‘Here’s How The Citizenship Amendment Bill Will Deepen Assam’s Existing Fault Lines’

At the stroke of midnight on 12th December, the global community will rise to the Day of International Universal Health Coverage themed: ‘Health For All: Keep the Promise’. Countries will share about interventions by the government and the private sectors that have contributed towards Sustainable Development Goals, mapping their progress towards universal health. What will India have for sharing? A divisive, anti-constitutional Citizenship Amendment Bill passed by the upholder of democracy, the Parliament. And quite paradoxically, both these historic days have an uncanny relationship with one another.

India, in recent years, has undertaken substantive measures aligning with this promise. The National Health Policy 2017 laid the roadmap to comprehensive health and well-being for all, and Ayushman Bharat, the flagship programme was launched on these lines in 2018. However, much lies at stake in achieving universal coverage with the realities grappling the country at present.

Global evidence demonstrates that higher per capita public health investment contributes to strong primary healthcare and improved health outcomes. India’s public health spending currently is only 1% of the GDP that has stagnated across years (National Health Profile, 2019). Low public investments in health have implications on the availability and access to quality healthcare. For instance, in terms of human resources, 27% of the sanctioned posts of Primary Health Centre (PHC) Physicians were found vacant, while rural areas had a shortage of 22% of Primary Health Center facilities (Rural Health Statistics, 2014-15) in the country.

The country contributes to one-fourth share of the burden of Tuberculosis with maternal mortalities in states that cross over 200 (highest in the South-east Asian region). The utilisation of healthcare is much higher in private care than public, and consequently, 18 % of the population incurring catastrophic costs, results in indebtedness due to healthcare. Clearly, in terms of health outcomes, India is way behind its similar contemporaries such as Bangladesh, Sri Lanka, Thailand, let alone rest.

(Mother with her child opposing Citizenship Amendment Bill in Assam; courtesy: Times of India)

On the occasion of 73rd Independence Day, Prime Minister Narendra Modi had urged the country to think of the consequences of uncontrolled population growth on the health and economy of the country. Five months henceforth, the BJP-led Government introduced and passed the divisive Citizenship Amendment Bill(CAB) that would provide Indian citizenship rights to all non-Muslim residents in Pakistan, Afghanistan, Bangladesh. This clearly implies an influx of immigrants from these countries and accessing resources and citizenship in the second-most populous country in the world. Quite ironically, induced population growth is what the country will witness.

The CAB has clear implications on states like Assam, reeling under a past and present of illegal immigration, ethnic tensions, and violence. Assam with a Multidimensional Poverty Index of 0.16 (the equivalent of Cambodia and other EAG states), is one of the slowest and disrupted economies in the country. Only 43% of the state’s population accesses public health facilities for care (NSSO, 75th round), and it stands highest in terms of Maternal Mortality Rate and the incidence of cancer (as well as Infant Mortality Rate higher than all-India levels).

Poor health infrastructure, access to medicines, tensions and poor access are predominant socio-economic factors for the high load of disease burden and mortalities. With the implementation of the CAB, this state is bound to bear the biggest burden of influx with an estimation of lakhs of immigrants (especially from Bangladesh) to move into Assam henceforth. Moreover, with a slow economy and poor health infrastructure, it is bound to slip further behind in terms of overall growth and health outcomes.

The goal of Universal Health Coverage as underlined by the World Health Organisation includes the utilization of health care services as per need of the communities, services that are comprehensive and are of good quality, and financial protection of individuals and families. The National Health Protection Scheme under Ayushman Bharat aims to cover over 10 crores of the lower quartile groups. The second part of the programme is creating 1.5 lakh Health and Wellness centres for a population of 1.3 billion.

Anti-CAB protests in Assam

Clearly, the programme itself does not have adequacy in terms of universal coverage. With CAB coming into effect, the per capita public health expenditure at ₹1657 (at present) will further dwindle with the population influx, while the overall public health spending sees no possibility of rising in the times to come.

Health as an indicator cannot be seen separate from politics that affect it both at macro and micro levels. The CAB is not just cross-cutting anti-secular, divisive lines but also bringing into serious critique the question: how do we envision Universal Health Coverage when the country’s politics induce divisive population influx? This needs to be argued, from the standpoint of its draconian nature and the threat to limited resources, dwindling investments, rising population, recession, and the high triple disease burden that the country is plagued with.

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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.

Read more about his campaign.

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.

Read more about her campaign.

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.

Read more about her campaign. 

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.

Read more about the campaign here.

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.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

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 Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’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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