Health & Life

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By YKA Staff

Many articles about working smarter, not harder have been doing the rounds of the internet. Any such articles would tell you about various methods that one can adopt to be more efficient with the least effort. However, we often ignore that the body and the brain need nourishment to perform smartly.

Did you know that 60% of the solid matter that makes up our brain is fat? And feeding ourselves essential and saturated fats keeps the grey cells active.

From staying hydrated to eating foods that have the same effect as the ‘smart’ drug Adderall, here’s a visual that’s going to help you fight mental lethargy.

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Source: Nerdgraph.com

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By Prachi Salve and Video Volunteers, Indiaspend.com:

Last year, in eastern Bihar’s Phulvari Sharif, 24-year-old Masahun Khatun was five months pregnant when she fell in the front yard of her house. For the next three weeks, Masahun and her husband shuttled between government hospitals and private practitioners, spending over Rs 40,000 on healthcare, as they tried to get an abortion. Masahun did not survive and her husband, a daily-wage labourer, is struggling to raise their four kids. This is their story:

Almost a decade after the government launched the Janani Suraksha Yojana (JSY; Mothers’ Protection Programme) to reduce maternal and infant mortality by promoting institutional delivery, too many Indian mothers die of causes related to childbirth.

India’s MMR, or maternal mortality ratio (number of maternal deaths per 100,000 live child births), was 178 in 2010-12, worse than poorer countries such as Myanmar and Nepal, and about the same as Laos and Papua New Guinea, according to WHO data. As many as 50,000 pregnant women die every year in India during childbirth, according to this UN report.

The positive news is that the MMR has declined from 212 in 2007-09. Some states, such as Kerala (66), Tamil Nadu (90) and Maharashtra (87) have MMRs that match richer countries such as Brazil (69), Philippines (89) and Cuba (80).

Assam (328), Uttar Pradesh (292), Uttarakhand (292), Rajasthan (255), Odisha (235), Madhya Pradesh (230), Chhattisgarh (230), Bihar (219) and Jharkhand (219) have the eight worst maternal mortality rates in India. These numbers match some of the world’s poorest countries, such as Mauritania (320), Equatorial Guinea (290), Guyana (250), Djibouti (230) and Laos (220).

How the public healthcare system fails the poorest Indians

Three video stories by Video Volunteers (a global initiative that provides disadvantaged communities with story and data-gathering skills) reveal how difficult childbirth is for the poor who have to depend on public-health services, and end up spending money that, in most cases, they do not have:

 

  • Below is the story of a pregnant woman in Bihar who was charged Rs 500 for cutting an umbilical cord. She also had to pay for painkillers needed before her delivery. Women in the village report that when they refused to pay, the ANMs refuse to attend to them. This is despite the government scheme (JSY) that hopes to reduce out-of-pocket expenditure for women below the poverty line by providing free ante-natal checkups, IFA (iron tablets) tablets, medicines, nutrition in health institutions, provision for blood transfusion, and transport to and from health centres.

  • This report below from Deogarh in western Jharkhand reveals corruption among auxiliary nurse mid-wives (ANMs) of a hospital who force pregnant women to pay for their services post-delivery.

  • As this report below details, pregnant women are forced to spend out of their pocket or are referred to other faraway health facilities because there aren’t enough medicines at a state-run health facility. Arti Devi was asked to deposit Rs 500 at a state-run health facility. It was a sum she could not afford, so was asked to go to another government hospital.

The JSY gives pregnant women–who deliver babies at home and live below the poverty line–Rs 500 as cash assistance, irrespective of the mother’s age and number of children, to give birth in a government or accredited private health facility.

The scheme focuses on poor, pregnant women, with a special focus on states with low institutional delivery rates: Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam, Rajasthan, Odisha, and Jammu and Kashmir.

The scheme also provides performance-based incentives to women health volunteers known as ASHA (Accredited Social Health Activist) to promote institutional deliveries.

Cash Entitlement For Mothers
Category Rural Areas Urban Areas
Mother’s package (Rs) ASHA’s package* (Rs) Mother’s package (Rs) ASHA’s package** (Rs)
Low-Performing  States 1400 600 1000 400
High-Performing States 700 600 600 400

The Promise Of Direct Transfers

A direct transfer of JSY benefits to the bank accounts of pregnant women started in 2013 and is now underway in 121 of 640 Indian districts.

JSY beneficiaries have increased from 0.7 million in 2005-06 to 10.4 million in 2014-15, an indicator that many pregnant women know of the scheme.

About 900,000 ASHAs get performance-based incentives to motivate pregnant women to give birth in health facilities. Of 10.4 million JSY beneficiaries in 2014-15, a large majority (nearly 87%) live in rural India.

State Subsidies Available, Yet Women End Up Paying

As many as 60% of women in Uttar Pradesh acknowledged paying money from their own pockets for certain services, according to an assessment of JSY conducted by United Nations Population Fund in Bihar, MP, Odisha, Rajasthan and Uttar Pradesh in 2012.

Paying For Medical Expenses
Particulars Bihar MP Odisha Rajasthan UP
Percentage of women interviewed who said they made some payment to the institution (%) 28 45 52.1 44 60
Average amount paid as hospital charges (in Rs) 91 42 1070 1389 1016
Average amount paid as medicine charges (in Rs) 550 121 1165.7 820 746
Average amount paid as other charges (in Rs) 78 136 727.8 296 651
Total average amount paid (in Rs) 719 299 1639 1350 839

Women in Madhya Pradesh reported the lowest out-of-pocket expenditure, Rs 299, followed by Bihar with Rs 719.

Households spent an average of Rs 5,544 per childbirth in rural areas, according to a recent survey by the statistics ministry.

Video Volunteers is a global initiative that provides disadvantaged communities with story and data-gathering skills, and IndiaSpend. Salve is a policy analyst with IndiaSpend.

This article was originally published on IndiaSpend.com, a data-driven and public-interest journalism non-profit.

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By YKA Staff:

You could be surrounded by honking cars on a road cramped with vehicles, standing in a metro or bus full of loud humans, or you could be having a hard day and want an instant pick-me-up. Music comes to our rescue wherever, whenever.

Studies reveal that listening to music releases the happy hormone-dopamine. It has the power to alter our moods, it can also make us better human beings, because music makes us more empathetic and sensitive.
In all honesty, nobody really needs a reason to listen to music.

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Source: Nerdgraph.com

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By Park Thaichon and Sara Quach:

Fast food giant McDonald’s has been under a cloud in recent years as its US customers turn to alternatives. In this “Fast food reinvented” series we explore what the sector is doing to keep customers hooked and sales rising.

While excess weight and obesity is a growing global concern, there has been more and more advertising and promotional effort encouraging the consumption of unhealthy food.

In many cases this marketing is targeted at children, and takes place online. In our recent study we investigated the impact of online marketing communications on children and their intention to consume unhealthy food. We found fast food ads on social networking sites can manipulate young audiences – their purchasing likelihood, their views of fast food and their eating habits.

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The qualitative study included a sample of 40 Australian children who use social networking sites. Half (21) of the children were male and the average age was 14 (the youngest being 12 and the oldest 16). Their parents were also present during the interview, however they agreed not to intervene during the conversation.

A growing problem

The prevalence of excess weight and obesity among Australians has been growing for the past 30 years. Between 2011 and 2012, around 60% of Australian adults were classified as overweight, and more than 25% of these fell into the obese category. In 2013, more than 12 million, or three in five Australian adults, were overweight or obese. On top of that, one in four Australian children were overweight or obese. Excess weight and obesity is only beaten by smoking and high blood pressure as a contributor to a burden of diseases.

Despite this, the food industry is succeeding in using marketing communications to change attitudes, perceptions and perceived norms associated with unhealthy food.

Consumers are lured by surprisingly cheap deals, which are especially attractive to teenagers and young adults with low income. But sales promotions such as discounts and coupons often offer only short-term benefits to consumers and are usually not effective among middle-age adults.

However, if a promotion is offered for a long period of time (i.e. more than three months), it can actually influence customer habits, encouraging repeat purchases – for example, the $1 frozen Coke.

Similarly, sales promotions can make other brands be perceived as less attractive by customers after a period of time. For instance, the $1 frozen Coke campaigns by McDonald’s and Hungry Jack’s affect the perception of frozen Coke in terms of monetary value. Many consumers become less willing to buy a frozen Coke that is more expensive than $1. The same can be said of $2 burgers or $5 pizzas.

The role of social networks

More than half (16 out of 30) of the respondents admitted they tended to change their eating habits after repeatedly being exposed to advertisements on social networking sites.

Yes, many people say that it is not good to eat fast food. I used to think so but not anymore. Look at their ads, they are colourful, many options and cheap.”

I just cannot resist it… I had been looking at the ads day after day and I decided that I needed to try these”.

Interestingly, fast food was associated with socialisation and fun among young consumers.

The ads make me feel like this is where we belong to. This is our lifestyle…where we hang out and can be ourselves.”

This is about our culture, young, active and free. We are kids but also not kids. We are different.”

Peer pressure

Peer pressure is heavily related to eating habits, especially during puberty when there is usually a shift from home influence to group motivation. Teenagers and young adults in particular tend to choose a particular type of food under peer pressure.

More than 70% of teenagers will choose a food according to the preference of their friends. This means marketing communications promoting fast food consumption can create a snowball effect within this group of customers. For example, Jack, Sara and Park go out together. If Jack and Sara order Big Burgers with extra cheese, the likelihood that Park will order another Big Burger with extra cheese is approximately 75%. In contrast, only 2.7% of people aged over 40 choose fast food because of their peers.

It’s clear marketing efforts by fast food chains can promote unhealthy eating habits. Also, peer influence plays an important part in forming eating habits. This means the intervention of government and health organisations should concentrate on increasing customers’ attention to health issues, self-efficacy and perceived norms, and at the same time, lessening the influence of marketing efforts aimed at motivating unhealthy eating habits.

The ConversationAbout the authors: Park Thaichon, Assistant Professor of Marketing, S P Jain School of Global Management and Sara Quach, PhD Student, Swinburne University of Technology

This article was originally published on The Conversation. Read the original article.

Image source: Roberto Trombetta/Flickr

By Malavika Thirukode:

Earlier, as a student, and now a practitioner, of public health, I always wonder why opinions about abortions are so polarized. Why is it that most people prefer not to talk about abortion? After all, it is one of the most widely conducted surgical procedure in the medical field. From Chinese literature of Emperor Shen Nung’s time to the Ebers Papyrus of Egypt and later, the 10th-century Persian physician Al-Rasi, all talk about abortion and contraception. Some historical figures like the Roman satirist Juvenal have gone as far as explicitly writing about “our skilled abortionists”. Over the years, these voices have been silenced by conservatism in religion, politics and by hegemonic gender roles. As a young working woman, I find the silence hypocritical and stifling. Conservatism, in development and public health, specifically in abortions, is a huge challenge.

Image source: Roberto Trombetta/Flickr
Image source: Roberto Trombetta/Flickr

International Conventions On Abortion

Several international laws explicitly state that young girls and women have the right to demand and access credible and relevant sexual and reproductive health information. These documents strongly support health as a human right, to be enjoyed by all, irrespective of differences and social classifications. Article 12.2 (a) of the International Covenant on Economic, Social and Cultural Rights, The Convention on the Elimination of All Forms of Discrimination against Women, Article 24 of the Convention on the Rights of the Child, the 1995 Beijing Platform for Action and the Millenium Development Goals, in addition to the most commonly quoted Programme of Action of the 1994 International Conference on Population and Development- all comprehensively and explicitly state that the right to sexual and reproductive health for every young person, girl and woman is all encompassing. The rights elicited in these Declarations not only state those aspects of health that need to be prioritised but also note the obstacles that hinder the furtherance of the right to health from a gendered perspective.

Encouraging agency for girls and women (Covenant on Economic, Social and Cultural Rights); the dynamic of relationships that women must navigate in families, marriage and associated vulnerabilities (discrimination), and a woman’s right to determine her fertility are some of the perspectives considered in these Declarations. The comprehensiveness of some of these is evident as they urge nations against criminalising aspects of sexual and reproductive health, as stated in the Beijing Platform for Action. These documents embolden young girls and women to experience sexuality and reproductive health, not only as ‘fertility’ but as being sex positive. They advocate for an understanding of relationships and pleasure through the implementation of valid sexuality and reproduction related education programmes.

While researching for this article, I was appalled at my ignorance of the scope of these texts, and at the same time pleasantly surprised to know that there are voices speaking in support of the agency of women. And the questions, why are we still scared to talk about it? Why do my friends and family still believe that to get an abortion would be a scene from their worst nightmare? Why am I told never to tell anyone? loom larger than ever.

Religion And Abortion

Besides religious arm wringing, lack of awareness, criminalisation and stigma have furthered the pro-life cause. When abortion or aspects of it are a crime, it not only forces women to resort to unsafe methods and service providers, but it perpetuates stigma as well. Interestingly, the perceived stigma of legal abortion dissuades professionals from choosing to train in the procedure. In countries like India, physicians are not always aware of the country’s liberal abortion laws. And medical professionals, who are unaware contribute to the already existing prejudice. Thus the vicious circle continues. Unsafe abortions, though, whether a high or low concern, remain a public health issue. Beyond religion and politics, medical and international development fraternities also have a role to play in normalizing abortion in communities and clinics.

The experiences of girls and women cannot be explained in terms of religion, and that a ‘man’ always knows best. ‘Viability’ is not a universal term, it is a personal philosophy. The choice to end a pregnancy is as noble and as brave as the choice to care for a physically challenged baby. But this is a choice and a personal one at that. If you are to practice choice and faith with relation to safe abortions, choose to support the girls and women in your life. Talk to them about contraception- the right way to use them, where you can find one, how you can ask for one and the like. Have faith that, armed with the correct information, she will be capable of choosing what she believes is best for her. And should you have to deal with a spiritual dilemma- non-violent dialogue/protest is your safest bet to heaven.

Demystifying Medical Abortion

The central message is that a safe abortion can not only save a life in the most straight-forward reality of decreased maternal mortality and morbidity but, if performed legally and safely, it allows the young woman to fulfill her aspirations. These will include one of these or a combination of the following: going back to school/college/university, earning a livelihood and improve her social mobility. Programmes like the NIKE Girl Hub and Gapminder’s Hans Rosling have all provided credible evidence that education leads to better reproductive health in young girls. By disallowing her fundamental right to choose, you simply stop her from ever moving out of the ‘vicious’ cycle of poverty, illiteracy and gender-based violence you often ‘quote’ as the evils of this millennium.

Reporting on abortion needs to be brought into the mainstream as it is fundamental to maternal health, by involving the medical as well as the international development fraternity. The Human Rights discourse has provided a good foundation for advocacy efforts by the two groups. The biggest hurdle in the implementation will be that of criminalisation. However, initiatives have shown that even in settings where abortion is criminal, both clinicians and advocates have initiated programmes to ensure that women have access to information on medically safe and successful procedures.

At the medical level, doctors must be encouraged to train for providing a safe procedure, irrespective of its social implications in a legal or restricted setting. Licensing procedures in restricted settings should be made easier to generate demand for the service. Abortion-related complications should be reported, and governments should ensure that providers and clients are protected from non-state aggression. The medical abortion method is very beneficial as, in severely restricted settings it allows for harm reduction strategies, which protect both the clinician and the client, without hampering access to evidence-based information. This has been the experience of initiatives such as Women on Waves and the Uruguay model, both of which have successfully helped women undergo a medical abortion.

The development sector needs to de-medicalise and demystify abortion to align with equality, equity and health as human rights, enshrined in the laws mentioned above. In legalized and restricted settings abortion counseling can be implemented by intermediate service providers such as pharmacists and paramedics. Medical abortions are often mistaken to be a surgical procedure when in reality it is medically induced through pills. Providers of herbal abortifacients can also be trained to provide the medicines. International non-governmental and advocacy organisations need to work towards decriminalizing and destigmatising abortions, especially in very religious communities and also within their institutional structures (commonly known as ‘Value Clarifications’). They must encourage greater acceptance of modern contraceptives to reduce the demand for clandestine procedures.

The Individual And Abortion

My parents often told me that the two things you should ‘avoid’ discussing in a crowd were politics and religion. How ironic that outside the pages of public health, human rights and popular wisdom, the laws on abortion are nothing but a poisonous concoction of religion and politics, one always trying to outdo the other!

Stories have an impact. Whether it is your own or that of a friend, acquaintance; or mere hearsay – even a myth says something about the individual, community, or a school of thought. Abortion too is a part of many stories. Some are of brave and angry women demanding a greater place in our world for women’s choices; some are that of priests and clergyman for recognition and redemption rather than termination. Some are of advocates at parliaments, international organisations and community movements. But most stories are that of your friends, maybe even yourself. And they often go unheard. Maybe you don’t think that it’s important to talk about it, or you are afraid to talk about it, for fear of being judged or incarcerated. For many, it is now just a memory. The voices of others are silent if your voice is not heard, if it is not articulated. They are silent until promises are kept and memories turn empowering not embarrassing.

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By Charu Bahri, Indiaspend.com:

In January this year, the government asked for public opinion on tougher new laws to curb smoking: To raise the minimum smoking age to 21 from 18, and to ban the sale of single cigarettes, which account for 70% of nationwide cigarette sales.

People responded enthusiastically; 45,000 emails and 100,000 letters poured in to the health ministry, as Reuters reported earlier this month. What they said, however, is not known because the government hasn’t yet read the messages, according to a health ministry representative quoted in the story.

Like those messages, the World Health Organisation’s Report on the Global Tobacco Epidemic 2015 is largely ignored in India. Its single-line message: Raising tobacco taxes can help curb smoking.

Curbing smoking is very important to India for two reasons:

  • About one million Indians die from smoking-related causes every year, which are among the top three ways to die
  • Smoking also saps Indians of money; more money, it emerges, than it earns for the government.

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Indians aged 35 to 69 spent Rs 104,500 crore ($15.9 billion) in 2011 on diseases associated with tobacco–including cancer, respiratory diseases, tuberculosis and cardiovascular diseases. This figure is almost six times as much as central-excise tax collections from all tobacco products that year, according to the Government of India, WHO and the Public Health Foundation of India.

To put the health cost of tobacco in further perspective, it exceeded the combined annual state and central government expenditure on health care by 12% in 2011.

Taxes on cigarettes rise–not enough–but they do. Bidis are the problem

A 10% price increase on tobacco products could cut consumption between 2% and 8% in developing nations, according to the WHO. Tax hikes increase prices, which in turn lower demand and protect people from the ill effects of tobacco.

“Raising taxes is a win-win situation,” said Arun Thapa, Acting WHO Representative to India. It’s good for human health and for the country’s fiscal health.”

Over the last 19 years, taxes on cigarettes in India have risen 1606%. As the next part of this series will tell you, that isn’t quite enough, and the six-tier tax structure is so complex–based on stick lengths and filters–that companies manipulate it with relative ease to keep demand intact.

The biggest problem in curbing tobacco use lies with the influence wielded by those who make the humbler–but more damaging–cousin of cigarettes, the bidi.

Taxes on a pack of bidis are 7% of the retail price, less than a tenth of the WHO’s suggested level of 75%. A 20-stick pack of best-selling cigarettes is taxed around 60% of retail price.

Bidi smokers make up 61% of the nation’s 120 million smokers, according to the Global Adult Tobacco Survey (GATS) 2010. This is a conservative estimate. Some studies peg the numbers of bidi smokers higher, at 73%, even 85%.

Bidi smokers face a higher risk of developing potentially-fatal chronic obstructive pulmonary disease (COPD), among other illnesses, because tobacco is packed more loosely in bidis, requiring smokers to inhale more strongly.

But the bidi industry has consistently squeezed concessions from the government.

Million of jobs and livelihoods at stake, so taxes must stay low, argue bidi barons

Here are some concessions the government gives the bidi industry:

  • Handmade bidi units (98% of bidis are handmade ) producing less than two million sticks in a year are exempt from excise duty.
  • Bigger bidi makers pay a duty of 1.6 paise per handmade stick and 2.8 paise per machine-made bidi. The duty on cigarettes varies between Rs 1.28 and Rs 3.37 per stick.

Some eight million people work as bidi rollers nationwide, said a representative of the All India Bidi Industry Federation.

“Imposing taxes on bidis and introducing pictorial warnings on bidi packs would lower demand,” said Sudhir Sable, secretary, All India Bidi Industry Federation. “Any fall in production would jeopardise the jobs of bidi rollers. It would also adversely impact tobacco farmers, as well as the thousands of corner shops selling the product.”

Increasing taxes on bidi would invariably increase the illicit trade in bidis, leading to the proliferation of fake bidis, Sable argued. It would also deprive states and the central government of tax revenue.

These arguments do not wash, say experts.

No socio-economic case for low bidi taxes, contend experts

In 2013, the bidi industry contributed less than 3% to the government’s central excise collection from tobacco products, not surprising, given the low excise duty it pays.

A Public Health Foundation of India study says there is indeed scope for taxes on bidis to be increased.

“Doubling bidi excise would help cut consumption by 40% and increase tax revenue by 22%,” said Monika Arora, director, Health Promotion and Tobacco Control Initiatives, Public Health Foundation of India.

Essentially, the argument goes, higher tax rates would offset any loss of excise from fall in consumption. In the bargain, spending on “useful” goods and services will grow.

“Money not spent on bidis or cigarettes will not disappear from the economy,” said Prabhat Jha, founding director of the Centre for Global Health Research, University of Toronto. “It will be spent on other products which generate employment.”

Additional revenue could help the government meet the cost of transitioning bidi workers to other means of employment. The government has previously considered a cess on cigarettes to encourage farmers to switch from tobacco to other crops.

So, why not tax all segments of the tobacco-products industry, experts suggest, to fund a gradual transition? Bidi workers, among some of India’s most disadvantaged people, can only benefit.

Bidi workers: Among India’s worst paid workers and plagued by ill health

“The effect (of high taxes and low consumption) on bidi employment will take years,” said the University of Toronto’s Jha. “It does not mean current bidi rollers will lose their jobs. It means fewer people will take low paying bidi rolling jobs in the future.”

West Bengal, Maharashtra, Andhra Pradesh and Karnataka are among India’s top bidi-producing states. In West Bengal’s district Murshidabad, bidi rolling is pretty much the only livelihood.

Bidi workers in Murshidabad earn Rs. 100/- per 1,000 bidis. Those in Uttar Pradesh earn Rs. 90/- per 1,000 bidis. Bidi workers are among the lowest-paid ‘manufacturing’ employees in India, according to this 2014 study. They constitute 1% of all employment in India but collectively earn 0.1% of all wages.

“They earn minimum wages or ‘negotiated’ wages,” said Sable. ‘Negotiated’ means a lower wage than the minimum government-prescribed wage, for which Sable said the consent of the local government authority is always taken.

“Lower wages are negotiated because the cost of the bidi has to be kept low for the consumer and also ensure parity with wages in neighbouring states,” said Sable.

Collusion between local government authorities and the bidi industry–as Sable admits to–keeps bidi workers in penury, while tying their daily wage to punishing targets of about 1,000 bidis a day causes ill health, write Sunanda Sen and Byasdeb Dasgupta in their book “Unfreedom and Waged Work: Labour in India’s Manufacturing Industry.”

Most workers are given tobacco to roll at home. Protective measures such as masks and gloves are unheard of, and soon enough, they suffer the ill effects of exposure to tobacco flakes and dust.

“Ear, throat and lower respiratory tract infections are common among bidi workers,” said Arora. “So are cancer and tuberculosis.”

Bidi workers and rollers exposed to tobacco dust had a six-fold higher incidence of respiratory impairments, such as breathlessness and cough, reported a 2006 study in Murshidabad, West Bengal.

Many women workers suffer gynaecological problems and pregnancy complications. This should be a concern, as 90% of the workforce is female.

Transitioning bidi workers to other manufacturing jobs would be good for them. Raising taxes on bidis would be good for the country as a whole. The only people who might not benefit are the bidi company barons.

(Bahri is a freelance writer and editor based in Mount Abu, Rajasthan.)

This article was originally published on IndiaSpend.com, a data-driven and public-interest journalism non-profit.

Photo Credit

By Sreya Salim

India’s medical education system is one of the largest in the world. The 381 medical colleges in the country produce about 45000 doctors annually. Ever since the first medical college was established in 1835 in Kolkata, the scope of health education in India has widened. From just 19 colleges and 1000 students in 1947, the sector has grown to house the largest number of medical colleges in the world. Many more are coming up in both the private and public sectors. However, little have these statistics done to better the state of public health in India. It is indeed a paradox that the country that has produced some of the best doctors and research papers in the world is home to more than 89 lakh unvaccinated children. Studies have shown that every seven minutes, a mother succumbs to death during childbirth in India. Basic health care in many villages is still a dream. Monsoon season has become synonymous to epidemics. Even preventable diseases have become nightmares in the Indian scenario. According to Indian Medical Journal’s 2013 report, our country needs about 600,000 more doctors to carry out healthcare related tasks. It was in this context that the government decided to increase the number of medical colleges in India. It may seem logical that more doctors would bring relief to an ailing health system. However, experts are of the opinion that matters are not that simple and require more serious thoughts and actions.

The government has been going on with programs to increase the number of medical colleges for a few years now. Health ministry has already planned 14 new medical colleges and has taken decisions to enhance the number of seats in six existing colleges around India. Many new private colleges have also been allowed. The government also plans to set up 200 more medical colleges over the next ten years thus increasing the number of MBBS seats by 10000. Though it has been proposed that this plan will pave the way for a better healthcare system, the concerns and questions raised by these reforms are many.

Lack Of Faculty

The lack of faculty in medical colleges is a problem that has been haunting the system for years. The disproportionate increase in the number of medical colleges has only aggravated the problem. With a large number of UG seats and very few PG seats, the issue is fast getting out of hands. Many medical colleges don’t have enough number of teachers to meet the MCI regulations. It is well known that many private colleges import doctors from various hospitals on the days of MCI inspection to pose as faculty. In government institutions, there is a large-scale transfer of doctors from one college to another. These make-do arrangements do harm to old and new medical colleges alike. Even though MCI has adopted physical measures like head counting to tackle this problem, little has these done to stop malpractices. While attempts have been made to make norms less stringent, it should be remembered that steps like these will only add on to the reduction in the quality of medical education and increased the workload of already overburdened doctors.

Makeshift Medical Colleges

Another important problem is that most of the new colleges lack an adequate infrastructure to educate students. Setting up a medical education institution is far different from establishing an arts or science college. Many new colleges just don’t have enough patients or investigation facilities, let alone a proper lecture hall and record books. Even the new AIIMS-like institutes set up in Patna and Bhubaneswar have been reported to lack even basic infrastructure. Many colleges haven’t even completed construction or land acquisition but have started classes for students. Red tape delay and corruption have made matters worse.

Skewed Distribution Of Colleges

Though India has more than 300 medical colleges, the fact that these are distributed in a skewed fashion has resulted in misdistribution of services. More than sixty percent of these institutions are located in South India, especially Kerala, Karnataka, Tamil Nadu, Andhra Pradesh and Maharashtra. Same applies to most of the new institutions coming up too. They are mostly concentrated in profitably potent areas. This is in spite of MCI’s regulation that for a medical college to be established there should be sufficient clinical load in that area. The clustering of colleges has led to a lack of availability of clinical material and faculty in many colleges. Moreover, most of the medical colleges serve urban areas rather than rural areas, leading to further deterioration of already ailing rural health system. It is high time we opened eyes to these problems.

Problems Of Privatisation

Encouraging privatisation of medical education can have many unforeseen consequences. Increased participation of private giants will result in the commercialisation of education, increased gap between rich and poor and the formation of a cadre of money minded, robotic physicians. It is a well-known fact that many private colleges adopt illegal measures to get MCI recognition, including the import of people to pose as patients during MCI inspections. In the long run, the entire health system of the country is affected, and it is the common man who suffers. Ensuring the quality of private medical colleges and making accreditation restrictions more stringent has become the need of the hour.

Solving Issues

Creating socially committed doctors should be the aim of medical education. It is high time India focused on quality rather than quantity. While opening new medical colleges may make headlines, it is important to realize that makeshift medical colleges will only worsen the condition of our already sick health sector. Many short term solutions like increasing the retirement age of medical college teachers, providing better incentives and channeling more funds have been proposed. However, it is important to seek a long-term solution. It is true that the healthcare industry needs more manpower. However, the fact that most of the young doctors who pass out prefer to work in foreign countries and cities should not be overlooked. Hence, better implementation of the present medical education programs so as to fill the gap in the rural health sector is necessary. According to Dr. P.K. Sasidharan, a leading physician and public health expert, increasing the number of medical colleges is useless unless and until a sea change occurs in our health policy. More attention should be given to decreasing the disease burden and increasing health awareness. Instead of focusing on creating more super specialists, strengthening of basic healthcare should be given more priority. The dream of basic healthcare can only be achieved through more innovative and well-planned strategies.

Just as too many cooks are said to spoil the broth, too many incompetent doctors will damage the healthcare system of the country. What India needs at the moment are a better health care policy and an army of young, efficient doctors to carry it out. Politicians and officials should realize that medical colleges made overnight cannot carry out the task of molding the young generation. Unless we open our eyes to facts, India’s healthcare industry will continue to suffer.

Memory

By Saima Noreen:

In the years since the world started going digital, one of the big changes has been that we don’t need to remember very much. Why risk forgetting a partner’s birthday or a dinner date with a close friend when you can commit the details to your computer, laptop, smartphone or tablet and get a reminder at the appropriate time?

Paul McCartney gave a useful insight into this in an interview over the summer. He claimed that back in the 1960s The Beatles may have written dozens of songs that were never released because he and John Lennon would forget the songs the following morning. “We would write a song and just have to remember it. And there was always the risk that we’d just forget it. If the next morning you couldn’t remember it – it was gone.”

How different to the way he records now then, when he can “form the thing, have it all finished, remember it all, go in pretty quickly and record it”.

https://theconversation.com/the-internet-is-eating-your-memory-but-something-better-is-taking-its-place-47590
‘I forgot to remember to forget’ John Raoux

With technology now well ingratiated into our everyday life, researchers have been investigating the lasting impact that it is having on the way that we learn and remember information. Some research has suggested that our reliance on technology and the internet is leading to ‘digital amnesia’, where individuals are no longer able to retain information as a result of storing information on a digital device.

In one study, for example, 1000 consumers aged 16 and over were asked about their use of technology. It found that 91% of them depended on the internet and digital devices as a tool for remembering. In another survey of 6000 people, the same study found that 71% of people could not remember their children’s phone numbers and 57% could not remember their work phone number. This suggests that relying on digital devices to remember information is impairing our own memory systems.

The Upgrade

‘Who you calling stoopid?’ Four Oaks

But before we mourn this apparent loss of memory, more recent studies suggest that we may be adapting. One such study from 2011 conducted a series of experiments looking at how our memories rely on computers. In one of them, participants were asked to type a series of statements, such as ‘an ostrich’s eye is bigger than its brain’.

Half of them were told that their documents would be saved, and half were told that they would not. Everyone was then tested to see if they could remember what they had typed. Those who had been told their work would be saved were significantly poorer at remembering the information.

In another experiment, participants were asked to type a series of statements that would be saved in specific folders. They were then asked to recall the statements and the folders in which the files were located. Overall, they were better at recalling the file locations than the statements. The conclusion from the two experiments? Technology has changed the way we organise information so that we only remember details which are no longer available, and prioritise the location of information over the content itself.

Group Mind

This idea that individuals prioritise where information is located has led some researchers to propose that digital devices and the internet have become a form of transactive memory. This idea, which dates back to the 1980s, refers to a group memory that is superior to that of any individual.

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According to this account, individuals can collectively store and distribute information using a shared store of knowledge. This store of knowledge means that individuals can access details that they may not know themselves by knowing that another individual remembers it, thus enhancing what information is available to them by communicating with other people. In the same way, individuals develop a transactive memory with the internet and rely on it for information by focusing on where details are located rather than the details themselves.

More recent research has extended this line of work and found that saving information on a computer not only changes how our brains interact with it, but also makes it easier to learn new information. In a study published last year, the participants were presented with two files that each contained a list of words. They were asked to memorise both lists. Half of the participants were asked to save the first file before moving on to the next list, while the others had to close it without saving.

The experiment revealed that the participants recalled significantly more information from the second file if they had saved the previous file. This suggests that by saving or ‘offloading’ information on to a computer, we are freeing up cognitive resources that enable us to memorise and recall new information instead.

In sum, anyone worrying that technology is wrecking one of our most important abilities should take some reassurance from these findings. It doesn’t necessarily mean that there is no cause for concern: for instance McCartney said in the same interview that the songs in the 1960s that did make it to the recording studio were the most memorable ones. So it is possible that the lack of technology made The Beatles better songwriters.

But it may be that just as oral storytelling was usurped by the written word, having digital devices to outsource our memories means that it is no longer necessary for us to try to remember everything. And if we can now remember more with a little help from our technology friends, that is arguably a great step forward. Rather than worrying about what we have lost, perhaps we need to focus on what we have gained.

Saima Noreen is a lecturer in Psychology at Goldsmiths, University of London

This article was originally published here on The Conversation in the Science + Technology section.

Image source: Free stock photos

By Asmita Sarkar:

Avinash will not grow older. Neither will the nine other people who have died of dengue already. What is most tragic about Avinash’s story is that his parents committed suicide after he passed away. “Babita’s left hand and Laxmichandra’s right hand were tied together with a dupatta. Babita was wearing her nightdress, just as she was when we last saw her about an hour before,” said Kavita Sejwal, their landlord.

Image source: Free stock photos
Image source: Free stock photos

2015’s dengue outbreak has been termed as the largest in the last five years. 1800 cases have already been registered. The season that should have been a welcome respite has turned into a source of dread and disease all over India.

The Delhi Govt. has ordered 1000 extra beds in state run facilities and cancelled holidays of health personnel, but there’s a limit to what they can do. Is it not better to make efforts from our end and prevent, instead of cure?

Here’s a list of things we can do to prevent dengue:

1. The dengue causing female Aedes aegypti mosquito breeds in dark places, closets and corners in domestic spaces. Cleaning out the junk and spraying with mosquito repellents regularly, helps in keeping the indoors mosquito-free.

2. Temephos (brand name Abate) is a pesticide that can be sprayed on stagnating water, that can’t be cleaned out, like water in coolers. Things that one can do, without waiting for someone from the municipal corporation to turn up, is to spray the water with Temephos or petrol to prevent larvae formation.

3. It can’t be emphasised enough that stagnating water in public spaces like puddles, garbage dumps, requires to be drained and sprayed with pesticides. While regular insecticide sprays are done by municipal corporations, we, as residents of the area, can take up the charge of making the community spaces healthier. It is, after all, our children who play in parks and grounds.

4. The dengue mosquito is active throughout the day, especially two hours, after sunrise and before sunset, and there is no vaccine for prevention of dengue. What one can personally do is wear clothes that covers as much skin as possible like full sleeved clothes and full pants, or any other clothing that covers most of our skin.

5. There are many products in the market like Odomos, which have DEET or Picaridin in them. These cream based products can be applied on the exposed portions of the body, as it confounds the mosquito’s senses and makes a person invisible to them. However, the creams should not be applied on the hands of young children and infants.

6. Covering overhead tanks, water storage facilities, putting meshes on air/water pipes are some infrastructural changes that retards the breeding process of the mosquitoes. The dengue mosquito can fly within 200 meters of its breeding site so it becomes imperative to cover up all open water storage facilities.

7. In domestic spaces, using mosquito coils, electric vapour mats can kill the mosquitoes and keep us safe. And these products are needed more in the day time than night, unlike popular belief.

8. In India, mosquito nets are not an uncommon site. It is also possible to spray limited amounts of Permethrin, an insecticide, on mosquito nets that are hung over the beds to keep the insects away.

9. While dengue doesn’t spread from person to person, an infected person should be kept away from spaces where they can be bit again because the infected mosquito can spread the disease further by biting a healthy person.

10. Finally, if you feel a fever coming on, get yourself tested. Early detection is the key to quick recovery. While dengue fever is not fatal, sometimes the patient develops Dengue Haemorrhagic Fever or Dengue Shock Syndrome, which can become a serious health risk.

Preventing dengue can’t be the Government’s responsibility alone. Following instructions issued by the Government about maintaining clean surroundings is the role of the community and the individual too. Don’t let anymore Amans and Avinashs die of a disease that is easily preventable.

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By Kim Murphy

People who binge drink on the weekend take more days off work, but the cost may be more than just economic.

Recently published research suggested alcohol and drug-related absenteeism costs the Australian economy around AU$3 billion a year. One of the report’s authors was quoted in the media as saying that “alcohol puts a bit of a tax on your immune system“. She said people may not realise drinking or drug-taking was: “causing their stomach upset, headache or worsening cold by Monday…”

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From the few studies that explore this, we know excess alcohol intake affects the immune system. But how does this effect manifest itself? Can a “big weekend” make people more susceptible to illness?

Heavy Drinking

Complex and tightly controlled, the immune system is made up of different cells and tissues, that together protect us from viruses and bacteria.

Chronic alcohol abuse can definitely alter the way our body responds to pathogens – reducing the numbers of killer T cells, for instance. These are white blood cells that act like the immune system’s soldiers, working to eliminate infected cells.

A reduction in killer T cells leaves people more prone to infections. But it’s possible other factors sometimes present in people who chronically abuse alcohol, such as poor diet, can also have that effect.

Drinking can influence the inflammatory response too. Inflammation is an important part of the immune mechanism that helps immune cells travel to the infection site (although if uncontrolled, inflammation can cause chronic disease and pain).

One recent study found that in the 20 minutes after a binge drinking session, participants had developed higher than normal levels of inflammation in their body. But two hours later, inflammation had dropped below the original levels.

As their blood alcohol level fell, the number of monocytes (types of white blood cells known as “phagocytes” because they’re able to recognise and ingest microbes) also fell. Participants’ blood showed decreased numbers of natural killer cells as well. These play a similar role as the killer T cells.

Similar results were found in a 2014 study on binge-drinking mice; their phagocytic cells decreased along with other changes to the immune system. These findings suggest even a single session of binge drinking may increase the risk of viral infections, such as colds. But moderate drinking (one drink per day for women and two for men) shows a different picture.

Moderate Drinking

A 1993 study looked at the association between smoking, drinking and the risk of developing the common cold – with volunteers given saline drops containing cold-causing viruses. It found drinking one or more glasses of alcohol a day decreased the risk. But this was only true for non-smokers; smokers were more prone to colds regardless of how much they drank.

An increase in alcohol seems to decrease the risk of developing a cold, but only for non-smokers. Velo Montana/Flickr, CC BY

A larger 2002 study examined the effects of wine, beer and spirits on the risk of developing the common cold. Participants were asked about their drinking and other lifestyle habits, as well as any colds they had over the course of a year.

People who drank wine – red wine in particular – had fewer colds than those who didn’t drink at all. And people who drank more than 14 glasses of wine per week had been the least ill that year. Beer and spirits didn’t appear to be protective against infection. But nor did they increase the risk of developing colds.

But these studies looked at the association between alcohol and colds. What about alcohol’s effect on the immune system itself?

The Immune System

A 2014 study in which rhesus monkeys were given open access to alcohol found monkeys who consumed moderate amounts of alcohol responded better to a vaccine. And monkeys who abstained, or drank heavily, had a lower immune response.

It also found monkeys who were moderate drinkers had slightly increased levels of certain cytokines. These are small proteins that help coordinate the immune response to infections and cell damage, either enhancing or dampening the response.

In these monkeys, the number of immune response-enhancing cytokines had increased, and that might be the mechanism that helped their improved response to the vaccine. It’s possible moderate drinking in humans may also enhance the immune response to vaccines and viral infections.

Different types of alcohol, as well as different intake levels, seem to play a strong role in our susceptibility to colds. And a weekend of binge drinking may indeed increase your susceptibility to viral infections, such as colds.

Given drinking is a social activity, going out for a drink increases exposure to infections as well. Still, like many other things in life, exercising moderation when drinking could help boost your immune response to the common cold and other viral illnesses.

The ConversationKim Murphy is an Immunology researcher at Monash University

This article was originally published here on The Conversation in the Health + Medicine section.

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Two years after her wedding in Jaisalmer, Rajasthan, Bhanu (left), then 17, swallowed sleeping pills and tried to kill herself. Kriti Bharti (right), a psychologist, helped Bhanu (her name has been changed for this story) annul her marriage to a 55-year-old barber, who allegedly paid her grandfather a marriage fee of two lakh rupees. Image source: indiaspend.com

By Devanik Saha:

On a cold December day in Jodhpur, 2014, Bhanu, 17, suddenly collapsed. Her parents rushed her to the hospital where doctors said their daughter—a married woman—had attempted suicide by swallowing sleeping pills.

After the recent release of suicide data by the National Crime Records Bureau (NCRB), the discourse has primarily focused on farmer suicides, a politically-sensitive issue. But Bhanu’s case is a reminder that little or no attention is focused on home-makers, a demographic more prone to suicide than farmers.

620 Two years after her wedding in Jaisalmer, Rajasthan, Bhanu (left), then 17, swallowed sleeping pills and tried to kill herself. Kriti Bharti (right), a psychologist, helped Bhanu (her name has been changed for this story) annul her marriage to a 55-year-old barber, who allegedly paid her grandfather a marriage fee of two lakh rupees. Image source: indiaspend.com
Two years after her wedding in Jaisalmer, Rajasthan, Bhanu (left), then 17, swallowed sleeping pills and tried to kill herself. Kriti Bharti (right), a psychologist, helped Bhanu (her name has been changed for this story) annul her marriage to a 55-year-old barber, who allegedly paid her grandfather a marriage fee of two lakh rupees. Image source: indiaspend.com

About 18% (20,412) of all suicides in 2014 were by housewives, against 4.3% (5,650) by farmers, according to the NCRB. There appears to be a decline, overall, in home-maker suicides, but the data reveal two things: one, a quiet, festering problem in Indian marriages and two, a problem with the numbers.

P Sainath, journalist and Magaysasay award winner who pioneered reporting on farm suicides, believes many women categorised as “housewives” are farmers.

Women farmers’ suicides are routinely undercounted because conventional societies mostly do not acknowledge women as farmers,” Sainath wrote this week. “And only a few have their names on title deeds or pattas. One result of this is that the ‘housewives’ category explodes in those years where states claim nil women farmers’ suicides. In some states, ‘housewives’ (including many who are farmers but not acknowledged as such) make up 70 per cent of all women suicides in some years.”

Even if that is wholly true, there is little question that thousands of home-makers are indeed killing themselves, as IndiaSpend‘s inquiries with psychiatrists and NGOs across the country confirmed.

Suicides By Home-makers (left) & As % Of Total Suicides (right), 2010-14

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How Bhanu went from 6th-standard dropout to teen bride

Bhanu, then 15, was married—against her wishes—to Ramchandra, 55, a barber and farmer. Since Bhanu’s father was a poor barber in Ajmer, he and his wife (Bhanu’s mother) handed over their daughter, and the responsibility for her eventual marriage, to her grandfather in Jaisalmer.

Bhanu’s grandfather pressured Bhanu to drop out of school, abandon studies and focus on learning housework, obviously in preparation for marriage. Bhanu, then in class six, became a bride in waiting. Her grandfather struck a wedding deal for Rs 2 lakh, without informing her parents.

Bhanu was forcibly married, following an ancient tradition called aamne samne ki shadi (literally, a wedding facing each other), where families cement ties through marriage.

While Bhanu married Ramchandra, his niece, age 8, married Bhanu’s 35-year-old uncle. Since Bhanu’s parents and she were more than 480 km apart, they did not hear about her marriage, until it was too late.

When Bhanu’s parents came to the eight-year-old’s wedding, they were shocked, they said, to find wedding rituals underway for their daughter as well. They protested and tried to file a police complaint. The police refused, although the marriage was illegal (18 is the legal age).

It was unimaginable for us that someone like her grandfather, whom we trusted so much, had married her off in a deal,” said her father, who requested that his name not be used. “It was quite shocking for us, but somehow we controlled ourselves and approached Kriti for help.”

Determined to annul the marriage, Bhanu’s parents contacted Kriti Bharti, a rehabilitation psychologist and founder of the Saarthi Trust, an NGO in Jodhpur. Bharti helped them file a court case and gain custody of their daughter. As the case was being tried, Bhanu’s husband repeatedly tried to take her away by force, claiming she was now his.

Do the data explain why home-makers commit suicide? Not quite

NCRB data on suicides and the attributed causes are not trustworthy and detailed enough, said experts. The data do not reflect the fact that suicide is not an event, but a complex interplay of factors.

Deaths in rural India are certified by village headmen (“panchyatdars”), although cases are investigated by the police and the process of registering a death is particularly inefficient in rural areas, according to this study published in the Indian Journal of Psychiatry

When it comes to data regarding suicides and the reasons for it, NCRB figures cannot be trusted at all,” said Vikram Patel, a psychiatrist with extensive experience on suicide. “Given the complexity of suicides, just listing single reasons for suicide is too simplistic. Further, the police aren’t trained to handle suicide cases and investigations and reporting is done randomly.”

Dr Rajesh Rastogi, Chief Psychiatrist at Delhi’s Safdarjung Hospital, agreed. “Just saying that dowry torture or domestic violence caused depression for a woman to commit suicide is naïve,” he said.

When the police investigate a matter, the reason that is the most publicly visible is attributed as a cause for suicide,” said Kamna Chibber, a clinical psychologist at Delhi’s Fortis Hospital. But that is not usually the real cause.

IndiaSpend had reported previously on how the data on farmer suicides are unreliable. That applies to home-maker suicides as well. Families often do not report suicide.

The stigma leads to under-reporting,” said Lakshmi Vijaykumar, a psychiatrist and member of the World Health Organisation’s International Network for Suicide Prevention & Research. “Many families want to avoid harassment by the police and avoid social ostracism, therefore, they never approach the police.”

What is driving housewives to suicide? Men play a big role

NCRB doesn’t give disaggregated causes data on housewives, only the data for overall suicides.

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Based on various psychiatrists’ and psychologists’ experiences, three points stand out:

1. Family background, past psychiatric history, genetic conditions and the immediate environment are significant factors.

2. Issues such as marital dissatisfaction, torture for dowry, domestic violence and economic difficulties are only the triggers or, in medical terminology, “stressors”. While the occurrence of more stressors increases risk, their mere presence cannot cause suicide.

3. India’s patriarchal society and stigma around women discussing depression and mental health issues play a significant role in increasing suicidal tendencies.

The cumulative and repetitive interaction of several factors in a complex manner results in suicides, according to a psychological autopsy study done in Bangalore, the only one on “completed (successful) suicides” and domestic violence.

Personal, biological and external environmental factors and the ability to handle stress and depression play a huge role,” said Patel.

Many studies note that almost 80% of those who commit suicide have depressive symptoms.

Rastogi explained it in simpler terms: Two friends are sitting in a room and a snake enters. Person A is terrified to see the snake, but person B has often stayed in rural areas and has killed many snakes. He barely flinches and advances to shoo away the snake.

What he means is that people handle stress differently. While one spouse may fight back against domestic violence and torture, another may keep quiet and accept it as her fate.

A woman commits suicide only when she is fully convinced that there is no other way to reduce her drudgery. She feels that she is not able to do anything to improve her situation,” said Chhibber.

Bhanu certainly felt that way. She told IndiaSpend that she was always battling her 55-year-old husband Ramachandra.

He constantly threatened me that he would take me with him forcibly, but I didn’t want to go with him,” said Bhanu. “Even during court sessions, he would intimidate me, which really scared me. I lost hope that things would ever get fine. Hence, I decided to end my life.”

Patel said these were widespread fears. “Domestic violence (emotional and physical), and economic difficulties are the major precipitating factors for suicides by married women,” he said.

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Women may have support from friends and family but may not have the financial independence to end a marriage.

Why do so many wives aged 15-29 kill themselves?

Over the past four years, 43% of suicides by home-makers have been in the 15-29 age group.

Suicides By Home-makers In The 15-29 Age Group (left) & As % Of All Home-maker Suicides, 2010-13

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IndiaSpend has reported previously how India has 36 million child brides, despite laws prohibiting child marriages.

This is the age group when the experiences associated with gender disadvantage are the most common,” said Patel, a view echoed by Chhibber.

Bhanu was 15 years old when she was married against her wishes, pushing her into deep mental conflict. Eventually, despite the support of her parents, the teenager could not cope.

Youth is the time when one is still trying to find one’s footing in life… often due to an unsupportive environment or one’s own personality traits, one is unable to achieve these milestones well and soon enough in life. In such circumstances when trouble strikes, it just becomes easier for one to collapse,” explained Sanjay Chugh, a Delhi psychiatrist. “As we grow older, we become more mature… in times of trouble, do have back up plans.”

Young brides get no allowances for the sudden burden of household responsibilities. A time of discovery and aspiration, for many, remains unfulfilled.

It pressurises her immensely,” said Bharti, “leading to mental imbalance and suicidal tendencies.”

Why aren’t housewives’ suicides discussed?

Farm suicides are widely discussed in India, but no one really talks of housewives killing themselves.

In our country, there is a stigma and fear surrounding mental health and a stifling silence around any conversation pertaining to mental illness,” said Kundu. “Even talking about it is taboo.”

If we have a body part which is burnt, we like to hide it from others because we believe that it can never heal,” said Bharti. “Similarly, our society has already believed that the issue of women getting equal rights and respect cannot be solved; therefore, these discussions never happen. Until, we believe that we truly can solve this situation, we can’t do anything.”

To Vijaykumar, the key point is political irrelevance. “It’s simple,” she said. “Housewives’ suicides aren’t politically important, that’s why politicians and experts don’t discuss it (the issue) much.”

Why decriminalising attempted suicide can help

India accounts for 21% of the global disease burden and is struggling with high malnutrition and high infant- and maternal-mortality rates. So, suicide has never been a significant public-health issue.

It does not help that India is short of mental-health professionals by 87%, according to data tabled in Parliament in 2013.

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Last year, the Centre announced a plan to decriminalise attempted suicide and scrap section 309 of the Indian Penal Code, which provides for a year in prison and a fine for anyone attempting suicide.

The Law Commission of India’s 210th report also suggested removing section 309, but there the matter rests.

Vijaykumar listed three benefits of this move:

1. It will allow anyone who has attempted suicide to be treated immediately without the medico-legal process. This will also remove the stigma.

2. It will be affordable for the family–private hospitals often overcharge to treat such patients, citing the legal process involved.

3. It will help collect data on those who attempt suicide and plan services for them. These cases are often under-reported or reported as accidents.

Rather than pressing charges against the victim, the focus should be on prosecuting the person who compelled the victim to commit suicide. The victim has already faced hardships and therefore, putting further pressure on her is unfair.” said Bharti.

Back in Jodhpur, the police did not charge Bhanu with Section 309 because Bharti pressurised them not to, leaning on them, successfully, to file a case of abetment to suicide (Section 306) against Ramchandra. Much legal action depends on arbitrariness.

Bhanu, with Bharti’s help, is now preparing to appear for her class ten examinations through the open-school system as a private candidate, which means she does not have to complete previous classes. She lives with her parents in Jodhpur, as her case meanders through the city’s courts.

Bhanu’s experience has shaped her ambitions. “Kriti didi (Bharti) is my idol, and I want to become a social worker like her,” said Bhanu. Her ambition: To eventually urge and help girls forced into early wedding to annul their marriages.

Bhanu is a pseudonym. We have not revealed her real name at her request.

(Saha is a freelance journalist based in New Delhi.)

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Injectables

By Vaagisha Das

Although India is a leading producer and exporter of vaccines, the country is home to one-third of the world’s unimmunised children. However, this is apparently no cause for worry, as believed by some parents in the U.S., sinceGod gave everyone the ability to heal from within and he gave us all the tools to heal naturally.” Contrasting the state of infant vaccinations in the U.S. with that of India seems almost ridiculous, yet with the growing number of anti-vaccination activists in America, the outcome remains surprisingly similar- gradual increase in the number of unimmunised children, causing widespread diseases, disabilities, and even death. While most American parents are wary of getting their children vaccinated due to an unfounded fear of vaccines causing autism, parents in India are unable to do so simply because they do not have the resources or the knowledge to comprehend why vaccination is needed. Hence, both the cases are based on uncertainty and fear of the unknown, and little is being done to dispel them of preconceived notions.

The Anti Vaccination Movement (AVM) in America is two pronged- one prong denies any direct correlation between vaccines and the diseases that they are taken as protection against diseases, while the other goes one step further and into the territory of vaccines being harmful for health. Supporters of the latter belief claim that the MMR (mumps-measles-rubella) vaccine causes autism, despite there being no evidence for the same. The American Academy of Pediatrics has released a list of more than 40 studies showing no link whatsoever between vaccines and autism, yet parents continue to protest against vaccines. The movement has further been popularised by celebrities such as Jenny McCarthy, who claimed to discover that her son ‘became’ autistic as a result of his shots- even though autism is a congenital disease.

When California sought to tighten its immunisation laws after a measles outbreak- a disease thought to be eradicated fifteen years ago- it faced angry protests from vocal activists, who went so far as to claim that the new law that made vaccination mandatory was akin to the Holocaust. This was based on the pro-choice argument of individuals being able to decide what ‘goes into their body’. Little did these activists keep in mind that unvaccinated kids would be endangering those who were too young, or others who were unable to get vaccinated due to medical conditions. Although the idea of stopping vaccination in its entirety seems far-fetched, these activists have been successful enough to force three states to pull back a ‘personal belief’ exemption for vaccination.

In India, vaccines are similarly available yet unable to be accessed by those who need them the most. However, this is not a matter of choice. Fewer than 44 percent of India’s young children receive the full schedule of immunisations. This is mainly due to ignorance and hence decreased demand, as well as the much popularised polio shots having stolen the spotlight- consequently side lining other vaccines available. For example, pneumonia is the leading killer of children in India, accounting for the death of a majority of children under five years of age. Vaccines for pneumonia, although available elsewhere, and not sold in India- attributing it to the low demand for these. In India’s slums, surveillance as well as keeping tabs on diseases is an arduous task. In many instances, people are unable to discuss or even identify the symptoms- thereby proving time and again the dangers of obliviousness.

Pneumonia accounted for 371,605 deaths in children under age five in 2008, India. According to recent estimates, the 81,275 annual deaths from measles in India account for three-quarters of the global deaths from this disease. It is estimated that two-thirds of the children who die of measles and the other preventable childhood diseases would have survived if they had been immunised. In America, non-vaccination brought an almost eradicated disease back. The limbs of a boy were amputated in order to save him for meningitis – which could’ve been prevented if he had been vaccinated. In such a case, the course of action open to us is simple: in order for this to stop, more of us must speak up until there’s no doubt remaining that vaccines are safe, necessary, and they work.

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By Shruti Sonal

Last week, as I stood bored in a corner at my 5 year old cousin’s birthday party, I could not help but observe the food laid out on the table. Numerous bottles of carbonated drinks, more packets of chips than could possibly be eaten, pastries topped with synthetic cream and noodles dripping with oil. However, I stopped myself before going into the “kids these days” mode. I was a part of the first generation that got hands on these products, and never let them go.

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As life becomes busier, health has taken a backseat. The habit of eating junk food is inculcated within us from childhood, as chocolates and chips are handed out to halt our tears. Further, they made their way into our tiffin boxes and were stocked on the shelves in our school canteens. The result was that one probably learned how to say Frooti and Lays before they learnt the alphabets. In this context, the Delhi High Court’s ruling, directing the Central government to enforce restrictions on the sale of junk food in and within 50 metres of school premises is significant.

India, having a young population, has long been worried about the rise of obesity, which plagues 5% of its population today. Combined with the liberalization of the economy and rising incomes, the influx of international processed-food brands has changed the way we eat. The key to understanding the popularity of junk food, despite the widespread knowledge that it is harmful to health, lies in science. At the turn of the century, as Americans battled obesity, food chain giants came under scrutiny. In an article published in New York Times, titled “The Extraordinary Science of Addictive Junk Food“, Michael Moss referred to the “Moskowitz Report” which looked into the reasons that drive people to over-consumption of junk food. Apart from the convenience and affordability associated with packaged food, the report discovered a theory of “sensory specific satiety” that highlighted the tendency for big, distinct flavors in junk food to overwhelm the human brain, which responds by depressing your desire to have more. The report argued that this is the guiding principle behind the success of the processed-food industry, immortalized by the Lays tagline “No one can eat just one!” This allowed researchers to decode the addictive nature of such kind of food items, which contain high levels of salt, starch and fat content that reward the brain with an instant feeling of pleasure.

Thus, once kids start regarding these food items as a part of their daily life, it is tough for them to leave them behind. The teary farewell bid to Maggi, despite the knowledge that it contained harmful elements, emphasized how eating processed food has become an essential part of our routine. In such a scenario, limiting their sale in school will play a key role in ensuring that they’re not overconsumed. Moreover, as lessons learnt in school stay with us for the rest of our lives, it will help in inducing a feeling of guilt before consuming these food times. Growing up in a school that sold coconut water instead of Coca Cola, and fresh Rajma Chawal in place of packaged noodles, I can vouch for the school’s role in affecting an individual’s food habits. It didn’t prevent us from consuming junk food altogether, but ensured that it remained restricted to the “special occasions” when we were allowed to bring a pack of chips and a bottle of soft drink each.

surrogacy-in-india pregnant women

By Vasudha Singh

Parenting is a fulfilling experience that many individuals wish to undertake in their lives. Due to conditions outside of their control many people find themselves incapable undergoing this experience and suffer emotionally at the lack of an avenue for the basic instinct of nurturing. Surrogacy is then a means of making this possible.

In India commercial surrogacy is legal. The Law Commission of India, based on the guidelines of the Indian Council for Medical Research (ICMR) to regulate Assisted Reproductive Technology procedures submitted the 228th report discussing the importance, need for surrogacy, and steps to control surrogacy arrangements. It provides legislation for respecting the privacy of the surrogate with an insistence on consent and contract based financial arrangements, calling for one of the parents to be the donor to respect the bond of affection.

surrogacy in india

Lack of skilled personnel and/or technology in their own country, shortage of donors, exclusion from services due to marital status or sexual orientation and services being available for cheaper prices in other countries are generally the reasons for cross border surrogacy. The cost of surrogacy in India ($30,000-$40,000) is significantly lower compared to US ($120,000-$180,000).

The Other Cost Of Surrogacy

There have been instances of forced surrogacies, arrangements where the surrogate plays little to no part in the decision making process, is lied to about the effects of the hormones and is implanted with multiple embryos for a higher chance pregnancy causing havoc to their health. The clinics or middlemen generally opt for women from poor, illiterate backgrounds for easy money and least risk.

Parents too suffer if the surrogate has a change of heart. Moreover there can be medical complications which cause the parents to shell out money at every stage, increasing the cost many times.

Law Defines A Parent, Not Love

In 2012 the Indian government issued a notification disallowing single/same-sex parents from using surrogates, thus ‘first world treatment at third world prices’ (Health Tourism India) is denied to one of the the biggest consumers of the surrogate market. As a result, other countries such as Thailand and Nepal gained footing in this market. Nepal allows surrogacy for foreign nationals, but the intended parents or the surrogate mother cannot be of Nepali origin. Due to lack of any strict regulations and porous borders, Indian surrogates are brought to Nepal, most probably after the embryo plantation is completed and the child then gets the document for exit from Nepal. However this entire business is conducted in secrecy so the transactions and associated economic benefit is only restricted to the Indian fertility clinics.

The Economics Of Surrogacy

In 2012, the surrogacy market generated $2 billion in India. International Social Work calls the Health Tourism industry as the “country’s second most popular industry” with 5% contribution in GDP (2013) and is expected to grow to $280 billion by 2020.

However, the surrogacy market largely works on black economy. With only 39 of 3000 fertility clinics in India being registered with the ICMR and even fewer following the guidelines, many of these transactions are illegal, and therefore are not counted in the GDP of India. The case of Indian surrogates in Nepal could be counted in the Gross National Product (GNP) of the nation which takes into account goods and services produced by a national outside the country as well.

With infertility on the rise, India needs to firstly, regulate the market so that all transactions are accounted for and secondly, India needs to legalise surrogacy for same sex couples and single parents. 21 countries have made same sex marriage legal and for India to willingly discount its contribution based on archaic laws of the British rule, is irrational. The Third World has a chance to set precedence of social justice and religious reasons for the ‘abnormality’ of same sex marriage does not and should not find place in it.

A few gender imbalanced laws should not deny any human being the chance of experiencing parenting, with their constitutions guaranteeing human dignity for all. All indicators point towards a pro same sex legislation and market regulation, moreover the economy demands it. Lastly, the society will benefit from a regulated market of nurturing than an exploitative one for the parents, surrogate and the child.

Television serial killer Dexter may be more of a psychopath than a sociopath due to his methodically delivered kills. Image source:  Pimkie/Flickr

By Xanthe Mallett

Psychopath and sociopath are popular psychology terms to describe violent monsters born of our worst nightmares. Think Hannibal Lecter in ‘Silence Of The Lambs’ (1991), Norman Bates in ‘Psycho’ (1960) and Annie Wilkes in ‘Misery’ (1990). In making these characters famous, popular culture has also burned the words used to describe them into our collective consciousness.

Television serial killer Dexter may be more of a psychopath than a sociopath due to his methodically delivered kills. Image source:  Pimkie/Flickr
Television serial killer Dexter may be more of a psychopath than a sociopath due to his methodically delivered kills. Image source: Pimkie/Flickr

Most of us, fortunately, will never meet a Hannibal Lecter, but psychopaths and sociopaths certainly do exist. And they hide among us. Sometimes as the most successful people in society because they’re often ruthless, callous and superficially charming, while having little or no regard for the feelings or needs of others.

These are known as “successful” psychopaths, as they have a tendency to perform premeditated crimes with calculated risk. Or they may manipulate someone else into breaking the law, while keeping themselves safely at a distance. They’re master manipulators of other peoples’ feelings, but are unable to experience emotions themselves.

Sound like someone you know? Well, heads up. You do know one; at least one. Prevalence rates come in somewhere between 0.2% and 3.3% of the population.

If you’re worried about yourself, you can take a quiz to find out, but before you click on that link let me save you some time: you’re not a psychopath or sociopath. If you were, you probably wouldn’t be interested in taking that personality test.

You just wouldn’t be that self-aware or concerned about your character flaws. That’s why both psychopathy and sociopathy are known as anti-social personality disorders, which are long-term mental health conditions.

psychopaths vs sociopaths 1
Although most of us will never meet someone like Hannibal Lecter from Silence of the Lambs, we all know at least one sociopath. Image source: shutterstock.com

What’s The Difference?

Psychopaths and sociopaths share a number of characteristics, including a lack of remorse or empathy for others, a lack of guilt or ability to take responsibility for their actions, a disregard for laws or social conventions, and an inclination to violence. A core feature of both is a deceitful and manipulative nature. But how can we tell them apart?

Sociopaths are normally less emotionally stable and highly impulsive – their behaviour tends to be more erratic than psychopaths. When committing crimes – either violent or non-violent – sociopaths will act more on compulsion. And they will lack patience, giving in much more easily to impulsiveness and lacking detailed planning.

Psychopaths, on the other hand, will plan their crimes down to the smallest detail, taking calculated risks to avoid detection. The smart ones will leave few clues that may lead to being caught. Psychopaths don’t get carried away in the moment and make fewer mistakes as a result.

Both act on a continuum of behaviours, and many psychologists still debate whether the two should be differentiated at all. But for those who do differentiate between the two, one thing is largely agreed upon: psychiatrists use the term psychopathy to illustrate that the cause of the anti-social personality disorder is hereditary. Sociopathy describes behaviours that are the result of a brain injury, or abuse and/or neglect in childhood.

Psychopaths are born and sociopaths are made. In essence, their difference reflects the nature versus nurture debate.

There’s a particularly interesting link between serial killers and psychopaths or sociopaths – although, of course, not all psychopaths and sociopaths become serial killers. And not all serial killers are psychopaths or sociopaths.

Thomas Hemming murdered two people in 2014 just to know what it felt like to kill. Tracey Nearmy/AAP Image
Thomas Hemming murdered two people in 2014 just to know what it felt like to kill. Tracey Nearmy/AAP Image

But America’s Federal Bureau of Investigation (FBI) has noted certain traits shared between known serial killers and these anti-social personality disorders. These include predatory behaviour (for instance, Ivan Milat, who hunted and murdered his seven victims); sensation-seeking (think hedonistic killers who murder for excitement or arousal, such as 21-year-old Thomas Hemming who, in 2014, murdered two people just to know what it felt like to kill); lack of remorse; impulsivity; and the need for control or power over others (such as Dennis Rader, an American serial killer who murdered ten people between 1974 and 1991, and became known as the “BTK (bind, torture, kill) killer”).

A Case Study

The Sydney murder of Morgan Huxley by 22-year-old Jack Kelsall, who arguably shows all the hallmarks of a psychopath, highlights the differences between psychopaths and sociopaths.

In 2013, Kelsall followed Huxley home where he indecently assaulted the 31-year-old before stabbing him 28 times. Kelsall showed no remorse for his crime, which was extremely violent and pre-meditated.

There’s no doubt in my mind he’s psychopathic rather than sociopathic because although the murder was frenzied, Kelsall showed patience and planning. He had followed potential victims before and had shared fantasies he had about murdering a stranger with a knife with his psychiatrist a year before he killed Huxley, allegedly for “the thrill of it“.

Whatever Kelsall’s motive, regardless of whether his dysfunction was born or made, the case stands as an example of the worst possible outcome of an anti-social personality disorder: senseless violence perpetrated against a random victim for self-gratification. Throughout his trial and sentencing, Kelsall showed no sign of remorse, no guilt, and gave no apology.

A textbook psychopath, he would, I believe, have gone on to kill again. In my opinion – and that of the police who arrested him – Kelsall was a serial killer in the making.

In the end, does the distinction between a psychopath and sociopath matter? They can both be dangerous and even deadly, the worst wreaking havoc with people’s lives. Or they can spend their life among people who are none the wiser for it.

This article is part of The Conversation’s Health+Medicine series.

Xanthe Mallett is a Senior Lecturer in Forensic Criminology at University of New England

This article was originally published here on The Conversation

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By Vaagisha Das

We have been taught to share many things in order to show our care. Faecal matter would definitely not be one of them. Yet this is what Raahil Batin’s father found himself doing to help treat his son, who had contracted inflammatory bowel disease. Faecal transplant, or to put it in layman terms, poop transfer, is exactly what it sounds like – transporting human waste from a ‘healthy’ donor to a patient with intestinal problems.

Bacteria, contrary to popular belief and overzealous use of anti-bacterial soaps, are not all your typical garden variety of harmful parasites. Some bacteria found in the intestine are immensely useful in food digestion, and their absence may cause the entire process to go haywire. This made doctors come up with an obvious solution- cram the required bacteria, along with the complimentary poop, into the patient’s intestine. Okay, maybe not exactly cram it- there are more scientific methods. Or one could go down the not so beaten track of popping ‘poop pills‘, courtesy advanced medical science. Some phrases of the English language will never be the same again.

Continuing the saga of terrifying yet fascinating medical treatments, here are a few more, ranging from ‘hey, that could actually work’ to ‘how is that actually working?!’

Leech Therapy: Earlier proposed by Sushruta in 800 B.C., leeches were considered the premium treatment procedure for anything involving skin diseases, to fever or inflammations. In a style reminiscent of fashion trends, this medieval practice has come round again as a popular and effective way to drain blood from the body after reconstructive surgery. Anticoagulant properties of the leech saliva make them unique – these bloodsuckers have been around a lot longer than vampires, and are far less sparkly.

leech-368345_1920
Bone Stretching: Ask the kid hanging from the bars in the Complan ad – growing taller is mainly in your genes, and once you’re stuck at 5′ 1″, there is not much you can do. Except that now there is. Not the most pleasant ‘treatment’, this procedure requires breaking bones in order to make them longer. A brace is placed between the two pieces of bone, and regenerated tissue fills the gap in due time, which later forms the perfectly healthy bone. This is also called distraction osteogenesis– because when in doubt, confuse people with science.

Hemispherectomy: A rare process involving the removal of half of the entire brain- no, this is very different from a lobotomy, though it does involve amputation of a part of the brain, mainly the ‘problematic’ area. This would be the localised part where epilepsy and seizures originate, and then the surges spread across the entire brain, much like ripples across the surface of water. Sure, it’s a throwback to when hacking away the problem might have been a surgeon’s favourite, but even with ‘half’ a brain, the patient will likely live to function effectively – the rest of the brain adapts to carry out the function of the missing part, and the rest of the skull space is filled with fluid. Why take pills when you can simply cut out the problem entirely?

Body Chilling Therapy: Walt Disney was not cryogenically frozen, much to the disappointment of urban legend fans. This is because such a technology does not exist outside of science fiction. However, what does exist is a process where the patient is frozen from the inside out – known as induced hypothermia through central venous infusion, a chilled saline solution, when injected intravenously, does something roughly akin to being lowered into an ice bath- it slows down the person’s bodily functions. The lowered temperature reduces the body’s need for oxygen, which in turn slows down the impending cardiac arrest and gives the patient extra time to be rushed to the hospital.

With such medical procedures already in use, maybe switching brains and ‘upgrading’ to better bodies will no longer be limited to the realm of futuristic movies- but are we quite ready for them? Well, maybe we could hold out for the hoverboards instead.

Chattisgarh woman with child. Image source: Wikimedia Commons

By Debarati Ghosh:

The Story of Chaiti Bai

Unlike every other ordinary day in the Bilaspur district of Chattisgarh, 22 year old Chaiti Bai could not go about her daily chores. She was unwell and weak, suffering from jaundice. At the proposal of the Community Health Centre’s messenger, she agreed to get herself treated from their health officer. However, Chaiti Bai and her husband were given a blank paper to sign on, before she could avail the treatment. Without thinking much of it at the time, her husband, Budh Singh signed it, and got her admitted.

Chattisgarh woman with child. Image source: Wikimedia Commons
Chattisgarh woman with child. Image source: Wikimedia Commons

What followed soon revealed the sham that the government’s family policy is. Without any prior information about the nature of the surgery, Chaiti Bai was operated upon, and sterilized. While her husband did not receive a single piece of official documentation from the health workers, Chaiti Bai’s condition worsened. She died the next day on her way to the district hospital, leaving her husband with their two children, and a cheque of Rs. 200,000 from the government.

Chaiti Bai was not the only victim of the sterilization camps that plague India. According to reports, 14 of the 83 women sterilized that day in November 2014 died, while the others had to be hospitalized. The Gaurella Community Health Centre has a target of sterilizing at least 800 women per year. Even as Prime Minister Narendra Modi urged for an investigation on this “unfortunate tragedy”; the state award winner for his work on sterilization, who was arrested for the deaths, Surgeon R. K. Gupta blamed the government for the deaths, stated that it was his “moral responsibility” to have performed the sterilizations.

More than 4 million sterilizations were conducted between 2013 and 2014, according to Government figures. The then Health Minister of India, Harsh Vardhan officially stated that the government has recorded 15,264 sterilization related deaths or failed surgeries between April 2009 and March 2013. It’s only with the rise in death tolls at sterilization camps, visibly declining sex ratio and the usage of outdated drugs and procedures like the cycle pumps to inflate their abdomens during the surgeries on hapless women, along with outrage over fowl plays such as the sterilization of the unsuspecting men in return for gun license, that the government’s family planning policies have come under a critical lens of Women Rights organizations and the mainstream media.

The Glitch in the Story

Growing up hearing the slogans of “HUM DO HUMARE DO”, we never quite questioned it, due to its appeal to common sense. The economically and geographically marginalized sections are the primary targets for the state-approved sterilization campaigns that offer a variety of incentives or disincentives for the participants and often employ coercive measures to attain their targets.

While this sounds all too obvious and the government may be applauded for its population control initiatives, something doesn’t quite add up. Questions arise such as:

  • Why are countries like China and Vietnam, with notoriously stringent one-child norm and reproductive restrictions, now removing these rules from their population control policies?
  • What is the role of the western funding agencies like the USAID, World Bank, Rockefeller Foundation or Ford Foundation in this entire picture?
  • And what lies ahead for the Indian economy given the rise in averted births and decline in population, which corresponds to an inevitable dearth of work forces and income generating populace?

These points get us questioning the goal that our government is seeking to attain and bring in the need for a more nuanced approach to the Indian population control policy.

Setting the Record Straight

The attitude to levy sanctions on the reproductive rights of the general population (especially the marginalized sections) goes way back to the times of Darwin and Reverend Malthus, echoed by agencies like the International Planned Parenthood Federation in the 1920s. The contemporary policies on population control can be best described in Amartya Sen’s words as being a “revival of Malthusian thinking in the recent years”. Simply put – letting the poor perish unattended since they are unworthy of life, and focus more on the development of the better race/class/caste.

In a collaborative study conducted on the impact of the Two-Child norm in India, Claire B. Cole notes the impact of India’s receipt of monetary sanctions from western agencies, which range from the targets issued by the Word Bank to avert 40 million births in a span of 10 years or target based economic funding from agencies like the USAID, World Bank, the Ford and Rockefeller Foundation. There are several intermediate agents like the Accredited Social Health Activists or ASHA workers, who receive bonuses for every person they motivate to undergo sterilization. What is bothersome about mushrooming internationally funded NGOs and agencies, is their affiliation which lies with the foreign funders and are thereby, not accountable to India. According to the Human Rights Watch’s report in 2012, these approaches have made the sterilization campaigns an exceedingly coercive process.

While the Population Growth Rate in India has fallen to 1.25% in 2014, due to the population momentum, it will continue to grow for at least the next sixty years. In such a situation, we can only expect to see a severe dwindling in the sex ratio and a decrease in the number of girl child in the Indian society. So much for the noise about developmental policies and progress!

cigarettes

By Manjusha Chatterjee

According to media reports, around 150 million new voters in the age group of 18 to 23 years exercised their political franchise for the first time in 2014. All political parties campaigned for India’s youth vote bank, the largest in the world, today. Politicians spoke of youth empowerment as the key to India’s success and rightly so.

Yet, it seems that we must remind our policymakers that empowering youth also involves safeguarding their future, protecting them from all probable dangers and allowing them to make informed choices. For this, welfare must override business. It is an open secret that business establishments court policymakers in the run for profit-making. Case in point, the tobacco industry, which has been lobbying in favour of weak, ineffective and delayed regulations on tobacco products for years. Regardless of the government in power, cigarette companies as well as bidi and smokeless tobacco associations rush down the power corridors with fallacious and unreasonable data to block tobacco control laws.

cigarettes

India enacted its tobacco control law – the Cigarettes and Other Tobacco Products Act (COTPA) in 2003, even before the World Health Organization’s Framework Convention on Tobacco Control (WHO-FCTC) came into force. Despite roadblocks posed by the industry, India has recorded several ‘firsts’ in the sphere of tobacco control: India was among the first to implement a national tobacco control programme, the first to regulate depiction of tobacco use in films and television programmes and the first to adopt a national target of 30% relative reduction in tobacco use by 2025.

One of the measures of COTPA that has received stiff resistance is the pictorial health warnings on tobacco product packages. Ever since the first set of warnings were introduced in 2006, the tobacco industry has rallied, lobbied, and succeeded in diluting and delaying the warnings on account of loss of revenue and clearing massive stockpiles. The most recent setback has been a delay in implementing large sized, 85% pictorial health warnings from April 1, 2015 following the absurd recommendation of a parliamentary committee on lack of scientific evidence on tobacco and cancer. The absurdity of these developments is compounded by the presence of a bidi baron as a member of the committee ‘scrutinizing’ tobacco control laws in India!

Youth are, without doubt, important stakeholders in tobacco control. While 5500 youth initiate tobacco use everyday in the country, school and college students have also been advocating for strong tobacco control laws since the 1990s. Youth have made representations to policymakers on pictorial health warnings since a Parliamentary Standing Committee on Human Resource Development first recommended them in 2001. In 2007, school students had written to the then Health Minister in support of strong pictorial health warnings. After severe delays, a mild set of warnings was implemented for the first time in 2009.

In another incident, as part of India’s legal mandate to rotate pictorial health warnings, thousands of youth signed a petition to the then Prime Minister requesting timely implementation of pack warnings depicting ‘mouth cancer’ in December 2010. They visited several Members of Parliament across political parties. Those warnings were never implemented. Three months since abeyance of the April 1st deadline, thousands of young Indians and tobacco control activists s have already written to the Health Ministry and the Hon’ble Prime Minister urging immediate implementation of the 85% warnings.

Pictorial health warnings, between 2009 and 2014, in India have covered 40% of the front display area of all tobacco products. This mandate falls short of the WHO-FCTC recommendation to cover at least 50% or more. Other countries in the South-Asian region like Nepal, Pakistan, Sri Lanka and Thailand have already introduced at least 85% pictorial health warnings and Australia has moved forward with plain packaging of tobacco products. India ranks poorly at 136th, in comparison to other countries on pictorial health warnings.

Very simply, pictorial health warnings convey the consequences of tobacco use. They warn users and potential users about what they are signing up for, with every intake. For young people, pack warnings are an effective way to understand the irreparable damage that tobacco use can cause, especially since the tobacco companies see tremendous merit in investing millions on the same packages, to make them colourful and attractive.

Off late, the government’s decision to stall the 85% warnings, loosen regulation on depiction of tobacco imagery in films as well as the Delhi High Court’s directive, on restricting the ban on chewing tobacco in Delhi, are regressive and murky. While countries are strategising roadmaps on tobacco-free futures, India seems to be on the wrong side of the road.

As for the tobacco industry, please know that youth around the world stand together for ‘No More Tobacco in the 21st Century’.

youth and tobacco

Image source: downtoearth.org.in

By Jyotsna Singh:

Note: This article has been republished from Down To Earth.

The biggest recipients of investment through aid programmes of rich nations have been the large commercial hospital chains in the emerging economy countries. Limited to a few million dollars till some years ago, the trend has picked up internationally with hundreds of dollars doled out to corporate chains. Indian corporate hospital chains have been the biggest beneficiaries of such aid programmes. Experts have raised concerns about issues of equity and poverty redressal.

Image source: downtoearth.org.in
Image source: downtoearth.org.in

Authors of a recent editorial in British Medical Journal Benjamin M Hunter and Susan F Murray of King’s College London, UK, carried out a preliminary analysis of investment commitments to private hospitals and clinics by international development finance institutions. They found that at least US $2.3bn has been committed by them of which $1.9bn had been committed in the last eight years.

Indian companies received $470m, ahead of Turkey ($345m), Brazil ($232m), China ($176m), Russia ($123m), and South Africa ($100m).Five beneficiaries are international chains (Saudi German Hospitals, Apollo Hospitals, Fortis Healthcare, IHH Healthcare Berhad, and Life Healthcare) and four are national chains (Max Healthcare, Acibadem Healthcare Group, Medicina, and Rede D’Or). Three of these are Indian chains, namely Apollo Hospitals, Fortis Healthcare and Max Healthcare.

In Britain, the policy is called beyond aid, which aims to address underlying causes of poverty, and focus on the use of loans and equity investments to support the growth of private companies. As part of this strategy, tens of millions of pounds have been committed by the Department for International Development’s investment arm, CDC Group, to private hospitals and clinics in countries like India, Bangladesh and South Africa. The trend became visible in 2012.

The two direct investments by CDC Group were between 2000 and 2012 ($6.1m in Prime Cure Clinics, South Africa, and $5m in Apollo Hospital Dhaka, Bangladesh) have been dwarfed by investments of some $65.5m since (in Rainbow Hospitals and Narayana Health, both India), which are expected to enable these hospital chains to expand to new cities.

The investments are made in the name of job creation and returns on investment. The House of Commons International Development Committee published in February 2015 that beyond aid policies “would be good for the UK in the short run as well as in the long run“.

The authors highlight concerns about impoverishment caused by healthcare costs and suffering caused by unnecessary medical tests in a profit-driven sector. Citing a report by the Department for International Development, they said that far more users of private healthcare are impoverished each year in India than users of the public sector—48 per cent compared with 15 per cent incur catastrophically high out-of-pocket health spending. They said the trend of helping profit-driven hospitals will be detrimental to healthcare in low and middle income countries.

Image source: wikimedia commons

By Garima Kushwaha:

Euthanasia has recently been in discussion since Aruna Shaunbaug’s case in India, who was left in a vegetative state of pain for 42 years, but also after a healthy but depressed 24-year old girl was granted permission for euthanasia in Belgium.

Image source: wikimedia commons
Image source: wikimedia commons

Euthanasia, which is the practice of ending your own life to relieve pain and suffering, is permitted in few countries including Belgium, Netherlands, Colombia and Luxembourg. Assisted suicide is legal in Switzerland, Germany, Japan, Albania and in the US states of Washington, Oregon, Vermont, New Mexico and Montana.

Three main arguments opposing legalization of euthanasia are:

1. Considering psychiatric patients as terminally ill

Euthanasia is meant to relieve pain that is unbearable and incurable. A pain classified as such can be either physical or mental. While mental disorder can be treated through psychotherapy and/or medication, it is, many a times, referred to as “hopeless condition” and hence qualifies for euthanasia. According to the New Yorker, 13% of Belgians who were euthanized last year weren’t terminally ill, as 50-60 psychiatric patients are euthanized each year in Belgium according to the nation’s federal euthanasia commission.

A person requesting euthanasia, as per the law, must be able to request it themselves and must demonstrate that they fully understand their choice. However, depressive illnesses are known to distort a person’s thinking and hence any judgment by a mentally ill person is questionable.

2. Slippery slope from voluntary euthanasia to involuntary euthanasia

The opponents’ of active euthanasia debate how legalized voluntary euthanasia can slip into involuntary euthanasia. The professor of law and medical ethics, John Keown from University of Cambridge, says in his report, “Once a doctor is prepared to make such a judgment in the case of [a] patient capable of requesting death, the judgment can, logically, equally be made in the case of a patient incapable of requesting death”. “If a doctor thinks death would benefit the patient, why should the doctor deny the patient that benefit merely because the patient is incapable of asking for it?” he further argues.

In fact, the New England Journal of Medicine has already reported such spillovers to involuntary mercy killing in a study. According to the Daily Mail, the study found that around one in every 60 patient deaths involved someone who didn’t want to die and half of the patients were over the age of 80. Additionally, two-thirds of those who died were not suffering from a terminal disease.

The report also mentioned that very often doctors would not inform the families because they considered it a medical decision to be made by them alone. The author of the study Professor Raphael Cohen-Almagor of Hull University said: “The decision as to which life is no longer worth living is not in the hands of the patient but in the hands of the doctor.”

3. Hampers doctor-patient relationship

Euthanasia has become a part of a doctor’s job in Belgium. However, the idea that a doctor can take a life may destroy the very foundation of trust between doctors and patients when a doctor, who is seen as a healer, can decide to end the patient’s life on their discretion. This ‘God Complex’ is another point in the controversy.

The American Medical Association opposes both euthanasia and physician-assisted suicide in its official statement. The statement reads: “Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.”

The fight against euthanasia law has been steaming up in Belgium after the removal of an age limit for the request. Many opposing groups in Belgium and worldwide are hoping to revoke the liberalization of the law of euthanasia and the right to die. Hence, it is extremely important to consider all the effects, concerns and potential misuse of making such a practice before we propose to bring active euthanasia to India.

Also Read: In Belgium Now, Children Can Legally Commit Assisted Suicide

Image source: Downtoearth.org

By Kundan Pandey:

Note: This article has been republished from Down To Earth.

High food prices result in malnutrition in India, says a study done on children from Andhra Pradesh.

The research published in the Journal of Nutrition says spikes in food prices during the last global recession were associated with a higher risk of malnutrition among Indian children.

Image source: Downtoearth.org
Image source: Downtoearth.org

The researchers from the Public Health Foundation of India (PHFI) and the University of Oxford, with a team from Stanford University and the London School of Hygiene and Tropical Medicine, examined the children who experienced “wasting”, a widely-used measure of malnutrition that shows a child has a lower-than-expected weight given their height. This is based on the standards set by the World Health Organization (WHO).

The researchers have used survey data from a sample of 1,918 children from poor, middle-income, and wealthy households living in the state, since 2002 for a longitudinal study on child poverty.

The researchers observed progress in child nutrition between 2002 and 2006 when the proportion of wasted children in (undivided) Andhra Pradesh fell slightly from 19 per cent to 18 per cent. However, this improvement had reversed by 2009 when 28 per cent of children were wasting—an increase of 10 percentage points compared with 2006. This was after high inflation in food prices, beginning in 2007 and continuing through 2009.

The researchers found that children’s food consumption dropped significantly between 2006 and 2009 as food prices increased. There were corresponding increases in wasting among children from poor and middle-income households, but not high-income households between 2006 and 2009. The paper suggests this supports the theory that poorer households have the smallest food reserves and are therefore hardest hit by rising food prices.

The researchers examined interview data from each household on food expenditure based on 15-day periods in 2006 and 2009 across eight food categories (rice, wheat, legumes, meat, fish, eggs, milk, fruits and vegetables). To examine the rise in food prices, the researchers used monthly price records collected by the Government of India.

Lead author of the study from PHFI, Sukumar Vellakkal, said that these findings suggest that poorer households face the greatest risk of malnutrition, in spite of the public distribution system, which provides subsidised food to a large proportion of the population. Better targeting of food security policies may be necessary to meet the needs of India’s most vulnerable households, he added.

Study co-author Jasmine Fledderjohann, of the University of Oxford, said, “Our findings show a sharp increase in wasting associated with food price spikes. It is possible that this rise would have been even greater without governmental programmes like the Public Distribution Scheme or the Midday Meal Scheme, which provides free meals to school children. It’s important to recognise that households may try a number of strategies to cope with rising food prices, such as going without, or switching to low-cost alternatives. More detailed research is needed in this area.”

Image source: Reshma Valliappan

By Reshma Valliappan:

Summer camps are often a thrilling time for kids. It’s those fun moments where a teenager gets to discover their wild side in the wilderness. Every camp specializes in certain outdoor activities based on where they are located. It could be trekking, climbing hills, kayaking, camping, singing songs around a fire, telling ghost stories, getting a crush, learning to cook without a stove. These are just a few.

Image source: Reshma Valliappan
Image source: Reshma Valliappan

However, there are camps that offer the complete opposite. These are basically for troubled teenagers who otherwise spend most of their regular school days doing all of the above while their friends are studying. The camps meant for these kids are devoid of animals and wildlife. There is no climbing, rafting, telling stories, listening to songs and music, or any emotional connections which would be allowed. They are called boot camps or correctional camps. Although they aren’t necessarily named so. Correctional camps are used for many purposes. Highly influenced by military training techniques – some even rely on “quick-fix” solutions. Children who are sent here are considered “lost cases” and parents feel that they have lost all control over these kids. In order to regain control of their children – these subtle named camps work with teenagers using behaviour modification. If you have studied psychology, in those wonderful stupid books of yours, thinking a little bit of Pavlov and Watson makes you an awesome two faced helper – think again.

As a teenager, I had run away from home and begun cutting myself at a very young age. Added to this list was my self-destructive behaviour and recklessness. This topped up with the layer of being tomboyish, playing basketball and being a flirt at a very young age qualified me as a highly appropriate candidate for one such camp. The most important trigger here was when a psychiatrist told my parents I was a boy stuck in a girl’s body. This jolted the daylights out of my parents, putting them into a crisis every day when they saw their daughter showing all the traits the shrink had told them. No surprise that many other parents were in the same boat, as it must have been their collective helplessness that had them throw us in the same camp.

I saw kids walking in, being held tightly by their parents. Some had this fear on their faces which made them look as red as tomatoes, almost like they had been crying on their way here or had most probably been slapped to get here. Mom said, “We”ll see you on the last day” Mr.Crater Face made it very clear to us that there was no escape. While he was introducing himself, I clearly remember how he glanced at some of the boys in the room. He picked on them and told them their pretty faces weren’t going to get them anywhere in life. I was put in the first group and he called us the “difficult attention seeking, good for nothing trouble makers”. As he approached one kid after the other, we heard crying. Some kids had started howling even. Every night we were watched and, we watched. And every night one of us tried comforting the other but simply could not.

The next day he stood and stared at me. Then asked me to make a circle and asked, “Are you a girl or a boy?” “I am a girl” “Really?” “Yes” He asked me to circle again. This time I saw my roommate in tears. I couldn’t understand why though. He made me make another circle and said, “I don’t see anything on you that says you are girl.” He looked at the others and made me stand in different positions.

Does she look like a girl to you?” He asked again, “Where does it show that she is a girl? Does she look like a girl from the back? If you saw her from the back (he made me stand with my back facing them) would you think she is a girl or boy?” They replied, “Boy”. My lips clamped together and I had no answer when he asked me, “Are you a girl or a boy?”

What really happened in between those days are better left forgotten. I don’t know where the rest of the kids are. I don’t know if they even survived after that. We were turned into robots in just one week. (Taken from Fallen Standing; My Life As A Schizophrenist)

I don’t know if I should be happy to be alive or grateful to have forgotten other days of the camp or blessed to be able to tell my story after 20 years. My 15 year old self is still stuck somewhere and I’ve let them both (the girl and the boy) live through me because there can be no other way.

I still do wonder what happened to those kids from my camp. I wonder if they’ve grown as I have. Or if they took their own lives. Or have they just remained robots without any memory. I know Mr.CraterFace is a big name now in my country. I did google him. He is on Facebook spreading the message of love on large platforms. I think I will be blessed if our paths never cross because my 15 year old self might do something I wouldn’t want.

There is nothing I can do to undo anything but only know my purpose and find my own meaning in life. I can only hope that every parent who feels they are losing control of their teenager reads this. Many people don’t even know such camps exist and many parents don’t know what happens in them. It always is too late by the time they do know. We only hear about stuff like this in movies – but movies are based on many true accounts. Every reckless, troubled, disturbed teenager is already living their lives as free spirits. We are called rebels because you expect us to fit into the framework as other children do. Don’t try to correct us because we will grow up hating ourselves or you. Change the social constructs around teenagers and children. Take out time to know the person inside.

For wannabe psychologists who think they know better, every ‘research’ out there on classical conditioning, is a child’s life. Every theory based on psychological experiments cost a child his or her emotional and sexual life. Every label you think you want to use on us, to enable us, to understand our conditions better gives someone else the power to continue such behaviour modifications. There is no monitoring system for the human mind and the abuse against it.

The field of psychology and psychiatry needs an entire course on developing a conscience before learning anything else.

I only wish for humans to develop a collective conscience and humanity.

This article was originally published here.

TRDLOGO1

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