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Best foot forward

Vaccination and improved sanitation keeps children healthy and less likely to die of childhood infections. This, in turn, encourages people to have smaller families. Sanchita Sharma writes.

health and fitness Updated: Jan 27, 2013 00:16 IST
Sanchita Sharma

Philanthropist and Gates Foundation co-chair Melinda Gates, 48, spent the past two days with villagers and grassroots government officials in Bihar and UP this week, while her husband and Microsoft founder Bill Gates, 57, rubbed shoulders with the world's movers and shakers at the World Economic Summit at Davos, Switzerland.

"Bill is in Davos talking about India's success at being free of polio for two years. India is an example for the world, what accomplished here can be done everywhere. People can see results: with hard work, good surveillance and quality vaccines, fewer children die. It gives people confidence that we can make things happen," said Melinda, who left Delhi on Friday night after her fifth visit to India.

Sharing stories about her travel to the poorest parts of the world with her three children -- daughters Jennifer, 15 and Phoebe, 10, and son Rory 13 - makes dinner-table conversations in their Seattle home more than a little unusual."Bill and I talk about our work with our children. Dinner-table conversations is often about TB and diarrhoea, the joke at home is that now no one finds it odd," says Melinda, who has been a longtime advocate for women's and children's health.

Family time
Melinda's call to her children on Thursday was peppered with stories from India. "I told them India has lots of problems, but I see and feel a lot of hope, it is palpable here. The amount of innovations here are unbelievable, and resources being given to health are high. African countries can just dream about it," says Melinda, who drew praise last year for her support of contraception despite being a Catholic. The Catholic Church is opposed to contraception.

India's National Population Policy and the National Rural health Mission support "voluntary and informed choice and consent" of people for use of contraception and sterilisation services, but spacing methods - oral contraceptive pills, intra-uterine devices, condoms, contraceptive injections etc - are still not as popular as permanent family planning methods, such as vasectomies in men and tubectomies in women.

"Though the Population Policy focuses on promoting rather than forcing a two-child norm to bring down total fertility rate - the total number of children a woman has in her lifetime, which should ideally be 2.1 to keep the population where it is - progress has been slow. Currently, the total fertility rate is 2.5, down from 3.2 in 1998 and 6 in 1951," says a Union health ministry official unwilling to be named.

In India, 21 states have achieved replacement fertility rate of 2.1 - Kerala and Tamil Nadu boast of fertility rates of 1.7 -the laggards are keeping the average up. Seven states have a fertility rate between 2.1 and 3 and the remaining seven have more than 3. Between Bihar and UP, the two most populous states account for 30% of India's population.

The problem is that apart from sterilisation, few contraception services are reaching women who need it. With more than half of India's population is in the reproductive age group of 15-49 years, the 69.1 per cent people not using contraceptives need to be convinced to use them. The Centre is trying to increase use by offering door-to-door delivery of contraceptives in 233 districts in 17 states a nominal piece of R 1 for a pack of 3 condoms, R 1 for a cycle of oral contraceptive pills and R 2 for a pack of one tablet of emergency contraceptive pill to prevent their chances of having an unwanted pregnancy.

Health for all
What works globally is persuading people to have fewer children by offering them health services to ensure their children survive till they are old and grey, along with contraceptive choices to plan pregnancies, which are just the issues the Gates Foundation is working with government in UP and Bihar, the two states with the worst health indices.

"The Foundation has been working with the Bihar government in 8 districts since 2010 and the results of improved coordination, training, immunisation and surveillance are showing. Scaling up and replicating learnings from Bihar in UP will strengthen health systems and bring down deaths sooner than later," she says.

The Gates Foundation works with a $36.2 billion endowment , most of it from the Gates and Warren Buffet, from which it gives grants for healthcare, agriculture, poverty alleviation and education. India is the biggest recipient of BMGF grants, getting about US$ 1.1 billion of the US 15 billion given as grants for global health since 1994.

In her three-day visit to India, Melinda met UP chief minister Akhilesh Yadav to discuss the progress on the newly-established partnership between the state and the Gates Foundation to support government programmes on mother and child health, nutrition and vaccine-preventable diseases and other infections.

"Simple things like getting all primary health centres functional and insisting healthworkers wear gloves and wash their hands before assisting a delivery lowers chances of infection and mother and child deaths," says Melinda.

Within 30 months, health indicators from the eight districts in Bihar have improved. And if the polio story is an indicator, the rest of the state and neighbouring UP will follow suit.