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Subject: Social Justice

  • Care as disability justice, dignity in mental health

    Introduction

    Mental health systems globally and in India continue to prioritise biomedical treatment and functional integration. They often overlook lived experiences of distress, social exclusion, and structural vulnerability. There is a need for a fundamental shift: from care as a technical service to care as disability justice, grounded in dignity, equity, and relational accountability.

    Reframing Mental Health Care Beyond Treatment

    1. Dignity-Centred Care: Positions dignity, rather than cure or productivity, as the primary objective of mental health systems.
    2. Disability Justice Lens: Recognises mental illness as shaped by intersecting social, economic, and political structures.
    3. Relational Accountability: Frames care as embedded in relationships, not limited to institutional or clinical settings.

    Limits of Dominant Psychosocial Disability Models

    1. Productivity Bias: Prioritises economic functionality and independence as markers of recovery.
    2. Reductionist Integration: Treats community inclusion as an end-state without addressing exclusionary social norms.
    3. Invisible Chronic Distress: Marginalises individuals whose suffering does not conform to biomedical recovery trajectories.

    Structural Determinants of Mental Distress

    1. Material Deprivation: Highlights housing insecurity, income precarity, and food scarcity as persistent stressors.
    2. Social Abandonment: Identifies shame, rejection, and relational breakdown as under-recognised drivers of distress.
    3. Political and Cultural Loss: Notes erosion of cultural meaning, safety nets, and social identity as contributory factors.

    Multiplicity of Explanations for Mental Illness

    1. Biological Factors: Includes neurotransmitter alterations and inflammatory markers.
    2. Psychological Factors: Covers trauma, grief, and interpersonal loss.
    3. Socio-Structural Factors: Integrates caste, gender, class, and institutional neglect into causation analysis.
    4. Intersectionality: Emphasises overlapping vulnerabilities rather than single-cause explanations.

    Care as Relational and Material Practice

    1. Everyday Care Practices: Includes shelter, nutrition, social connection, and safety as therapeutic.
    2. Non-Linear Recovery: Rejects uniform timelines and outcome metrics.
    3. Shared Responsibility: Frames care as a collective moral obligation rather than individual compliance.

    Justice-Oriented Mental Health Engagement

    1. Recognition of Harm: Acknowledges that distress often arises from unjust social arrangements.
    2. Ethical Accountability: Asks what society owes to those it has marginalised.
    3. Transformative Focus: Shifts emphasis from symptom management to social repair.

    Implications for Education, Research, and Practice

    1. Curricular Reorientation: Calls for training that values lived experience and contextual care.
    2. Practice Diversity: Recognises non-specialist and community-based care providers.
    3. Interdisciplinary Learning: Supports integration of social theory, ethics, and practice.
    4. Systemic Support: Emphasises that professional competence requires institutional backing, not credentials alone.

    Conclusion

    Mental health care must be reimagined as an ethical, relational, and justice-oriented practice rather than a narrowly clinical intervention. By centering dignity and disability justice, the article calls for a paradigm shift that recognises suffering as socially produced and care as a shared societal responsibility.

    Mental Health in India

    1. About 10.6% of Indian adults, roughly 11 out of every 100 adults, were living with a diagnosable mental health disorder, according to a 2015-16 National Mental Health Survey (NMHS) conducted by the National Institute of Mental Health and Neurosciences (NIMHANS).
    2. The survey also revealed:
      1. 15% of India’s adult population experiences mental health issues requiring intervention
      2. The lifetime prevalence of mental disorders was 13.7%, indicating that around 14 out of every 100 people in India have experienced a mental disorder at some point in their lives
      3. Mental health disorders are more prevalent in urban areas (13.5%), compared to rural areas (6.9%).

    PYQ Relevance

    [UPSC 2024] In a crucial domain like the public healthcare system, the Indian State should play a vital role to contain the adverse impact of marketisation of the system. Suggest measures through which the State can enhance the reach of public healthcare at the grassroots level.

    Linkage: The article directly links to GS-II (Social Justice, Health) by highlighting the limitations of market-centric and outcome-driven public healthcare in addressing mental health and disability. It also enriches GS-IV by framing mental health care as an ethical obligation grounded in dignity, compassion, and justice rather than mere service delivery.

  • Measles  

    Why in the News?

    • According to recent global health reports, measles caused approximately 95,000 deaths in 2024, despite the presence of a highly effective vaccine.
    • Most deaths occurred among unvaccinated children under five, highlighting concerns about declining immunization coverage, vaccine hesitancy, and disruptions in routine immunization services in several regions.
    • The spike has raised alarms globally, making measles a significant public health priority in 2025.

    About Measles

    • Type: Highly contagious airborne viral disease.
    • Causative Agent: Measles virus (family Paramyxoviridae, genus Morbillivirus).
    • Severity: Can lead to pneumonia, encephalitis, blindness, and death.

    Who Is at Risk?

    • Any non-immune person.
    • Higher risk:
      • Unvaccinated young children
      • Pregnant persons
    • Common in parts of Africa, the Middle East, and Asia.

    Treatment

    • No specific antiviral treatment.
    • Management is supportive (hydration, fever control, nutrition, monitoring complications).

    Prevention

    • Measles-Rubella (MR) vaccine offers long-term protection.
    • India:
      • Measles vaccine included in Universal Immunization Programme (UIP) in 1985.
      • Ongoing campaigns aim to eliminate measles and rubella.

    UPSC Prelims Pointers

    • Measles virus → Paramyxoviridae.
    • Virus survives 2 hours in air/surfaces → high transmission.
    • No antiviral; vaccine is key preventive tool.
    • Koplik spots → diagnostic hallmark.
    • India introduced measles vaccine in Universal Immunization Programme (UIP) → 1985.
    • Recent spike in global deaths makes measles a current affairs hotspot.
    HINI virus is sometimes mentioned in the news with reference to which one of the following diseases? (2015)

    (a) AIDS 

    (b) Bird flu 

    (c) Dengue 

    (d) Swine flu

  • Shingles Disease 

    Why in the news?

    A recent large study shows that shingles vaccination can reduce the risk of death from dementia and may help slow disease progression.

    What is Shingles

    • A viral infection characterized by a painful rash
    • Causative agent: Varicella zoster virus (VZV)
      • Same virus responsible for chickenpox
      • Remains latent in nerve cells after recovery from chickenpox
      • Can reactivate later in life

    Transmission

    • Shingles itself is not contagious
    • But the virus can spread to people without prior immunity, causing chickenpox (not shingles)

    Symptoms

    • Cluster of blisters appearing in a band-like pattern on one side of the body (typically torso, neck, or face)
    • Pain, burning, tingling sensation
    • Fever, fatigue, headache
    • Can lead to post-herpetic neuralgia (long-term nerve pain)
    HINI virus is sometimes mentioned in the news with reference to which one of the following diseases? (2015)

    (a) AIDS 

    (b) Bird flu 

    (c) Dengue 

    (d) Swine flu

  • Ultra-Processed Food Epidemic in India

    Why in the news?

    A recent Lancet three-paper series highlights the rapid rise in ultra-processed food (UPF) consumption globally, including India, and its strong link to rising obesity, diabetes, cardiovascular diseases, and premature mortality. The case of an 18-year-old Indian youth with obesity and early-onset metabolic disorders illustrates the growing public health crisis.

    What are Ultra-Processed Foods?

    According to the NOVA classification, ultra-processed foods are:

    • Industrial formulations with multiple chemical and cosmetic ingredients
    • Made using high-fructose corn syrup, hydrogenated oils, flavour enhancers, emulsifiers, preservatives, colours
    • Designed for long shelf life, hyper-palatable taste and convenience
      Examples: Soft drinks, chips, packaged noodles, biscuits, sugary beverages, chocolates, breakfast cereals, frozen pizzas, ready-to-heat meals, chicken nuggets, processed meats.

    Difference from Processed Foods:
     Processed = minimal changes (washing, canning, cooking).
     Ultra-processed = heavy industrial formulations, low nutrients, high calories.

    Note: NOVA is a food classification system developed by the University of São Paulo (Brazil) that categorises foods based on the extent and purpose of industrial processing, not nutrients.

    India’s UPF Consumption – Why It’s a Concern?

    • Huge surge in consumption: Retail sales of UPFs in India jumped from USD 0.9 billion (2006) → USD 38 billion (2019) (approx. 40-fold increase).
    • Rising NCD (Non-Communicable Diseases) burden: As per ICMR–INDIAB (2023): Obesity: 28.6%, Diabetes: 11.4%, Prediabetes: 15.3%, Abdominal obesity: 39.5% and Childhood obesity rising: 2.1% → 3.4% (NFHS).
    A company marketing food products advertises that its items do not contain trans-fats. What does this campaign signify to the customers? (2011)

    1. The food products are not made out of hydrogenated oils. 

    2. The food products are not made out of animal fats/oils. 

    3. The oils used are not likely to damage the cardiovascular health of the consumers. 

    Select the correct answer using the code given below: 

    (a) 1 only (b) 2 and 3 only (c) 1 and 3 only (d) 1, 2 and 3

  • 2.25 Crore Ineligible Beneficiaries removed  from Free Ration Scheme

    Why in the News?

    About 2.25 crore ineligible people were removed from the NFSA free ration list in the past 4–5 months to ensure benefits reach only rightful beneficiaries.

    About Free Ration Scheme:

    • Foodgrain Allocation: The scheme provides 5 kg of free foodgrains (wheat or rice) per person per month to poor households for basic sustenance.
    • Criteria for Ineligibility: Ineligible individuals included those owning four-wheelers, earning above the income threshold, holding company directorships, or deceased persons.
    • Verification Process: The Centre identified suspect entries and shared them with States for verification and deletion.
    • Role of State Governments: States are responsible for identifying beneficiaries, issuing ration cards, and continuously updating lists.
    • Current Coverage: The scheme currently covers around 80.56 crore people, with scope to add about 0.79 crore more beneficiaries.
    • Ration Card & Distribution Network: India has over 19 crore ration card holders and around 5 lakh fair price shops.
    • Beneficiary Categories:
      • Antyodaya Anna Yojana (AAY): 35 kg per household per month
      • Priority Households (PHH): 5 kg per person per month

    About National Food Security Act, 2013 (NFSA):

    • Enactment: NFSA was signed into law on 12 September 2013, with effect from 5 July 2013.
    • Coverage Goal: It aims to provide subsidized food grains to about two-thirds of India’s population, covering 75% rural and 50% urban populations.
    • Legal Entitlements: It converts food security schemes into legal entitlements for eligible households.
    • Subsidized Prices: Mandated Targeted Public Distribution System prices:
      • Rice – ₹3/kg
      • Wheat – ₹2/kg
      • Coarse grains – ₹1/kg
    • Household Head Provision: The eldest woman aged 18 or above in a household is designated as the head for issuing ration cards.
    • Nutritional Support: Pregnant women, lactating mothers, and children (6 months–14 years) receive free meals under ICDS and Mid-Day Meal schemes.
    • Maternity Benefits: Pregnant and lactating women are entitled to a ₹6,000 maternity benefit, paid in installments.
    • Entitlements Under NFSA:
      • Priority Households: 5 kg foodgrains per person per month
      • AAY Households: 35 kg per month
      • Universal coverage of ICDS and Mid-Day Meals
    [UPSC 2018] With reference to the provisions made under the National Food Security Act, 2013, consider the following statements:

    1. The families coming under the category of ‘below poverty line (BPL)’ only are eligible to receive subsidies food grains.

    2. The eldest woman in a household, of age 18 years or above, shall be the head of the household for the purpose of issuance of a ration card.

    3. Pregnant women and lactating mothers are entitled to a ‘take-home ration’ of 1600 calories per day during pregnancy and for six months thereafter.

    (a) 1 and 2 (b) 2 only* (c) 1 and 3 (d) 3 only

     

  • [pib] National Social Assistance Programme (NSAP)

    Why in the News?

    PIB has provided an update regarding the progress of National Social Assistance Programme (NSAP).

    About National Social Assistance Programme (NSAP):

    • Overview: Launched on 15 August 1995, NSAP is a Centrally Sponsored Scheme under the Ministry of Rural Development.
    • Objective: To provides financial and food security to individuals living below the poverty line (BPL), fulfilling the Directive Principles of State Policy (Article 41) by supporting the elderly, widows, persons with disabilities, and families suffering the loss of a breadwinner.
    • Coverage: It operates across rural and urban India, covering over 3.09 crore beneficiaries.
    • Components of NSAP:
      1. Indira Gandhi National Old Age Pension Scheme (IGNOAPS): Provides ₹200/month to citizens aged 60–79 and ₹500/month to those 80+, with States adding top-up support.
      2. Indira Gandhi National Widow Pension Scheme (IGNWPS): Offers ₹300/month to widows aged 40–79 and ₹500/month for those 80+.
      3. Indira Gandhi National Disability Pension Scheme (IGNDPS): Extends ₹300/month to persons aged 18–79 with severe disabilities; ₹500/month for those 80+.
      4. National Family Benefit Scheme (NFBS): Grants a one-time ₹20,000 to BPL families on the death of a breadwinner aged 18–59.
      5. Annapurna Scheme: Supplies 10 kg of free food grains/month to senior citizens eligible for IGNOAPS but not receiving pension.

    Implementation and Monitoring Framework:

    • Selection: Eligible beneficiaries identified by Gram Panchayats and Urban Local Bodies.
    • Disbursement: About 94% through Direct Benefit Transfer (DBT) to bank or post office accounts; cash-at-doorstep allowed in special cases.
    • Monitoring: Each State/UT appoints a Nodal Secretary; quarterly progress reports are mandatory, and failure to submit can lead to withholding of funds.
    • Transparency Measures: Integration with Public Financial Management System (PFMS) ensures real-time tracking, Aadhaar linkage, and prevention of duplication.

    Recent Update (2024–25):

    • NSAP disbursed funds of ₹6,143.92 crore (IGNOAPS), ₹2,150.03 crore (IGNWPS), ₹243.74 crore (IGNDPS), and ₹394.29 crore (NFBS & Annapurna).
    • 2.5 crore+ beneficiaries have Aadhaar-linked accounts ensuring transparent payments.
    • Budget for 2025–26: ₹9,652 crore, with IGNOAPS receiving the largest share (₹6,645.9 crore).
    • Digital Life Certification (DLC) mobile app launched in July 2025, enabling Aadhaar-based verification and reducing manual procedures.
    • The programme continues to serve as a core pillar of India’s social safety net, enhancing welfare delivery and inclusion through digitisation, DBT, and Aadhaar authentication.

  • The Second Issue: On Surrogacy for a Second Child

    Introduction

    The Surrogacy (Regulation) Act, 2021 stipulates that an “intending couple” is eligible for surrogacy only if they do not have any surviving child, biological, adopted or via surrogacy, except where the child is physically or mentally challenged or has a life-threatening disorder.A petition has been filed before the Supreme Court by a couple facing secondary infertility who seek to use surrogacy to have a second child. Their argument: the law’s restriction interferes with the reproductive choices of citizens and treats primary and secondary infertility differently.

    What is the law’s objective and rationale

    1. Objective of the Act: The primary stated purpose is to prohibit commercial surrogacy, regulate fertility and surrogacy clinics, and protect surrogate mothers and children born through surrogacy.
    2. Eligibility restriction: Section 4(iii)(C)(II) mandates the ‘no surviving child’ condition for an intending couple.
    3. Rationale for restriction: The government’s position is that the use of another woman’s body for surrogacy demands strict regulation; therefore, limiting eligibility helps prevent exploitation and commercialization.
    4. Court’s interim view: The Supreme Court has indicated the restriction appears “reasonable” but is examining whether the ban on surrogacy for couples with a surviving child amounts to a violation of reproductive choice.

    How does the law differentiate primary and secondary infertility

    1. Secondary infertility defined: In this context, it refers to couples unable to conceive or carry a pregnancy to term despite having borne a child naturally earlier.
    2. Law’s silence on distinction: The Act does not expressly differentiate between primary and secondary infertility in defining “infertility” for eligibility. The petitioners argue the statute uses “infertility” generically and should be read to include secondary infertility.
    3. Effect of the distinction: As a result of the clause, a couple with one surviving (healthy) child is barred from surrogacy for a second child, even if they face medical infertility. The petition argues this amounts to unreasonable discrimination.

    Why is this matter significant now?

    1. Reproductive autonomy at stake: The case raises the question whether reproductive choice including whether and how many children to have falls under the fundamental right to privacy and reproductive autonomy (Article 21).
    2. Scale of the issue: Secondary infertility affects a substantial number of couples; the law’s bar effectively restricts access to surrogacy for many intending parents. The article emphasises that restricting access solely because a couple already has a child may not align with the law’s stated objective.
    3. Precedents of regulation being diluted: The Court recently relaxed age restrictions for couples who had frozen embryos prior to the law’s enactment, signalling willingness to interpret surrogacy law expansively.
    4. Contradiction with other family-related rights: There is no law in India capping the number of children a person may have naturally; yet, the surrogacy law imposes a “one-child existing” rule. This invites scrutiny of rational basis for differentiation.

    What are the potential implications of a broader interpretation”

    1. Facilitating access: A more expansive reading allowing surrogacy for intending parents would align the law with reproductive autonomy and reduce arbitrary differentiation.
    2. Safeguard against exploitation: The law can maintain its core safeguards against commercialisation and exploitation while enabling access for medically infertile couples seeking a second child.
    3. Policy coherence: It would harmonise the surrogacy statute’s eligibility norms with the lack of statutory restriction on the number of natural children and prevent unjust exclusion of couples.
    4. Legal precedent: A favourable interpretation could open up examination of other eligibility criteria under the Act (such as age or marital status) in light of constitutional rights.

    What are the counter-arguments and concerns?

    1. Risk of commercial surrogacy revival: Critics argue liberalising eligibility may inadvertently open doors to exploitation of surrogate mothers and a resurgence of commercial surrogacy in disguised form.
    2. Resource and monitoring constraints: Greater eligibility implies more oversight burden on regulatory infrastructure (ART clinics, surrogacy boards, monitoring of insurance/compensation).
    3. State interest in regulation: The restriction can be defended as within the State’s margin of appreciation to regulate surrogacy in public interest, preserving dignity of women and children.
    4. Potential slippery slope: Expanding eligibility might raise questions about single individuals, LGBTQ+ couples or live-in partners accessing surrogacy, aspects the law currently restricts.

    Conclusion

    The surrogacy debate in India reflects the evolving tension between state regulation and personal autonomy. While the law rightly seeks to prevent exploitation and commercialisation, it must not overlook the constitutional promise of reproductive freedom and equality. A more inclusive, rights-based interpretation, sensitive to medical realities like secondary infertility, would uphold both ethical safeguards and individual dignity, aligning the law with India’s vision of gender justice and compassionate governance.

    Value Addition: Surrogacy Law in India

    Legal Framework:

    Surrogacy (Regulation) Act, 2021

    • Objective: Regulate surrogacy procedures, prohibit commercial surrogacy, and ensure ethical practices in assisted reproduction.
    • Type allowed: Only altruistic surrogacy (no monetary compensation except medical expenses and insurance).
      • Assisted Reproductive Technology (Regulation) Act, 2021
    • Objective: Regulate ART clinics and banks; maintain records, screening, and ethical standards for gamete donation and IVF processes.
    • Together, these Acts create a twin legal framework governing all forms of medically assisted reproduction in India.

    Key Provisions of the Surrogacy (Regulation) Act, 2021

    1. Eligibility of intending couple:
      • Must be Indian citizens, legally married, and aged:
        • Husband: 26–55 years
        • Wife: 23–50 years
      • Must possess a certificate of infertility from a District Medical Board.
      • Must not have any surviving child (biological, adopted, or through surrogacy), except if the child is mentally/physically challenged or suffers a life-threatening disorder.
    2. Eligibility of surrogate mother:
      • Must be a married woman with a child of her own.
      • Age limit: 25–35 years.
      • Can act as a surrogate only once in her lifetime.
      • Must be a close relative of the intending couple.
      • Must obtain a certificate of medical and psychological fitness.
    3. National and State Surrogacy Boards: Oversee implementation, formulate policies, and ensure ethical compliance.
    4. Penal provisions:
      • Commercial surrogacy, sale/purchase of human embryos, and exploitation of surrogate mothers attract imprisonment up to 10 years and fine up to ₹10 lakh.

    Objectives and Rationale

    1. Prevent commercial exploitation: Protects poor women from being coerced into surrogacy for financial gain.
    2. Ensure child welfare: Guarantees the child’s legal status and parentage from birth.
    3. Promote ethical medical practices: Prevents unregulated fertility clinics and misuse of technology.
    4. Align with constitutional morality: Balances individual reproductive rights with social ethics and public health considerations.

    Judicial and Policy Developments

    1. SC observations (2023–2025):
      • Examining secondary infertility cases to test whether barring surrogacy for a second child violates reproductive autonomy under Article 21.
      • Previously allowed age relaxation for couples with frozen embryos prior to enactment of the Act.
    2. Delhi High Court (2023): Directed the government to reconsider rules preventing single women or widows from accessing surrogacy, citing discrimination concerns.
    3. Policy evolution: Shift from the 2015 ban on foreign commercial surrogacy to a 2021 framework permitting only altruistic domestic surrogacy.

    PYQ Relevance

    [UPSC 2023] Explain the constitutional perspectives of Gender Justice with the help of relevant constitutional provisions and case laws.

    Linkage: This question is key as it tests understanding of Articles 14, 15 and 21 on women’s equality and autonomy. This is central to debates like the Surrogacy Act 2021, which restricts reproductive choice and raises issues of bodily rights and gender justice.

  • [pib] Swasth Nari, Sashakt Parivar Abhiyaan (SNSPA)

    Why in the News?

    The Union Health Ministry has achieved three GUINNESS WORLD RECORDS titles under the “Swasth Nari, Sashakt Parivar Abhiyaan (SNSPA)”, highlighting India’s leadership in women’s health and preventive care.

    Guinness World Records Achieved

    • Most people registered on a health care platform in one month: 3.21 crore (3,21,49,711).
    • Most people signed up for breast cancer screening in one week: 9.94 lakh (9,94,349).
    • Most people signed up for vital signs screening online in one week (State level): 1.25 lakh (1,25,406).

    These records reflect unprecedented participation across India’s digital health platforms under the Ayushman Bharat initiative.

    About Swasth Nari, Sashakt Parivar Abhiyaan (SNSPA):

    • Objective: Strengthen women’s, children’s, and family health services, focusing on rural, tribal, and underserved regions.
    • Launch: Introduced on 17 September 2025 by the PM, jointly led by Ministry of Health and Family Welfare and the Ministry of Women and Child Development.
    • Scale: Over 10 lakh health camps at Ayushman Arogya Mandirs, Community Health Centres (CHCs), and District Hospitals.
    • Screenings: Anaemia, hypertension, diabetes, TB, breast and cervical cancers, sickle cell disease, reproductive health conditions.
    • Services offered: Maternal, child, adolescent health including antenatal care, immunisation, nutrition counselling, menstrual hygiene, mental health, lifestyle awareness.
    • Digital Monitoring: SASHAKT portal ensures real-time data tracking and transparency.
    • Jan Bhagidaari: Collaboration with private hospitals, SHGs, Anganwadis, Panchayati Raj institutions, volunteers.
    • Tribal Focus: Specialised medical services and tailored counselling for remote and tribal areas.

    What is Rashtriya Poshan Maah?

    • Overview: Part of POSHAN Abhiyaan (National Nutrition Mission); celebrated annually since 2018.
    • 2025 Edition: 8th Poshan Maah, aligned with SNSPA for synergised impact.
    • Aim: Mobilise communities to improve nutrition of children, pregnant women, lactating mothers, and adolescent girls.
    • Activities: Poshan Panchayats, health and nutrition camps, recipe demos, rallies, school-Anganwadi outreach, Jan Andolan approach.
    • Focus Areas (2025):
      • Anaemia Mukt Bharat and micronutrient awareness.
      • Complementary feeding practices for infants and toddlers.
      • Poshan-Vatika (nutri-gardens) for food security.
      • Promotion of traditional and regional diets for sustainable nutrition.
    [UPSC 2024] With reference to the ‘Pradhan Mantri Surakshit Matritva Abhiyan’, consider the following statements:

    1. This scheme guarantees a minimum package of antenatal care services to women in their second and third trimesters of pregnancy and six months post-delivery health care service in any government health facility.

    2. Under this scheme, private sector health care providers of certain specialities can volunteer to provide services at nearby government health facilities.

    Which of the statements given above is/are correct?

    Options: (a) 1 only (b) 2 only* (c) Both 1 and 2 (d) Neither 1 nor 2

     

  • [25th October 2025] The Hindu Op-ed: Respect the health rights of India’s children

    PYQ Relevance

    [UPSC 2020] In order to enhance the prospects of social development, sound and adequate health care policies are needed particularly in the fields of geriatric and maternal health care. Discuss.

    Linkage: Just as maternal and geriatric health require targeted policies, this article highlights the urgent need for child specific pharmaceutical regulation, reinforcing that inclusive social development demands age-segmented health care frameworks addressing the unique vulnerabilities of each group.

    Mentor’s Comment

    The tragic deaths of 25 children in Madhya Pradesh due to contaminated cough syrup have reignited a critical debate on India’s regulatory failure in child health and pharmaceutical safety. The incident exposes deep gaps in monitoring, quality control, and the larger question of how India safeguards its youngest citizens’ right to health. For UPSC aspirants, this issue links to public health governance (GS-2), ethical administration (GS-4), and inclusive growth (GS-3), all central to understanding India’s social contract with its people.

    Why in the News?

    Twenty five children lost their lives after consuming contaminated cough syrup, a tragedy that shocked the nation. The pediatrician involved reportedly received a ₹2.54 lakh commission for prescribing the syrup, raising questions about medical ethics, accountability, and the systemic failure of regulation. This is not an isolated case, since 2022, contaminated syrups from India have caused deaths in Gambia, Uzbekistan, Indonesia, and Cameroon, denting India’s image as the “pharmacy of the Global South.” The issue marks a repeated failure of quality control and enforcement, despite India having one of the largest pharmaceutical industries in the world.

    Where the Focus Needs to Be

    1. Regulatory framework: The emphasis must shift from blame to building robust regulatory architecture for the distribution of pediatric medicines.
    2. Child health protection: India must uphold its constitutional commitment under Article 39(f), ensuring children’s right to health and development.
    3. Legal ecosystem: Existing laws, such as the Pre-Conception and Pre-Natal Diagnostic Techniques Act and National Policy for Children 2013, must evolve to cover medicine safety for children.

    How Inadequate Oversight Endangers Children

    1. Weak pharmacovigilance: Insufficient clinical data and lack of dedicated pediatric testing result in drugs for adults being extrapolated for children.
    2. Dosage disparity: Absence of age-specific dosage guidelines often leads to overmedication and severe side effects.
    3. Special needs ignored: Pediatric pharmacology demands unique formulations, but most drugs are designed with adults as the reference.
    4. Ethical breach: The commission based medical practice further erodes trust, especially when children’s lives are at stake.

    What the Global Framework Teaches India

    1. Regulatory precedents: The European Union’s Paediatric Use Marketing Authorisation and the U.S. Best Pharmaceuticals for Children Act (BPCA) mandate pediatric testing for all drugs.
    2. Holistic approach: These frameworks ensure drug safety through clinical data collection, financial incentives for manufacturers, and legal enforcement.
    3. Indian gap: India lacks such comprehensive laws; existing rules focus only on general health safety, not pediatric-specific provisions.

    Why Pediatric Medicines Need Special Policy Attention

    1. Essential medicine concept: The WHO defines essential medicines as those meeting priority health needs. Pediatric formulations should be an integral part of this.
    2. Affordability: Without public support, many families cannot afford safe alternatives, forcing them to buy untested drugs.
    3. Domestic R&D: India’s dependency on adult-tested formulations highlights the absence of child focused pharmaceutical innovation.
    4. Education and regulation: Pharmacists and caregivers need training to ensure proper dosage and drug choice.

    How India Can Reform Pediatric Drug Policy

    1. Zero tolerance on contamination: Strong penalties and criminal accountability for substandard and spurious drugs.
    2. Independent regulator: A separate Pediatric Drug Safety Division within CDSCO (Central Drugs Standard Control Organisation).
    3. Integrated surveillance: Real time data monitoring for adverse pediatric drug reactions through digital reporting.
    4. International benchmarking: Alignment of India’s pediatric drug policy with WHO and OECD standards.
    5. Public awareness: Dissemination of safety information to parents, caregivers, and schools.

    Need for India Data

    1. Evidence based policy: India must base its pediatric drug policy on domestic child health data rather than extrapolations from adult studies or foreign datasets.
    2. Malnutrition link: Toxicity of contaminated syrups is worsened by underlying malnutrition, emphasizing a multi sectoral child health approach.

    Conclusion

    India’s children represent 39% of its population, yet policy neglect leaves them vulnerable to unsafe drugs and unethical practices. The current crisis is not just about regulatory lapses but about violating the fundamental right to health and life under Article 21. India must institutionalize a child-specific pharmaceutical policy, backed by strict monitoring, ethical medical practices, and international standard oversight. Ensuring safe, affordable, and regulated pediatric medicines is not merely a policy choice, it is a moral obligation and constitutional duty.

  • [10th October 2025] The Hindu Op-ed: India’s mental health crisis, the cries and scars

    PYQ Relevance:

    [UPSC 2023] Explain why suicide among young women is increasing in Indian Society.

    Linkage: Mental distress is deeply intertwined with societal issues like increasing suicide rates among young women, poverty, marginalization, and the impact of modernization and urbanization.

    Introduction:

    The National Crime Records Bureau’s Accidental Deaths and Suicides in India (ADSI) 2023 report recorded 1,71,418 suicides, a marginal 0.3% rise from 2022. While the suicide rate per lakh population declined slightly, absolute numbers remain high, underscoring a deep social, economic, and psychological crisis.

    National Data and Trends as per ADSI, 2023:

    1. Demographics: Men constituted 72.8% of suicides in 2023.
    2. Leading Causes: Family problems: 31.9%; Illness: 19%; Substance abuse: 7%; Relationship and marriage-related issues: around 10% combined.
    3. Regional Variation: The Andaman and Nicobar Islands, Sikkim, and Kerala had the highest suicide rates, while Maharashtra, Tamil Nadu, Madhya Pradesh, Karnataka, and West Bengal together accounted for over 40% of all cases.
    4. Urban vs Rural: Cities reported consistently higher suicide rates than rural areas, reflecting the psychological stress of urbanisation and competition.

    Farmer Suicides and Rural Distress:

    1. Farmer deaths: 10,786 suicides (6.3% of total) in 2023, concentrated mainly in Maharashtra and Karnataka.
    2. Long-term pattern: Over 1,00,000 farmers have taken their lives since 2014. Between 1995 and 2015, nearly 2,96,000 deaths were linked to debt, market volatility, and institutional neglect.
    3. Underlying causes: Debt, crop failure, inadequate price support, and the absence of reliable social safety nets.
    4. Invisible victims: Homemakers and caregivers, particularly women, face rising rates of depression and domestic stress but remain underrepresented in official data.

    Student Suicides in India:

    • Rising Trend: Students account for 6–8.1% of all suicides (NCRB data). In 2023, there were 13,892 student suicides, a 65% rise over the decade, outpacing the national average increase.
    • Major Causes: Academic pressure, parental expectations, toxic competition, and poor mental health infrastructure are leading contributors.
    • Psychological Impact: Surveys show high levels of anxiety, depression, and distress, with notable gender disparities in emotional well-being.

    Magnitude of Mental Illness in India:

    1. Estimated burden: Nearly 230 million Indians live with mental disorders ranging from depression and anxiety to bipolar disorder and substance use.
    2. Treatment gap: 70–92% of individuals with severe illness receive no formal care.
    3. Lifetime prevalence: 10.6%, according to national health data.
    4. Global comparison: WHO estimates India’s suicide rate at 16.3 per 1,00,000, significantly higher than the global average.

    Value Addition:

    India’s Mental Health Governance and Legal Framework:

    • Mental Healthcare Act, 2017:
      1. Guarantees the right to affordable, quality mental health care.
      2. Decriminalises suicide and mandates insurance coverage for psychiatric illnesses.
      3. Upholds patient dignity and autonomy under Article 21 of the Constitution.
    • Judicial reinforcement: In Sukdeb Saha vs State of Andhra Pradesh (2025), the Supreme Court reaffirmed mental health as a fundamental right, compelling state accountability.
    • District Mental Health Programme (DMHP): Covers 767 districts, expanding access to outpatient services, suicide prevention, and counselling.
    • Tele MANAS Helpline: A 24×7 service offering over 20 lakh tele-counselling sessions, particularly beneficial in underserved regions.

    Supreme Court Intervention:  Sukdeb Saha vs. State of Andhra Pradesh (2025):

    • Overview: The Supreme Court invoked Articles 32 and 141 to issue 15 binding “Saha Guidelines” addressing student suicides and mental health governance in educational institutions.
    • Key Judgment: It upheld mental health as an integral component of the right to life.
    • Key Guidelines include:
      1. Policy Mandate: All institutions must adopt a mental health policy consistent with UMMEED, MANODARPAN, and the National Suicide Prevention Strategy.
      2. Counseling Requirement: Appointment of one certified mental health counselor in every institution with 100+ students.
      3. Academic Practices: Ban on batch segregation, public shaming, and unrealistic academic targets.
      4. Helpline Visibility: Mandatory display of Tele-MANAS and other helpline numbers in classrooms, hostels, and websites.
      5. Staff Training: Biannual mental health sensitization for teachers and administrators on crisis response.
      6. Inclusivity Measures: Institutions must ensure non-discriminatory support for SC/ST/OBC/EWS, LGBTQ+, and disabled students.
      7. Crisis Management: Establish confidential reporting systems for ragging, discrimination, and assault, with immediate counseling access.
      8. Preventive Steps: Control access to common means of suicide (e.g., rooftops, ceiling fans) and promote interest-based career counseling.

    Systemic Gaps and Institutional Failures:

    1. Workforce shortage: Only 0.75 psychiatrists and 0.12 psychologists per 1,00,000 population, below WHO’s minimum of 1.7 psychiatrists and far from the ideal of 3.
    2. Underfunding: Mental health receives only 1.05% of India’s health budget, compared to 8–10% in countries like Australia, Canada, and the UK.
    3. Policy–practice gap:
      • The Mental Healthcare Act (2017) decriminalised suicide and guaranteed the right to care.
      • The National Suicide Prevention Strategy (2022) targeted a 10% reduction in suicides.
      • However, implementation remains weak, and suicides continue to rise.
    4. Non-functional initiatives:
      • The Manodarpan school-based support scheme remains largely inactive.
      • ₹270 crore allocated for mental health is largely unspent.

    Persistent Challenges:

    1. Treatment Gaps: 70–92% of individuals with common disorders like depression and anxiety remain untreated.
    2. Infrastructure Deficits: Inadequate availability of psychotropic medicines and rehabilitation services, which meet less than 15% of actual demand.
    3. Stigma and Awareness: Over 50% of Indians still attribute mental illness to personal weakness or shame, limiting early intervention.
    4. Workforce Urban Bias: Mental health professionals remain concentrated in cities, leaving rural areas, where 70% of India’s population lives, largely unserved.

    Steps to Strengthen India’s Mental Health System: Way Forward

    1. Budget Expansion: Raise mental health allocation to at least 5% of total health spending, ensuring resources for workforce, infrastructure, and medicine.
    2. Workforce Development: Train and deploy mid-level mental health providers to fill rural gaps and meet WHO’s minimum density.
    3. Integration: Embed mental health into primary health care and universal insurance coverage.
    4. Monitoring: Create a cascade-based national monitoring system to track outcomes, ensure accountability, and guide funding.
    5. Anti-Stigma Campaigns: Institutionalise mental health education in schools and workplaces, aiming for 60% literacy coverage by 2027.
    6. Cross-Ministerial Coordination: Establish a unified framework linking health, education, social justice, and labour for cohesive policy execution.