s was slightly draining but certainly very meaningful. No teacher, friend, family or office colleague ever stresses on ‘using the mind’ in an ordinary conversation as much as Tellis does. That is such a welcome treat but can get stressful if one is not used to an obscene amount of honest questioning of mundane experiences of life. So it’s almost like a challenge to sit in Tellis’s company and also to keep up with his very creative, rational onslaught, if I may call it that.

Btw, he referred to himself as a girl few times yesterday but that somehow didn’t sound as disturbing to my ‘heterosexual, slow, peace-seeking, forgetful and forgiving Vipassana’ mind, as I expected it to sound. Till before yesterday’s meeting, I still imagined myself to be a rigid person from the convent education regime imposed on me in childhood, but I guess I have (un)learned lots and moved on from there at least. Was introspecting that since gender is a social construct we grow up rehearsing in our minds (along with societal reinforcements) but what we call just ‘the mind’ must not have a notion of ‘gender’ by itself unless we feed it with stereotypes of how to look at itself and the person carrying it.

What I am then implying is that if a person’s gender has everything to do with his/her state of mind along with what one is feeling at that moment, then, at the cost of sounding complicated, I think it’s ok for a person to feel masculine and/or feminine traits and in different combinations at different points in his/her life. For instance, taking the two commonly used gender categories of man and woman, aggression as a quality is considered ‘masculine’ but women can be aggressive too when they have to fend for themselves as single women or single mothers. Being tender and caring is considered to be a ‘feminine’ trait but men can become caring too. I know at least three almost non-sexist, almost non-patriarchal and caring men - two male teachers and one male classmate precisely - while I also know of many more patriarchal and non-patriarchal but aggressive women, who survive the 'big bad world', which is considered a 'masculine' thing to do.

So, who else can decide that combination of qualities but the person concerned himself/herself as per his/her requirement/need? Then the logic of dividing people into distinct categories (queer vs. non queer, homosexual vs. heterosexual etc) also loses meaning to an extent unless it is done to fight a political fight, where asserting group identity becomes necessary to demand basic human rights.

Coming back to Tellis, I decided to be ok when I heard a statement like ‘I am a clean girl’ (in the context of hygiene practices) from a person who is physically a man, who exudes tender vibrations while uttering swear words all the time. I realise it’s a very interesting combination of qualities we have here but what is clear and certain is this person’s humanity. He might speak profanities and have the skill to mount rib cracking jokes on them, but one doesn’t ‘feel’ offended while sitting next to him. His vibration should have created lots of discomfort considering possibilities of all that can come out of his extraordinarily witty brain, but thankfully, he ‘feels’ like a very sensitive, genuine and reliable person. This I am sure about. Glad I finally met him.

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

Hunger Kills (June 2010 story)

http://www.hardnewsmedia.com/2010/06/3577

Why do governments in India refuse to accept mass malnutrition and starvation deaths, while the reality is so intensely stark, widespread and tragic?

Even a preliminary inquiry concerning starvation in India would reveal numerous reports of entire families wiped out by chronic malnutrition. People get trapped in a negative spiral of poverty, malnutrition, starvation, unemployment, ill-health and severe immune deficiency till death comes to their rescue, releasing them from this unbearable misery.

Take the recent case of five starvation deaths in the Bariha family of Balangir district of Orissa between September and December of 2009, which were attributed to 'a medical condition' like malaria - the usual official practice of denial when it comes to reacting to such easily preventable deaths. "Research shows that even medicine does not work on an empty stomach, so people starving with chronic malnutrition are bound to die within a couple of days, despite last-minute medical interventions," said Prof Ritupriya Mehrotra at Jawaharlal Nehru University (JNU). "This is just the tip of the iceberg. Therefore, such deaths, when reported, should be used as a marker by the government to identify communities in need of urgent government assistance," she told Hardnews.

After the reported deaths in Balangir, the National Human Rights Commission (NHRC) was compelled to appoint a special team in March 2010 to investigate deaths in the Bariha family and prepare a detailed report on the underlying causes. The report is not in the public domain yet. Ironically, Damodar Sarangi, who led this special NHRC team, refused to share his experience of interaction with impoverished village survivors, trapped in the same vicious circle of poverty, starvation, unemployment and sickness - and already in the death-queue, awaiting their turn. Instead, he asked this reporter to file an RTI to get the required information.

The Kalahandi-Balangir-Koraput (KBK) belt of Orissa is one of the most starvation-prone regions in India. NHRC has made special recommendations to provide free cooked food to old, infirm and destitute people here in the past. "The problem is not so much about how many schemes there are. It is about how many get implemented and reach out to the people they're meant for. There are 22 central government schemes already in place that could benefit the people but actually do not," Devinder Sharma, a renowned food policy analyst, told Hardnews.

Dr Preet Rustagi, senior fellow at the Institute for Human Development (IHD), Delhi, said, "Besides other districts in India, we have identified the KBK belt where priority or urgent interventions are needed not just to ensure food security by enabling access to food, whichever the government scheme may be, but also to improve communication, infrastructure and literacy amongst women to improve overall well-being." IHD has studied eight Indian states on behalf of the UN World Food Programme to identify the most food-insecure groups.

"In an interim order of 2002 passed in the famous People's Union for Civil Liberties (PUCL) vs. Union of India and Others case (famously called the Right to Food case), the Supreme Court said no state in India should have starvation deaths or else the state administration would be held responsible. That is the reason why no government official will formally admit to these deaths as 'starvation deaths' or else they will have to face the heat. Starvation deaths like in the Bariha family are, therefore, said to be caused by anything but under-nutrition," said Pradeep Baisakh, a writer-activist who met some of the starving families in Balangir.

When Hardnews contacted Balangir Collector Sailendra Narayan Dey, he flatly rubbished media reports about starvation deaths and disconnected the phone after saying, "Deaths keep happening everywhere because of one or the other reason, mostly diseases. All these reports are false. You journalists make up stories. There are no starvation deaths here."

A collector who denies media reports about starvation deaths would obviously go on to deny any relief claims by members of the family. He will not accept that the deaths were due to (preventable) malnutrition in the larger community. "Had he acknowledged these starvation deaths for what they were, he could have put his act together and prevented further deaths by ensuring that the poor and needy get the food security benefits due to them. So you can only imagine the kind of suffering people are living in," said Kumaran from JNU, who is researching food security and hunger.

"Those left behind to fend for themselves when the head of the family starves to death, literally, beg to die themselves. Their situation is so deplorable because they have no financial assets left after everything they had is sold off to meet medical expenses in their last ditch effort to save the loved one. To make conditions worse, the promise of 100-days annual work under the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS) stands broken because neither is work provided for even half of the days promised, nor are timely wages given. Instead of waiting for three-four months to get their dues, people migrate out in a desperate search for work to get money to buy food," lamented Baisakh, after returning from his field-survey. Land is not a sustainable source of income in the entire KBK belt as it is a drought-prone area with dwindling forests and natural resources, he added.

"How can we call the society we live in 'civil' when the degree of inequality between the rich and poor is so immense? Only the top five per cent are well-to-do, while, a sizeable percentage of farmers, widows, children and the destitute are either dying of under-nutrition or committing suicides every year," said Dr Vandana Prasad, joint convener, Jan Swasthya Abhiyan.

"The high GDP is just an average number that hides the income disparities between the haves and haves-not. The rates of infant mortality and maternal mortality are so high in India, with 50 per cent children dying of under-nutrition and a large number of women dying of anemia. These are all preventable deaths that can be avoided by adequate, nutritious food that people should be able to buy, considering the steadily rising prices of foodgrains," she said.

"Starvation death, therefore, is not a technical or a medical issue, and should not be conceptualised as an individual's problem. It reflects a larger socio-economic reality that must be dealt with at a systemic, macro level," she explained.

Said Alaknanda Sanap, "In terms of fair distribution of the benefits of government schemes, people in north India face a higher degree of caste and class bias from administrators as compared to those in south India, even though there are other issues there." Sanap has researched provisioning under the Integrated Child Development Services (ICDS) scheme at the National University of Educational Planning and Administration, Delhi.

A groundbreaking writ petition filed in 2001 by PUCL in the Supreme Court regarding hunger in Rajasthan has led to the emergence of a Right to Food (RtF) campaign in India with the core demand of making the right to food and secure employment a fundamental right of every citizen as part of Right to Life enshrined in the Constitution. There have been 50 interim orders since then as the case continues.

Major Supreme Court orders regarding the RtF campaign have converted food and employment schemes into legal entitlements and achieved universalisation (expansion) of food entitlement programmes like ICDS through anganwadis and the mid-day-meal scheme in primary schools run or aided by the government.

NC Saxena and Harsh Mander (both top retired government officials) have been appointed commissioner and special commissioner to the apex court, respectively, to monitor all food schemes in the country. They have the authority to hold states accountable for not providing people their legal entitlements with regard to the right to food.

Saxena has experienced first-hand the high level of under-reporting of severe malnutrition by state governments. Despite documented hunger and destitution in the Kalahandi district of KBK, for instance, the official 'severe malnutrition' figure is a laughable one per cent. "Most state governments, in our experience, deny extreme hunger or starvation in their states and present wrong data. It is a serious problem that must be resolved urgently. Then there is the problem of governance. State-level administrators, especially in the ministry of women and child development, think it is an easy place to make quick money, especially after the recent hike in nutrition-related project funding. This attitude has to change. Thirdly, we need to decide upon a protocol to identify starvation deaths," said Saxena.

"The main challenge for us is to recognise hunger and starvation while it is happening, not after the deaths have taken place," said Harsh Mander. Revealing heartrending details about how poor people respond to hunger, he said, "There are some whose longing for food gradually fades away because they don't get it, others eat less and get habituated to low diet, or else find pseudo-foods for psychological relief. There are people in Orissa who beg for starch leftovers after rice is cooked by their neighbours. This starch is their main food. There are others who boil and eat grass and tubers, sometimes even poisonous ones, to fill their stomach even though the nutrition value of such food is zero. Some people, like the elderly, end up grazing cattle for the whole day to get two chapattis in return. So high is the level of hunger and destitution in India, but it becomes visible only when people die."

Identifying the challenges in dealing with the situation, Mander said, "We do have the famine code in a few states but what we don't have is a 'starvation code'. But before deciding on that, we need to adequately define and agree upon a common definition and some 'measurement' criteria for starvation." Saxena and Mander were speaking at a national conference on identification of acute hunger to prevent starvation deaths held recently in JNU.

The RtF campaign has led to a demand for a proper Food Security Act. The draft bill ran into trouble recently as the empowered group of ministers suggested clauses like a reduced entitlement of 25 kg food grain at Rs 3 per kg (as against the existing 35 kg at Rs 2 per kg), that too for a few 'targeted' people, even though the majority live below the poverty line. "The draft bill is a very unfair document that doesn't look at overall nutritional needs and multiple entitlements of everyone in society. Hopefully, the improved draft will be designed bearing in mind the larger issues of food production and distribution, and economic and agricultural policies, all of which tend to be anti-poor," said Dr Vandana Prasad.

Devinder Sharma suggests that if self-reliant, traditional food security systems are re-introduced in five out of six lakh villages of India, it would go a long way in significantly reducing the existing high level of nutritional and food insecurity. He said, "If only we could go back to our traditional roots wherein village community elders preserved foodgrains for collective or emergency usage - there would not be a single starvation death." He cited a popular saying in these self-sufficient villages, "Jide ghar daane, aude nyane vi syaane (a household with enough foodstock will obviously have healthy children/family members)." Are the state governments, and the aam aadmi government, listening?

From the print issue of Hardnews : JUNE 2010

Film review: 'So shall you reap'

http://www.hardnewsmedia.com/2010/09/3693

Ajay Bhardwaj's film rips apart the mask of food politics pushed by biotech companies.

Shaweta Anand Delhi

As part of 'Filmy Feast' held in Delhi recently, Ajay Bhardwaj's So Shall You Reap stood out for its honest portrayal of the plight of Indian farmers. Many of them are anxiously trapped in the web of promises made by profit-seeking biotech companies, feeling all the more insecure in the stark absence of pro-farmer government policies.

Monsanto and Indian Mahyco are two such companies facing scathing critique in the film for selling genetically modified (GM) cotton or Bt cotton to unsuspecting Indian farmers. Surprisingly, Indian regulatory bodies allow introduction of such GM crops even though no independent health-safety tests have been conducted on them except by the biotech companies themselves.

In this 35-minute documentary, Bhardwaj covers a lot of ground as he strings together perils of sowing and reaping GM crops in villages of Punjab, Haryana and Andhra Pradesh. He successfully brings out the food politics played out by companies, governments and, in protest and retaliation, by farmers who are rejecting the paradigm of dependent/market-based agriculture by opting for organic methods in a few places.

The timing of this film's screening is especially critical in the backdrop of ongoing deliberations within the central and state governments on whether or not to bring GM vegetables on our dinner plates. While the usual pro-GM argument is that GM crops will bring in food security for all, this film brings out the experience of farmers at grassroots who vouch that this food technology is not geared to help them but to allow biotech companies to mint more money at any cost.

The film enters a rural landscape where farmers cultivating small pieces of land invest every rupee and fiber of emotion into the crops they are planting, hoping that the yield will sustain their needs. Their hope turns into rage when the promise of Bt cotton - the only GM plant allowed in India - fails the test of time, leading to dead cattle, allergic body reactions, reduced soil productivity and near bankruptcy. Agriculture becomes an expensive exercise of dependence on agri-biotech companies that prepare Bt seeds, pesticides and fertilisers, together creating a trap for more input-intensive cropping, including more water for irrigation.

Though it's a short film, crucial minutes are spent explaining how crops are genetically modified in sophisticated labs by isolating genes for exotic traits from one species and artificially fitting them into other species, something that nature would never allow. The most touching moment is when a farmer confessed how his heart broke when he had to uproot his own Bt cotton crop ruthlessly as Bt-resistant pests had ruined it!

He luckily managed to plant paddy as crop failure is not an option when his only piece of land was on lease and he had family responsibilities to shoulder. However, if you have seen Peepli Live, you would know that committing suicide is a definite option many farmers have already chosen in depressing times.

Unlike the other Indian film, Poison on the Platter, screened at the festival, Bhardwaj's film talks about realistic alternatives farmers are already opting for in many Indian villages, for instance, in Punjab, Andhra Pradesh and Kerala. In a befitting reply to a cold-blooded State (and its cash-rich cricket empire obsessed Union agriculture minister), many farmers have completely stopped usage of chemicals in their fields and are doing much better by turning back to traditional, organic, self-dependent agricultural practices, including seed preservation.

Made in a dozen regional languages, this film is a brainchild of members of Kheti Virasat Mission, a Punjab-based group, for screening all over the country, to inspire farmers to go back to traditional agricultural practices. The filmmaker, who has been exposed to life in rural Punjab for a decade and has made extraordinary documentaries on the rise of Dalit consciousness, Sufism, contrasting the 'victim narrative' of Partition days etc, was roped in for his comprehensive understanding of grassroots issues.

For anyone willing to take a peek into what's going on in the lives of Indian farmers while biotech companies make merry, this film is a must-watch.

Also see, To B(t) or not to B(t) (Hardnews, April 2010) http://www.hardnewsmedia.com/2010/03/3509

From the print issue of Hardnews: SEPTEMBER 2010

Nothing ‘natural’ about it

http://www.hardnewsmedia.com/2010/09/3686

Violence against women is rooted deep in the way girls are brought up to become 'women' and boys are made into 'men'

That women are not treated with dignity unless they shout from rooftops is to say the least. Women often find that they are treated as non-intellectual objects meant to entertain men at workplaces, perhaps so that the latter can perform better in a competitive, aggressive environment. Many office-going, educated women complain about not being treated in their day-to-day dealings with men in public and private spaces as human beings with intellect and their own subjectivity.

Talking about the subtle violence against women in media offices, Smriti Singh (name changed), a media professional who has worked for at least three Indian TV channels in the last ten years, says: "We often find the camera men or their assistants desperate to put the lapel mike (small microphone wired from under the clothes) on women celebrities or news reporters, just for that ever-so-slight touch of pleasure while adjusting the wires. Sometimes other male co-workers in the studio wait through the process to see if the woman's cleavage would get accidentally revealed, even for a fleeting moment. And then this becomes the staple of the men's gossip sessions, which get more graphic and enjoyable, but only for them."

Even walking the city streets alone can make a woman feel very unsafe. "No matter what I wear, men ogle at me. When I was in school, I stopped walking to tuition classes alone because boys on bikes would ride past making kissing sounds. It became very annoying and a constant source of anxiety for me," shares Vidhi Choudhary, a student from the Centre for Media Studies.

"I HAVE A car now, so I feel much safer when I travel," she adds. But a far greater number of women have to depend on public transport. "Travelling in buses is such a nightmare. During monsoons, even metro travel has become so unpleasant. Someone or the other is always on the lookout for that split second when he can touch a woman's private parts as it is easy to blame the overcrowding when confronted," says Savita Sindhu, a Delhi University student.

So what do women do when they are harassed? "Some stay silent and ignore troublesome men while others choose to confront them. Either way, we should not let our work get affected," says Choudhary.

Even the relatively progressive Jawaharlal Nehru University (JNU) is not free of incidents of harassment of women. "Physical mobility gets restricted for most girls once they are out of the JNU campus. However, even within the campus we keep getting cases of violence ranging from mental to physical torture faced by women despite being in consensual relationships, and even after marriage," says Akanksha Kumar, former student representative of the JNU's Gender Sensitisation Committee Against Sexual Harassment (GSCASH), a pioneering institution that acknowledges and punishes harassers on campus, both men or women, after a rigorous formal enquiry and fact-finding process.

"At least three recent cases of violence faced by girl students from their male teachers have come to light. The power dynamics in such cases come into play much more strongly. If the girls speak up, they might lose out on grades, but if they don't, they will certainly lose their self-esteem. Understandably, speaking up is a difficult choice at this point, but a few women do make that choice," says Kumar.

With a patriarchal set-up,restrictions on women start from childhood itself and gradually get extended to higher institutes of learning or work spaces as well, as if restricting and silencing women is the most 'natural' thing to do," explains Akhila Singh, a Delhi-based women's activist. From the clothes they wear to how 'gracefully' they should walk and talk, who they can speak with, how many hours they can spend out of home - limitations on women cover almost everything under the sun. Of course, depending on where they are located - for instance, whether in the rural or urban set-up - the restrictions (and the violence or suppression if they resist) can take various forms.

Indeed, killing of couples-in-love reveals an all-time low in levels of misogyny - as if female foeticide, infanticide, high levels of anaemia and malnutrition in women weren't enough of social problems based on deep-seated discrimination against women. Ninety per cent of the times, it is the girl's family that attacks the duo as their 'honour' gets violated when she chooses to fall in love and decides to marry a man outside set social norms. This was one of the findings of a study conducted by National Commission for Women in 2009 with help from Shakti Vahini, an NGO.

Advocate Renu Mishra, who has been relentlessly fighting for women's rights in Lucknow for the past decade, gives an interesting depiction of the subtlety in the working of patriarchal norms. She says, "If a girl straightens her spine and walks briskly with her eyes meeting the eyes of the passers-by, without her shoulders drooping an inch, she is immediately 'corrected' by someone in the family and asked to walk demurely, head bent downwards, to be a 'decent' girl. But if a man walks hesitantly, with his eyes on his feet, he's instantly reprimanded and asked to 'become a man' by fearlessly looking up into the eyes of people as he walks on the street."

It is from here that the difference in socialisation begins.

Being fearful thus becomes a desired feminine trait, but 'boys become men' as they turn aggressive. "But in police stations and courts, women are generally asked why didn't they fight back or resist the perpetrator hard enough. How can anyone sane expect women to fight back or strongly resist a man when all they are taught from childhood is to stay quiet and submit to them?" rues Mishra.

"For thousands of years, women have been trapped inside homes. Today, a large number of them have chosen to move out of the domestic sphere with vigour and determination. This effort to change the status-quo by questioning male domination in every possible way is being met with rising rates of crime against women," says Albeena Shakil, member of All India Democratic Women's Association (AIDWA).

The Delhi Human Development Report 2006 published by the Delhi government, in a section devoted to crime against women and safety, points to the alarming rise in the rate of crime against women in the capital. Adverse female-to-male ratio, high levels of rapes, sexual harassment, domestic violence etc make Delhi a very hostile and unfriendly city for women.

According to the 'Safe Cities Baseline Survey', whose findings were released in July 2010 by Kiran Walia, state minister for health and family welfare, violence against women is quite 'normalised' in the city. A large number of women live in a constant state of anxiety when out of home. However, as the National Crime Records Bureau data shows, this heightened state of discomfort is not a Delhi-specific phenomenon.

It is one thing to dig out studies and surveys to say how terrible this male-dominated society is. It is quite another to survive this suffocating system and to involve men as well in the process.

"Often men don't know how to help and have to be told how to do so without confrontation with the perpetrator," remarks Dr Suraiya Baluch, director of Princeton University's Sexual Harassment/Assault Advising, Resource and Education (SHARE) programme. Speaking at an event organised by GSCASH in JNU, Baluch acknowledged high levels of violence against women in the US and discussed community-level solutions that seek to involve everyone, especially bystanders, in stopping acts of harassment of women.

In a similar vein, Ruchi Sinha, Chairperson, Centre for Criminology and Justice, Tata Institute of Social Sciences, says it is not feasible for women alone to deal with the high rates of crime against them. For instance, all-women police stations were earlier sought as havens of justice for female victims of violence since policemen don't take their complaints seriously. But the actual experience in states like Orissa and Tamil Nadu showed that women police officers end up being heavy-handed or indiscriminate, promoting the very stereotypes they were meant to break. Indeed, violence against women cries out for an all-inclusive approach, which doesn't shrink from looking beyond merely legal solutions.

From the print issue of Hardnews : SEPTEMBER 2010