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Despite Progress, India Remains The Second Most Unequal Economy In The World After Russia

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By Rahul Ahluwalia, Yamini Atmavilas and Nachiket Mor:

India is the second most unequal economy in the world after Russia, according to a 2017 Oxfam report entitled ‘An economy for the 99%’. More sobering is the fact that even the people we might consider to be middle-class in India are really quite poor.

According to a study by Pew Research Center, even though India’s poverty rate fell from 35% in 2001 to 20% in 2011, the population that could be considered middle income saw only a marginal increase, going from about 1% to just 3%. This means that instead of a swelling middle class, India saw a movement of its population from poor to low-income* earners.


The study pointed out that, “these were people hovering closer to $2 than $10 in daily income, and thus still a ways from the transition to middle-income status.”  At that income threshold, a large proportion of Indians are at the edge of the global poverty line, possibly only one economic or health shock away from slipping back into poverty.

Where Our Efforts Must Lie

Given the sheer size of the problem, it would be infeasible for India to address this problem through transfers of wealth from the tiny sliver of high- and middle-income people (3% of the population) to the poor and low-income (97%). The focus of the effort must instead lie in improving the environmental constraints that keep people in poverty and strengthening the enablers that can allow them to take charge of their own lives. Some of these enablers would include access to good healthcare and associated financial protection, basic financial services, good pre-school education and nutrition support services, and agricultural productivity services. However, strengthening these enablers, while eminently feasible, will not be easy.

Let us take healthcare for mothers and babies as an example.

We know babies are more likely to survive when they receive essential newborn care–thermal care (drying and skin-to-skin contact), hygiene and infection control (cord-care and caregiver handwashing), and early and immediate breastfeeding.

We also know that these practices are more likely in clinical settings than at home in low resource settings. When these practices are followed diligently, women can return to their homes healthier and better able to take care of themselves and their babies. It also allows their children to thrive and to grow up into strong adults who are able to successfully pursue efforts that will change their income status. Ensuring that all of this happens has, therefore, become a key focus of efforts in the healthcare sector.

Photo Courtesy: Charlotte Anderson

An example of this is the Janani Suraksha Yojana (JSY), a government-run conditional cash transfer programme launched in 2005-06 to persuade women to deliver their babies in hospital settings. In the decade since it was launched, it has significantly improved the rate of hospital deliveries among rural women.

A nine-state analysis of the effects of JSY tells us the following: while inequality in access to care has reduced dramatically—in 2010, 49% of women on average were delivering at facilities, compared to 20% pre-programme—there still remains a large gap in accessing hospital-based delivery. The analysis reveals that nearly 70% of this could be attributed to differences in male literacy, disparities in access to emergency obstetric care and high levels of poverty.

In Bihar, for instance, after an initial spurt in women giving birth in facilities and delivery rates improving from 19.9% in 2005-06 to 63.8% in 2015-16, growth has stagnated in recent years. In some districts, such as Bhojpur, Buxar, Jehanabad, Munger, Patna and Rohtas, over 80% of women deliver in facilities, whereas in others, such as Darbhanga, East Champaran, Kishanganj and Sitamarhi, that figure is around 50%.

A key finding from a recent study that examined the effect of Ananya–a health system training and community outreach intervention on reproductive, maternal and newborn health care utilisation in Bihar–was the large effect of gender inequity, specifically child marriage, on limiting the impact of the programme. We also know that maternal education and maternal incomes have strong positive associations with several health and development results including infant mortality, nutrition and women’s reproductive agency.

Efforts to further improve access to basic healthcare for mothers and babies, in addition to the JSY, would now need to address these additional sets of factors that research has revealed are acting as blockers to further progress.

Working Towards An Equitable India

India has made tremendous progress in reducing absolute poverty in the past two decades. The pace of poverty reduction has also accelerated over time: it was three times faster between 2005 and 2012 than in the previous decade. Despite this, and despite India’s promising economic growth, 97% of the country would still be considered poor or low-income by global standards of poverty.

Moreover, as we look beyond a monetary assessment of progress to other dimensions of well-being—nutrition, education, employment—we see that while those indicators have improved, they have done so to a lesser extent than in other developing countries.

For India’s future growth to be more equitable, as the healthcare example reveals, we will need to take into account myriad inter-connected and underlying factors. Fortunately, there are lessons that can be built upon, and in so doing, we can inch closer and closer towards an equitable India.

*Defined as between ₹34 and ₹170 per day, per person, or ₹170 to ₹850 per day, per family, using a PPP  exchange rate of ₹17 for $1.

With inputs from Amrita Agarwal, Debarshi Bhattacharya, Diva Dhar, Sabah Hamid and Suneeta Krishnan.

Views expressed in this article are personal.

About the authors:

  1. Rahul Ahluwalia is currently working as a consultant with the policy team of the Bill and Melinda Gates Foundation, India Country Office.
  2. Yamini Atmavilas is the India Lead for Gender Equality, India Country Office, Bill & Melinda Gates Foundation.
  3. Nachiket Mor currently serves as the Country Director of the Bill & Melinda Gates Foundation. He is also a member of the Health Commission for the State of Himachal Pradesh.

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

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Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

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MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

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A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

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A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

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A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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