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Resource centre on India's rural distress
 
 

Then There Were Three by Anuradha Raman
Poor, pregnant with third child? Even the state’s giving up on you.

Why Less For More

    * The ministry of health and family welfare wants to target poor, pregnant women with more than two children, take away entitlements and benefits
    * Critics say the two-child norm will severely restrict the number of beneficiaries of the Janani Suraksha Yojana scheme. The scheme, launched in 2005, has been a great success.
    * India has committed to a target-free approach at the UN conference on population and development platform
    * Maternal mortality ratio is now 254/1,00,000 live births, infant mortality rate 53/1,000 live births

***

“If there is electricity in every village, people will watch TV till late night and then fall asleep. They won’t get a chance to produce children. When there is no electricity, there is nothing else to do but produce babies.”

—Ghulam Nabi Azad, 2009

That was the Union health minister blaming power outages for India’s burgeoning population. To be charitable to Ghulam Nabi Azad, the comment still puts the onus on the state for providing power so that couples stay glued to their TV sets. But the health minister’s solution still revived memories of coercive state intervention, like the ’70s forced sterilisation programme. Now, the ministry of health and family welfare has hit upon another incursive programme to contain the population. It wants to target pregnant women with more than two children, and take away entitlements that accrue to them.

In a recent affidavit submitted to the Supreme Court, the ministry has submitted that it intends to provide cash assistance to pregnant women of age 19 and above for up to two live births. The submission is being read by many as a scheme firm up the two-child norm in the country by targeting the poor and the most vulnerable section of society—women in the BPL category.

Understandably, the ministry’s move has been greeted by protests from several quarters. It’s seen as an attack on poor women who often have no choice over how many children they conceive. And by the government’s own admission, the scheme launched for poor pregnant women, namely the Janani Suraksha Yojana (JSY), has been a success. So why lessen its width and scope? The programme, with an annual budget of Rs 1,200 crore, is not exactly a drain on the country’s reserves. Also, world over, with the exception of China, coercive methods of controlling population have been shunned. (Currently, India, with a population of 1.21 billion, is next only to China, with its 1.35 billion-plus people.) Also, India has committed itself to a target-free approach as far as its population is concerned at the UN International Conference on Population and Development Platform of Action.

But first, some facts. India has the dubious distinction of having the largest number of child/maternal deaths in the world. Over the past decade, maternal mortality—the number of women dying during childbirth—has seen a decline. The maternal mortality ratio (MMR) is currently at 254/1,00,000 live births, with the infant mortality rate (IMR) at 53/1,000 live births. However, the rate of decline is not sufficient to achieve the MMR target of under 100/1,00,000 live births and an IMR of less than 30/1,000 live births by the Eleventh Plan end.

For a country that never tires of boasting about its economic growth, this was an ugly reality that had to be confronted. To address this problem, in 2005 the UPA government launched the National Rural Health Mission (NRHM). Its major objective was to provide accessible, affordable quality healthcare to the country’s vulnerable population. And the JSY was seen as key to achieve this. According to a ministry official, if the two-child norm comes through, 60 per cent of the targeted women will be excluded. “Besides, it is women with more than two children who are vulnerable. The proposal might actually lead to women staying away from institutional care,” he says.

Incidentally, one of the JSY’s immediate objectives was to promote universal access to institutional deliveries by providing a financial package to the pregnant woman. Home deliveries also got a financial package, but a smaller one. The rationale is to push institutional deliveries since it helps the pregnant woman get the best medical care through a team of skilled birth attendants which would improve her chances of a safe delivery.

All women who deliver at a health facility are eligible for a cash transfer of Rs 1,400. The amount is given at or immediately after the delivery to help cover expenses—drugs, supplies, transport, food and costs, such as paying an accompanying attendant. Women delivering at home are eligible for Rs 500.

That the scheme was successful is evident from the fact that from 2,00,000 beneficiaries in ’06, the numbers rose to over one crore in 2010 and continues to rise. Which is why the ministry’s move has baffled many. According to Sejal Dand, advisor to the office of the commissioner of food security, “the move smacks of wilful neglect by the government and targets the most vulnerable section of the population”. Adds senior lawyer Colin Gonsalves, “This is nothing but cruelty on the part of the Centre. It will be responsible for every mother and child who dies as a result of this act.”

Incidentally, linked to this scheme is another one launched by the women and child department a few months ago. The Indira Gandhi Matritva Suraksha Yojana provides for a cash transfer of Rs 4,500 for every institutional delivery but it also excludes women below 19 and those who have more than two children. Shree Ranjan, joint secretary, ministry of health and family welfare, though, denies any ill intent: “We are not penalising those with more children. We want to provide an enabling environment for pregnant women by providing them with social security. Besides, the law states that no woman below 18 can marry and the scheme cannot go contrary to the law.”

While that may be the case, social realities are far removed from government schemes. The National Family Health Survey shows that the average marriage age hovers around 17.2 and almost 26 per cent of women in the reproductive age group get married by the age of 15 and have delivered two children by 19.

State counsel Mohan Parasara says “the scheme is sought to be delinked only in high-performance states and not in the entire country”, adding that the arguments against miss the reality which is to “enforce institutional delivery”.

The Tata Institute of Social Sciences, in a presentation, mentions how exclusions end up hurting the very group for which enabling schemes are targeted and stresses that coercion is not the solution: “It only alienates more people from seeking state support and democratic possibilities...and further demonstrates the abdication of the state’s responsibility”.

That the UPA is anti-poor is evident in the manner the Right to Food is being contested. That it is also anti-women is only now coming into the open.