Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Empowering the girl child

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Jharkhand’s SAAMAR campaign to fight malnutrition

Note4Students

From UPSC perspective, the following things are important :

Prelims level : SAAMAR campaign

Mains level : Various facets of hunger and malnutrition in India

The Jharkhand government has announced the launch of the SAAMAR campaign to tackle malnutrition in the state.

We can expect an MCQ like:

Q.SAAMAR campaign sometimes seen in news is related to:

() Bovine health

() Mother and Child Health

() Non-communicable diseases

() None of these

SAAMAR

  • SAAMAR is an acronym for Strategic Action for Alleviation of Malnutrition and Anemia Reduction.
  • The campaign aims to identify anaemic women and malnourished children and converge various departments to effectively deal with the problem in a state where malnutrition has been a major problem.
  • Every second child in the state is stunted and underweight and every third child is affected by stunting and every 10th child is affected by severe wasting and around 70% of children are anaemic NFHS-4 data.

Features of the scheme

  • Although existing schemes are there, seeing the current situation, the intervention was required with a ‘different approach to reduce malnutrition.
  • SAAMAR has been launched with a 1000 days target, under which annual surveys will be conducted to track the progress.
  • It talks of convergence of various departments such as the Rural Development Department and Food and Civil Supplies and engagement with school management committees, gram sabhas among others and making them aware of nutritional behaviour.
  • Most importantly, the campaign, as per the note, also tries to target Primarily Vulnerable Tribal Groups.

Outlined strategy under the scheme

  • To tackle severe acute malnutrition children, every Anganwadi Centres will be engaged to identify these children and subsequently will be treated at the Malnutrition Treatment Centres.
  • In the same process, the anaemic women will also be listed and will be referred to health centres in serious cases.
  • All of these will be done by measuring Mid-Upper Arm Circumference (MUAC) of women and children through MUAC tapes and Edema levels.
  • Angawadi’s Sahayia and Sevika will take them to the nearest Health Centre where they will be checked again and then registered on the portal of State Nutrition Mission.

Why need such a scheme?

  • The state government runs various schemes under Child Development Schemes, National Nutrition Mission among others to deal with the situation, but it is not enough.
  • Dealing with malnutrition in the state monitoring has been an important concern due to the lack of doctors or health care workers.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Rajya Sabha passes MTP Bill, 2020

Note4Students

From UPSC perspective, the following things are important :

Prelims level : MTP Act

Mains level : Termination of Pregnancy (MTP) and associated issues

The Rajya Sabha has passed the Medical Termination of Pregnancy (Amendment) Bill, 2020 that increases the time period within which an abortion may be carried out.

What are the differing opinions with regards to the Termination of Pregnancy (MTP) Amendment Bill, 2020? Discuss.

MTP Bill, 2020

The MTP Bill was passed in Lok Sabha in March 2020. Its salient features included:

  • Proposing requirement for the opinion of one provider for termination of pregnancy, up to 20 weeks of gestation and introducing the requirement of the opinion of two providers for termination of pregnancy of 20-24 weeks of gestation.
  • Enhancing the upper gestation limit from 20 to 24 weeks for special categories of women which will be defined in the amendments to the MTP Rules and would include ‘vulnerable women including survivors of rape, victims of incest and other vulnerable women (like differently-abled women, Minors) etc.
  • Upper gestation limit not to apply in cases of substantial foetal abnormalities diagnosed by Medical Board. The composition, functions and other details of the Medical Board to be prescribed subsequently in Rules under the Act.
  • Anonymity of the person: The name and other particulars of a woman whose pregnancy has been terminated shall not be revealed except to a person authorised in any law for the time being in force.

Benefits sought with the bill

  • It is seen as a step towards the safety and well-being of the women and many women will be benefitted from this.
  • Recently several petitions were received by the Courts seeking permission for aborting pregnancies at a gestational age beyond the present permissible limit on grounds of foetal abnormalities or pregnancies due to sexual violence faced by women.
  • The proposed increase in gestational age will ensure dignity, autonomy, confidentiality and justice for women who need to terminate the pregnancy.

Flaws in the bill

  • The Bill allows abortion after 24 weeks only in cases where a Medical Board diagnoses substantial foetal abnormalities.
  • This implies that for a case requiring abortion due to rape, that exceeds 24-weeks, the only recourse remains through a Writ Petition.
  • The Bill does not specify the categories of women who may terminate pregnancies between 20-24 weeks and leaves it to be prescribed through Rules.
  • The Act (and the Bill) requires an abortion to be performed only by doctors with a specialization in gynaecology or obstetrics.
  • As there is a 75% shortage of such doctors in community health centres in rural areas, pregnant women may continue to find it difficult to access facilities for safe abortions.

Key Issues and Analysis

  • There are differing opinions with regard to allowing abortions. One opinion is that terminating a pregnancy is the choice of the pregnant woman and a part of her reproductive rights.
  • The other is that the state has an obligation to protect life, and hence should provide for the protection of the foetus.
  • Across the world, countries set varying conditions and time limits for allowing abortions, based on foetal health, and risk to the pregnant woman.
  • Several Writ Petitions have been filed by women seeking permission to abort pregnancies beyond 20-weeks due to foetal abnormalities or rape.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Intensified Mission Indradhanush (IMI) 3.0

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Mission Indradhanush

Mains level : Universal immunization programme

States and UTs have started the implementation of the Intensified Mission Indradhanush 3.0, a campaign aimed to reach those children and pregnant women who have been missed out or been left out of the routine immunisation.

Do not get confused with the Mission Indradhanush for Public Sector Banks launched in 2015. It aims at revamping the functioning of the Public Sector Banks to enable them to compete with the Private Sector Banks.

Intensified Mission Indradhanush (IMI) 3.0

  • IMI 3.0 is aimed to accelerate the full immunization of children and pregnant women through a mission mode intervention.
  • The campaign is scheduled to have two rounds of immunisation lasting 15 days (excluding routine immunisation and holidays).
  • It is being conducted in pre-identified 250 districts/urban areas across 29 States/UTs in the country.
  • Beneficiaries from migration areas and hard to reach areas will be targeted as they may have missed their vaccine doses during the pandemic.

About the Mission Indradhanush

  • Mission Indradhanush seeks to drive towards 90% full immunisation coverage of India and sustain the same by the year 2020. It was launched in December 2014.

Aims and objectives

  • It aims to immunize all children under the age of 2 years, as well as all pregnant women, against eight vaccine-preventable diseases.
  • The diseases being targeted are diphtheria, whooping cough, tetanus, poliomyelitis, tuberculosis, measles, meningitis and Hepatitis B.
  • In 2016, four new additions have been made namely Rubella, Japanese Encephalitis, Injectable Polio Vaccine Bivalent and Rotavirus.
  • In 2017, Pneumonia was added to the Mission by incorporating the Pneumococcal conjugate vaccine under Universal Immunisation Programme

Try this question from CSP 2016:

Q.‘Mission Indradhanush’ launched by the Government of India pertains to:

(a) Immunization of children and pregnant women

(b) Construction of smart cities across the country

(c) India’s own search for the Earth-like planets in outer space

(d) New Educational Policy

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

[pib] National Creche Scheme

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Creche scheme

Mains level : Maternity benefits act

The Union Minister of Women and Child Development have given information about the National Creche Scheme to the Lok Sabha.

Try this PYQ:

Q.Which of the following statements is/are correct regarding the Maternity Benefit (Amendment) Act, 2017?

  1. Pregnant women are entitled to three months pre-delivery and three months post-delivery paid leave.
  2. Enterprises with creches must allow the mother a minimum of six crèche visits daily.
  3. Women with two children get reduced entitlements.

Select the correct answer using the code given below.

(a) 1 and 2 only

(b) 2 only

(c) 3 only

(d) 1, 2 and 3

National Creche Scheme

  • The Ministry of WCD implements the NCS for the children of working mothers as a Centrally Sponsored Scheme through States/ UTs with effect from 01.01.2017.
  • It aims to provide daycare facilities to children (age group of 6 months to 6 years) of working mothers.

The Scheme provides an integrated package of the following services:

  • Daycare facilities including sleeping facilities.
  • Early stimulation for children below 3 years and pre-school education for 3 to 6 years old children
  • Supplementary nutrition (to be locally sourced)
  • Growth monitoring
  • Health check-up and immunization

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

MTP amendment Bill

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Paper 2- MTP (Amendment) Bill and issues with it

The article discusses the provision of the medical board in the MTP (Amendment) Act and issues with it.

Proposal of medical board

  • The Medical Termination of Pregnancy (Amendment) Bill (‘MTP Bill’) passed in the Lok Sabha is scheduled to be tabled for consideration in Rajya Sabha.
  • The Act prescribes the setting up of medical boards in every state and Union territory (UT), consisting of a gynaecologist, paediatrician, radiologist or sonologist and any other members as proposed by that state or UT.
  • Each board will be responsible for diagnosing substantial foetal abnormalities that necessitate termination of pregnancy after a 24-week gestation period.
  • Medical boards are a form of third-party authorisation and were not envisaged in the MTP Act, 1971.

Issues with the proposal

  • In the context of the current healthcare budgetary challenges, this proposal to set up infrastructure across the country to regulate medical termination of pregnancies is both financially unsound and practically impossible.
  • India’s healthcare system has neither the financial investment nor the infrastructure to sustain the operation and functioning of medical boards in every state and UT.
  • Due to the weak healthcare infrastructure in the country, it would be practically impossible to constitute these boards with the requisite specialists.
  • Even where they are set up, the accessibility of such boards for pregnant persons, especially those living in rural areas, remains a major challenge.
  • More importantly, subjecting people to multiple invasive examinations is a grave violation of their rights to privacy and dignity.
  • Requiring pregnant persons to navigate a bureaucratic web of authorisation will inevitably lead to delays and thereby impede access to safe and legal abortion services.

Poor public financing and privatisation of healthcare

  • At 1.6 per cent of GDP in 2019-20 India’s current level of public financing of health is one of the lowest in the world
  • This has meant that most health expenditure in the country is out of pocket (OOP) — borne by patients themselves.
  • OOP expenditure on healthcare is recorded at 58.7 per cent as per the National Health Accounts in 2016-17.
  • The central government has preferred to incentivise private players to set up or offer services, instead of building infrastructural and professional capacity.
  • Privatisation drives up costs of care and the handing over of public facilities to the private sector can have catastrophic consequences.
  • They additionally remain non-accountable to state authorities in terms of affordability or transparency for instance, through Right to Information enquiries, or to uphold fundamental rights like non-discrimination in treatment or employment, or even the fundamental right to health.
  • The National Sample Survey Organisation (NSSO)’s 75th report shows that less than 20 per cent of the population is covered by health insurance in India.
  • According to the National Health Profile 2017, India has only one doctor for roughly 10,200 people in the public sector.

Consider the question “Discsss the changes made by the Medical Termination of Pregnancy (Amendment) Bill and the challenges its provision could face.”

Conclusion

Poor public health infrastructure and absence of specialists across the country have meant that most abortions do not happen in the public sector, but at private centres or at home. With overwhelming shortfalls in specialist availability, especially in rural and scheduled areas, it would be impossible to constitute boards with requisite specialist representation as contemplated under the MTP Bill.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Pradhan Mantri Matru Vandana Yojana (PMMVY)

Note4Students

From UPSC perspective, the following things are important :

Prelims level : PMMVY

Mains level : Maternity healthcare

The government’s maternity benefit scheme, or Pradhan Mantri Matru Vandana Yojana, has crossed 1.75 crores, eligible women, till the financial year 2020, the Centre informed Parliament.

PMMVY

  • The PMMVY is a maternity benefit program introduced in 2017 and is implemented by the Ministry of Women and Child Development.
  • It is a conditional cash transfer scheme for pregnant and lactating women of 19 years of age or above for the first live birth.
  • It provides partial wage compensation to women for wage-loss during childbirth and childcare and to provide conditions for safe delivery and good nutrition and feeding practices.
  • Under the scheme, pregnant women and lactating mothers receive ₹5,000 on the birth of their first child in three instalments, after fulfilling certain conditionalities.
  • In 2013, the scheme was brought under the National Food Security Act, 2013 to implement the provision of cash maternity benefit stated in the Act.
  • The direct benefit cash transfer is to help expectant mothers meet enhanced nutritional requirements as well as to partially compensate them for wage loss during their pregnancy.

Eligibility Conditions and Conditionalities

The first transfer (at pregnancy trimester) of ₹1,000 requires the mother to:

  • Register pregnancy at the Anganwadi Centre (AWC) whenever she comes to know about her conception
  • Attend at least one prenatal care session and taking Iron-folic acid tablets and TT1 (tetanus toxoid injection), and
  • Attend at least one counselling session at the AWC or healthcare centre.

The second transfer (six months of conception) of ₹2,000 requires the mother to:

  • Attend at least one prenatal care session and TT2

The third transfer (three and a half months after delivery) of ₹2,000 requires the mother to:

  • Register the birth
  • Immunize the child with OPV and BCG at birth, at six weeks and at 10 weeks
  • Attend at least two growth monitoring sessions within three months of delivery

Additionally, the scheme requires the mother to:

  • Exclusively breastfeed for six months and introduce complementary feeding as certified by the mother
  • Immunize the child with OPV and DPT
  • Attend at least two counselling sessions on growth monitoring and infant and child nutrition and feeding between the third and sixth months after delivery

Before judging this factual information, take this PYQ form 2019:

Q.Which of the following statements is/are correct regarding the Maternity Benefit (Amendment) Act, 2017?

  1. Pregnant women are entitled to three months pre-delivery and three months post-delivery paid leave.
  2. Enterprises with creches must allow the mother a minimum of six crèche visits daily.
  3. Women with two children get reduced entitlements.

Select the correct answer using the code given below.

(a) 1 and 2 only

(b) 2 only

(c) 3 only

(d) 1, 2 and 3

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Paternity Leave in India

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : Parental care and associated societal perspectives

Indian cricket captain has opted for paternity leave amidst an ongoing tournament. This has led to his criticism as well as praise for prioritizing family.

Q.Paternity leave is one of the solutions which can help in ending the “motherhood penalty”.  Examine with context to working mothers.

What is Paternity leave?

  • Paternity leave is a short period of leave for the father to take immediately following childbirth to help care for the child and assist the mother.
  • Parental leave is a longer period of leave granted to look after the infant child, usually after the expiration of paternity/maternity leave.

Legal Aspects of Paternity Leave in India

There is no specific or explicit law for paternity leave in India.

  • Maternity leave is governed by the Maternity Benefit Act, 1961 which was last amended in 2017 to enhance the period of maternity leave to 26 weeks from the previous 12 weeks.
  • The Central Civil Service (Leave Rules), 1972 allows for 15 days of paid paternity leave before childbirth or up to 6 months from the date of the delivery of the child.
  • An attempt was made to introduce a pan India legislation on paternity leave in 2017 as a private member’s bill in Lok Sabha, but it was not successful.
  • The Paternity Benefit Bill, 2017, provided for a paid leave of fifteen days which could be availed up to three months from the date when the child was born.
  • It also included an adopted child below the age of three months and applied to men in the organised i.e. private as well as unorganised sectors.

Popular trends

  • The longest leave –– six months –– is provided by Ikea, which extends rules from home country Sweden to India.
  • Among Indian companies, Zomato made news in 2019 when it decided to give 26-week paternity leave to its employees.

Precursors in India

  • The Central Government recently announced that male government employees who are ‘single parents’ which included widowers, divorcees, or unmarried men raising children single-handedly would now be entitled to “child care leave” (CCL).
  • Here, they would receive 100% of the leave salary for the first 365 days of leave and 80% of leave salary for the next 365 days.
  • This leave was previously only available to women employees.

Why paternity leave matters?

  • Most working new mothers (for those who can make that choice) opt for maternity leave either just before the birth or after childbirth.
  • It paves the way for at least their temporary, and sometimes their permanent exit from the workplace.
  • On the other hand, not many fathers experience much difference in their employment and workplace situation after their child is born, which may either be voluntary by not taking time off or involuntary.
  • This structural difference is one of the key components that influence gender dynamics both in the workplace and at home.

The gender dynamics behind

  • Lack of paternity leave not only robs new fathers of the crucial chance to bond with their newborn child but also reinforces women’s role as the primary caregiver and underpins the belief that child care is predominantly the mother’s job.
  • Paternity leave is a way to directly address the gender dynamic that prevails both at the workplace and at home.
  • The undue burden of childcare that is placed on women at home is bound to and does, spill over into their workplace and professional lives.
  • The natural effect of it is that it puts hurdles across women’s careers and might slow their growth prospects while some women might choose to quit altogether.

Way forward

  • By only having maternity leaves and not giving due consideration to paternity leave, the stereotype that women belong at home, taking care of children is reinforced.
  • By no means is the introduction of paternity leave a panacea for gendered workplaces, but it will be a significant step in combating and overcoming stereotype.
  • For India, a decent way to begin would be to have a national policy on paternity leave that would include all fathers and would apply irrespective of whether they worked in the organised or unorganised sectors.
  • Shifting from a purely maternity oriented care framework to a parental care framework which would involve both parents would be beneficial for all stakeholders and is what we need today.

Conclusion

  • A major benefit that accrues from paternity leave is that it eases pressure and stigma from women at the workplace, as they no longer are the only ones who are taking leave for child care purposes.
  • Paternity leave is also one of the solutions which can help in ending the “motherhood penalty”.
  • The motherhood penalty is a term that describes the disadvantages that women with children face as compared to women who don’t in workplaces.
  • Fathers need to be active co-parents and not just helpers to their female partners/wives.
  • And for ones with feminist’s perspectives, they should not look paternity leave as a sole vacation for men.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Improving the diet of low income households to address malnutrition

Note4Students

From UPSC perspective, the following things are important :

Prelims level : National Family Health Survey

Mains level : Paper 2- Problems of malnutrition and issues with it

The article suggests the ways to deal with the menace of malnutrition in the country.

Findings of the first phase of NFHS-5

  • Recently, the first phase of the NFHS-5 survey was published.
  • The deteriorating nutrition and anaemia indicators, especially among children is a cause for concern.
  • More deterioration in nutrition indicators following the COVID-19 pandemic is feared in the next phase of NFHS-5.
  • This deterioration would be on account of loss of livelihoods, reduced food consumption among the poor and disruption of government nutrition programmes.

Challenges

  • Unlike a disease outbreak there may not be any popular demand to address malnutrition — the public, by and large, does not have adequate information about the damage malnutrition causes.
  • Hence, in the Indian context, it becomes the responsibility of the government/civil society to first provide information and awareness to the community about malnutrition.

Steps to be taken

  • The government should examine the current nutrition-related programmes, and analysing why they are not able to reduce malnutrition faster.
  • Additional interventions could be introduced in pockets, identified as high-burden districts.
  • There should be different norms and more intensive interventions within the ICDS for these chronically malnourished pockets.
  • We need to know if the National Nutrition Policy 1993 is still operational.
  • If not, it seems that we are attempting to address this problem without a policy framework or plan of action.

Addressing the root cause of malnutrition in India

The following three deficits are the root cause of malnutrition in India.

1) Dietary deficit

  • There is a large dietary deficit among at least 40 per cent of our population of all age groups, shown in— the National Nutrition Monitoring Bureau’s Third Repeat Survey (2012), NFHS 4, 2015-16, the NNMB Technical Report Number 27, 2017.
  • Our current interventions are not being able to bridge this protein-calorie-micronutrient deficit.
  • The NHHS-4 and NFHS-5 surveys reveal an acute dietary deficit among infants below two years, and considerable stunting and wasting of infants below six months.
  • Unless this maternal/infant dietary deficit is addressed, we will not see rapid improvement in our nutritional indicators.

2) Information deficit at household level

  • We do not have a national IEC (information, education and communication) programme that reaches targeted households to bring about the required behavioural change regarding some basic but critical facts.
  • For example, IEC tells about the importance of balanced diets in low-income household budgets, proper maternal, child and adolescent nutrition and healthcare.

3) Inequitable market conditions

  • The largest deficit, which is a major cause of dietary deficiency and India’s chronic malnutrition, pertains to inequitable market conditions.
  • Such market conditions deny affordable and energy-fortified food to children, adolescents and adults in lower-income families.
  • The market has stacks of expensive fortified energy food and beverages for higher income groups, but nothing affordable for low-income groups.

Conclusion

Raising the diet of our people from subsistence level to higher levels of nourishment by overcoming the triple deficit is the only way to improve the nutritional indicators of our population — amongst children, adolescents and adults.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Need to focus on the well-being of the child from womb to first five years

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Trends in the various data of NFHS

Mains level : Paper 2- Analysis of NFHS-5 data

The article analyses the data of NHFS-5 and try to factors responsible for the outcomes.

Analysing health and nutrition of child through NHFS-5

  • The recently released fifth round of the National Family Health Survey (NFHS-5) provide insights into some dimensions of micro-development performance before COVID struck.
  • The latest round only has data for 17 states and five Union territories.
  • Madhya Pradesh, Uttar Pradesh, Punjab, Rajasthan and Tamil Nadu are notable exclusions.
  • Many of the child-related outcomes are also determined by state-level implementation, therefore neither success nor failure can be attributed to state or the centre alone.

Let’s understand the data

  • The NFHS has 42 indicators related to child’s health and nutrition.
  • Indicators fall into nine categories and each of these can be divided into outcomes and inputs.
  • For example, neonatal, infant and under-5 mortality rates can be thought of as outcomes.
  • Similarly, all the nutrition indicators —stunting, wastage, excess wastage, underweight and overweight can also be classified as outcomes.
  • In contrast, the post-natal care indicators relating to visits made by health workers and the extent and nature of feeding for the child can be classified as inputs.

Outcomes of the survey

  • On the front of wasting (weight for height of children) these is an improvement because even though the gains were marginal, they reversed a negative trend between 2005 and 2015. 
  • India continues to be successful in preventing child deaths, but the health and nutrition of the surviving, living child has deteriorated, somewhat worryingly.
  • India continued to make progress in preventing child-related deaths (neonatal, infants and under-5).
  • The pace of improvement in child mortality slowed down relative to the previous 10 years (Fig.1).
  • Figure 2 shows the six indicators where outcomes have deteriorated. These all relate to what happens after survival:
  • The health (anaemia, diarrhoea, and acute respiratory illness (ARI)) and nutrition (stunting, and overweight) of the child deteriorated between 2015 and 2019.
  • The absolute deterioration in health and nutrition indicators must be seen against the fact that they reversed the historic trends of steady improvements.

What explains the outcomes

  • Implementation capacity of individual states probably played an important role.
  • Sector-specific factors such as changing diets are also implicated.
  • A broader deterioration in outcomes hints at the likelihood of a common factor, namely the macro-economic growth environment, which determines employment, incomes and opportunities.
  • At the least, it is safe to conjecture that some of these outcomes are inconsistent with the narrative of a rapidly growing economy.

Conclusion

As discussed in Chapter 5 of the Economic Survey of 2015-16, perhaps the next big welfare initiative of the government should be a mission-mode focus on the well-being of the early child (and of course the mother), from the womb to the first five years, which research shows is critical for realising its long run potential as an individual.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Burden of Anaemia in India

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Anaemia

Mains level : Anaemia

Indian women and children are overwhelmingly anaemic, according to the National Family Health Survey (NFHS) 2019-20 released this month, and the condition is the most prevalent in the Himalayan cold desert.

Anaemia is the condition of having a lower-than-normal number of red blood cells or a quantity of haemoglobin. How widespread is it in India?

What is Anaemia?

  • The condition of having a lower-than-normal number of red blood cells or a quantity of haemoglobin. It can make one feel tired, cold, dizzy, and irritable, and short of breath, among other symptoms.
  • A diet that does not contain enough iron, folic acid, or vitamin B12 is a common cause of anaemia.
  • Some other conditions that may lead to anaemia include pregnancy, heavy periods, blood disorders or cancer, inherited disorders, and infectious diseases.

How widespread is anaemia in our country?

  • In Phase I of the NHFS, result factsheets have been released for 22 states and UTs.
  • In a majority of these states and UTs, more than half the children and women were found to be anaemic.
  • In 15 of these 22 states and UTs, more than half the children are anaemic. Similarly, more than 50 percent of women are anaemic in 14 of these states and UTs.
  • The proportion of anaemic children and women is comparatively lower in Lakshadweep, Kerala, Meghalaya, Manipur, Mizoram, and Nagaland.
  • However, it is higher in Ladakh, Gujarat, J&K, and West Bengal, among others.
  • Anaemia among men was less than 30 percent in a majority of these states and UTs.

What was the methodology used?

  • NFHS used the capillary blood of the respondents for the estimation of anaemia. For children, haemoglobin of fewer than 11 grams per decilitre (g/dl) indicated anaemia.
  • For non-pregnant and pregnant women, it was less than 12 g/dl and 11g/dl respectively, and for men, it was less than 13 g/dl.
  • Among children, the prevalence was adjusted for altitude and among adults, it was adjusted for altitude and smoking status.

Why is anaemia so high in the country?

  • Iron-deficiency and vitamin B12-deficiency anaemia are the two common types of anaemia in India.
  • Among women, iron deficiency prevalence is higher than men due to menstrual iron losses and the high iron demands of a growing foetus during pregnancies.
  • Lack of millets in the diet due to overdependence on rice and wheat, insufficient consumption of green and leafy vegetables could be the reasons behind the high prevalence of anaemia in India.

What about the cold desert region of the western Himalaya?

  • In the union territory of Ladakh, a whopping 92.5 per cent children, 92.8 per cent women, and around 76 per cent men are anaemic in the given age groups, as per the survey.
  • The high prevalence in this region could be due to the short supply of fresh vegetables and fruits during the long winter each year.
  • Crops here are generally only grown in summer and during winter; residents fail to get a regular supply of green vegetables and fresh produce from outside, due to restricted connectivity in harsh weather.
  • However, there could be other factors as well and the causes of anaemia here are yet to be scientifically ascertained.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

India needs to rethink its nutrition agenda

Note4Students

From UPSC perspective, the following things are important :

Prelims level : NFHS

Mains level : Various facets of hunger and malnutrition in India

Poor nutritional outcomes in NFHS-5 show that a piecemeal approach does not work.

Nutrition-related data released by NFHS-5

  • The Ministry of Health and Family Welfare has released data fact sheets for 22 States and Union Territories (UTs) based on the findings of Phase I of the National Family Health Survey-5 (NFHS-5).
  • The 22 States/ UTs don’t include some major States such as Tamil Nadu, Rajasthan, Punjab, Uttar Pradesh, Jharkhand, Odisha and Madhya Pradesh.

Practice Question: The latest findings from the National Family Health Survey data shows a sign of worry. Suggest the policy measures required to tackle the health and nutrition-related issues in India.

Worrying findings

  • There is an increase in the prevalence of severe acute malnutrition in 16 States/UTs (compared to NFHS-4 conducted in 2015-16). Kerala and Karnataka are the only two big states where there is some decline.
  • The percentage of children under five who are underweight has also increased in 16 out of the 22 States/UTs.
  • Anaemia levels among children as well as adult women have increased in most of the States with a decline in anaemia among children being seen only in four States/UTs.
  • There is also an increase in the prevalence of other indicators such as adult malnutrition in many States/ UTs.
  • Most States/UTs also see an increase in overweight/obesity prevalence among children and adults shows the inadequacy of diets in India both in terms of quality and quantity.
  • The data report an increase in childhood stunting (an indicator of chronic under-nutrition and considered a sensitive indicator of overall well-being) in 13 of the 22 States/UTs.
  • Poshan Abhiyaan, one of the flagship programmes of the PM, launched in 2017, aimed at achieving a 2% reduction in childhood stunting per year.

Economic growth vs health indicators

  • There is an increase in the prevalence of childhood stunting in the country during the period 2015-16 to 2019-20.
  • This calls for serious introspection on not just the direct programmes in place to address the problem of child malnutrition but also the overall model of economic growth that the country has embarked upon.
  • The World Health Organization calls stunting “a marker of inequalities in human development”.
  • Over the last three decades, India has experienced high rates of economic growth. But this period has also seen increasing inequality, greater informalisation of the labour force, and reducing employment elasticities of growth.
  • Currently, India is witnessing a slowdown in economic growth, stagnant rural wages and highest levels of unemployment. This is reflected in the rising number of reported starvation deaths from different parts of the country.
  • The situation has become even worse due to the pandemic and lockdown-induced economic distress.
  • Field surveys such as the recent ‘Hunger Watch’ are already showing massive levels of food insecurity and decline in food consumption, especially among the poor and vulnerable households.
  • All of this calls for urgent action with commitment towards addressing the issue of malnutrition.

Social protection schemes and their impact on nutrition indicators

  • Social protection schemes and public programmes such as the Mahatma Gandhi National Rural Employment Guarantee Scheme, the Public Distribution System, the Integrated Child Development Scheme (ICDS), and school meals have contributed to a reduction in absolute poverty as well as previous improvements in nutrition indicators.
  • However, there are continuous attempts to weaken these mechanisms through underfunding and general neglect.
  • Only about 32.5% of the funds released for Poshan Abhiyaan from 2017-18 onwards had been utilized.
  • There are some improvements seen in determinants of malnutrition such as access to sanitation, clean cooking fuels and women’s status – a reduction in spousal violence and greater access of women to bank accounts.

A piecemeal approach

  • The overall poor nutritional outcomes show that a piecemeal approach addressing some aspects does not work.
  • Direct interventions such as supplementary nutrition (of good quality including eggs, fruits, etc.), growth monitoring, and behaviour change communication through the ICDS and school meals must be strengthened and given more resources.
  • Universal maternity entitlements and child care services to enable exclusive breastfeeding, appropriate infant and young child feeding as well as towards recognizing women’s unpaid work burdens have been on the agenda for long, but not much progress has been made on these.
  • The linkages between agriculture and nutrition both through what foods are produced and available as well as what kinds of livelihoods are generated in farming are also important.

Conclusion

  • The basic determinants of malnutrition – household food security, access to basic health services and equitable gender relations – cannot be ignored any longer.
  • An employment-centred growth strategy which includes the universal provision of basic services for education, health, food and social security is imperative.
  • There have been many indications in our country that business as usual is not sustainable anymore.
  • It is hoped that the experience of the pandemic, as well as the results of NFHS-5, serve as a wake-up call for a serious rethinking of issues related to nutrition and accord these issues priority.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Matru Sahyogini Samitis Scheme

Note4Students

From UPSC perspective, the following things are important :

Prelims level : ICDS, Matru Sahyogini Samitis Scheme

Mains level : Not Much

The MP government has issued an order for the appointment of committees led by mothers to ensure better monitoring of services delivered at Anganwadi or day-care centres across the State.

Try this PYQ:

Q.Which of the following are the objectives of ‘National Nutrition Mission’?

  1. To create awareness relating to malnutrition among pregnant women and lactating mothers.
  2. To reduce the incidence of anaemia among young children, adolescent girls and women.
  3. To promote the consumption of millets, coarse cereals and unpolished rice.
  4. To promote the consumption of poultry eggs.

Select the correct answer using the code given below:

(a) 1 and 2 only

(b) 1, 2 and 3 only

(c) 1, 2 and 4 only

(d) 3 and 4 only

Matru Sahyogini Samitis

  • Called ‘Matru Sahyogini Samiti’ or Mothers’ Cooperation Committees, these will comprise 10 mothers at each Anganwadi centres.
  • They would be representing the concerns of different sets of beneficiaries under the Integrated Child Development Services, or National Nutrition Mission.
  • Beneficiaries’ would include children between six months to three years, children between three years and six years, adolescent girls and pregnant women and lactating mothers.
  • These mothers will keep a watch on weekly ration distribution to them as well as suggest nutritious and tasteful recipes for meals served to children at the centres.
  • The move is being taken as per the mandate of the National Food Security Act, 2013 (NFSA).

Its’ functioning

  • The committees will include mothers of beneficiary children as well as be represented by pregnant women and lactating mothers who are enrolled under the scheme.
  • The Anganwadi scheme includes a package of six services delivered at the centres, including supplementary nutrition, health services including vaccination, early education, among others.
  • The Committees will also include a woman panch, women active in the community and eager to volunteer their support to the scheme, teachers from the local school, and women heads of self-help groups (SHG).

Why such a move?

  • This is in a move that is aimed at strengthening community response to the problem of hunger and malnutrition in the State.
  • With the help of mothers, we will be able to turn anganwadis into a community health system, a nutrition management centre, and spread awareness against social evils.
  • These will turn into a model for local governance as well as allow for greater engagement between communities and the State government.

Back2Basics: Integrated Child Development Services (ICDS)

  • The ICDS aims to provide food, preschool education, primary healthcare, immunization, health check-up and referral services to children under 6 years of age and their mothers.
  • The scheme was launched in 1975, discontinued in 1978 by the government of Morarji Desai, and then relaunched by the Tenth Five Year Plan.
  • The tenth FYP also linked ICDS to Anganwadi centres established mainly in rural areas and staffed with frontline workers.
  • The ICDS provide for anganwadis or day-care centres which deliver a package of six services including:
  1. Immunization
  2. Supplementary nutrition
  3. Health checkup
  4. Referral services
  5. Pre-school education (Non-Formal)
  6. Nutrition and Health information

Implementation

  • For nutritional purposes, ICDS provides 500 kilocalories (with 12-15 grams of protein) every day to every child below 6 years of age.
  • For adolescent girls, it is up to 500-kilo calories with up to 25 grams of protein every day.
  • The services of Immunisation, Health Check-up and Referral Services delivered through Public Health Infrastructure under the Ministry of Health and Family Welfare.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Threat of malnutrition to promise of India

Note4Students

From UPSC perspective, the following things are important :

Prelims level : POSHAN Abhiyan

Mains level : Paper 2- Analysing the contribution of POSHAN Abhiyan

POSHAN Abhiyan has completed 1000 days. The article analyses the challenges country face on the nutrition front which has been exacerbated by the Covid-19 induced disruptions.

Severity and impact of malnutrition

  • Malnourished children tend to fall short of their real potential — physically as well as mentally.
  • That is because malnutrition leaves their bodies weaker and more susceptible to illnesses.
  • In 2017, a staggering 68% of 1.04 million deaths of children under five years in India was attributable to malnutrition, reckoned a Lancet study in 2019.
  • Without necessary nutrients, their brains do not develop to the fullest.
  • Malnutrition places a burden heavy enough for India, to make it a top national priority.
  • About half of all children under five years in the country were found to be stunted (too short) or wasted (too thin) for their height, estimated the Comprehensive National Nutrition Survey, carried out by the Ministry of Health and Family Welfare with support of UNICEF three years ago.

POSHAN Abhiyan against the background Covid-19 disruption

  • The Prime Minister’s Overarching Scheme for Holistic Nutrition (POSHAN) Abhiyaan in 2018, led to a holistic approach to tackle malnutrition.
  • Under it, the government strengthened the delivery of essential nutrition interventions.
  • COVID-19 is pushing millions into poverty making them vulnerable to malnutrition and food insecurities.
  • Pandemic-prompted lockdowns disrupted essential services — such as supplementary feeding under anganwadi centres, mid-day meals, immunisation, and micro-nutrient supplementation which can exacerbate malnutrition.
  •  Leaders from academia, civil society, development partners, community advocates and the private sector have come together as part of ‘commitment to action’.
  • The ‘commitment to action’ includes commitments around sustained leadership, dedicated finances, multi-sectoral approach and increased uninterrupted coverage of a vulnerable population under programmes enhancing nutrition.

Financial commitments

  • India already has some of the world’s biggest early childhood public intervention schemes such as the Integrated Child Development Scheme, the mid-day meal programme, and Public Distribution System.
  • India needs to ensure coverage of every single child and mother.
  • To ensure this, the country needs to retain its financial commitments for nutrition schemes.
  • Economic insecurities often force girls into early marriage, early motherhood, discontinue their schooling, and reduce institutional deliveries, cut access to micronutrient supplements, and nutritious food.
  •  Accelerating efforts to address these will be needed to stop the regression into the deeper recesses of malnutrition.

Conclusion

It takes time for nutrition interventions to yield dividends, but once those accrue, they can bring transformative generational shifts. Filling in the nutrition gaps will guarantee a level-playing field for all children and strengthen the foundations for the making of a future super-power.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Anganwadi centres

Note4Students

From UPSC perspective, the following things are important :

Prelims level : ICDS program

Mains level : Paper 2- Role of Anganwadi centres in ICDS

The article highlights the role of Anganwadi’s in the effective implementation and service delivery under the ICDS.

Gaps in the utilisation of services by ICDS

  • The economic fallout of COVID-19 makes the necessity of quality public welfare services more pressing than ever.
  • The Integrated Child Development Services (ICDS) programme is one such scheme.
  • ICDS caters to the nutrition, health and pre-education needs of children till six years of age as well as the health and nutrition of women and adolescent girls.  
  • However, recent reports have shown gaps in the utilisation of services.

Recasting the Anganwadi centres

  • Anganwadi centres (AWCs) could become agents of improved delivery of ICDS’s services.
  • According to government data, the country has 13.77 lakh Anganwadi centres (AWCs).
  • These centres have expanded their reach, but they need to play a much larger role in anchoring community development.
  • Nearly a fourth of the operational AWCs lack drinking water facilities and 36 per cent do not have toilets.
  • In 2015, the NITI Aayog recommended better sanitation and drinking water facilities, improved power supply and basic medicines for the AWCs.
  • NITI Aayog also suggested that these centres be provided with the required number of workers, whose skills should be upgraded through regular training.
  •  It has acknowledged the need to improve anganwadi centres.
  • The Central government’s Saksham Anganwadi Scheme aims to upgrade 2.5 lakh such centres across the country. It is up to the state governments to take up the baton
  • Only a limited number of AWCs have facilities like creche, and good quality recreational and learning facilities for pre-school education.
  • An approach that combines an effective supplementary nutrition programme with pedagogic processes that make learning interesting is the need of the hour.

Steps taken for effective implementation of ICDS

  • Effective implementation of the ICDS programme rests heavily on the combined efforts of the anganwadi workers (AWWs), ASHAs and ANMs.
  • The Centre’s POSHAN Abhiyaan has taken important steps towards building capacities of AWWs.
  • Technology can also be used for augmenting the programme’s quality.
  • AWWs have been provided with smartphones and their supervisors with tablets, under the government schemes.
  • Apps on these devices track the distribution of take-home rations and supplementary nutrition services.
  • The data generated should inform decisions to improve the programme.
  • In Andhra Pradesh and Telangana, anganwadi centres have been geotagged to improve service delivery.
  • Gujarat has digitised the supply chain of take-home rations and real-time data is being used to minimise stockouts at the anganwadi centres.

Conclusion

Government must act on the three imperatives. First, while infrastructure development and capacity building of the anganwadi remains the key to improving the programme, the standards of all its services need to be upscaled. Second, states have much to learn from each other’s experiences. Third, anganwadi centres must cater to the needs of the community and the programme’s workers.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

[pib] Thalassemia Bal Sewa Yojna

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Thalassemia

Mains level : Not Much

Union Health Ministry has launched the second phase of “Thalassemia Bal Sewa Yojna” for underprivileged Thalassemic patients.

Thalassemia Bal Sewa Yojna

  • This scheme was launched in 2017 under the Coal India CSR funded Hematopoietic Stem Cell Transplantation (HSCT) program.
  • It aims to provide a one-time cure opportunity for Haemoglobinopathies like Thalassaemia and Sickle Cell Disease for patients who have a matched family donor.
  • The initiative was targeted to provide financial assistance to a total of 200 patients by providing a package cost not exceeding Rs. 10 lakhs per HSCT.

What is Thalassemia?

  • Thalassemia is an inherited blood disorder characterized by less oxygen-carrying protein (haemoglobin) and fewer red blood cells in the body than normal.
  • When there isn’t enough haemoglobin, the body’s red blood cells don’t function properly and they last shorter periods of time, so there are fewer healthy red blood cells travelling in the bloodstream.
  • Symptoms include fatigue, weakness, paleness and slow growth.
  • Mild forms may not need treatment. Severe forms may require blood transfusions or a donor stem-cell transplant.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Assisted Reproductive Technology Bill needs a thorough review

Note4Students

From UPSC perspective, the following things are important :

Prelims level : ART Bill

Mains level : Paper 2- Concerns with the ART Bill

There are several issues with the Assisted Reproductive Technology Bill and these issues need consideration before the passage of the Bill.

What the Bill aims to achieve

  • Union Health Minister introduced the Assisted Reproductive Technology (Regulation) Bill, 2020 (Bill) in the Lok Sabha.
  • Its aim is to regulate ART banks and clinics, allow safe and ethical practice of ARTs and protect women and children from exploitation.
  • The Bill was introduced to supplement the Surrogacy (Regulation) Bill, 2019 (SRB), which awaits consideration by the Rajya Sabha after review by two parliamentary committees.

Concerns with the Bill

1)  Exclusion in the access of ART

  • .The Bill allows for a married heterosexual couple and a woman above the age of marriage to use ARTs.
  • It excludes single men, cohabiting heterosexual couples and LGBTQI individuals and couples from accessing ARTs.
  • This violates Article 14 of the Constitution and the right to privacy jurisprudence of Puttaswamy, where the Supreme Court held that “ the liberty of procreation, the choice of a family life” concerned all individuals irrespective of their social status and were aspects of privacy.
  • In Navtej Johar case, Justice Chandrachud exhorted the state to take positive steps for equal protection for same-sex couples.
  • Unlike the SRB, there is no prohibition on foreign citizens accessing ARTs.
  • Foreigners can access ART but not Indian citizens in loving relationships.
  • This fails to reflect the true spirit of the Constitution.

2) Consent

  • The ART Bill does little to protect the egg donor.
  • Harvesting of eggs is an invasive process which, if performed incorrectly, can result in death.
  • The Bill requires an egg donor’s written consent but does not provide for her counselling or the ability to withdraw her consent before or during the procedure.
  • She receives no compensation or reimbursement of expenses for loss of salary, time and effort.
  • Failing to pay for bodily services constitutes unfree labour, which is prohibited by Article 23 of the Constitution.
  • The commissioning parties only need to obtain an insurance policy in her name for medical complications or death; no amount or duration is specified.
  • The egg donor’s interests are subordinated in a Bill proposed in her name.
  • The Bill restricts egg donation to a married woman with a child (at least three years old).

3) Threat of eugenics

  • The Bill requires pre-implantation genetic testing.
  • If the embryo suffers from “pre-existing, heritable, life-threatening or genetic diseases”, it can be donated for research with the commissioning parties’ permission.
  • These disorders need specification or the Bill risks promoting an impermissible programme of eugenics.

4) Overlap with Surrogacy Regulation

  • There is considerable overlap between ART and SRB sectors. Yet the Bills do not work in tandem.
  • Core ART processes are left undefined; several of these are defined in the SRB.
  • Definitions of commissioning “couple”, “infertility”, “ART clinics” and “banks” need to be synchronised between the Bills.
  • A single woman cannot commission surrogacy but can access ART.
  • The Bill designates surrogacy boards under the SRB to function as advisory bodies for ART, which is desirable.
  • However, both Bills set up multiple bodies for registration which will result in duplication or lack of regulation (e.g. surrogacy clinic is not required to report surrogacy to National Registry).
  • Also, the same offending behaviours under both Bills are punished differently + punishments under the SRB are greater.
  • Offences under the Bill are bailable but not under the SRB.
  • Finally, records have to be maintained for 10 years under the Bill but for 25 years under the SRB.
  • The same actions taken by a surrogacy clinic and ART clinic  attract varied regulation.

Other concerns

  • Children born from ART do not have the right to know their parentage, which is crucial to their best interests and protected under previous drafts.
  • There is no distinction between ART banks and ART clinics, given that gamete donation is not compensated, economically viability of ART Banks raises a question.
  • In previous drafts, gametes could not be gifted between known friends and relatives if this is not changed, gamete shortage is likely.
  •  The Bill’s prohibition on the sale, transfer, or use of gametes and embryos is poorly worded and will confuse foreign and domestic parents relying on donated gametes.
  • Unusually, the Bill requires all bodies to be bound by the directions of central and state governments in the national interest, friendly relations with foreign states, public order, decency or morality — being broadly phrased, it undermines their independence.

Way forward

  • The Bill to maintain a grievance cell but clinics must instead have ethics committees.
  • Mandated counselling services should also be independent of the clinic.
  • The poor enforcement of the PCPNDT Act, 1994, demonstrates that enhanced punishments do not secure compliance — lawyers and judges also lack medical expertise.
  • Patients already sue fertility clinics in consumer redressal fora, which is preferable to criminal courts.

Conclusion

The Bill raises several constitutional, medico-legal, ethical and regulatory concerns, affecting millions and must be thoroughly reviewed before passage.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Making malnutrition free India by 2030

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Paper 2- Malnutrition and health of the child

The article analyses the problem of malnutrition in India and suggests the pathways to achieve the malnutrition free India by 2030.

Severity of the nourishment problem in India

  • There were  189.2 million undernourished people (28 per cent of the world) in India in 2017-19, as per the combined report of FAO, IFAD, UNICEF, WFP and WHO (FAO, et.al. 2020) on “The state of Food Security and Nutrition in the World”.
  •  India accounts for 28 per cent (40.3 million) of the world’s stunted children (low height-for-age) under five years of age, and 43 per cent (20.1 million) of the world’s wasted children (low weight-for-height) in 2019.
  • In India, the problem has been more severe amongst children below the age of five years.
  • As per the National Family Health Survey (NFHS, 2015-16), the proportion of underweight and stunted children was as high as 35.8 per cent and 38.4 per cent respectively.
  • In several districts of Bihar, Jharkhand, Uttar Pradesh, Madhya Pradesh, Rajasthan and even Gujarat, the proportion of underweight children was more than 40 per cent.

Aims of the National Nutrition Mission (NNM)

  • Ending all forms of malnutrition by 2030 is also the target of Sustainable Development Goal (SDG-2) of Zero Hunger.
  • Towards this end, NNM aims to reduce stunting, underweight and low birth weight each by 2 per cent per annum.
  • It aims to reduce anaemia among children, adolescent girls and women, each by 3 per cent per annum by 2022.
  • However, the Global Burden of Disease Study 1990–2017 has estimated that if the current trend continues, India cannot achieve these targets under NNM by 2022.

Understanding the key determinants and deciding policy response

1) Mothers’ education

  • Mothers’ education, particularly higher education, has the strongest inverse association with under-nutrition.
  • Women’s education has a multiplier effect not only on household food security but also on the child’s feeding practice and the sanitation facility.
  • Despite India’s considerable improvement in female literacy, only 13.7 per cent of women have received higher education (NFHS, 2015-16).
  • Therefore, programmes that promote women’s higher education such as liberal scholarships for women need to be accorded a much higher priority.

2) Sanitation and access to safe drinking water

  • The second key determinant of child under-nutrition is the wealth index, which subsumes access to sanitation facilities and safe drinking water.
  • WASH initiatives, that is, safe drinking water, sanitation and hygiene, are critical for improving child nutritional outcomes.
  • In this context, the Swachh Bharat Abhiyan aims to eliminate open defecation and bring about behavioural changes in hygiene and sanitation practices.
  • In five years of the Abhiyan, as per government records, rural sanitation coverage has gone from 38.7 per cent in 2014 to 100 per cent in 2019, while the sanitation coverage in urban cites has gone up to 99 per cent by September 2020.
  • This remarkable achievement of the Swachh Bharat Abhiyan, subject to third-party evaluations, is expected to have a multiplier effect on nutritional outcomes.

3) Leveraging agricultural policies

  • We should leverage agricultural policies and programmes to be more “nutrition-sensitive” and reinforcing diet diversification towards a nutrient-rich diet.
  • Food-based safety nets in India are biased in favour of staples: rice and wheat.
  • They need to provide a more diversified food basket, including coarse grains, millets, pulses and bio-fortified staples.
  • Bio-fortification is very cost-effective in improving the diet of households and the nutritional status of children.
  • The Harvest-Plus programme of CGIAR can work with the Indian Council of Agricultural Research (ICAR) to grow new varieties of nutrient-rich staple food crops.

4) Promotion of exclusive breastfeeding, complementary foods, diversified diet

  • The promotion of exclusive breastfeeding and the introduction of complementary foods and a diversified diet after the first six months is essential to meet the nutritional needs of infants and ensure appropriate growth and cognitive development of children.

5) Access to prenatal and postnatal care

  • Access and utilisation of prenatal and postnatal health care services also play a significant role in curbing undernutrition among children.
  • Aanganwadi workers and community participation can bring significant improvements in child-caring practices.

Consider the question “Assess the severity the problem of malnutrition in India and suggest the measure to achieve the goal of malnutrition free India by 2030”

Conclusion

To contribute towards the holistic nourishment of children and a malnutrition free India by 2030, the government needs to address the multi-dimensional determinants of malnutrition on an urgent basis.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Increasing age of marriage will be exercise of carceral power by state

Note4Students

From UPSC perspective, the following things are important :

Mains level : Paper 2-Increasing the age of marriage for girls and implications

The article examines the issue of the age of marriage of girls and its relation with their education level and economic status.

Trends in early marriage

  • The National Family Health Survey (NFHS-4) data 2015-16 points to certain trends in early marriages:
  • That rural women are likely to marry earlier than their urban counterparts.
  • The higher up a woman is on the wealth quintile, the later she marries.
  • Most importantly, it establishes a direct causal link between education levels and delayed age of marriage.
  • Women with 12 years or more of schooling are most likely to marry later.
  • Only 8 per cent rural girls who drop out in the age group 6 to 17 years cite marriage as the reason.

Impact on STs and SCs

  • According to the wealth quintile data, the poorest households are concentrated in rural India.
  • The lowest quintile, which is most likely to marry off their girls early out of socio-economic necessities, have 45 per cent of the Scheduled Tribe (ST) and 25.9 per cent Scheduled castes.
  • The NFHS-4 data on women aged 15-49 by number of years of schooling completed shows that 42 per cent ST women and 33 per cent SC women have received no schooling.

Issues

  • Marriages in India are governed by various personal laws which set varying minimum ages for girls as also the Prohibition of Child Marriage Act (PCMA), 2006, where it is 18 years for girls and 21 for boys.
  • This is compounded by The Protection of Children from Sexual Offences (POCSO) Act, 2012, that increased the age of consent, from 16 years to 18 years.
  • Several studies have shown how this has criminalised self-arranged adolescent marriages as parents often misuse it to punish couples marrying without their approval, especially in cases of inter-caste marriages.

Way forward

  • The National Human Rights Commission showed how higher education levels lead to a lower likelihood of women being married early and recommended that the Right to Education Act, 2009, be amended to make it applicable up to the age of 18 years.
  • Noting the law’s patriarchal underpinnings, the 18th Law Commission report (2008) asked for uniformity in the age of marriage at 18 years for both men and women and lowering the age of consent to 16 years. Government could act on such a recommendation.

Consider the question “What are the advantages of increasing the minimum age of marriage for girls. Also, examine the issues with the move.

Conclusion

The median age at first marriage for both men and women in India has registered a significant decadal improvement with more people now marrying later than ever before. Any attempt to leapfrog through quick-fix and ill-conceived punitive measures will only considerably reverse these gains.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Increasing the age of marriage for girls and related issues

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Paper 2- Increasing the age of marriage for girls

The article analyses the issues with objectives of increasing the age of marriage for girls.

Poverty of mother: Important factor

  • Raising the age of marriage is the could be the way to improve the health and nutritional status of mothers and their infants.
  • An article published in the journal The Lancet Child and Adolescent Health analyses data on stunting in children and thinness in mothers in the latest round of the National Family Health Survey 4 (2015-16).
  •  The authors examine the strength of the association between many different causal factors.
  •  As it turns out, the poverty of the mother plays the greatest role of all by far.
  • Instead of early pregnancy causing malnourishment, they may both be the consequences of poverty.
  • The best way to go about breaking such a cycle would be to pick the factors perpetuating it, it would be the poverty of the mother in this case.

Declining fertility rate in India

  • India’s fertility rates have been declining to well below replacement levels in many States, including those with higher levels of child marriage.
  • This could be the reason for the shift from fuelling fears about booming populations to expressing concern for the undernourishment of children.
  • So, the problem of “populations explosion” is not the real problem as the demographic data suggests.

Concern

  • The change in the marriage age will leave the vast majority of Indian women who marry before they are 21 without the legal protections.

Conclusion

The proposal and the objective to be achieved through raising the age of marriage needs reconsideration for the reasons cited above.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

PCPNDT Act and rule changes during pandemic

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Paper 2-PCPNDT Act

The article deals with the issues of suspension of some requirements under PCPNDT Act. It also discusses the role judiciary played in 25-years jurisprudence around the Act.

Context

  • Last week, the Supreme Court deferred a pronouncement on the legality of the Centre’s now-lapsed controversial notification relating to the rules of the law banning sex-selective abortions.
  • The apex court similarly erred on the side of caution in June, choosing not to stay the Ministry of Health and Family Welfare’s gazette notification.

What were the changes

  • One of the rules requires a five-yearly renewal of registration of genetic laboratories, ultrasound clinics and imaging centres, subject to the fulfilment of eligibility criteria.
  • Another mandate to submit monthly records on the conduct of pregnancy-related procedures to the designated authority.
  • State governments and Union Territories are required to furnish quarterly reports to the Centre on the implementation of the law.
  • The Union Health Ministry had maintained that various procedural deadlines were relaxed in the wake of the public health crisis and that such flexibility would in no way jeopardise the larger objectives of the law.

Issues with the suspension

  • Activists saw no rationale behind the suspension of rules, since the operation of diagnostic laboratories had been declared essential services.
  • They were understandably apprehensive that the freeze would result in large-scale violations.
  • It is one thing to offer relaxation for delays in the completion of formalities via an administrative order, but altogether another to declare a freeze via a gazette notification, they argued.

Court judgements on PCPNDT Act

  • The 25-year jurisprudence around the PCPNDT legislation does not justify a casual approach on the enforcement of its various provisions.
  • The Court last year ruled that the non-maintenance of medical records as per Section 23 of the PCPNDT Act could serve as a conduit in the grave offence of foeticide.
  • In its 2016 judgment, the Supreme Court authorised the seizure of illegal equipment from clinics and the suspension of their registration as well as speedy disposal of relevant cases by the States.

Consider the question “How far has the PCPNDT Act been successful in dealing with the menace of sex-selective abortion? What are the shortcomings in the Act?”

Conclusion

Crucially, the alarming decline witnessed in recent decades in India’s sex ratio at birth calls for uncompromising adherence to public policy, more than is evident from evolving case law.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Seeking a more progressive abortion law

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- Shortcomings in the Medical Termination of Pregnancy Act 1971 and need of the more progressive abortion law in the country.

Context

The Medical Termination of Pregnancy Bill doesn’t do enough to secure women’s choices and interests.

Deaths due to unsafe abortion and previous attempts to legislate

  • Deaths due to unsafe abortions: Recent reports have shown that more than 10 women die every day due to unsafe abortions in India.
    • And backward abortion laws only contribute to women seeking illegal and unsafe options.
  • The Cabinet has recently approved the Medical Termination of Pregnancy (Amendment) Bill, 2020 (MTP Bill, 2020) which will soon be tabled in Parliament.
    • It seeks to amend the Medical Termination of Pregnancy Act, 1971 (MTP Act) and follows the MTP Bills of 2014, 2017 and 2018, all of which previously lapsed in Parliament.

Provisions of the current law

  • Foetus-age based division: The MTP Act divides its regulatory framework for allowing abortions into categories, according to the gestational age of the foetus.
    • Up to 12 weeks: Under Section 3, for foetuses that are aged up to 12 weeks-
    • Only one medical practitioner’s opinion is required to the effect that the continuance of the pregnancy would pose a risk to the life of the mother or cause grave injury to her physical or mental health.
    • Or there is a substantial risk that if the child is born, it would suffer from such physical or mental abnormalities as to be seriously handicapped.
    • Between 12 weeks and 20 weeks: But if the foetus is aged between 12 weeks and 20 weeks-
    • At least two medical practitioners’ opinions conforming to either of the two conditions are required.
    • What beyond 20 weeks? Beyond 20 weeks, termination may be carried out where it is necessary to save the life of the pregnant woman.
  • Definition of grave injury: The MTP Act also specifies that ‘grave injury’ may be explained as
    • The anguish caused by a pregnancy arising out of rape, or the anguish caused by an unwanted pregnancy arising out of the failure of a contraceptive used by a married woman or her husband.

What are the issues with the current law?

  • Several issues arise from the current framework under the MTP Act.
  • First-Lac of autonomy of women: At all stages of the pregnancy, the healthcare providers, rather than the women seeking an abortion, have the final say on whether the abortion can be carried out.
    • It is true that factors such as failure of contraceptives or grave injury are not required to be proved under the MTP Act.
    • However, to get the pregnancy terminated solely based on her will, the woman may be compelled to lie or plead with the doctor.
    • Thus, at present, pregnant women lack autonomy in making the decision to terminate their pregnancy and have to bear additional mental stress, as well as the financial burden of getting a doctor’s approval.
    • On request abortion in 67 countries: Indian’s law is unlike the abortion laws in 67 countries, including Iceland, France, Canada, South Africa and Uruguay, where a woman can get an abortion ‘on request’ with or without a specific gestational limit (which is usually 12 weeks).
  • Second-Prejudice against unmarried women: The MTP Act embodies a clear prejudice against unmarried women.
    • According to ‘Explanation 2’ provided under Section 3(2) of the Act, where a pregnancy occurs due to failure of any birth control device or method used by any “married woman or her husband”, the anguish caused is presumed to constitute a “grave injury” to the mental health of the pregnant woman.
    • While the applicability of this provision to unmarried women is contested, there is always the danger of a more restrictive interpretation, especially when the final decision rests with the doctor and not the woman herself.
  • Third-Restriction of 20 weeks’ limit: Due to advancements in science, foetal abnormalities can now be detected even after 20 weeks.
    • Danger to mother’s life only condition after 20 weeks: The MTP Act presently allows abortion post 20 weeks only where it is necessary to save the life of the mother.
    • Problem with this restriction: The above restriction means that even if a substantial foetal abnormality is detected and the mother doesn’t want to bear life-long caregiving responsibilities and the mental agony associated with it, the law gives her no recourse unless there is a prospect of her death.

What does the bill fail to address?

  • While the MTP Bill, 2020, is a step in the right direction, it still fails to address most of the problems with the MTP
  • First, it doesn’t allow abortion on request at any point after the pregnancy.
  • Second, it doesn’t take a step towards removing the prejudice against unmarried women by amending the relevant provision.
  • And finally, it enhances the gestational limit for legal abortion from 20 to 24 weeks only for specific categories of women such as survivors of rape, victims of incest, and minors.
    • This means that a woman who does not fall into these categories would not be able to seek an abortion beyond 20 weeks, even if she suffers from a grave physical or mental injury due to the pregnancy.

What are the provisions for the case of foetal abnormality in the bill?

  • Limit irrelevant if the foetal abnormality is diagnosed by the Medical Board: The Bill does make the upper gestational limit irrelevant in procuring an abortion if there are substantial foetal abnormalities diagnosed by the Medical Board.
    • This means that even if there is no threat to the mother’s life, she would be able to procure an abortion as soon as a substantial foetal abnormality comes to light.
    • While this is an important step and would have in the past helped many women who fought long battles in Court without recourse.
    • Rules against unnecessary delays: It is crucial that this provision is accompanied by appropriate rules for the Medical Boards that guard against unnecessary delays, which only increase the risks associated with a late abortion.

Conclusion

  • Recognition of women’s right: The Supreme Court has recognised women’s right to make reproductive choices and their decision to abort as a dimension of their personal liberty (in  X v. Union of India,2017) and as falling within the realm of the fundamental right to privacy (in K.S. Puttaswamy v. Union of India, 2017). Yet, current abortion laws fail to allow the exercise of this right.
  • The bill does not do enough: While it is hoped that MTP Bill, 2020 will not lapse in Parliament like its predecessors, it is evident that it does not do enough to secure women’s interests, and there is still a long road ahead for progressive abortion laws.

 

 

 

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

[op-ed of the day] Amendments to Medical Termination of Pregnancy Act are a mixed bag

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- Medical Termination of Pregnancy Act amendment and issues involved.

Context

The Union Cabinet’s approval of the amended Medical Termination of Pregnancy (MTP) Bill 2020 was reported on January 29. This amendment was long due and has made some anticipated changes demanded by women’s groups and courts, including the Supreme Court.

Why the amendment was necessitated?

  • Abortion (unsafe) accounts for almost 10 per cent of maternal deaths in India.
  • No provision to avoid unsafe abortion: The amended Act doesn’t have any new substantial provisions to avoid unsafe abortions.
    • The right to safe abortion (at least till 12 weeks, when it is safer) would have made the state responsible to provide safe abortion services.
  • Reduce the burden on judiciary: The proposed amendments will definitely reduce the burden on the judiciary, especially given the plethora of cases seeking permission for abortion beyond the prescribed duration of 20 weeks.
  • Two types of Court cases: The court cases are broadly two types.
    • The first group of cases: These are pregnancies that extend beyond 20 weeks of gestation as a result of rape, incest or of minor women.
    • The new Act rightly addresses these by extending prescribed period abortion to 24 weeks.
    • However, such cases form a minuscule proportion of the total number. For such cases, even the 24-week cap can be done away with, provided the abortions can be safely done.
    • The second group of cases
    • These are of pregnancies that become unwanted after congenital foetal anomalies are found upon testing.
    • With advancements in prenatal foetal screening/diagnostic technologies, more such cases are knocking at the doors of courts.
    • Marginal interval under the current act: Anomalies detected at 17-20 weeks provide only a marginal interval to conduct an abortion under the current Act.
    • The extension to 24 weeks seems to give cover to these cases for abortion services, reducing the burden on courts.

How the law could be misused?

  • Possibility of using any anomaly as a ground for abortion: The amendments have opened up the possibility for any congenital anomaly to be used as grounds for abortion.
    • Anomalies which are incompatible with life provide grounds for access to abortion at any time during pregnancy -not just 24 weeks of gestation-as long as the woman desires it and it doesn’t endanger her health.
    • But with advancements in diagnostic technologies, more anomalies will be detected, including those which are compatible with life.
  • Social acceptability and anomaly: What constitutes an anomaly changes depending on what is considered socially desirable.
    • Issue of raising children with disability: Technology-aided detection of “undesirability” could now find social support, as has been the case with female foetuses.
    • This raises concerns that raising children with disability, especially in the absence of state support and poor social attitudes, could go down a similar path.

The risk to the life of women

  • Abortion beyond 12 weeks carries serious health risks.
    • 12 weeks provision under current law: Current law requires the expert opinion of two registered medical practitioners for the abortion beyond 12 weeks.
      • Extending the limit to 20 weeks and risk involved: 12-week requirement has been delayed till 20 weeks, though the physiology of pregnancy and risks associated with procedures for second-trimester abortions haven’t changed significantly.
      • Possibility of more complications: Without the strengthening of public services, easing second-trimester abortions between 12-20 weeks opens the possibilities of more complications and endangers the life of the woman.

Conclusion

With congenital anomalies as a ground for abortion, the eugenic mindset of having socially desirable children could push more women into risky late abortions. The approach of medical boards advising courts in cases of late abortions under this Act will be critical to balancing women’s right to choose with risk to the woman and the motives for abortion. The rules framed under the Act must address this in no uncertain terms.

 

 

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

[pib] The Medical Termination of Pregnancy (Amendment) Bill, 2020

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Highlights of the bill

Mains level : MTP: Ethical and health issues surrounding it

The Union Cabinet has approved the Medical Termination of Pregnancy (Amendment) Bill, 2020 to amend the Medical Termination of Pregnancy Act, 1971.

About the Bill

  • The Medical Termination of Pregnancy (Amendment) Bill, 2020 is for expanding access of women to safe and legal abortion services on therapeutic, eugenic, humanitarian or social grounds.
  • It aims to increase upper gestation limit for termination of pregnancy under certain conditions and to strengthen access to comprehensive abortion care, under strict conditions, without compromising service and quality of safe abortion.

Salient features of proposed amendments:

  • Proposing requirement for opinion of one provider for termination of pregnancy, up to 20 weeks of gestation and introducing the requirement of opinion of two providers for termination of pregnancy of 20-24 weeks of gestation.
  • Enhancing the upper gestation limit from 20 to 24 weeks for special categories of women which will be defined in the amendments to the MTP Rules and would include ‘vulnerable women including survivors of rape, victims of incest and other vulnerable women (like differently-abled women, Minors) etc.
  • Upper gestation limit not to apply in cases of substantial foetal abnormalities diagnosed by Medical Board. The composition, functions and other details of Medical Board to be prescribed subsequently in Rules under the Act.
  • Anonymity of the person: Name and other particulars of a woman whose pregnancy has been terminated shall not be revealed except to a person authorised in any law for the time being in force.

Benefits

  • It is a step towards safety and well-being of the women and many women will be benefitted by this.
  • Recently several petitions were received by the Courts seeking permission for aborting pregnancies at a gestational age beyond the present permissible limit on grounds of foetal abnormalities or pregnancies due to sexual violence faced by women.
  • The proposed increase in gestational age will ensure dignity, autonomy, confidentiality and justice for women who need to terminate pregnancy.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

ICDS Programme

Note4Students

From UPSC perspective, the following things are important :

Prelims level : ICDS and its components

Mains level : Forms of malnutrition in urban areas and their preventive measures

 

Centre seeks to revamp the ICDS scheme in urban areas. For this NITI Aayog will develop draft policy, which will be circulated to the Ministries for consultations.

Integrated Child Development Services (ICDS)

  • The ICDS is a government programme in India which provides food, preschool education, primary healthcare, immunization, health check-up and referral services to children under 6 years of age and their mothers.
  • The scheme was launched in 1975, discontinued in 1978 by the government of Morarji Desai, and then relaunched by the Tenth Five Year Plan.
  • Tenth FYP also linked ICDS to Anganwadi centres established mainly in rural areas and staffed with frontline workers.
  • The ICDS provide for anganwadis or day-care centres which deliver a package of six services including:
  1. Immunization
  2. Supplementary nutrition
  3. Health checkup
  4. Referral services
  5. Pre-school education(Non-Formal)
  6. Nutrition and Health information

Implementation

  • For nutritional purposes ICDS provides 500 kilocalories (with 12-15 grams of protein) every day to every child below 6 years of age.
  • For adolescent girls it is up to 500 kilo calories with up to 25 grams of protein every day.
  • The services of Immunisation, Health Check-up and Referral Services delivered through Public Health Infrastructure under the Ministry of Health and Family Welfare.

Revamp for Urban Areas

  • Health and ICDS models that work in rural areas may not work in urban areas because of higher population density, transportation challenges and migration.
  • Children in urban areas were overweight and obese as indicated by subscapular skinfold thickness (SSFT) for their age.
  • The first-ever pan-India survey on the nutrition status of children, highlighted that malnutrition among children in urban India.
  • It found a higher prevalence of obesity because of relative prosperity and lifestyle patterns, along with iron and Vitamin D deficiency.
  • According to government data from 2018, of the 14 lakh anganwadis across the country there are only 1.38 lakh anganwadis in urban areas.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Pulse Polio Programme

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Polio and its vaccine

Mains level : Pulse Polio Programme

The beginning of this year’s Pulse Polio Programme was inaugurated from the Rashtrapati Bhavan itself.  To prevent the virus from coming to India, the government has since March 2014 made the Oral Polio Vaccination (OPV) mandatory for those travelling between India and polio-affected countries.

The Pulse Polio Programme

  • India launched the Pulse Polio immunisation programme in 1995, after a resolution for a global initiative of polio eradication was adopted by the World Health Assembly (WHA) in 1988.
  • Children in the age group of 0-5 years are administered polio drops during national and sub-national immunisation rounds (in high-risk areas) every year.

India is polio-free

  • According to the Ministry of Health, the last polio case in the country was reported from Howrah district of West Bengal in January 2011.
  • The WHO on February 24, 2012, removed India from the list of countries with active endemic wild polio virus transmission.
  • Two years later, the South-East Asia Region of the WHO, of which India is a part, was certified as polio-free.

Back2Basics

What is Polio?

  • The WHO defines polio or poliomyelitis as a highly infectious viral disease, which mainly affects young children.
  • The virus is transmitted by person-to-person, spread mainly through the faecal-oral route or, less frequently, by a common vehicle (e.g. contaminated water or food) and multiplies in the intestine, from where it can invade the nervous system and can cause paralysis.
  • Initial symptoms of polio include fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs. In a small proportion of cases, the disease causes paralysis, which is often permanent.
  • There is no cure for polio, it can only be prevented by immunization.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

[op-ed snap] Children of lesser gods

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- Health.

Context

The deaths of nearly 200 children in Kota, from largely preventable diseases, lays bare the condition of the healthcare system in India.

Where does India stand?

  • According to UNICEF’s ‘State of World’s Children 2019’ report, India reported the maximum number of deaths of children under five in the world in 2018.
  • 8,82,000 children under five died that year.
  • That means around 2,416 deaths per day.
  • The death of children due to largely-preventable illnesses is a matter of serious concern and calls for urgent introspection.

Factors that govern child health

  • Most of the children who died in Gorakhpur, Muzaffarpur and Kota belong to the lowest strata of the society.
  • It won’t be wrong to conclude that they were victims of structural violence.
  • This structural violence is unleashed through a multitude of social, political and economic factors apathy of healthcare professionals, poor health services/infrastructure
  • And low rates of female literacy, economic inequality, the rigid caste system, social apartheid, lack of political will and patriarchy play role.
  • As a society, we have stopped looking at the deaths of our citizens through the prism of compassion and concern.
  • Structural violence influences the nature and distribution of extreme suffering.

What is being done in the wrong way?

  • The government is considering the takeover of 750 district hospitals by private medical colleges through a public-private partnership (PPP) model.
  • This, despite ample evidence about the failure of the model in the country’s healthcare system.
  • Nobel laureate Kenneth Arrow demonstrated that profit and private involvement in healthcare lead to an erosion of trust.
  • An Individual’s demand for medical services is irregular and unpredictable, the involvement of a private market model for such services can be disastrous.
  • The U.S.’s experiences in the PPP model in healthcare have shone a light on the deficits in transparency and highlighted the lack of care of vulnerable groups.

Conclusion

  • What urgently a sincere engagement by the state in matters concerning peoples’ health.
  • We need to question the government’s priorities in a country where nearly a million children die every year

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

[pib] Comprehensive Lactation Management Centres

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Comprehensive Lactation Management Centres

Mains level : Breastfeeding and its significance

News

Breast Milk Banks in India are known as Comprehensive Lactation Management Centres (CLMC) and Lactation Management Unit (LMU) depending on the level of health facilities where these units are established.

Comprehensive Lactation Management Centres (CLMC)

  • CLMC works as per the National Guidelines on Establishment of Lactation Management Centres in Public Health Facilities.
  • The foremost endeavour of the health care providers in a health centre is to conserve the natural act of breastfeeding.
  • Lactation Management Centres are in no way intended to lessen the importance of mother’s own milk or the practice of breastfeeding.
  • If mother’s own milk is insufficient or not available for any unavoidable reason, Donor Human Milk (DHM) is the next best alternative to bridge the gap.
  • The Government has set a target of ensuring 70 per cent infants to have access to breast milk by the year 2025. Target will subsequently be increased to 100 per cent.

Why need such banks?

  • It is universally accepted that breast milk is the optimum exclusive source of nutrition for the first six months of life, and may remain part of the healthy infant diet for the first two years of life and beyond.
  • Despite advances in infant formulas, human breast milk provides a bioactive matrix of benefits that cannot be replicated by any other source of nutrition.
  • When the mother’s own milk is unavailable for the sick, hospitalized newborn, pasteurized human donor breast milk should be made available as an alternative feeding choice followed by commercial formula.
  • There is a limited supply of donor breast milk in India and it should be prioritized to sick, hospitalized neonates who are the most vulnerable and most likely to benefit from exclusive human milk feeding.

Related facts

  • Asia’s first milk bank was established in 1989 at Sion Hospital, Mumbai.
  • In 2017, the first public milk bank, called the Vatsalya — Maatri Amrit Kosh, was established at Lady Hardinge Medical College.
  • It was established in collaboration with the Norwegian government and the Oslo University as part of the Norway–India Partnership Initiative (NIPI).

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Golden Rice

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Golden rice, Fortified rice

Mains level : Malnutrition elimination strategies


Bangladesh is set to becoming the first country to approve plantation of Golden Rice variety to counter Vitamin A deficiency.

Golden Rice

  • In the late 1990s, German scientists developed a genetically modified variety of rice called Golden Rice.
  • It is a variety of rice (Oryza sativa) produced through genetic engineering to biosynthesize beta-carotene, a precursor of vitamin A, in the edible parts of rice.
  • It differs from its parental strain by the addition of three beta-carotene biosynthesis genes.
  • The parental strain can naturally produce beta-carotene in its leaves, where it is involved in photosynthesis.

Why golden rice?

  • Golden Rice is intended to produce a fortified food to be grown and consumed in areas with a shortage of dietary vitamin A.
  • It was claimed to be able to fight Vitamin A deficiency, which is the leading cause of blindness among children and can also lead to death due to infectious diseases such as measles.
  • Rice is naturally low in the pigment beta-carotene, which the body uses to make Vitamin A. Golden rice contains this, which is the reason for its golden colour.
  • The claim has sometimes been contested over the years, with a 2016 study from Washington University in St Louis reporting that the variety may fall short of what it is supposed to achieve.

Why in Bangladesh?

  • Advocates of the variety stress how it can help countries where Vitamin A deficiencies leave millions at high risk.
  • In Bangladesh, over 21 per cent of the children have vitamin A deficiency.
  • The Golden Rice that is being reviewed in Bangladesh is developed by the Philippines-based International Rice Research Institute.
  • According to the institute, this rice variety will not be more expensive than the conventional variety.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

[pib] Intensified Mission Indradhanush (IMI) 2.0

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Mission Indradhanush

Mains level : Immunization programme in India


Union Minister of Health and Family Welfare have reviewed the preparedness within States for rollout of Intensified Mission Indradhanush (IMI) 2.0.

Intensified Mission Indradhanush 2.0

  • IMI was launched from Vadnagar in 2017 and immunization has been given a strong push in the Gram Swaraj Abhiyaan and Extended Gram Swaraj Abhiyaan.
  • The IMI 2.0 aims to achieve targets of full immunization coverage in 272 districts in 27 States and shall be implemented in the block level (652 blocks) in Uttar Pradesh and Bihar.
  • In October 2017, the PM Modi launched IMI, an ambitious plan to accelerate progress.
  • It aimed to achieve 90% full immunization coverage with focus towards districts and urban areas with persistently low levels.
  • IMI was built on MI, using additional strategies to reach populations at high risk, by involving sectors other than health.
  • It was an effort to shift routine immunization into a Jan Andolan, or a “peoples’ movement”.

Salient features of IMI 2.0

  • Immunization activity will be in four rounds over 7 working days excluding the RI days, Sundays and holidays.
  • Enhanced immunization session with flexible timing, mobile session and mobilization by other departments.
  • Enhanced focus on left-outs, dropouts, and resistant families and hard to reach areas.
  • Focus on urban, underserved population and tribal areas.
  • Inter-ministerial and inter-departmental coordination.
  • Enhance political, administrative and financial commitment, through advocacy.
  • IMI immunization drive, consisting of 4 rounds of immunization will be conducted in the selected districts and urban cities from Dec 2019 to March 2020.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Outreach of the Maternity schemes in India

Note4Students

From UPSC perspective, the following things are important :

Prelims level : PMMVY

Mains level : Maternity benefits in India


The Pradhan Mantri Matru Vandana Yojana (PMMVY) scheme has been able to reach less than a third of the eligible beneficiaries reveals RTI Act.

About PMMVY

  • The PMMVY is targeted only at women delivering their first child.
  • A cash amount of ₹6,000 is transferred to the bank account of the beneficiary in three instalments upon meeting certain conditions.
  • These include early registration of pregnancy, having at least one ante-natal check-up and registration of childbirth.

Outreach of PMMVY

  • PMMVY is a vital programme to support lactating mothers and pregnant women by compensating them for loss of wages during their pregnancy
  • Almost 61% of beneficiaries registered under the between April 2018 and July 2019 (38.3 lakh out of the total 62.8 lakh enrolled) received the full amount of ₹6,000 promised under the scheme, according to an RTI reply.
  • However, the researchers assert that since the scheme failed to reach at least 49% of all mothers who would have delivered their first child (an estimated total of 123 lakh for 2017), the scheme was able to benefit only 31% of its intended beneficiaries.

Why such low outreach?

  • Several factors impeded proper implementation of the programme that aims to fight malnutrition among children.
  • These include an application form of about 23 pages, a slew of documents such as mother-child protection card, Aadhaar card, husband’s Aadhaar card and bank passbook aside from linking their bank accounts with Aadhaar.
  • The requirement to produce the husband’s Aadhaar card results in excluding women who may be living with men they are not married to, single mothers and those who may be staying at their natal home.
  • Women must also have the address of their marital home on their Aadhaar card, which often results in newlyweds being either left out or forced to go from door-to-door when pregnant and needing rest and care.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

SAANS Initiative

Note4Students

From UPSC perspective, the following things are important :

Prelims level : SAANS

Mains level : Pneumonial deaths in India

Union Minister for Health and Family Welfare has launched SAANS, a campaign aimed at reducing child mortality due to pneumonia, which contributes to around 15% deaths annually of children under the age of five.

SAANS

  • SAANS stands for ‘Social Awareness and Action to Neutralise Pneumonia Successfully’.
  • It aims to mobilise people to protect children from pneumonia, and train health personnel and other stakeholders to provide prioritised treatment to control the disease.
  • Under the campaign, a child suffering from pneumonia can be treated with pre-referral dose of anti-biotic amoxicillin by ASHA workers.
  • Health and wellness centres can use pulse oximeter (device to monitor oxygen saturation) to identify low oxygen levels in the blood of a child, and if required, treat him by use of oxygen cylinders.

Pneumonia deaths in India

  • As per HMIS data, under-five mortality rate in the country is 37 per 1000 live births, of which 5.3 deaths are caused due to pneumonia.
  • The government aims to achieve a target of reducing pneumonia deaths among children to less than three per 1,000 live births by 2025.
  • The HMIS data for 2018-19 ranked Gujarat second in the number of child deaths due to pneumonia, after Madhya Pradesh.
  • The State ranked fifth in infant mortality due to pneumonia.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

The Lancet Countdown on Health and Climate Change

Note4Students

From UPSC perspective, the following things are important :

Prelims level : About the report

Mains level : Childrens susceptiblity to climate change in India

Climate change is already damaging the health of the world’s children and is set to shape the well-being of an entire generation according to a major new report published in The Lancet.

The Lancet Countdown on Health and Climate Change

  • The report is a comprehensive yearly analysis tracking progress across 41 key indicators, demonstrating what action to meet Paris Agreement targets — or business as usual — means for human health.
  • The project is collaboration between 120 experts from 35 institutions, including the World Health Organisation, the World Bank, University College London, and the Tsinghua University in Beijing.

Highlights of the report

  • The report notes that as temperatures rise, infants will bear the greatest burden of malnutrition and rising food prices — average yield potential of maize and rice has declined almost 2% in India since the 1960s, with malnutrition already responsible for two-thirds of under-5 deaths.
  • Also, children will suffer most from the rise in infectious diseases — with climatic suitability for the Vibrio bacteria that cause cholera rising 3% a year in India since the early 1980s, the study warns.
  • Diarrhoeal infections, a major cause of child mortality, will spread into new areas, whilst deadly heatwaves, similar to the one in 2015 that killed thousands of people in India, could soon become the norm.

A note of caution

  • This report shows that the public health gains achieved over the past 50 years could soon be reversed by the changing climate.
  • If the world follows a business-as-usual pathway, with high carbon emissions and climate change continuing at the current rate, a child born today will face a world on average over 4˚C warmer by their 71st birthday, threatening their health at every stage of their lives.
  • Nothing short of a 7.4% year-on-year cut in fossil CO2 emissions from 2019 to 2050 will limit global warming to the more ambitious goal of 1.5°C.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

[pib] Bharatiya Poshan Krishi Kosh

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Bharatiya Poshan Krishi Kosh

Mains level : Malnutrition elimination strategies in India


The Union Minister of Women and Child Development (WCD) has announced Bharatiya Poshan Krishi Kosh (BPKK).

Bharatiya Poshan Krishi Kosh

  • The Harvard Chan School of Public Health through its India Research Center and the Bill and Melinda Gates Foundation will document and evaluate promising regional dietary practices.
  • The BPKK will be a repository of diverse crops across 128 agro-climatic zones in India for better nutritional outcomes.
  • In consultation with Ministry of WCD and Bill & Melinda Gates Foundation, the project team will select around 12 high focus states which are representative of the geographical, social, economic, cultural and structural diversities of India.
  • In each of the states or group of states the team will identify a local partner organization which has relevant work experience in Social and Behavior Change Communication (SBCC) and nutrition for developing the food atlas.

Why such move?

  • The, two other approaches are required to complement the Government’s efforts to promote healthy dietary practices.
  • One, addressing the challenge of malnutrition at such a vast scale requires a basic understanding of the social, behavioural and cultural practices that promote and reinforce healthy dietary behaviours both at the individual and community level.
  • Two, creating the first ever data base that links relevant agro-food system data at the district, with an aim to map the diversity of native crop varieties that will be more cost-effective and sustainable over the long run.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

State of the World’s Children Report 2019

Note4Students

From UPSC perspective, the following things are important :

Prelims level : State of the World’s Children Report 2019

Mains level : Read the attached story


  • UNICEF released its State of the World’s Children report for 2019.

Highlights of the report

  • The UNICEF report found that one in three children under the age of five years
  • Around 200 million children worldwide — are either undernourished or overweight.

Children in India

  • In India, every second child is affected by some form of malnutrition.
  • The report said 35% of Indian children suffer from stunting due to lack of nutrition, 17% suffer from wasting, 33% are underweight and 2% are overweight.
  • According to government figures, stunting and wasting among children in the country has reduced by 3.7 per cent and the number of underweight children have reduced by 2.3 per cent from 2016 to 2018.

Other details

  • One in five children under age 5 has vitamin A deficiency, which is a severe health problem in 20 states.
  • Every second woman in the country is anaemic, as are 40.5% children.
  • One in ten children are pre-diabetic.
  • Indian children are being diagnosed with adult diseases such as hypertension, chronic kidney disease and diabetes.

India’s among its neighbors

  • Among countries in South Asia, India fares the worst (54%) on prevalence of children under five who are either stunted, wasted or overweight.
  • Afghanistan and Bangladesh follow at 49% and 46%, respectively. Sri Lanka and the Maldives are the better performing countries in the region, at 28% and 32%, respectively.
  • India also has the highest burden of deaths among children under five per year, with over 8 lakh deaths in 2018.
  • It is followed by Nigeria, Pakistan and the Democratic Republic of Congo, at 8.6 lakh, 4.09 lakh and 2.96 lakh deaths per year, respectively.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Government launches SUMAN scheme, assures free medicines for pregnant women

Note4Students

From UPSC perspective, the following things are important :

Prelims level : SUMAN scheme

Mains level : Nothing much

News

The central government launched the Surakshit Matritva Aashwasan (SUMAN) scheme aiming zero preventable maternal and newborn deaths in India.

Provisions

    • Under the scheme, pregnant women, mothers up to 6 months after delivery, and all sick newborns will be able to avail of free healthcare benefits.
    • The beneficiaries visiting public health facilities are entitled to several free services. 
    • These include at least four antenatal check-ups that also includes:
      • one checkup during the 1st trimester
      • at least one checkup under Pradhan Mantri Surakshit Matritva Abhiyan
      • Iron Folic Acid supplementation
      • Tetanus Diptheria injection 
      • other components of comprehensive ANC package
      • six home-based newborn care visits
    • There will be zero expense access to the identification and management of complications during and after the pregnancy. 
    • The government will also provide free transport from home to health institutions.
    • There will be assured referral services with the scope of reaching health facility within one hour of any critical case emergency and Drop back from institution to home after due discharge (minimum 48 hrs). 
    • The pregnant women will have a zero expense delivery and C-section facility in case of complications at public health facilities.
    • It will ensure respectful care with privacy and dignity, with early initiation and support for breastfeeding, zero dose vaccination and free and zero expense services for sick newborns and neonates.

Benefits

    • It will help in bringing down maternal and infant mortality rates in the country. 
    • According to the government, India’s maternal mortality rate has declined from 254 per 1,00,000 live births in 2004-06 to 130 in 2014-16. 
    • Between 2001 and 2016, the infant mortality rate came down from 66 per 1,000 live births to 34.
    • WHO defines the quality of care for mothers and newborns as “the extent to which health care services provided to individuals and patient populations improve desired health outcomes. In order to achieve this, health care must be safe, effective, timely, efficiently integrated, equitable and people-centered.”

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Rheumatic fever

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Penicillin, Rheumatic fever

Mains level : Child healthcare in India

  • The government is planning to procure penicillin centrally for three years and give it to all children between 5-15 years who are diagnosed with rheumatic fever.
  • The drug will be dispensed through primary health centres or administered by ASHAs.

Rheumatic fever

  • A rare but potentially life-threatening disease, rheumatic fever is a complication of untreated strep throat caused by bacteria called group A streptococcus.
  • The main symptoms — fever, muscle aches, swollen and painful joints, and in some cases, a red rash — typically begin two to four weeks.
  • The knees, ankles, elbows, and wrists are the joints most likely to become swollen from rheumatic fever.
  • The pain often migrates from one joint to another.
  • However, the greatest danger from the disease is the damage it can do to the heart.

Why a concern?

  • India has a high burden of rheumatic fever and rheumatic heart disease — the latter often goes undiagnosed and leads to many maternal deaths at the time of childbirth.
  • Studies indicate the prevalence of rheumatic heart disease in India to be about 2/1000 population.
  • However surveys conducted in school children in the age group of 5-16 years by ICMR gives overall prevalence of 6/1000.
  • Rheumatic fever is endemic in India and remains one of the major causes of cardiovascular disease, accounting for nearly 25-45% of acquired heart disease.

Reviving Penicillin

  • Penicillin, discovered in 1928, is still the first line antibiotic in many western countries, but it gradually went out of the Indian market even though some of its more expensive derivatives continue to be prescribed.
  • Penicillin appears to reduce the attack rate in rheumatic fever by as much as 80%.
  • Penicillin went out of production in India because of unrealistic price control.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

[op-ed snap] Sexual and reproductive health data need to be accurate to form effective basis for policy

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing much

Mains level : Reproductive Health

Context

On World Contraception Day, there is a need to talk about reproductive health practices and the rights of people in India. 

Reproductive health

  • The government has been vocal about the need for a small and healthy family to contribute to India’s socio economic growth in the long term.
  • To achieve this vision, there is a need for Sexual and Reproductive Health and Rights (SRHR), which are fundamental for family planning and the overall well-being of individuals.

Family planning

  • India’s family planning programme dates back to the 1950s and it has made significant progress. 
  • The recent emphasis on increasing spacing between children and providing access to the basket of contraceptive choices poses the promise of universal access to reproductive health services.
  • The NFHS 4 shows that the use of modern contraceptive methods (mCPR) continues to be around 48% since 2006. 
  • In the states which showed mCPR decline, sterilisation contributed to more than 70% of contraceptive use. 
  • Further, according to NFHS 4, female sterilisation in India continues to be around 37% since 2006, despite health complications and deaths, highlighting the gender inequality in contraceptive use. 
  • This could be because of lack of accessibility or awareness of other contraceptive methods and requires immediate redressal.
  • According to NHFS 4.36% females and only 0.3% males underwent sterilisation which showcases the level of the disparity. 
  • With male sterilisation on rapid decline, Ministry of Health and Family Welfare released the National Health Policy 2017 which aims uptake of male sterilisation to 30%.

The issue of data

  • India has a vast repository of health and demographic data. But such a repository can also be confusing. 
  • Contraceptive use data from large-scale surveys show different levels in selected geographies, making planning challenging. 
  • These inaccuracies could be due to errors in data collection. But the errors in data collection impact the quality of data, which compromises the survey findings.
  • Researchers have pointed out that data quality gets affected due to factors like interviewer bias, which leads to incorrect data entry. 
  • The level of the bias has been found to be higher in the states that recorded a decline in mCPR. It reflects that the findings were influenced due to errors in data collection. 
  • Also, there is difficulty in distinguishing between methods like sterilisation and hysterectomy for some interviewers, which leads to incorrect reporting.
  • Research shows that state-level decline in the utilisation of mCPR and decline in sterilisation acceptance could lead to a reduction in the use of mCPR.

Way ahead

  • There is a need to address data quality issues and introduce technological interventions in data collection, training, and capacity-building of survey officials. 
  • The role of the National Data Quality Forum (NDQF), a multi-institutional initiative hosted by Indian Council of Medical Research (ICMR) becomes crucial in addressing the gaps between data collection and analysis and using that data for advocacy and policy making.
    • NDQF aims at improving data quality for better and efficient research, identify discordance and errors, and establish protocols and good practices for improving data quality. 
    • It plans to create an integrated platform to share new ideas, develop advanced techniques with the use of Artificial Intelligence (AI) and technology, for improving data quality in health and demographic research for effective policy planning.
  • The onus should be on making data collection inclusive of people, choice, agency, awareness, and decision-making. 
  • It is also crucial to address women’s reproductive rights.

Conclusion

The focus should be on improving data for identifying the issues in contraceptive use and addressing gender inequality in SRHR in India. 

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Issues in debate around setting an age limit for IVF

Note4Students

From UPSC perspective, the following things are important :

Prelims level : IVF

Mains level : Ethical issues surrounding IVF


Oldest women gave birth with IVF

  • A 74-year-old woman from AP was recently recorded as the oldest in the world to give birth to twins through in-vitro fertilization or IVF.
  • The medical community has expressed ethical and medical concerns over conception at such an advanced age.

Why this is a concern

  • The average life expectancy of an Indian woman is 70 and of a man 69 and the medical community has expressed concerns over future of children born to such an elderly couple.
  • Medical technology has reached a stage where we can get even a 90-year-old pregnant. But there are complications that can risk human life.
  • Pregnancy in old age poses multiple risks — hypertension, diabetes, convulsions, bleeding, and cardiac complications to name a few.
  • The womb of an older woman has to be prepared by injecting hormones for the foetus to grow for nine months.
  • Also, a woman of that age cannot breastfeed.

Can a doctor face action?

  • Internationally this pregnancy is being condemned. Everything could have gone wrong. It sets a wrong precedent said doctors organization.
  • Several experts have demanded punitive action, saying the Indian Council of Medical Research (ICMR) should deregister his Andhra Pradesh centre.
  • But with no law in place — a Bill is pending — the assisted reproductive technology (ART) industry continues to operate in a grey zone.
  • In 2005, when ICMR drafted guidelines for ART, it had not set an age limit keeping in mind that reproductive rights were a fundamental right for a woman.
  • The guidelines have been amended after an elderly woman in Haryana gave birth through IVF. Since the Bill on ART has not been passed yet, legal action against such clinics is impossible.
  • ART clinics are expected to self-regulate.

The Assisted Reproductive Technologies (Regulation) Bill, 2010

  • Globally, an estimated 15% of couples are infertile.
  • The ART Regulation Bill, 2010, states that in the Indian social context, children are “old-age insurance”.
  • The Bill proposes the upper age limit at 45 for women and 50 for men to undergo the IVF procedure.
  • As of now, several centres rely on ICMR’s 2017 guidelines that recommend the same age limits. Even for adoption, the total age of the couple must not exceed 110 years.
  • With increasing life expectancy, doctors are in talks with the government to increase the IVF age limit to 50-52 years for women.
  • Until then, several experts self-regulate, some counsel senior citizens to drop the idea, and others refuse them IVF treatment.

The counter-view

  • Societal pressure to have children, the fear of living without support in old age, and the loss of an only child often encourage couples.
  • A lot of couples tell that they want an heir to pass their life’s earnings to.
  • Some doctors argue that childbirth is a personal decision and each individual has the right to make that choice after counselling.
  • Still, a doctor has to conduct tests for the heart, bone structure, diabetes, blood pressure to judge the feasibility of pregnancy.

Laws in other countries

  • Most countries that have a law range the upper limit for IVF between 40 and 50 years.
  • In the US, the upper limit for IVF is 50, and for ovum donation, 45.
  • In Australia, guidelines prohibit IVF beyond menopause (52 years).
  • In the UK, 42 is the age limit for women to seek free insurance under National Health Service. In Canada, the age limit is 43.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

[pib] Pradhan Mantri Matru Vandana Yojana

Note4Students

From UPSC perspective, the following things are important :

Prelims level : PMMVY

Mains level : Success of PMMVY


  • Pradhan Mantri Matru Vandana Yojana (PMMVY), a flagship scheme of the Government for pregnant women and lactating mothers has achieved a significant milestone by crossing one crore beneficiaries.

About PMMVY

  • PMMVY is a direct benefit transfer (DBT) scheme under which cash benefits are provided to pregnant women in their bank account directly to meet enhanced nutritional needs and partially compensate for wage loss.
  • Implementation of the scheme started with effect from 01.01.2017.
  • Under the ‘Scheme’, Pregnant Women and Lactating Mothers (PW&LM) receive a cash benefit of Rs. 5,000 in three installments on fulfilling the respective conditionality.
  • They include early registration of pregnancy, ante-natal check-up and registration of the birth of the child and completion of first cycle of vaccination for the first living child of the family.
  • The eligible beneficiaries also receive cash incentive under Janani Suraksha Yojana (JSY). Thus, on an average, a woman gets Rs. 6,000.

Performance by states

  • Madhya Pradesh, Andhra Pradesh, Himachal Pradesh, Dadra & Nagar Haveli and Rajasthan are the top five States/UT in the country in implementation of PMMVY.
  • Odisha and Telangana are yet to start implementation of the scheme.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

The burden of malnutrition in under-5 children in India

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Malnutrition

Mains level : U5 malnutrition and mortality in India


  • A report published in The Lancet Child & Adolescent Health gives comprehensive estimates of disease burden due to child and maternal malnutrition and the trends of its indicators in every state of India from 1990 to 2017.

Key findings

  • The death rate attributable to malnutrition in under-5 children in India has dropped by two-thirds from 1990 to 2017.
  • Malnutrition is, however, still the underlying risk factor for 68% of the deaths in under-five children in India.
  • The Disability-Adjusted Life Years (DALY) rate attributable to malnutrition in children varies 7-fold among the states — a gap between a high of 74,782 in Uttar Pradesh and a low of 11,002 in Kerala.
  • Other states with a high burden are Bihar, Assam and Rajasthan. followed by Madhya Pradesh, Chhattisgarh, Odisha, Nagaland and Tripura.

U5 mortality

  • The proportion of under-5 deaths attributable to malnutrition, which is 68.2% across India, ranges between a high of 72.7% in Bihar and a low of 50.8% in Kerala.
  • Rajasthan, Chhattisgarh and Uttar Pradesh are states with a high such proportion, while Meghalaya, Tamil Nadu, Mizoram and Goa have the lowest proportions of such deaths.
  • Among the malnutrition indicators, low birth weight is the largest contributor to child deaths in India, followed by child growth failure which includes stunting, underweight, and wasting.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

India Iodine Survey 2018-19 Report

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Highlights of the report

Mains level : Iodine related deficiencies in Children


  • Tamil Nadu has the lowest consumption of iodized salt despite being the third biggest producer of salt in the country, according to a first-of-its-kind national survey to measure the coverage of iodised salt.

Highlights of the Survey

  • The study shows that 76.3% of Indian households consumed adequately iodised salt, which is salt with at least 15 parts per million of iodine.
  • The five worst performers were Tamil Nadu (61.9%), Andhra Pradesh (63.9%), Rajasthan (65.5%), Odisha (65.8%) and Jharkhand (68.8%).
  • The survey was conducted by Nutrition International in collaboration with the AIIMS and the Indian Coalition for the Control of Iodine Deficiency Disorders (ICCIDD).
  • The survey tested the iodine content in samples of cooking salt from households to estimate the coverage of iodised salt.
  • The survey revealed that 13 out of 36 States have already achieved Universal Salt Iodisation or have 90% of households with access to adequately iodised salt.

Why such difference

  • The northeastern States are doing very well with respect to iodised salt consumption at the household level because of the distance they have from the three salt producing centres — Gujarat, Rajasthan and Tamil Nadu.
  • By and large most States get their salt from Gujarat and Rajasthan and because of the distance, it is sent by rail.
  • Salt-producing States have access to common (or non-iodised) salt and, therefore, they start consuming it since it is readily available.

Salt production in India

  • Rajasthan, which is the second largest producer of salt, also figured among the five worst covered States.
  • Gujarat produces 71% of salt in the country, followed by Rajasthan at 17% and Tamil Nadu at 11%.
  • The rest of the country accounts for a mere 1% of salt produced.

Significance of Iodised Salt

  • Iodine is a vital micro-nutrient for optimal mental and physical development of human beings.
  • Deficiency of iodine can result in a range of disabilities and disorders such as goitre, hypothyroidism, cretinism, abortion, still births, mental retardation and psychomotor defects.
  • Children born in iodine deficient areas may have up to 13.5 IQ points less than those born in iodine sufficient areas.
  • India made fortification of salt with iodine mandatory for direct human consumption in 1992. This was relaxed in 2000 and then reimposed in 2005.
  • In 2011, the Supreme Court, too, mandated universal iodisation for the control of iodine deficiencies.

Key recommendations

  • The key recommendation of the study is to sustain the momentum so that iodine coverage does not fall below current levels.
  • It also recommends that the States and the Centre work together to address the current gaps and look into issues that vary from one State to another, leading to adequately iodised salt not being produced.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

India’s Child Well-being Report

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Highlights of the report

Mains level : Child healthcare in India


  • India’s Child Well-being Index was recently released.

India’s Child Well-being Report

  • The India child well-being index is a crucial report that can be mined both by the Government and civil organisations to achieve the goal of child well-being and we will use this report effectively.
  • The report is released by the NGO World Vision India and research institute IFMR LEAD.
  • One of the primary objectives of this index is to garner attention to the under-researched theme of child well-being in India, and inspire further academic and policy conversations on related issues.
  • This report provides insights on health, nutrition, education, and sanitation and child protection.
  • The report is an attempt to look at how India fairs on child well-being using a composite child well-being index.

Performance by the states

  • Kerala, Tamil Nadu, Himachal Pradesh and Puducherry topped the charts in the child well-being index, a tool designed to measure and tracks children’s well-being comprehensively.
  • Meghalaya, Jharkhand and Madhya Pradesh featured at the bottom.

24 indicators

  • Focusing on the three key dimensions, 24 indicators were selected to develop the computation of the child well-being index.
  • The dimensions of the index include healthy individual development, positive relationships and protective contexts.
  • The report highlights the multi-dimensional approach towards measuring child well-being — going beyond mere income poverty.

A policy trigger

  • The research has brought to the fore compelling insights on child well-being in India.
  • The report, meanwhile, calls for States to look at their respective scores on the dimensions of child well-being, and to prepare for priority areas of intervention with specific plans of action.
  • It also hopes to trigger policy level changes, seek better budgetary allocations and initiate discussions with all stakeholders, which can help in enhancing the quality of life of all children in the country.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Breast milk banks to ensure all infants get protective cover

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Benefits of breast milk

Mains level : Read the attached story


  • A breast milk bank proposed by the Neonatology Forum (NNF), Kerala, is expected to provide solutions to all such babies who required intensive care at birth or are not able to be breastfed immediately for various other reasons.
  • There are many mothers who are not able to produce breast milk for various medical reasons.

About the milk bank

  • Any lactating mother can donate to the bank.
  • The milk stored in the bank will be pasteurised and would follow the international guidelines for safety.
  • Such milk becomes a blessing for working mothers who require joining work soon after their maternity leave.
  • Breast Milk Bank provides a cheaper option for the needy.

Protection

  • India faces the challenge of having the highest number of low birth weight babies with 20% mortality and morbidity in various hospitals.
  • Death of preterm babies is among three major causes of neonatal deaths. In all the neonatal intensive care units, about one-third of the babies would be preterm.
  • Feeding these babies with breast milk can significantly bring down the risk of infections.
  • These milk banks help the baby not just with the feed, but gives protection from many infections because of its inherent property to provide immunity to the infant.

On WHO guidelines

  • The World Health Organisation has said that breast milk is “tailor made” for human infants.
  • If for some reason, mother is not able to feed the infant, her milk should be expressed and fed, according to WHO.
  • The Neonatology Forum had been following this diktat and insists that the newborns are aggressively breastfed in the first hour.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Non-pneumatic Anti-Shock Garment (NASG)

Note4Students

From UPSC perspective, the following things are important :

Prelims level : About NASG

Mains level : Maternity healthcare in India


  • Project Sahara, an initiative in the state of Gujarat uses a unique technique to prevent maternal mortality due to excess bleeding.

Non-pneumatic Anti-Shock Garment (NASG)

  • Most mothers after child delivery suffer from postpartum haemorrhage (PPH) that leads to continuous and excessive bleeding.
  • The rapid loss of blood because of PPH reduces the body’s blood pressure and can even cause death.
  • The non-pneumatic anti-shock garment (NASG) applies pressure to the lower body and abdomen, thereby forcing the blood that was getting accumulated in the pelvic area to other essential organs of the body.
  • The neoprene garment quickly stabilizes vitals and gives doctor enough time for treatment.

Why need NASG?

  • As such, in November 2018, Babu started a new project, called Sahara, that aimed at reducing haemorrhage-related maternal deaths by providing new mothers with a special suit —the NASG.
  • PPH-related deaths accounts for significant number of maternal mortality in India.
  • A lot of mothers become anaemic because of poor nutrition. This weakness compounds the damage caused by excessive and sudden bleeding.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

[op-ed of the day] Having the last word on ‘population control’

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing Much

Mains level : Better Ways to ensure Population Control

Note- Op-ed of the day is the most important editorial of the day. Aspirants should try to cover at least this editorial on a daily basis to have command over most important issues in news. It will help in enhancing and enriching the content in mains answers. Please do not miss at any cost.

CONTEXT

On July 11, World Population Day, a Union Minister expressed alarm, in a Tweet, over what he called the “population explosion” in the country, wanting all political parties to enact population control laws and annulling the voting rights of those having more than two children.

Demographic transition – The Economic Survey 2018-19 notes that India is set to witness a “sharp slowdown in population growth in the next two decades”. The fact is that by the 2030s, some States will start transitioning to an ageing society as part of a well-studied process of “demographic transition” which sees nations slowly move toward a stable population as fertility rates fall with an improvement in social and economic development indices over time.

Reasons

  • The demand for state controls on the number of children a couple can have is not a new one.
  • It feeds on the perception that a large and growing population is at the root of a nation’s problems as more and more people chase fewer and fewer resources.
  • This image is so ingrained in the minds of people that it does not take much to whip up public sentiment which in turn can quickly degenerate into a deep class or religious conflict that pits the poor, the weak, the downtrodden and the minorities against the more privileged sections.
1.Target free approach –The essence of the policy was the government’s commitment to “voluntary and informed choice and consent of citizens while availing of reproductive health care services” along with a “target free approach in administering family planning services”.

2.Lifecycle framework –  “lifecycle framework” which looks to the health and nutrition needs of mother and child not merely during pregnancy and child birth but “right from the time of conception till the child grows… carrying on till the adolescent stage and further”.

3.Offering More Choices – This argument is not about denying services but about offering choices and a range of services to mother and child on the clear understanding that the demographic dividend can work to support growth and drive opportunity for ordinary people only when the population is healthy.

Crucial connections

1.The health and education status – Thus, family health, child survival and the number of children a woman has are closely tied to the levels of health and education of the parents, and in particular the woman; so the poorer the couple, the more the children they tend to have.

2.Not particular to religion – This is a relation that has little to do with religion and everything to do with opportunities, choices and services that are available to the people.

3.Relation with poverty – The poor tend to have more children because child survival is low, son preference remains high, children lend a helping hand in economic activity for poorer households and so support the economic as well as emotional needs of the family.

Comparison –

1.On the basis of wealth – As the National Family Health Survey-4 (2015-16) notes, women in the lowest wealth quintile have an average of 1.6 more children than women in the highest wealth quintile, translating to a total fertility rate of 3.2 children versus 1.5 children moving from the wealthiest to the poorest.

2.On the basis of education – Similarly, the number of children per woman declines with a woman’s level of schooling. Women with no schooling have an average 3.1 children, compared with 1.7 children for women with 12 or more years of schooling. 

Control is not the desired way –

  • Demographers are careful not to use the word “population control” or “excess population”.
  • The NPP 2000 uses the world “control” just thrice: in references to the National AIDS Control Organisation; to prevent and control communicable diseases, and control of childhood diarrhoea.
  • This is the spirit in which India has looked at population so that it truly becomes a thriving resource; the life blood of a growing economy.
  • Turning this into a problem that needs to be controlled is exactly the kind of phraseology, mindset and possibly action that will spell doom for the nation.
  • Today, as many as 23 States and Union Territories, including all the States in the south region, already have fertility below the replacement level of 2.1 children per woman.
  • So, support rather than control works.

Conclusion

  • The damage done when mishandling issues of population growth is long lasting.
  • Let us not forget that the scars of the Emergency are still with us. Men used to be part of the family planning initiatives then but after the excesses of forced sterilisations, they continue to remain completely out of family planning programmes even today.
  • The government now mostly works with woman and child health programmes. Mistakes of the Emergency-kind are not what a new government with a robust electoral mandate might like to repeat.

 

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Chandipura Virus

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Chandipura Virus

Mains level : Not Much


  • Medical officers are on high alert after a 5 year old died of Chandipura Virus in Gujarat.

Chandipura virus

  • The Chandipura virus was discovered by 2 Pune-based virologists of the National Institute of Virology (NIV) in 1965.
  • The Chandipura Vesiculovirus (CHPV) predominantly affects children.
  • The virus spreads mainly through the bite of sand flies and sometimes through mosquitoes.
  • The symptoms include sudden high fever accompanied by headache, convulsions and vomiting, sometimes leading to unconsciousness.
  • Cases have mostly been reported during monsoon and pre-monsoon, when sand flies breed.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

“State of Food Security and Nutrition in the World” Report


  • The “State of Food Security and Nutrition in the World” was recently released.

About the report

  • It is published by the UN Food and Agriculture Organization (FAO) and other UN agencies including the WHO.
  • The report estimated that 820 million people worldwide did not have enough to eat in 2018, up from 811 million in the previous year.
  • At the same time, the number of overweight individuals and obesity continue to increase in all regions.

Highlights of the report

  • The number of people going hungry has risen for the third year running to more than 820 million. After decades of decline, food insecurity began to increase in 2015.
  • Africa and Asia account for more than nine out of ten of the world’s stunted children, at 39.5% and 54.9% respectively.
  • However at the same time, obesity and excess weight are both on the rise in all regions, with school-age children and adults affected particularly.

India scenario

  • The number of obese adults in India has risen by a fourth in four years, from 24.1 million in 2012 to 32.8 million in 2016.
  • While India’s undernourished population has dropped by roughly the same fraction in 12 years, from 253.9 million in 2004-06 to 194.4 million in 2016-18.

Compared with China

  • The report has a section on economic growth in China and India, and its effect on poverty.
  • Between 1990 and 2017, the two countries had an average GDP per capita growth rate of 8.6 per cent and 4.5 per cent respectively, the report said, citing World Bank.
  • In both countries, the increase in GDP per capita has been accompanied by poverty reduction.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

[pib] LaQshya Initiative

Note4Students

From UPSC perspective, the following things are important :

Prelims level : LaQshya Initiative

Mains level : Not Much

  • The Minister of State (Health and Family Welfare) informed about LaQshya Initiative in the Lok Sabha.

LaQshya Initiative

  • Government of India has launched “LaQshya” (Labour room Quality improvement Initiative) to improve quality of care in labour room and maternity operation theatres in public health facilities.
  • Aim: To reduce preventable maternal and newborn mortality, morbidity and stillbirths associated with the care around delivery in Labour room and Maternity Operation Theatre and ensure respectful maternity care.

Objectives

  • To reduce maternal and newborn mortality & morbidity due to hemorrhage, retained placenta, preterm, preeclampsia and eclampsia, obstructed labour, puerperal sepsis, newborn asphyxia, and newborn sepsis, etc.
  • To improve Quality of care during the delivery and immediate post-partum care, stabilization of complications and ensure timely referrals, and enable an effective two-way follow-up system.
  • To enhance satisfaction of beneficiaries visiting the health facilities and provide Respectful Maternity Care (RMC) to all pregnant women attending the public health facilities.

Following types of healthcare facilities have been identified for implementation of LaQshya program:

  1. Government medical college hospitals.
  2. District Hospitals & equivalent health facilities.
  3. Designated FRUs and high case load CHCs with over 100 deliveries/month ( 60 in hills and desert areas)

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

[op-ed of the day] A demographic window of opportunity

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing Much

Mains level : Population control Policies

Note- Op-ed of the day is the most important editorial of the day. Aspirants should try to cover at least this editorial on a daily basis to have command over most important issues in news. It will help in enhancing and enriching the content in mains answers. Please do not miss at any cost.

CONTEXT

Last month, the United Nations released the 26th revision of World Population Prospects and forecast that India will overtake China as the most populous country by 2027. The only surprise associated with this forecast is the way it was covered by the media. Is this good news or bad news? Is it news at all?

Most populous country

  • We have known for a long time that India is destined to be the most populous country in the world.
  • Population projections are developed using existing population and by adjusting for expected births, deaths and migration.
  • For short-term projections, the biggest impact comes from an existing population, particularly women in childbearing ages.
  • Having instituted a one-child policy in 1979, China’s female population in peak reproductive ages (between 15 and 39 years) is estimated at 235 million (2019) compared to 253 million for India.

History

  1. Failures of punitive actions
  • History tells us that unless the Indian state can and chooses to act with the ruthlessness of China, the government has few weapons in its arsenal.
  • Almost all weapons that can be used in a democratic nation, have already been deployed.
  • These include restriction of maternity leave and other maternity benefits for first two births only and disqualification from panchayat elections for people with more than two children in some States along with minor incentives for sterilisation.
  • Ground-level research by former Chief Secretary of Madhya Pradesh Nirmala Buch found that individuals who wanted larger families either circumvented the restrictions or went ahead regardless of the consequences.

2.Incentives for population control

  • Second, if punitive actions won’t work, we must encourage people to have smaller families voluntarily.
  • There are sharp differences in fertility among different socio-economic groups.
  • Total Fertility Rate (TFR) for the poorest women was 3.2 compared to only 1.5 for the richest quintile in 2015-16.
  • Desire to invest in their children’s future – Research with demographer Alaka Basu from Cornell University shows that it is a desire to invest in their children’s education and future prospects that seems to drive people to stop at one child.
  • Richer individuals see greater potential for ensuring admission to good colleges and better jobs for their children, inspiring them to limit their family size.
  • Thus, improving education and ensuring that access to good jobs is open to all may also spur even poorer households into having fewer children and investing their hopes in the success of their only daughter or son.
  • Accessible contraceptive  – Provision of safe and easily accessible contraceptive services will complete this virtuous cycle.

3.Population and policy

  • Third, we must change our mindset about how population is incorporated in broader development policies.
  • Population growth in the north and central parts of India is far greater than that in south India.
  • These policies include using the 1971 population to allocate seats for the Lok Sabha and for Centre-State allocation under various Finance Commissions.
  • In a departure from this practice, the 15th Finance Commission is expected to use the 2011 Census for making its recommendations.
  • This has led to vociferous protests from the southern States as the feeling is that they are being penalised for better performance in reducing fertility.
  •  Between the 1971 and 2011 Censuses, the population of Kerala grew by 56% compared to about 140% growth for Bihar, Uttar Pradesh and Madhya Pradesh.
  • A move to use the 2011 Census for funds allocation will favour the north-central States compared to Kerala and Tamil Nadu.
  • However, continuing to stay with a 1971 Census-based allocation would be a mistake.

Way Forward

  •  Investment in the education and health – In order to maximise the demographic dividend, we must invest in the education and health of the workforce, particularly in States whose demographic window of opportunity is still more than a decade away.
  • Staying fixated on the notion that revising State allocation of Central resources based on current population rather than population from 1971 punishes States with successful population policies is shortsighted.
  • This is because current laggards will be the greatest contributors of the future for everyone, particularly for ageing populations of early achievers.
  • Enhancing their productivity will benefit everyone.
  • It is time for India to accept the fact that being the most populous nation is its destiny.
  • It must work towards enhancing the lives of its current and future citizens.

By Root

Caretaker @civilsdaily

Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

[pib] Janani Suraksha Yojana

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Janani Suraksha Yojana

Mains level : Maternity healthcare in India

Janani Suraksha Yojana (JSY)

  • Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health Mission (NHM).
  • It is being implemented with the objective of reducing maternal and infant mortality by promoting institutional delivery among pregnant women.
  • The scheme is under implementation in all states and Union Territories (UTs), with a special focus on Low Performing States (LPS).
  • It was launched in April 2005 by modifying the National Maternity Benefit Scheme (NMBS).
  • The NMBS came into effect in August 1995 as one of the components of the National Social Assistance Programme (NSAP).
  • The scheme was transferred from the Ministry of Rural Development to the Department of Health & Family Welfare during the year 2001-02.

Various measures under JSY

  • The scheme focuses on the poor pregnant woman with special dispensation for States having low institutional delivery rates namely the States of UP, Uttaranchal, Bihar, Jharkhand, MP, Chhattisgarh, Assam, Rajasthan, Orissa and J&K.
  • While these States have been named as Low Performing States (LPS), the remaining States have been named as High performing States (HPS).
  • Exclusion criteria of age of mother as 19 years or above and up to two children only for home and institutional deliveries under the JSY have been removed.
  • Eligible mothers are entitled to JSY benefit regardless of any age and any number of children.
  • BPL pregnant women, who prefer to deliver at home, are entitled to a cash assistance of Rs 500 per delivery regardless of age of women and the number of children.
  • States are encouraged to accredit private health facilities for increasing the choice of delivery care institutions.

By Root

Caretaker @civilsdaily


 

  • Aim: To generate awareness and improve efficiency of delivery of welfare services meant for women
  • Launched on 22 January 2015 with an initial corpus of Rs. 100 crore
  • Joint initiative of Ministries of Women & Child Development, Health & Human Resource Development

Districts Identified

The three criteria for selection of districts:

  1. Districts below the national average (87 districts/23 states);
  2. Districts above national average but shown declining trend (8 districts/8 states)
  3. Districts above national average and shown increasing trend (5 districts/5 states- selected so that these CSR levels can be maintained and other districts can emulate and learn from their experiences)
  • First Phase:

100 districts have been identified on the basis of low Child Sex Ratio as per Census 2011 covering all States/UTs as a pilot With at least one district in each state

  • Second Phase

The scheme has further been expanded to 61 additional districts selected from 11 States/UT having CSR below 918


 

Strategies:

  • Implement a sustained Social Mobilization and Communication Campaign to create equal value for the girl child & promote her education
  • Focus on Gender Critical Districts and Cities low on CSR for intensive & integrated action
  • Mobilize & Train Panchayati Raj Institutions/ Urban local bodies/ Grassroot workers as catalysts for social change
  • Ensure service delivery structures/ schemes & programmes are sufficiently responsive to issues Of gender and children’s rights
  • Enable Inter-sectoral and inter-institutional convergence at District/ Block/ Grassroot levels

Implementation:

  1. Centre: A National Task Force (NTF) headed by Secretary WCD
    State: A State Task Force (STF)
  2. District: District Task Force (DTF) headed by the District Collector/ Deputy Commissioner with representation of concerned departments
  3. Block: A Block Level Committee headed by SDM/ SDO/ BDO
  4. Gram Panchayat/ Municipality: Respective Panchayat Samiti/ Ward Samiti
  5. Village: Village Health Sanitation and Nutrition Committees
Published with inputs from Swapnil

By Root

Caretaker @civilsdaily

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