We need a multi-pronged approach to end child marriage

 

Uma Mahadevan Dasgupta writes: Legislation, education and government action must be used together to help families keep teenage girls in school

At a children’s gram sabha two years ago, a schoolgirl stood up to say her mother was forcing her into marriage. Her face was taut with pain as she spoke. Her classmates did not take their eyes off her face; they recognised their friend’s reality. That girl’s child marriage was prevented, and she is continuing her studies – but we need to talk about child marriage. Teenage girls should be in school and achieving — not married off before they attain adulthood.

Reports suggest that more child marriages have been noticed during the Covid pandemic. However, data from the fourth round of the National Family Health Survey (NFHS4) in 2015-16 shows that even before Covid, one in four girls in India was being married before 18. Around 8 per cent of women aged 15-19 years were mothers or pregnant at the time of the survey. The first phase findings of NFHS5 (2019-20) show that the needle has not moved substantially on ending child marriage.

Conditional cash transfers (CCTs) have been the main policy instrument introduced by most states in the last two decades to end child marriage. However, with one-size-fits-all conditions, that may not always be responsive to the lived realities of teenage girls. CCTs alone cannot change social norms. We need a comprehensive approach.

Child marriages happen within a social and economic context, embedded in a set of beliefs about the status of women and girls, and their role as wives and mothers. Associated with these are the reality of domestic labour and care work performed by women; a belief that girls need to marry early for safety and protection; and apprehensions about the risk to family honour or economic burden. High levels of child marriage reflect discrimination and lack of opportunities for women and girls in society.

Child marriage violates girls’ human rights. It makes them almost invisible to policy. It cuts short their education, harms their health, and limits their ability to fulfil themselves as productive individuals participating fully in society. The low domestic status of teenage wives typically condemns them to long hours of domestic labour; poor nutrition and anaemia; social isolation; domestic violence; early childbearing; and few decision-making powers within the home. Poor education, malnutrition, and early pregnancy lead to low birth weight of babies, perpetuating the intergenerational cycle of malnutrition. The costs of child marriage include teenage pregnancy, population growth, child stunting, poor learning outcomes for children and the loss of women’s participation in the workforce.

What, then, should be the policy interventions to end child marriage? Legislation is one part of the approach. Karnataka amended the Prohibition of Child Marriage Act in 2017, declaring every child marriage void ab initio, making it a cognisable offence, and introducing a minimum period of rigorous imprisonment for all who enable a child marriage.

Other drivers of social change must play a fundamental role. These include expansion of secondary education, access to safe and affordable public transport, and support for young women to apply their education to earn a livelihood. Expansion of education goes beyond access. Girls must be able to attend school regularly, remain there, and achieve. States can leverage their network of residential schools, girls’ hostels, and public transport, especially in underserved areas, to ensure that teenage girls do not get pushed out of education. Girls’ clubs should be systematically formed in high school to provide informal social networks for group study, solidarity, and resilience. Teachers should hold regular gender equality conversations with high school girls and boys to shape progressive attitudes that will sustain into adulthood.

Empowerment measures, too, are required to end child marriage, such as community engagement through programmes like Mahila Samakhya. Children’s village assemblies in the 2.5 lakh gram panchayats across India can provide a platform for children to voice their concerns.

Governmental action can drive social change. Field bureaucrats across multiple departments, including teachers, anganwadi supervisors, panchayat and revenue staff, all of whom interact with rural communities, should be notified as child marriage prohibition officers. Finally, and most important of all, decentralising birth and marriage registration to gram panchayats will protect women and girls with essential age and marriage documents, thus better enabling them to claim their rights.

Written by Uma Mahadevan Dasgupta

Source: Indian Express, 25/11/21

Solving the child malnutrition puzzle

 The recently released National Family Health Survey (NFHS) 5 data raise serious concerns about India’s growth story. Behind the glitter of the stock market touching new heights, lies the gloomy reality of India’s ballooning childhood malnutrition. In India, 37.8 per cent of children under 5 years of age are stunted. This is 16 per cent higher than the average for Asia (22 per cent). The situation of wasting is no better, with 20.8 per cent of children under 5 years of age affected, which is higher than average for Asia (9 per cent). The Global Nutrition Report, 2020, highlights that 68 per cent of under-5 mortality in India is due to malnutrition. As per the latest NFHS 5 report, over 35 per cent of children under 5 are stunted and over 20 per cent are wasted in 18 out of the 22 states for which data is released. That amounts to 47 million children, the largest in any part of the world. Out of the two, stunting, also known as growth retardation, has serious long-term health and economic consequences.

As countries move up the income ladder, the rates of stunting and wasting declines, a phenomenon observed globally. However, India is an outlier and breaks this causality. States with relatively high per capita incomes have stunting rates comparable to the poorest African countries. In many Indian states, the situation is worse than that of poor sub-Saharan African countries. For instance, Bihar, Manipur and West Bengal have similar per capita income ($) as sub-Saharan African countries — Liberia, Tanzania and Zimbabwe — but, the average stunting rates in Bihar (43 per cent), Assam (35 per cent) and West Bengal (34 per cent) are 10-12 per cent higher than that of Liberia (33 per cent), Tanzania (32 per cent) and Zimbabwe (3 per cent) respectively. The situation is worse when it comes to middle-income states like Goa, Maharashtra, Gujarat, Andhra Pradesh, Telangana and Karnataka with similar per capita income ($) as Peru, Egypt and Morocco. The average stunting rates in Goa (26 per cent) Maharashtra (35 per cent), Gujarat (39 per cent), Telangana (33 per cent) and Karnataka (35 per cent) are almost 10-15 per cent higher than that of Peru (12 per cent), Egypt (22 per cent) and Morocco (15 per cent). Understanding this paradox among Indian states, which has an unusually high level of stunting relative to their economic development, merits investigation.

Despite this high prevalence, India has rarely undertaken a comprehensive study to understand the pathogenesis of stunting. Therefore, what we have is a lopsided understanding of the problem. As per WHO, stunting can be attributable to medical and socio-economic factors. The medical factors include genetics (parents’ height), access to nutrition and mother’s health (anaemia, BMI). Besides, there are economic factors — income, poverty, access to healthcare, mother’s education and labour force participation — and social factors — caste, race, women status and place of residence etc. Of these, which ones are proximate and which one the distant factors, we simply don’t know.

Based on this conceptualisation, economic factors like average per capita income and prevalence of multi-dimensional poverty are loosely correlated with the prevalence of high stunting in states of AP, Telangana, Gujarat, Maharashtra & Karnataka. Similarly, maternity care characteristics (ante-natal care during pregnancy, post-natal care and consumption of folic acid during pregnancy), although extremely important, but, are weakly associated with high stunting rates in these states. Despite relatively modest economic growth and favourable maternity characteristics, high prevalence of stunting in these states defies logic. After all, these states have been the flagbearers of India’s growth story since 1991.

In popular parlance, poverty is synonymous with stunting. Poor households and poor states are expected to have stunted children. But what could explain significantly higher stunting rates in middle-income states?

First, women’s educational status, especially secondary and above, along with female labour force participation partly resonates with high stunting rates. Maternal literacy is an important determinant of a child’s nutritional status. Literate mothers are expected to be aware of their health, nutrition and breastfeeding practices. This finding, however, reflects the tragic reality of women bearing the undue burden of childcare. Second, the mother’s health, the prevalence of anaemia in women of reproductive age. India is one of the most anaemia-prone countries in the world. Children under age 5 and women of productive age are particularly vulnerable. Several studies have explored the strong association between stunting and the presence of anaemia in women of childbearing age. For instance, women of low BMI had greater odds of developing anaemia and the children of anaemic mothers are at greater risk of being stunted. The implication, a vicious circle of anaemia and stunting — stunted children of anaemic mothers are at greater risk of developing anaemia. The NFHS 5 data corroborate this finding — all women in reproductive age who are anaemic stands at 59 per cent in Andhra Pradesh, 40 per cent in Goa, 63 per cent in Gujarat, 48 per cent in Karnataka, 55 per cent in Maharashtra and 58 per cent in Third, urban slums and lack of sanitation is a potential contributor to stunting. Despite claims, India still lags behind sub-Saharan African countries in terms of safely managed sanitation services. States like Maharashtra, Andhra Pradesh, Telangana, Karnataka have a significant population living in urban slums who do not have access to improved sanitation facilities. The difference in sanitation practices between Indian states and their African counterparts explains the difference in stunting rates.

The other, atypical factor that has an impact on the prevalence of stunting is genetics (mother’s height). As per WHO, the golden rule of measuring stunting in children is the height for age Z score (HAZ). A child is considered stunted if the HAZ score is two standard deviations below the median of WHO child growth standard. The height of children is closely associated with the height of mothers. For instance, the average female height in South Asia, including India, is approx. 150-156 cm, whereas, the average female height in Europe and Africa is 164-168 cm and 160-165 cm respectively. Genetic differences can explain the differences in the stock of stunted children in two regions, but it can’t be the dominant factor in explaining the flow of stunted children. The analysis, then, boils down to the real culprits — anaemia and low BMI among women, social and gender inequalities, which together manifest in the problem of malnutrition among children.

(The writer is an economist with Swaniti Initiative, previously worked with Prime Minister Economic Advisory Council, Government of India & FAO of United Nations. Views are personal).

Source: Indian Express, 20/01/21

Children and the pandemic

Disruption in health services, suspension of mid-day meals, use of ASHA workers for COVID-related activities could aggravate India’s malnutrition problem.

COVID-19 has changed the way we have been taking all that is precious to us for granted. It has not only made the world pause, reflect and rearrange priorities in life, but has made many of us aware of our privileges and shown us a mirror to how we react to human sufferings as a society. While we come to terms with the COVID-induced changes one cannot comprehend the damage that the pandemic will inflict on children, albeit indirectly. Since the outbreak, the world has focused its attention acutely on the higher fatality rate the virus has caused among the elderly and launched a scientific enquiry on why children have emerged relatively unaffected. But amidst decoding this mysterious eccentricity of the virus, what has escaped our attention is the long-term damage the cascading effect of COVID-19 is likely to cause in children — through inadequate health services, broken medical supplies, interrupted access to nutritious food and income loss in families.

The long-term impact of the pandemic on economic and social systems remains invisible, but experts have begun to caution with worrying forecasts. Drawing from a recent Lancet study, the UNICEF has warned that three lakh children could die in India over the next six months due to disrupted health services and surge in child-wasting, a form of malnutrition when the child is too thin for his/her height. India is expected to bear one of the heaviest tolls of this preventable devastation, partly because its record in managing malnutrition among children was grim even in pre-COVID-19 times. India is home to half of the “wasted children” globally, reckons the recently launched Global Nutrition Report 2020. More than a third (37.9 per cent) of our children under-five years are stunted, and over a fifth (20.8 per cent) are wasted, the report adds. These rates are significantly higher compared to average prevalence in developing countries, which stand at 25 per cent for stunting and 8.9 per cent for wasting. Furthermore, even the National Family Health Surveys (NFHS) data shows that in the decade up to 2015, children suffering from severe acute malnutrition grew to 7.5 per cent from 6.4 per cent. Separately, Observer Research Foundation reports that with 15 per cent of the total population in the “hungry” bracket, India is one of the most undernourished regions in the world.

This nutrition insecure backdrop of India makes it dangerous to live through an extreme adversity like the current pandemic without proper planning for protection of our vulnerable population. Past few weeks, the entire country has been in lockdown mode to contain the infection which has brought economic activities to a complete standstill and resulted in income losses. Mid-day meals, the main source of nutrition for millions of children had to be suspended with schools shut, and congregations banned. Some states are trying to substitute it with dry ration but sharing of food by other family members in such trying times cannot be ruled out.

Overall health outreach services have been disrupted amid the panic the virus has triggered. Services of our front-line workers, the ASHAs and Anganwadi workers, had to be diverted for COVID-19 surveillance activities. Considering that they have been the lifeline of government’s nutrition programmes, this is bound to result in neglect of children and their nutrition status.

The highly infectious nature of the virus has prompted decisions that have caused serious economic distress, particularly to those dependent on daily wages to survive. Vulnerable groups have been further pushed to poverty. Children belonging to poor households face the highest vulnerability in terms of physical growth and brain development at crucial stages of their life because of highly compromised, untimely, and unhealthy meals, poor dietary intake and weakened immune system. Hence, pregnant or lactating mothers, infants and young children need protection not just from the virus, but from a lack of healthcare facilities, inadequate diet and misinformed breastfeeding practices.

Even as lockdown regulations ease and essential healthcare including antenatal care services slowly start resuming, the pandemic has already led to severe adverse consequences for mothers and children, particularly those facing socio-economic disadvantages. To restore efficiency in the system, special rations, including nutrients like protein, good fats, vitamins, essential minerals with less sugar, need to be made readily available on an urgent basis for mothers and children, so that their weakened immunity is boosted to fight deadly infections.

Government silos are abundant with 71 million tonnes of rice and wheat, recently there were images of pulses rotting in godowns that went viral. It is important to mobilise resources to increase the access of people to a diversified diet. Nutrition programmes like the Integrated Child Development Services (ICDS), mid-day meals, and anganwadi centres should continue to work as essential services and provide rations and meals to beneficiaries’ homes. States need to innovate strategies to support marginalised workers and ensure access of food at people’s doorsteps. As the numbers of vulnerable are set to soar, the country needs to expand preventive coverage of access to food and pre-empt a hunger crisis.

Post the pandemic, new strategies will have to be planned out for strengthening community-based management of acute malnutrition. Structural reforms of the Nutritional Rehabilitation Centres (NRCs) will have to be considered along with a ready workforce that has to be trained to fulfil the needs of the population during and post-pandemic. This will ensure access to nutrition services for women and children, improving their health.

The battle ahead is full of grave challenges. Properly planned, sustainable, inclusive polices and relief measures need to be implemented with an efficient, skilled and motivated workforce on the ground with seamless coordination between the Centre and states. Post pandemic, we shouldn’t have to live with this one regret — that the preventable damage surpassed the damage that was unpreventable.

Source: Indian Express, 18/06/2020

India tops list on reported child sexual abuse imagery

New research has placed India at the top of the list of countries from where the maximum number of reports (38.8 lakh) related to suspected online child sexual abuse imagery (CSAI) originated. Of the over 2.3 crore reports available with the United States-based National Centre for Missing and Exploited Children (NCMEC) from 1998 to 2017, India, Indonesia and Thailand account for 37%. In terms of volume of reports per 1,000 estimated internet users for each country, however, the top three countries involved in CSAI are Iraq, Thailand and Somalia. While the volume of reports in Thailand is 63.8 per 1,000, the number for India at 11.9 per 1,000 is much lower. The results illustrate that CSAI has grown exponentially globally, to nearly 1 million detected events per month. Of the over 2.3 crore reports of suspected incidents of CSAI, almost a crore or 40% occurred in 2017 alone. That’s an exponential rise from the 5.7 lakh reports NCMEC received in its first ten years of operation. In the list of top 10 countries in terms of number of reported events, Indonesia is at second place with 17.4 lakh, followed by Thailand, Mexico, Bangladesh, the United States, Brazil, Vietnam, Algeria and Pakistan.

Source: Times of India, 1/10/2019

How helicopter parenting is limiting the development of children

The mere mention of the term ‘helicopter parenting’ is enough to spark a huge debate at any dinner party or forum, with new parents and old expressing their opinions on the best practices.

The mere mention of the term ‘helicopter parenting’ is enough to spark a huge debate at any dinner party or forum, with new parents and old expressing their opinions on the best practices. I remember a post I shared on my social media a few months ago on this topic created much fervour among my new mom friends, as they carefully debated the pros and cons of it.

While there is no doubt that all parents work in the best interest of the children and do the very best they can from what they know, when parenting styles impact future performance and behaviours, especially in the workplace, they are subject to much scrutiny.

The concept of helicopter parents and its identified impact on individuals later on in life and work, is one such carefully researched and analysed topic.

The term “helicopter parenting” was first coined in 1990 by Jim Fay and Foster Cline in their book, Parenting with Love and Logic that gained importance with the college admissions staff who noticed how parents were actively involving themselves in the admissions process.

According to research, there are three key types of behaviour that can be defined as helicopter parenting. Parents who seek detailed information about their children’s lives, limit their children’s autonomy, and intervene directly in their children’s lives. While it is important that parents actively engage with their children, the study suggests that there is a fine line between involvement and control that needs to be managed. For example, a parent who calls the college professor to check up on a student’s performance or those who write the CV for their child applying to college or for an internship or job.

In the Indian context, the combination of helicopter parenting with our own cultural conditioning and concepts of raising children in a more protected environment, has had an adverse effect later on in life.

It has been identified that the children of helicopter parents tend to have a poorer emotional functioning, poor decision making capabilities, low problem solving skills, and were less prone to empathetic and pro social behaviors. While there are some good elements to helicopter parenting, when they practice information seeking without control, tipping the balance scale can significantly impact the development of the child.

Michigan State University surveyed over 700 employers who were looking to recruit recent college graduates and found that a third of them had parents submitting resumes, a quarter had parents calling in to urge them to employ their son or daughter, and about 4% of parents even showed up to the job interview!

Some of the key impacts of helicopter parents that are visible in the workplace are as follows:

*Poor decision making capabilities: When parents take the role of the advisor or mentor or sounding board a step further and make every decision in their children’s lives, they limit their ability to discern and take decisions later on in life

*Inability to handle failure: In a constantly disruptive and evolving world, building resilience as one of the key skillsets is critical.

(Author Shubika Bilkha is an entrepreneur, leadership coach and advisor partner, EdpowerU. Views expressed here are personal)

Source: Hindustan Times, 12/09/2019

Child rights body, IIT Kanpur develop kit to spread sexual-abuse awareness

The kit is a set of cards, posters, short animation clips and games, which can be used by teachers or an NGO to conduct an interactive workshop for children about sexual-abuse awareness, according to the minutes of the 38th statutory meeting of the National Commission for Protection of Child Rights (NCPCR).

The apex child rights body in collaboration with the IIT Kanpur has developed a kit to spread awareness about sexual abuse among children by using interactive means to teach them about personal safety, respecting their body and overcoming guilt.

The kit is a set of cards, posters, short animation clips and games, which can be used by teachers or an NGO to conduct an interactive workshop for children about sexual-abuse awareness, according to the minutes of the 38th statutory meeting of the National Commission for Protection of Child Rights (NCPCR).

Noting that an unaware child may easily fall trap to sexual abuse without realising that he or she is wronged, the commission said the kit would help in spreading awareness as any kind of physical or psychological abuse could scar a child’s life forever.

“Through the workshop, children learn about personal safety, respecting their body and overcoming guilt,” it said. “It also gets children to talk about this issue with their peers and understand that they need to speak up, which many kids don’t.” The kit also features game cards as an intervention to assess the learning acquired by children.

It can be used in classrooms for kids aged between 8-12 and in a group of 30-35 students in one session. It has manuals, reading and video material for the teacher or workshop facilitator to read and understand how to conduct the workshop.

The workshop kit has been vetted by the psychologists at Central Institute of Psychiatry, Ranchi, and a revised version will be developed based on their feedback.

Source: Hindustan Times, 17/08/2019

Bengal has most child marriages

If you thought the Bimaru states topped in child marriages, think again. West Bengal now has the highest incidence of girls aged between 15 and 19 years being married off, far ahead of states such as Rajasthan that one traditionally associated with child brides. However, the findings of the National Family Health Survey-4 (NFHS-4), conducted in 2015-16, show a steady decline across states, barring a marginal rise in two states – Himachal Pradesh and Manipur. The national average for child marriages now is 11.9% of all girls aged 15-19. When NFHS-3 was conducted in 2005-06, Bihar topped in child marriages, with a prevalence of 47.8%; Jharkhand was second with 44.7% and Rajasthan third (40.4%). Bengal was fourth with 34%. But in the 10 years since then, some Bimaru states — Bihar, Jharkhand, Rajasthan and Uttar Pradesh — managed to reduce the incidence of child marriage by over 20 percentage points. In the same period, Bengal managed only an 8.4 percentage point reduction. District-level analysis using NFHS-4 reveals that Murshidabad (39.9%) in Bengal shows the highest prevalence of child marriage, followed by Gandhinagar (39.3%) in Gujarat and Bhilwara (36.4%) in Rajasthan. Bihar has the most number of districts with high prevalence (20), followed by Bengal (14) and Jharkhand (11).

Source: Times of India, 8/02/2019

K’taka LS seats worse than Bihar’s in child nutrition

 Karnataka has more parliamentary constituencies than Bihar and Odisha put together in the list of those with the worst child malnutrition. Shockingly, 12 out of 14 Lok Sabha constituencies in Jharkhand and 19 out of 29 in Madhya Pradesh figure in this list making them the states with the worst record in childhood malnutrition indicators. In contrast, 17 of Kerala’s 20 constituencies figure in the list of the best and none in the worst. This was revealed in a study done by a multidisciplinary team of academics from Harvard University, the Institute of Economic Growth in Delhi, Tata Trust, and Niti Aayog. The study, reported in the Economic & Political Weekly, mapped data on childhood malnutrition from the national family health survey conducted in 2015-16 on to 543 parliamentary constituencies. It provides estimates for four child malnutrition indicators (stunting, underweight, wasting, and anaemia) for each constituency. A total of 72 PCs were in the top bracket of prevalence for all indicators — 12 in Jharkhand, 19 in Madhya Pradesh, 10 in Karnataka, six in Rajasthan and eight in Uttar Pradesh. Of the 70 PCs with the best record on all four indicators, 17 were in Kerala, nine were in West Bengal, and seven each in Odisha and Tamil Nadu. Overall, Nagaland, Manipur, Mizoram, and Kerala showed low prevalence of the four conditions of malnutrition and Jharkhand showed high prevalence. Interestingly, only 8 out of 80 PCs in Uttar Pradesh and 6 out of 40 in Bihar figured among the worst. Surprisingly, though Assam is considered a backward state, none of its constituencies figured among the worst and four out of its 14 PCs were among the best. In fact, none of the north eastern states figure in the list of the worst PCs. Seven out of 11 constituencies spread over the seven NE states other than Assam figure among the best. These include the two constituencies each that Arunachal Pradesh and Tripura have. The distribution of underweight (inadequate weight for age) and stunted (inadequate height for age caused by chronic malnutrition) children under five shows similar trends with Jharkhand, Madhya Pradesh, UP, Bihar and Chhattisgarh showing the highest burden. Three PCs in UP, Shrawasti, Kaisarganj and Bahraich, with over 60% of the children being stunted, showed the highest burden for stunting. Punjab, Himachal Pradesh, Telangana, Tamil Nadu, and Kerala showed the lowest burden. Idukki in Kerala had the lowest burden of 13.7%. The PCs with the highest prevalence of underweight are Singhbhum in Jharkhand (60.9%), Puruliya in West Bengal (58.2%), and Shahjahanpur in Uttar Pradesh (54.3%). Again, three PCs in Kerala fared best, with Kannur recording the lowest burden of 10.5%. Prevalence of wasting (low weight for height, usually the result of acute food shortage and/or disease) is highest in central and western India, particularly in MP, Gujarat, Maharashtra, Chhattisgarh, and Jharkhand. Jamshedpur in Jharkhand had the highest prevalence of 40.6%. Parts of southern, eastern and northern India show the lowest rates with two PCs in Manipur having the lowest burden of 7.6%. The highest rates of anaemia (when haemoglobin level is below 11) were found mostly throughout central India, particularly in Madhya Pradesh, southern Rajasthan, Haryana, and Gujarat. Singhbum in Jharkhand (83.0%), Banswara in Rajasthan (79.3%), and Khargone in MP (79.1%) were the worst off.
Again the two PCs with the least prevalence of anaemia were Attingal and Kollam in Kerala with about 19.5%. The study found no constituency with high burden of stunting, underweight, wasting or anaemia within states with better nutrition outcomes. It did, however, find stand-out PCs in states with poor indicators. Future studies ought to try and find positive practices or characteristics in these constituencies that could be applied to other PCs, the authors urged.

Source: Times of India, 23/01/2019

South Asia is a dangerous place to be born

In 2018, one million newborn babies died before they reached one month of age. My wish for 2019 is that we will see many more South Asia babies getting the urgent attention and quality care that they need and deserve.

Right now, as you read this, babies that have just been born here in South Asia are battling for their lives. The lucky ones are in a special newborn care unit with doctors and nurses working hard to keep them alive – keeping them warm; giving them oxygen and antibiotics if they need them. For too many, the battle will be lost before their lives even properly begin.

South Asia is a dangerous place to be born. In 2018, one million newborn babies died before they reached one month of age. Every one of these deaths is a tragedy for the family. And the sheer number of deaths is an outrage. This number – one million newborn baby deaths – is 40% of all newborn deaths if we look around the globe. The risk of dying is the same for a South Asian newborn as it is for a baby in Sub-Saharan Africa.

The availability of clinics and hospitals is still an issue in some places, as is transport to get to them on time. But this is no longer the main problem. The key issue is how good, or how bad, the care for pregnant mothers and newborns is. When we know that every year, one million babies here in our region will be dead within the first month of being born, we have a strong indication that the quality of care is simply not good enough.

The good news that I can share is that mothers and families actually can do a lot themselves to counter the threat of poor care. They are far from powerless and they are crucial to improving this situation. They can start by looking critically at the care they get when a new baby is on its way. There are very visible signs of quality care to look for at their clinic or hospital. It starts with the fundamentals: Is the place clean? Look at the health care workers: are they able and willing to answer your questions? Are they washing their hands before they touch you and the baby? You don’t need a medical degree to look for these signs and they will be a good indicator of how well the mother, the birth and child will be handled.

What can you do if you do not feel comfortable with the quality? The answer is to speak up! Bring to the attention of the director of the clinic or hospital. Post your concerns about the quality on social media. Or talk to a journalist who might be able to write a story about it. Each one of us may have very little power, but together we are powerful. And if more mothers and families complain about the lack of appropriate care, we have better chances of improving the situation for the next newborn. You really do have a crucial part to play in creating change.

At home, mothers and families can also help ensure that a baby has the best chances of survival. Making sure that no girl becomes pregnant before she is 20 years old and her body can sustain a healthy pregnancy and is fully developed to give birth will help improve South Asia’s grave newborn death statistics. Families can help make sure that an expecting mother gets her first medical check within the first 12 weeks of pregnancy. That way, she can be given advice and problems can be detected before too long has passed. And, by choosing to breastfeed and to start breastfeeding right after the baby is born, the mother is giving her newborn the best chances to survive that first month when the new baby girl or boy is extremely vulnerable.

So, there is plenty that mothers and families can do to help protect their newborns. It is not all in the hands of doctors, nurses and birth attendants.

My wish for 2019 is that we will see many more South Asia babies getting the urgent attention and quality care that they need and deserve. Every child has the right to survive – and I wish for joy and happiness in every new family with a healthy and thriving newborn.

Jean Gough is regional director, Unicef for South Asia

Source: Hindustan Times, 2/01/2019

Children must have a voice in the kind of city they want

A child-friendly city would have to protect them from violence, allow them to grow up in an inclusive space, and let their voices be heard.

Go to any park in Gurugram (or any other city in India) and it is likely you will be met with the wonderful sight of children playing. For a child, growing up in a city can be both a delightful experience as well as one fraught with dangers. Remember the scene from the movie Taare Zameen Par in which the boy walks the streets of Mumbai and experiences all its sights and smells? It was a heady scene, but almost unimaginable for our children.

The city street is seen as dangerous today — not a place to explore and discover. This applies equally to women, who are increasingly unable to access the city for pleasure and discovery. In most of our cities today, children are less able to venture out on their own. In Gurugram, because streets have not been designed for walking or cycling, children are not encouraged to go out by themselves at all. Further, safety concerns mean even more protection for children. For many of them, walking to school is not a reality anymore.

A child-friendly city is being talked about nowadays by international actors as well as the United Nations. Such a city would have to include features such as protection from violence, allowing children to grow up in an inclusive space, providing them with good quality open areas as well as letting their voices be heard regarding issues that affect their lives. A child-friendly city must also provide access to quality services and not discriminate against children, irrespective of their gender, social status and other such factors. In India, Bhubaneswar is one city that has included the phrase “child -friendly” in their planning — and made safe paths for walking, good crossings, streetlights, well-maintained parks.

Children must have a voice in the kind of city that they want, as they carry the burden of the future. They have clearly demonstrated their ability to be political actors. In the recent civic action to protect the Aravali Bio Diversity Park, students raised their voices to claim their right to green, open spaces. The campaign against bursting firecrackers has been very successful, in part because the voices of children were most prominent. Children must be seen as contributers to making a city a better place for all.

Equally important are children who have fewer life opportunities because of economic and social issues. Good schooling and access to services are essential to building a more inclusive society and therefore, more inclusive cities. For example, not all children have access to parks, mostly those who live within gated communities. I have seen that sometimes children from economically weaker sections of the society are prevented from playing in public parks, which is an extreme form of discrimination. The right to play is as important as the right to go to school.

We are also living in times when screens occupy children’s time so much that they do not actually enjoy public spaces. Recent research has shown that the free play that children engage in, especially without the supervision of adults, helps teach them many social skills. Children must be included as important voices in the planning of cities so that they are able to influence their present as well as their future.

Source: Hindustan Times, 20/12/2018

Fight the good fight for our children

The saying in the Hindi belt – The poor have to suffer in every circumstance – was ringing in my head like a sledgehammer. The question that was bothering me the most: Till when will we allow this dastardly game of turning injustice into an aphorism and the aphorism into infamous tradition to continue?

It was a lazy morning of October 14, 2010 but I was seething with anger. The saying in the Hindi belt: Garib ki har jagah maut hai (The poor have to suffer in every circumstance), was ringing in my head. The question that was bothering me the most: Until when will we allow this game of turning injustice into an aphorism and the aphorism into infamous tradition to continue? My colleagues in Kanpur, Lucknow and Delhi were thinking on similar lines.

By the time it was afternoon we had collectively resolved to prove this saying to be incorrect, at least this time round. What had happened was that a girl student of class six in Kanpur had been assaulted yet had been left outside her residence by the school authorities. Her parents made a living as daily wage workers. The girl was bleeding and was not even in a position to explain who had contributed to this dreadful condition. Short on resources, her parents somehow took the help of neighbours to take their daughter to a hospital. The doctors declared her dead the same evening.

Could there have been a more tragic end to an innocent life?

By this time, her distraught parents had just one recourse left -- going to the police. A report was somehow registered and a police procedure was initiated. The Mayawati government was in power in Uttar Pradesh at that time. She was renowned for following a zero-tolerance policy towards crime and criminals. The administration of the local police was with an officer perceived to be close to the chief minister. Mayawati assiduously followed the principle of implementing procedures irrespective of whether the officer was her favourite or not. The case involved a heinous crime with a girl from a modest background and the media was presenting it in a manner they deemed fit. Therefore, the police had to produce some progress as soon as possible. The easiest option was exercised to achieve this goal. The neighbourhood rickshaw-puller, who sometimes dropped the girl to school, was charged with rape and murder and instantly apprehended. Not just this, mud was flung on her mother’s character in a systematic manner.

Don’t you find this astonishing? The daughter of a poor man is killed and another poor man implicated in the murder. It seemed facing misfortune was embedded in their destiny.

At that time our correspondent interviewed the accused rickshaw-puller in the prison. His version of proceedings was frightening and Hindustan decided to bring it to light. Seeing their so-called good work being put under the scanner flustered the police officers. But, so ingrained was their arrogance that they even implicated two correspondents of Hindustan in false cases. Not just this, a mob was sent to our Kanpur office in order to intimidate the staff.

Despite all this, my colleagues in Hindustan didn’t waver from their path. By pursuing the case of Divya (name changed) we worked towards empowering disadvantaged women. We knocked on the doors of Kanpur city’s biggest intellectuals. We reached out to schools and colleges to raise awareness among young girls and saw the gradual emergence of a mass movement. News about the case reached the power corridors of Lucknow. Not just was a directive issued from the secretariat to suspend the alleged confidant of the chief minister but a number of other officers and policemen were also suspended. Not just this, the probe was handed over to the Crime Branch-Criminal Investigation Department. The newly-appointed officers began the probe on a clean slate. They discovered that the son of the director of the school in which Divya studied had carried out the crime. He was arrested. But the case didn’t end there. Only the first round in the battle for justice had been won. To ensure that probe moved forward logically, the police reached the court with all the relevant evidence and the perpetrator got the punishment he deserved required some more effort. With that unfinished task was linked our morale which still continued to be high.

Ultimately, on December 5 this year, a court in Kanpur pronounced life imprisonment to the culprit. The idea of narrating this entire story to you wasn’t to glorify Hindustan or my colleagues. Even as I write these lines, there is one question that is still bothering me: Divya may have got justice, but when will the judicial process become sensitive in a country where 106 incidents of rape take place every day?

Clearly, justice was delivered to Divya. But the fight for the protection of the rights of women and children is far from over.

Shashi Shekhar is the editor-in-chief, Hindustan

Source: Hindustan Times, 10/12/2018

The children left behind

UNESCO report highlights the gaps in education policy for children of migrants.

People move around India all the time. Around 9 million move to live in another state every year while the rates of those migrating within their state have doubled over just 10 years. If you were an education minister tasked with making sure schools are flexible enough to deal with this, what would you do?

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UNESCO has published a global report on migration and displacement. Entitled ‘Building bridges’ not walls’, it looks at countries’ achievements and bottlenecks in helping migrant and displaced children benefit from a quality education. People have always moved away from their homes, in search of better education opportunities, for work. In India, education was the main reason young men gave for moving within the country.

A lot has been done to help internal migrants. In 2009, the Right to Education Act made it mandatory for local authorities to admit migrant children. National-level guidelines allow for flexible admission of children, for providing transport and volunteers to support mobile education, and creating seasonal hostels. The guidelines are designed to improve coordination between sending and receiving districts and states. And because central directives may not cover all bases, many states also did their part. Gujarat introduced seasonal boarding schools and started an online child tracking system. In Maharashtra, village authorities worked with local volunteers to provide after-school psychosocial support to children left behind by seasonal migrating parents and Tamil Nadu provides textbooks in other languages.

Some of the children most in need of new solutions are the children of seasonal workers. In 2013, 10 million children lived in rural households with a family member who was a seasonal worker. This movement is common within the construction industry: A survey of 3,000 brick kiln workers in Punjab found that 60 per cent were inter-state migrants.
The Global Education Monitoring Report shines a light on these children. Eight out of 10 migrant children in worksites across seven Indian cities did not have access to education. Among young people who have grown up in a rural household with a seasonal migrant, 28 per cent identified as illiterate or had an incomplete primary education. The report shows that up to 40 per cent of children from seasonal migrant households are likely to end up in work rather than school.

One reason for this is that the interventions designed by states are aimed at helping children who are in their home communities, but they do not actively address the challenges faced by those who are on the move. There are other challenges. Despite efforts, a pilot programme used on brick kiln sites in Rajasthan to track the progress of out of school children did not improve learning in any substantial way. Teachers on the sites reported culture, language, lifestyle, cleanliness and clothing as major barriers between them and the kiln labour community.

While analysing migration and its links to education, it is hard to ignore one of its most visible results on Indian cities: The growth of slums. But policymakers seem to turn a blind eye to them. Our estimates are that an additional 80 million children will live in slums around the world by 2030.

It was positive to see the 2016 India Habitat III national report commit the government to universal provision of basic services including education. Yet, research from the same year showed that urban planners were not being trained to understand the needs of slum dwellers. Our research shows there is only one urban planner for every 1,00,000 people in India, while there are 38 for the same number of people in the UK.

With shifting goalposts, the task of education ministers is not enviable. But I believe that our work over this past year can help. It is time for states to address the education needs of children and youth who have already migrated. The government must face up to the permanence of informal settlements. Like it or not, education is on the move

Source: Indian Express, 30/11/2018

Sustained efforts must to reduce India’s infant mortality below 25 by 2030

It would require better institutional delivery, strengthening routine immunisation, scaling-up of special newborn care units to treat malnourished and ill newborns, providing holistic nutrition, and meeting the national commitment to make the country open-defecation free by 2019, to help us reach the goal.

India’s under-five mortality rate (U-5MR) dropped four points in a single year in 2016, to 39 deaths per 1,000 live births from 43 in 2015. Apart from being the sharpest fall in a year, the decline also brought down India’s U-5MR below the global average of 39.1, according to data released by the United Nations on Tuesday. With 26 million births each year, India has the world’s largest birth cohort, and the four-point reduction in Infant Mortality Rate has led to 120,000 lives saved in one year. Another first for India is that its proportion of child deaths equals its share of the global births, with India accounting for 18% of the total births and 18% of U-5MR deaths worldwide.

Just three years ago, more than one million children died before reaching their fifth birthday from preventable and treatable causes, such as preterm birth complications, acute respiratory infections such as pneumonia, intrapartum-related complications, congenital anomalies and diarrhoea. Neonatal deaths, or newborn deaths within 28 days of birth, because of pregnancy-related complications, accounted for 53% of all under-five deaths in 2016. Many of these newborns and children could have been saved by increasing institutional deliveries, postnatal follow-ups, improving mother and child nutrition, and providing water, sanitation and immunisations. Only one in five new mothers in India get the full antenatal care, shows National Family Health Survey 2016.

The sharp decadal increase in institutional deliveries in public and private hospitals, up from 38.7% in 2006 to 78.9% in 2016, has lowered birth-related complications and helped India eliminate maternal and neonatal tetanus. But more needs to be done. It is imperative to widen the immunisation net so that all children are protected against vaccine-preventable diseases, such as diarrhoea and childhood pneumonia. Boosting breastfeeding is another low-resource method to heighten childhood immunity and lower risk of infections. Only 41.6% of children under the age of three were breastfed within one hour of birth in 2015, up from 23.4% in 2005.

Though there has been fourfold decline in the gender gap in survival of the girl child from 10% in 2012 to 2.5%, the bias against the girl child remains high in India. Globally, girl child survival rates are 11% higher than boys.

Further increasing institutional delivery, strengthening routine immunisation under Mission Indradhanush, scaling up of special newborn care units to treat malnourished and ill newborns, providing holistic nutrition under Poshan Abhiyan (national nutrition mission), and meeting the national commitment to make the country open-defecation free by 2019, will collectively help reach its Sustainable Development Target to bring down U-5MR below 25 by 2030.

Source: Hindustan Times, 19/09/2018

The law must find ways to deal with online abuse of children

Given the nature of the menace, only a collective effort of all stakeholders, including service providers, content providers, civil society and regulatory authorities, can help redress it. Young lives are at stake and there is no time to waste

Last week, Supreme Court judge, Justice Madan Lokur, brought up an issue that often fails to get adequate notice, unless things really get out of hand: the online abuse of children. Speaking at a seminar in New Delhi, Justice Lokur emphasised the need to look at violence against children in a larger context — going beyond physical violence to look at psychological violence inflicted through online sources. In the past two years or so, there has been a spate of incidents involving children and the darker side of the Internet, be it pornography, cyber bullying, or online games such as the Blue Whale Challenge or the latest deadly online game, the Momo Challenge. The Momo challenge, similar to the Blue Whale challenge, consists of a variety of self-harming dares, which becomes increasingly risky as the game progresses and it finally ends with a suicide challenge.

The threat to children from online sources has become so serious that technology giant Google has announced that it is employing a new Artificial Intelligence (AI) to combat online spreading of content involving child sexual abuse. The new AI technology, Google said, will significantly help service providers, NGOs and other tech firms to improve the efficacy of child sexual abuse material detection and reduce human reviewers’ exposure to the content. This development is important since the effects of such violence have strong, long-lasting effects on the physical and mental health of the young victims. The direct and indirect economic costs are substantial because such abuse undermines the long-term potential of both victims and societies.

In a scathing commentary on the lack of preparedness of Indian lawmakers and agencies in protecting children from the menace of online abuse, a 2016 report by Unicef India said the issue has received very little attention and is not even included in the National Crime Records Bureau statistics as a separate category. Such cases are often not registered or investigated because of limited understanding of child online offences system. Also, there is not enough forensic capacity to investigate online offences and inadequate cooperation by India for investigating international offences.

Given the nature of the menace, only a collective effort of all stakeholders, including service providers, content providers, civil society and regulatory authorities, can help redress it. Young lives are at stake and there is no time to waste.

Source: Hindustan Times, 17/09/2018

No child left behind

To get good nutrition to all Indians, we need delivery models that are collaborative across domains

The urgency to address poor nutrition in India, especially among children,adolescent girls and women is compelling, and re-confirmed in virtually every survey — from NFHS-4 in 2015-16 (the latest available information), to the Global Nutrition Report 2016 and the Global Hunger Index (GHI) 2017, which ranks India at 100 out of 119 countries, with a low overall score of 31.4. Among children less than 5 years, wasting (low weight for height), continues to be 21% in the 2017 index — it was 20% in 1992. There has been a reduction in stunting (height for age) – from 61.9% in 1992 to 38.4% in 2017, reported in the GHI 2017. Mortality among children less than 5 years old has declined to around 5% from 11% during the same period, according to both the GHI and the NFHS. However, 25% of India’s children less than 5 years old are still malnourished.

Add to this the fact that 190.7 million people in India sleep hungry every night, and over half of adolescent girls and women are anaemic, and the conclusion is obvious — despite a 7% compound annual growth rate over the last decade and the various programmes to improve nutrition, levels of under-nutrition are unacceptably high.

No time to waste

This grim reality has rightly lead to a renewed emphasis to address the various forms of poor nutrition – stunted, wasted, anaemic and underweight children; anaemic girls and women, especially in the 15-49 age group. The recently announced flagship program of the Ministry of Women and Child Development will be anchored through the National Nutrition Mission (NNM), or Poshan Abhiyaan, with its own specific budget of ₹9,046 crore and a proposed World Bank loan of $200 million, to ensure convergence among the various programmes of the government. Additionally, NITI Aayog has worked on a National Nutrition Strategy (NNS), isolated the 100 most backward districts for stunting and prioritised those for interventions.

A cynical view would be that we have seen such declarations before – after all, the special attention to nutrition was highlighted in 2008 when the Prime Minister’s National Council on India’s Nutrition Challenges was constituted. A detailed report, “Addressing India’s Nutrition Challenges”, was submitted in 2010 by the Planning Commission, the convergence of an extensive and multi-sector consultation. But nothing changed significantly.

The optimistic view says that exploring new models to address the structural and systemic issues on a priority basis, learning from what has worked or not, and single-minded focus on implementation will be critical to delivering better nutritional outcomes and meeting the Sustainable Development Goals, to which India is a signatory. Additionally, initiatives like Swachh Bharat Abhiyan, where implemented, will contribute positively to nutrition outcomes, and well-structured public-private partnerships could be the catalyst.

Seen in this context, the overhaul of capacity and capability in three existing programmes, designed to reach populations most at risk, should be the first priority — namely, the Integrated Child Development Services (ICDS), with its network of 1.4 million Anganwadi Centres, reaching almost 100 million beneficiaries who include pregnant and nursing mothers and children up to 6 years; mid-day meals (MDM) that reach almost 120 million children in schools; and the Public Distribution System (PDS) that reaches over 800 million people under the National Food Security Act.

The National Nutrition Strategy (NNS) has set very ambitious targets for 2022 and the Poshan Abhiyaan has also specified three-year targets to reduce stunting, under-nutrition and low birth weight by 2% each year, and to reduce anaemia by 3% each year. For purposeful action, it is imperative to have common goals and metrics for improving nutrition, which can then be disaggregated by year, State, district, etc., into a nutrition dashboard, with metrics that are clear and measurable and a real-time tracking mechanism, much like we track economic data. It is interesting to note that the National Nutrition Monitoring Bureau (NNMB), established in 1972, was dissolved in 2015.

Both the NNS and the NNM have recognised the criticality of working collaboratively across Ministries; yet both are silent on the constructive role that the private sector, development agencies and civil society can and must play in realising these ambitious goals. Altering the fundamentals of poor nutrition requires multiple and sustained interventions over a period of time — increased availability and accessibility of nutritious food, potable water, hygiene and sanitation, primary health care, etc. The approach, commitment and resources therefore have to be inter-generational, multi-sector, multi-dimensional and multi-year. To simplify a complex issue, the challenge for India is to simultaneously address insufficient and poor diets, inadequate hygiene and sanitation and better management of disease and infections.

Success in this domain will be driven by coordinated action on multiple fronts, but there are at least three urgent priorities.

Three priorities

One, to adequately re-engineer the ICDS, MDM and PDS for greater effectiveness. This is an ideal initiative for public-private partnerships as the strength of good private sector companies is in creating and designing frameworks, structures, processes and metrics for action, implementation and tracking. For example, involving the best nutritionists to work with local communities on calorie and nutrition dense supplementary foods, using easily available local ingredients that are within the ICDS and MDM budget guidelines, and produced by self-help groups, could easily be anchored by the relevant private sector and development agencies, working with State governments, and considered a corporate social responsibility initiative. The key advantages of this disaggregated supply model are that it engages local communities, generates employment and ensures minimal leakage as it works with and inside the community. This will also ensure that space and other constraints of lack of hygiene at Anganwadi Centres do not become impediments in the supply of nutritious food.

Two, to mandate and scale staple food fortification comprising edible oil, wheat, rice and dairy products, in addition to salt. There is persuasive evidence from several countries of the efficacy and cost-effectiveness of large-scale staple food fortification to address “hidden hunger” or micro-nutrient deficiencies. The effectiveness of iodised salt in significantly reducing iodine deficiency is well-established in India empirically. The success of micro-nutrient fortified food is that it does not entail a change in behaviour. Considerable work will also have to be done to make fortified rice and wheat available through the PDS. This requires addressing the supply chain capability to deliver — another excellent PPP initiative, that has been piloted in several States for edible oil and wheat flour and can easily be replicated. A case in point is the mandate of July and August 2017 to use fortified oil, salt and wheat flour in the ICDS and MDM by the Ministries of Women and Child Development and Human Resource Development, respectively. In the absence of coordination with industry to create an effective supply chain, this proposed intervention will be another missed opportunity.

Mandatory fortification with micro-nutrients often sparks an emotional debate, and the way to think about it is that these universally consumed staple foods become the carriers of vitamins and minerals that people need but do not get in sufficient quantity from the food they consume.

Three, multiple campaigns designed to inform, communicate and educate on nutrition-specific and nutrition-sensitive behaviours like breast feeding, diet diversity, hand-washing, de-worming, safe drinking water, hygiene and sanitation. Nutrition has to be “marketed” and made interesting, engaging, simple and personally relevant — this is an expertise where the private sector can meaningfully contribute.

Awareness and delivery

Nutrition is complex, and therefore its delivery must be simplified through greater awareness and actions. The delivery models must be collaborative across domains, with clear decision rights and hard-wired processes, enabled by technology and a significant investment in strengthening people competencies. Unless economic growth improves social and human development, it cannot be sustained. Equally, economic growth itself is impeded by low levels of productivity in an under-nourished and malnourished population.

Vinita Bali is a strategy adviser and independent director, and chairs the Global Alliance for Improved Nutrition

Source: The Hindu, 18/08/2018