đŸ’„Join UPSC 2027,2028 Mentorship (July Batch) + XFactor Notes & Microthemes PDF
Talk to Mentor

Civilsdaily

Login

Subject: Health

  • Battling the bug

    Context

    With multiple cities in China under a public health lockdown, global supply chains of various essential products and consumer goods are likely to be affected. This should be particularly worrisome for India, which has a roughly $93 billion total trade and about $57 billion trade imbalance with China.

    Cause of worry turned into a reality

    • Public health experts have worried most about an animal virus-
      • That gets into humans.
      • Causes human-to-human transmission.
      • Has high infectivity and a range of clinical severity.
      • With no human immunity, no diagnostic tests, drugs or vaccines.
    • An emerging virus, called the 2019 novel coronavirus (2019-nCoV), appears to be just that.
    • With the World Health Organisation declaring it a Public Health Emergency of International Concern (PHEIC), this outbreak is now a pandemic.

    What is coronavirus

    • Group of animal virus: Coronaviruses are a group of animal viruses identified by their crown-like (corona) appearance under a microscope.
    • SAARS connection: The 2019-nCoV belongs to this group of viruses, six of which, including the 2003 Severe Acute Respiratory Syndrome (SARS) and the 2012 Middle East Respiratory Syndrome (MERS) viruses, were earlier known to cause disease in humans.
      • Genetic similarity with other viruses: Genetic sequencing of the virus from five patients showed it to be 5 per cent identical to the SARS virus.
    • Bats as hosts: Since the SARS outbreak in 2003, scientists have discovered a large number of SARS-related coronaviruses from their natural hosts-bats.
      • Previous studies have shown some of these bat coronaviruses to have the potential to infect humans.
      • Genetic sequencing showed it to human coronavirus to be over 96 per cent identical to a bat coronavirus.
      • Thus, 2019-nCoV clearly originated from bats, jumped into humans either directly or through an intermediate host, and adapted itself to human-to-human transmission.
      • Bats are a particularly rich reservoir for viruses with the potential to infect humans.
      • Examples of these include viruses such as Hanta, Rabies, Nipah, Ebola and Marburg viruses, and others that have caused high levels of mortality and morbidity in humans.
      • India has 117 species and 100 sub-species of bats, but we know little about the viruses they harbour and their disease potential.

    India’s response

    • India’s response includes-
      • Surveillance of arriving passengers at airports.
      • Awareness drives in the border states.
      • Designation of hospitals with isolation wards and the availability of protective gear (e.g. masks) to health workers.
      • SOP: There are clear operating procedures for sample collection and its transport to the National Institute of Virology, Pune, which is the nodal testing centre.
      • A self-declaration mechanism is in place and a 24×7 telephone helpline has been set up.
    • Two areas of concern
      • 1. Promotion of untested medicines: There is mixed messaging promoting AYUSH products that are untested and of questionable efficacy.
      • 2. India- a hot zone of zoonotic pathogens: India has been a “hot zone” for the emergence of new zoonotic (animal-derived) pathogens for over a decade.
      • But we continue to lack the capacity to quickly identify, isolate and characterise a novel pathogen.
      • Example of China: China is a good example of how investments in research and public health will allow it to take a lead on developing diagnostic tests, vaccines and drugs for this new virus. We must do the same and prepare for the future.
    • Disruption in global supply chains and concerns for India
      • With multiple cities in China under a public health lockdown, global supply chains of various essential products and consumer goods are likely to be affected.
      • This should be particularly worrisome for India, which has a roughly $93 billion total trade and about $57 billion trade imbalance with China.
      • Disruption in medicine supply: The Indian pharmaceuticals industry imports about 85 per cent of its active pharmaceutical ingredients from China.
      • Any disruption in this supply chain would adversely affect the availability of medicines in India, which would be required in an outbreak situation.
      • Need to support local pharma. industry: India must, therefore, take steps to correct this imbalance and support the local pharmaceuticals industry in reducing its dependence on China

    Possible scenarios

    • Public health experts estimate that the epidemic will peak in three months.
    • From here on, there are a few possible scenarios, but which of these would play out is hard to guess.
    • 1st possibility: There could be very large numbers of cases and global spread of the virus with a low CFR of 0.1-0.5 per cent, like the bad flu. Or the same with increased CFR, which would lead to significant mortality.
    • 2nd possibility: It is also possible that the outbreak spiralled in China due to a combination of factors not present elsewhere, such as population density, food habits and the Chinese New Year, which sees large population movements.
      • It is also possible that the pandemic may not sustain outside China and die out like the 2003 SARS outbreak.
    • Whatever be the case, surveillance and sensible public health measures will be needed over the next few months.

    Conclusion

    India escaped the 2003 SARS and 2012 MERS outbreaks largely unscathed. This may still be the case with 2019-nCoV, but the laws of probability are likely to catch up soon. It would help to invest, build capacity and be ready.

     

     

     

     

  • Nutrition and the Budget’s fine print

    Context

    There are well-equipped schemes to address the malnutrition, plugging the policy gaps is the problem.

    Nutrition and hunger in India

    • Global Hunger Index rank 102: A few months ago, the Global Hunger Index, reported that India suffers from “serious” hunger, ranked 102 out of 117 countries.
    • Only one-tenth of children getting proper diet: Just a tenth of children between six to 23 months are fed a minimum acceptable diet.
    • Urgency reflected in the budget: The urgency around nutrition was reflected in the Union Finance Minister’s Budget speech, as she referred to the “unprecedented” scale of developments under the scheme for Holistic Nutrition, or POSHAN Abhiyaan, the National Nutrition Mission with efforts to track the status of 10 crore households.
    • The Economic Survey notes that “Food is not just an end in itself but also an essential ingredient in the growth of human capital and therefore important for national wealth creation”.
    • How malnutrition affects? Malnutrition affects cognitive ability, workforce days and health, impacting as much as 16% of GDP (World Food Programme and World Bank).

    Addressing Nutrition through Agriculture

    • Multiple dimension of malnutrition: There are multiple dimensions of malnutrition that include-
      • Calorific deficiency.
      • Protein hunger.
      • Micronutrient deficiency.
    • Addressing the issue through Agriculture: An important approach to address nutrition is through agriculture.
      • The Bharatiya Poshan Krishi Kosh which was launched in 2019 is a recent attempt to bridge this gap.
      • The krishi kosh was launched by Ministry of Women and Child Development along with Bill & Melinda Gates Foundation (BMGF).
      • Existing schemes can well address India’s malnutrition dilemma. Following is the analysis of budgetary allocation and expenditure in the previous year.

    First- Calorific deficiency

    • The Integrated Child Development Services (ICDS) scheme provides a package of services including-
      • Supplementary nutrition.
      • Nutrition and health education.
      • Health check-ups and
      • Referral services addressing children, pregnant and lactating mothers and adolescent girls, key groups to address community malnutrition, and which also tackle calorific deficiency and beyond.
      • Underutilisation of funds: For 2019-20, the allotment was â‚č27,584.37 crore but revised estimates are â‚č24,954.50 crore, which points to an underutilisation of resources.
      • Which area needs the emphasis: The allocation this year is marginally higher, but clearly, the emphasis needs to be on implementation.
    • Mid-Day Meal Scheme: Another pathway to address hunger is the Mid-Day Meal Scheme, to enhance the nutrition of schoolchildren.
      • Here too, the issue is not with allocation but with expenditure.
      • The 2019-20 Budget allocation was â‚č11,000 crore and revised estimates are only â‚č9,912 crores.

    Second-Protein Hunger

    • Contribution of pulses: Pulses are a major contributor to address protein hunger.
      • Underutilisation of funds: A scheme for State and Union Territories aims to reach pulses into welfare schemes (Mid-Day Meal, Public Distribution System, ICDS) has revised estimates standing at just â‚č370 crores against â‚č800 crore allocation in the 2019-20 Budget.

    Third-micronutrient deficiency

    • Horticulture Mission: The Horticulture Mission can be one of the ways to address micronutrient deficiency effectively, but here too implementation is low.
      • Revised estimates for 2019-20 stand at â‚č1,583.50 crores against an allocation of â‚č2,225 crores.
    • National Millet Mission: In 2018-19, the Government of India launched a national millet mission which included renaming millets as “nutri-cereals” also launching a Year of Millets in 2018-19 to promote nutritious cereals in a campaign mode across the country.
      • This could have been further emphasised in the Budget as well as in the National Food Security Mission (NFSM) which includes millets.
      • Under-utilisation of funds: The NFSM strains to implement the allocation of â‚č2,000 crores during 2019-20, as revised expenditures stand at â‚č1,776.90 crore.
      • Need to sustain the momentum: As millets have the potential to address micronutrient deficiencies, the momentum given to these cereals needs to be sustained.

    POSHAN Abhiyan and issues involved

    • 72% expenditure on technology: The National Nutrition Mission which is a major initiative to address malnutrition, had 72% of total expenditure going into “Information and Communication Technology.
      • Misplaced focus: The focus of the bulk of the funding has been on technology, whereas, actually, it is a convergence that is crucial to address nutrition.
      • Under-utilisation of funds: Only 34% of funds released by the Government of India were spent from FY 2017-18 to FY 2019-20 till November 30, 2019.
      • Limiting the possibility of an increase in the allocation: With underspending, allocations for subsequent years will also be affected, limiting the possibility of increasing budgets and the focus on nutrition schemes.

    Agriculture-nutrition link

    • The agriculture-nutrition link is another piece of the puzzle.
    • Link not explicitly mentioned: While agriculture dominated the initial Budget speech, the link between agriculture and nutrition was not explicit.
      • Why the link is important: The link is important because about three-fifths of rural households are agricultural in India (National Sample Survey Office, 70th round)
      • The malnutrition rates, particularly in rural areas are high (National Family Health Survey-4).
      • Need for greater emphasis: Agriculture-nutrition linkage schemes have the potential for greater impact and need greater emphasis.

    Way forward

    • Focus: Focus on nutrition-related interventions, beyond digitisation.
    • Bring all departments in one place: Intensify the convergence component of POSHAN Abhiyaan, using the platform to bring all departments in one place to address nutrition.
    • Nutrition based activities by farmer-producer: Direct the announcement to form 10,000 farmer producer organisations with an allocation of â‚č500 crores to nutrition-based activities.
    • Youth schemes: Promotion of youth schemes to be directed to nutrition-agriculture link activities in rural areas.
    • Emphasis on fund allocation: Give explicit emphasis and fund allocation to agriculture-nutrition linked schemes.
    • Early disbursement and utilisation of funds: Ensure early disbursement of funds and optimum utilisation of schemes linked to nutrition.

    Conclusion

    Nutrition goes beyond just food, with economic, health, water sanitation, gender perspectives and social norms contributing to better nutrition. This is why the implementation of multiple schemes can contribute to better nutrition.

     

  • Medical Devices (Amendment) Rules, 2020

    The Ministry of Health and Family Welfare has notified changes in the Medical Devices Rules, 2017 to regulate medical devices on the same lines as drugs under the Drugs and Cosmetics Act, 1940.

    Medical Devices (Amendment) Rules, 2020

    • These rules are applicable to devices intended for internal or external use in the diagnosis, treatment, mitigation or prevention of disease or disorder in human beings or animals” (as notified by the ministry).
    • It requires online registration of these devices “with the Central Licensing Authority through an identified online portal established by the Central Drugs Standard Control Organisation for this purpose.
    • Among the information that the manufacturer has to upload are “name & address of the company or firm or any other entity manufacturing the medical device along with name and address of manufacturing site.
    • It also need to upload certificate of compliance with respect to ISO 13485 standard accredited by National Accreditation Board for Certification Bodies or International Accreditation Forum.
    • This would mean that every medical device, either manufactured in India or imported, will have to have quality assurance before they can be sold anywhere in the country.
    • After furnishing of the above information a registration number will be generated. Manufacturer shall mention the registration number on the label of the medical device.

    What are the items covered under the new Rules?

    • A large number of commonly used items including hypodermic syringes and needles, cardiac stents, perfusion sets, catheters, orthopaedic implants, bone cements, lenses, sutures, internal prosthetic replacements etc are covered under the new rules.
    • For some items such as sphygmomanometers (used to monitor blood pressure), glucometers (to check blood sugar), thermometers, CT scan and MRI equipment, dialysis and X-ray machines, implants etc, different deadlines for compliance have been set.
    • For example for the first three, it is January 2021, for the others it is April next year. For ultrasound equipment, it is November 2020.

    Is this a sudden move?

    • This has been in the offing for some time now.
    • In October last year, the ministry had circulated copies of the then proposed notification for public comments following recommendations of the Drugs Technical Advisory Board (DTAB), which is the highest technical body for these decisions and has experts among its members.
    • In April last year, the DTAB had recommended that all medical devices should be notified as “drugs” under the drug regulation law to ensure they maintain safety and quality standards.
    • The notification makes it clear that the government has issued it in consultation with the DTAB.

    Why was the move required?

    • For much of the last one year, the health sector has been at the centre of attention following revelations about faulty hip implants marketed by pharma major Johnson & Johnson.
    • This has caused major embarrassment to the government, too, as it exposed the lack of regulatory teeth when it came to medical devices.
    • The matter dragged on, exposing the regulatory loopholes until finally the company agreed in court to pay Rs 25 lakh each to the 67 people who had had to undergo revision surgeries because the implants were defective.
    • That is really where the discussion started about regulation of medical devices.

    What are the penal provisions under Indian law?

    • There are various penal provisions under the Drugs and Cosmetics Act, 1940 for various kinds of offences. Manufacture or sale of substandard items is punishable with imprisonment of at least 10 years, which may extend to imprisonment for life.
    • There is also a provision for fine that will “not be less than Rs 10 lakh rupees or three times value of the confiscated items”.

  • Novel Coronavirus renamed as COVID-19 by WHO

    The World Health Organization (WHO) gave an official name to the disease caused by the novel coronavirus. The death toll from the virus has now crossed 1,000 and the disease has infected tens of thousands of people, the majority of them in China.

    COVID-19

    • The disease will be called “COVID-19”; the “CO” stands for coronavirus, “VI” for virus and “D” for disease.
    • The coronavirus itself is called “nCoV-2019”.

    WHO nomenclature

    • The WHO, in consultation with the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO), has identified best practices for naming new human diseases.
    1. These best practices apply to a new disease:
    2. That is an infection, syndrome, or disease of humans;
    3. That has never been recognised before in humans;
    4. That has potential public health impact; and
    5. Where no disease name is yet established in common usage
    • Names that are assigned by the WHO may or may not be approved by the International Classification of Diseases (ICD) at a later stage.
    • The ICD, which is also managed by the WHO, provides a final standard name for each human disease according to standard guidelines that are aimed at reducing the negative impact from names while balancing science, communication and policy.

    Terms to avoid

    • The agreed best practices include advice on what the disease names should not include, such as geographic location (Middle East Respiratory Syndrome, Spanish Flu, Japanese encephalitis).
    • Disease names should not include people’s names (Creutzfeldt-Jakob disease, Chagas disease), the species or class of animal or food (swine flu, monkeypox etc.), cultural or occupational references (miners, butchers, cooks, nurses etc.) and terms that incite “undue fear” such as death, fatal and epidemic.
    • The use of names such as “swine flu” and “Middle East Respiratory Syndrome” has had “unintended negative impacts” by stigmatising certain communities and economic sectors.

    Terms to include

    • The best practices include using generic descriptive terms such as respiratory diseases, hepatitis, neurologic syndrome, watery diarrhoea.
    • They include using specific descriptive terms that may indicate the age group of the patients and the time course of the disease, such as progressive, juvenile or severe.
    • If the causative pathogen is known, it should be used as part of the disease name with additional descriptors such as the year when the disease was first reported or detected.
    • The names should also be short (rabies, malaria, polio) and should be consistent with the guidelines under the International Classification of Diseases (ICD) Content Model Reference Guide.
    • As per the WHO, “severe” should be used only for those diseases that have a very high initial case fatality rate. “Novel” can be used to indicate a new pathogen of a previously known type
    • In the case of the novel coronavirus, “recognizing that this term will become obsolete if other new pathogens of that type are identified”, the WHO has now changed its name.

  • Arsenic Contamination

    As the geography of arsenic contamination spreads, there is an urgent need for governments to reorient mitigation measures. That’s because the focus till now has only been on drinking water, but new research says arsenic has contaminated our food chain.

    Arsenic contamination of water

    • Arsenic contamination in groundwater is one of the most crippling issues in the drinking water scenario of India.
    • According to the latest report of the Central Ground Water Board (CGWB), 21 states across the country have pockets with arsenic levels higher than the BIS stipulated permissible limit of 0.01 milligram per litre (mg/l).
    • The states along the Ganga-Brahmaputra-Meghna (GBM) river basin — Uttar Pradesh, Bihar, Jharkhand, West Bengal and Assam — are the worst affected by this human-amplified geogenic occurrence.
    • In India, arsenic contamination was first officially confirmed in West Bengal in 1983.
    • Close to four decades after its detection, the scenario has worsened.
    • About 9.6 million people in West Bengal, 1.6 million in Assam, 1.2 million in Bihar, 0.5 million in Uttar Pradesh and 0.013 million in Jharkhand are at immediate risk from arsenic contamination in groundwater.

    Effects of arsenic poisoning

    • Long-term exposure to arsenic in drinking water can cause cancer in the skin, lungs, bladder and kidney. It can also cause other skin changes such as thickening and pigmentation.
    • The likelihood of effects is related to the level of exposure to arsenic and in areas where drinking water is heavily contaminated, these effects can be seen in many individuals in the population.
    • Increased risks of lung and bladder cancer and skin changes have been reported in people ingesting arsenic in drinking water at concentrations of 50 ”g/litre, or even lower.

    Affecting food

    • Recent research says arsenic contamination in groundwater has penetrated the food chain.
    • It eventually causes photo-accumulation of arsenic in the food crops, especially in the leaves, can emanate from contaminated water sprayed on them.
    • Yet the focus remained on drinking water, and the affected regions became the primary stake-holder in the mitigation approach.

    Way forward

    • Mitigation measures — that are currently focused on drinking water — must have a more comprehensive approach to ensure arsenic-free water for drinking and agricultural products.
    • That means that the government must check for arsenic in water used for agricultural produce.
    • Both the Union and state governments must work toward facilitating research that can investigate the accumulation of arsenic in crops and addressing the agricultural concerns of the affected regions.
    • They must watch out for arsenic percolation in the food chain and the possibilities of biomagnification.
    • The government needs to also conduct a larger study on the arsenic contamination of our food chain and its health impacts to understand its spatial spread through the agricultural supply chain.

  • A mix Indian health care can do without

    Context

    In India, multiple policy pronouncements over the last few years have expressed an implicit intent to emulate certain features of the U.S. health system which is one of the most prodigal health systems, and it is a well-known reality that it is infamously poor-performing.

    Emulating the U.S. health system in India and problems in this approach

    • Implicit intent to emulate the U.S. system: In India, multiple policy pronouncements over the last few years have expressed an implicit intent to emulate certain features of the U.S. health system like-
      • Enhance private initiative.
      • And uphold the insurance route as the way to go for health care.
    • AB-NHPS scheme: These are being largely envisaged while riding on the back of the Ayushman Bharat-National Health Protection Scheme (AB-NHPS).
      • AB-NHPS aims to provide insurance cover to nearly 50 crores poor Indians.
      • The mechanism to check insurance frauds: The AB-NHPS affirmed strong mechanisms to check insurance fraud which was commonplace in its precursor programme, the Rashtriya Swasthya Bima Yojana (RSBY).
      • New of fraud in AB-NHPS: Recently, 171 hospitals were reported to have been de-empanelled from the AB-NHPS on charges of fraud.
    • How are the frauds in AB-NHPS sought to be tackled? The response to these has been envisaged through an unprecedented bolstering of administratively-heavy and technology-driven mechanisms.
      • Anti-fraud units: National- and state anti-fraud units have been established and partnerships with fraud control companies conceived.
      • One would ask this question: what is wrong in all of this?
    • What is wrong with this approach? Let us return to the U.S. once again.
      • Administrative intensive: Multiple layers of complex arrangements and concomitant complex regulatory provisions have made the U.S. system one of the most administratively and technologically intensive systems in the world.
      • 50% spending going for the wages: More than 50% of health-care spending in the U.S. in 2010 went into health worker’s wages, with a large chunk of the growth in health-care labour taking place in the form of non-clinical workers.
      • Very little going into improving health: What this entails is that for every penny spent on health care, very little goes into actually improving health.

    What are the concerns in emulating the U.S. system?

    • Sub-satisfactory operations at the large cost: The new system necessitates-
      • A battery of new structures.
      • Personnel cadres.
      • Data systems.
      • And working arrangements only in order to sub-satisfactorily operate an insurance scheme that would cover less than half the population.
      • Disregarding the death spiral that policy-driven over-reliance on private health care could lead to considerable costs which would not primarily contribute to improving health outcomes.
      • Ethical concerns over unnecessary spending: While a besottedness with cutting-edge technology and state-of-the-art systems can help garner eyes and promote businesses, each unnecessary penny incurred this way raises significant ethical concerns.
    • Problems of inadequate funding
      • Funding sufficient only for a quarter of beneficiary: Gupta and Roy have shown how the allocation for the AB-NHPS for 2019-20 would have covered less than a quarter of the targeted beneficiaries.
      • Paltry increase in allocations: For 2020-21, there has been a paltry increase in health-care sector allocation (5.7% above 2019-20 RE), while the allocation for the AB-NHPS is unchanged.
      • It is very possible that the AB-NHPS continues to remain insufficiently funded and incapable of extending considerable financial risk protection to the poor.
    • Diversion of limited funds to wasteful areas
      • Attractive on face: Embracing the complexities associated with robust regulation of the insurance programme and making the requisite technological and administrative investments appear attractive and commendable on the face.
      • Diversion of limited fund: However, these complexities entail diverting highly limited resources towards wasteful and dispensable high-end areas.
      • These funds could have been set aside for much more pressing and productive domains, such as public hospitals and health centres.
      • Improvements in these areas would have strongly reflected in terms of tangibly better health outcomes.
      • AB-NHPS reinforcing contradictions: Rather, the AB-NHPS appears attuned to reinforcing a stark contradiction wherein trailblazing but unproductive high-end structures thrive alongside decrepit but potentially fructuos basic structures.

    Conclusion

    The fanfare with which AB-NHPS was launched, can hide the pressing concerns which lie underneath. The government must ensure that every penny spent on improving healthcare is used in the most optimal way and ensure that India’s AB-NHPS won’t end up the US healthcare way.

  • Fine-tuning the Surrogacy Bill

    Context

    • In a recent report, a Select Committee of Parliament has recommended that the contentious clause limiting surrogacy only to “close relatives” to be removed from the Surrogacy (Regulation) Bill, 2019.
    • These recommendations aim to make the benefits of modern technology more easily available to infertile couples.
    • A look at the genesis of the Bill, its provisions and why the current report could signal some progressive amendments in the Bill:

    What are the provisions of the Surrogacy (Regulation) Bill?

    • The Surrogacy Bill proposes to allow altruistic ethical surrogacy to intend infertile Indian married couples in the age groups 23-50 years (women) and 26-55 years (men).
    • It was first mooted in 2016 in the wake of repeated reports of exploitation of women who were confined to hostels, not provided adequate post-pregnancy medical care and paid a pittance.
    • The couple should have been legally married for at least five years and should be Indian citizens.
    • They cannot have a surviving child, either biological or adopted, except when they have a child who is mentally or physically challenged or suffers from a life-threatening disorder with no permanent cure.
    • It requires surrogacy clinics to be registered, and national and state surrogacy boards to be formed.
    • It makes commercial surrogacy, and abandoning or disowning a surrogate child punishable by imprisonment up to 10 years and a fine up to Rs 10 lakh.

    What changes has the Select Committee suggested?

    • The Select Committee recommended that the “close relatives” clause should be removed, and any “willing” woman should be allowed to become a surrogate mothe.
    • It has strongly backed the ban on commercial surrogacy.
    • It has also recommended that divorced and widowed women aged between 35 and 45 years should be able to be a single commissioning parent.
    • It has emphasised the need for a five-year waiting period for childless married couples could be waived if there is a medical certificate that shows that they cannot possibly conceive.
    • It has recommended that persons of Indian origin should be allowed to avail surrogacy services.
    • It has not, however, recommended expanding the definition of commissioning parent to include singles, either men or women.
    • It also recommended that the ART Bill (which deals with assisted reproductive technologies) should be brought before the Surrogacy bill so that all the highly technical and medical aspects could be properly addressed.

    What is the ART Bill?

    • The Assisted Reproductive Technology (Regulation) Bill has been in the making since 2008.
    • It aims to regulate the field through registration of all IVF clinics and sperm banks, segregation of ART clinics and gamete banks etc.
    • It also requires national and state boards to be established for the purpose of regulation of the fertility market.
    • The Select Committee report says: “Surrogacy is a part and parcel of ART and hence the Surrogacy Bill should come into force only after the enactment of ART Bill.
    • Bringing Surrogacy Bill before the ART will be irrelevant and also create duplication of Boards.
    • The Standing Committee on Health and Family Welfare, too has “strongly recommended” to the government that the two Bills should be brought together and not in isolation.

    How big is India’s surrogacy market?

    • Estimations by the ICMR put it around 2,000-odd babies per year through commercial surrogacy — when a woman is paid an agreed sum for renting her womb.
    • CII figures say surrogacy is a $2.3-billion industry fed by a lack of regulations and poverty.

    What happened the last time the Bill was scrutinized by a parliamentary panel?

    • The Bill was earlier scrutinized by the Parliamentary Standing Committee on Health and Family Welfare.
    • That committee had recommended that compensation should be the norm and the word “altruistic” should be replaced with “compensated”.
    • Couples — including those in live-in relationships — should be allowed to choose surrogates from both within and outside the family. Altruistic surrogacy, it observed, is tantamount to exploitation.
    • The “close relative” condition is open to misuse in a patriarchal setup, the committee had observed.
    • Given the patriarchal familial structure and power equations within families, not every member of a family has the ability to resist a demand that she be a surrogate for another family member.
    • A close relative of the intending couple may be forced to become a surrogate which might become even more exploitative than commercial surrogacy.
    • These recommendations were not accepted by the government.

  • Seeking a more progressive abortion law

    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.

     

     

     

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

    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.

     

     

  • Global Report on Medical Data Leak

     

    Medical details of over 120 million Indian patients have been leaked and made freely available on the Internet, according to a recent report.

     Global Report on Medical Data Leak

    • It is published by Greenbone Sustainable Resilience, a German cybersecurity firm.
    • The first report was published in October 2019 in which Greenbone revealed a widespread data leak of a massive number of records, including images of CT scans, X-rays, MRIs and even pictures of the patients.
    • The follow-up report, which was published, classifies countries in the “good”, “bad” and “ugly” categories based on the action taken by their governments after the first report was made public.
    • India ranks second in the “ugly” category, after the U.S.

    Highlights of the report

    • As per the follow-up report, Maharashtra ranks the highest in terms of the number of data troves available online, with 3,08,451 troves offering access to 6,97,89,685 images.
    • The next is Karnataka, with 1,82,865 data troves giving access to 1,37,31,001 images.
    • The number of data troves containing this sensitive data went up by a significant number in the Indian context a month after the initial report was published.
    • It is a notable fact for the systems located in India, that almost 100% of the studies (data troves) allow full access to related images stated the report.

    What led to the leaks?

    • Greenbone’s original report says the leak was facilitated by the fact that the Picture Archiving and Communications Systems (PACS) servers, where these details are stored.
    • These servers are not secure and linked to the public Internet without any protection, making them easily accessible to malicious elements.

    Impact of leaks

    • The leak is worrying because the affected patients can include anyone from the common working man to politicians and celebrities.
    • In image-driven fields like politics or entertainment, knowledge about certain ailments faced by people from these fields could deal a huge blow to their image.
    • The other concern is of fake identities being created using the details, which can be misused in any possible number of ways.