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Immunise your children or you won't get food rations: Uttar Pradesh district threatens poor families -Priyanka Vora

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Administrations are not supposed to cut off rations but health officials seem to think that the threat will work. Experts denounce the measure.

“Tikkakaran nahin toh khadyadhan nahin.” No vaccination, no ration. Rajwanti Devi Jaiswal, an Accredited Social Health Activist or ASHA in Uttar Pradesh’s Bahraich district repeated the slogan so often that it sounded like a chant.

The district has one of the lowest child immunisation rates in India – according to the most recent round of the National Family Health Survey, only one of every ten children in the district is fully immunised.

Desperate to increase the immunisation rate, district officials are threatening to cut off subsidised food rations to poor parents who fail to get their children vaccinated. The administration is well aware that restricting a family’s access to food entitlements is against the law, but officials claim they do not intend to act on the threat.

“I know we can’t really stop any family’s ration, but the threat is helping,” said Rakesh Kumar, district supply officer of Bahraich who responsible for the functioning of the public distribution system in the district.

Kumar said that the district magistrate’s office asked his department in October in implement these measures. According to Kumar, ASHA workers like Jaiswal are supposed to report the names of families refusing vaccination to the officials in the food supply department, who in turn instruct kotedaars or rations shop owners to tell these families that they will not get their rations.

District magistrate Ajay Deep Singh said that what his office is doing does not constitute coercion. “We know we cannot deprive any family of food grains,” he said. “This is just a administrative technique we are using to pressure the families, so they don’t deprive their children from life-saving vaccinations.”

Kumar claimed that more people have started coming in to get their children immunised in the last two months since the government threatened to withhold their rations. “In the end, it is benefitting the children,” he said.

In many districts with low immunisation rates, communities are resistant to immunisation because they do not trust the government health system. Jaiswal, who is the ground level health worker responsible for outreach on immunisations, has faced this mistrust. “The minute these mothers see us, they run away with their children in the fields,” she said.

But instead of working to gain the trust of communities, Bahraich’s administration has resorted to a quick fix. “The officers are using coercion because they have failed to motivate the community to willingly vaccinate their children,” said public health and bioethics expert Dr Anant Bhan.

Fear of vaccination

Child vaccination is a major focus area of the Indian government’s attempts to improve the health and survival chances of children. The government launched the national programme of immunisation called Mission Indradhanush in 2014.

But districts like Bahraich continue to underperform on immunisations. Health experts say the underperformance is rooted in the abysmal state of the public health infrastructure in Uttar Pradesh’s Terai region, as reported in previous stories in this series on the high maternal and infant mortality in the region. In addition, these districts have low levels of income and literacy.

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