A manifesto for good health
It happened four years ago. I was barely three weeks old as the first executive director of Jansankhya Sthirata Kosh-National Population Stabilisation Fund when I was challenged by the governing body to meet the chief minister of Uttar Pradesh. Shailaja Chandra, former bureaucrat writes.lucknow Updated: Jun 28, 2011 19:40 IST
It happened four years ago. I was barely three weeks old as the first executive director of Jansankhya Sthirata Kosh-National Population Stabilisation Fund when I was challenged by the governing body to meet the chief minister of Uttar Pradesh.
“Go and meet Mayawati and describe to her the state of affairs in the state where 65% of girls are married well before the age of 18, the unacceptably high levels of mothers and children’s deaths, the stunting and wasting of thousands of children born to anaemic, malnourished mothers — factors that were producing generations of children compromised at birth. An exorbitant liability for India’s most populous state,” they declared. I was motivated enough to give it a try.
Meeting Mayawati was next to impossible but it was a unique experience.
For weeks I wrote letters to everyone of any importance in the CM’s personal office. I made persistent phone calls to every decision maker in the state’s health hierarchy — demanding, pleading, cajoling and even getting into a stormy huff. Having mustered enough ammunition to complain, as a last resort I telephoned cabinet secretary Pradesh Shashank Shekhar Singh. Rather unexpectedly he took my call and suggested I meet him in UP Bhavan in Delhi when he was next in the city.
I got my power point presentation ready, replete with socio-economic indicators and intra-state comparisons. On reaching UP Bhavan, I was received with utmost courtesy — even fanfare — as specially guarded iron gates were thrown open by black bandgala clad guards and I was whisked upstairs and ushered into the VIP waiting room. Minutes later, I was face to face with Singh.gh.
Gentle and polite he none-the-less looked askance at my computer and waved it away. But he invited me to come to Lucknow and make a presentation in his office. A couple of days later, I reached there to be received like a VIP and treated as such. Singh personally chaired the meeting and issued instructions to the entire health regatta and the commissioner of Lucknow Division.
I was acutely aware that the cabinet secretary’s attention span would soon start waning and the attendant bureaucrats would contest the statistics as fallacious. So I blurted out my piece by making two impassioned pleas.
First, I said, could he as the cabinet secretary persuade the cm to direct that an audit be conducted of every maternal death that occurred in a health facility or at home? I conceded that nothing miraculous was likely to happen but at least the issue of maternal deaths would come into focus.
Second, I said, could the state organise a meeting for editors and reporters of leading vernacular newspapers from all of UP’s districts when they could be sensitised about intra state indicators? I got a “Yes” to both my questions. Whether the maternal deaths were ever audited I cannot say, though the health secretary assured me they were doing it.
The meeting of editors and a huge cross-section of reporters did take place a couple of months later. UP’s health minister attended the inauguration and said all the right things about responsible parenthood. The journalists were shown how to access district level data on 13 different indices which affect health the most.
They were intrigued to see the ranking of each district within UP and also across the country. They learnt how to operate the GIS maps and view the state health data based on a composite index developed by the International Institute of Population Sciences, Mumbai. The outcome was unbelievable.
The reporters actually published district specific reports highlighting why several districts had the worst indices in the country- be it on the basis of contraceptive use, deaths of children under five, female literacy, immunization status of children, households without drinking water and toilets to name just a few.
After three years I left the Jansankhya Sthirata Kosh. As happens with us all, I ceased to think about Uttar Pradesh and its never-ending misery. But with the Assembly elections round the corner, perhaps it is time to pull out my wish list once more. But first consider the facts before addressing what should be done.
The 2011 census tells us that in the last 10 years Uttar Pradesh has grown by 20 percent. The contribution of UP exceeds the combined contribution of the states of Rajasthan, Madhya Pradesh, Chhattisgarh and Jharkhand put together. The all India maternal mortality ratio is 254 but in Uttar Pradesh it is nearly double that —the worst in the country after Assam.
The rural infant mortality rate is also the third worst in the country. The child sex ratio in UP has plummeted in 60 districts out of 70, with Agra topping the list of female foeticide prone districts..
If one could influence election manifestoes, what would one say?
The biggest returns would come from announcing a blanket ban on teenage marriages and by rewarding collectors and panchayats that help families to postpone early marriage. The manifesto should simply say that the party would make registration of marriages compulsory by law and thereby pin down the bureaucracy throughout the state to implement the law.
In one stroke, thousands of 15 and 16-year-olds might be allowed to continue schooling. They would also not be deprived of their youth and childhood to be burdened with premature motherhood and domestic drudgery. The spin off would be healthier mothers, healthier children and a sharp reduction in UP’s fertility rate.
Secondly, among the really poor, repeated childbirths are seen as an insurance against multiple infant and child deaths. Even when that is not the case, men cannot be bothered with using condoms.
Therefore, the manifesto should give the women a way out and announce that intra uterine devices (IUDs) that give a 10-year protection against pregnancy would be provided at state cost. The costs of transporting women to a health facility, screening them, inserting the IUD and providing for aftercare visits would be borne by the Government in toto.
That cost would be negligible compared to the cost of dealing with lakhs of sickly mothers and their underweight, malnourished infants, to say nothing of the incapacity of both to get educated. Women would jump at the idea as nothing else can give them assured freedom from unwanted pregnancies with the option of reversing the decision at will.
First Published: Jun 28, 2011 15:58 IST