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Why India cannot follow new WHO guidelines to protect mothers



India must double antenatal visits by health workers to pregnant women to reduce the risk of stillbirths and pregnancy complications, according to a new World Health Organisation (WHO) guideline released last November. Is India ready to implement this and other new guidelines to protect its mothers? It is not, an analysis of government data and research studies shows.

The new guidelines are important, given that, despite a 62 per cent reduction in child mortality between 1990 and 2015, more children (1.3 million) below five died in India in 2015 than anywhere in the world; the country had more stillborn babies than any other, 26 per cent of neonatal deaths, and close to a fifth of 303,000 maternal deaths in 2015.

The government, on February 15, joined a new network to improve the quality of care for maternal, newborn and child health, announced by the WHO and committed to halving preventable deaths of pregnant women and newborns in health facilities over the next five years.

The quality of antenatal care is vital to reduce the risk of stillbirths and pregnancy complications, and the absence of it explains why more women enrolling for hospital deliveries in India isn’t translating into fewer maternal deaths.

India’s maternal mortality rate (MMR) was 178 deaths per 100,000 live births in 2011-12, worse than Sri Lanka (30), Bhutan (148) and Cambodia (161), and worst among the BRICS countries: Russia (25), China (27), Brazil (44), and South Africa (138).

In November 2016, the government launched the Pradhan Mantri Surakshit Matritva Abhiyan, or the Prime Minister Safe Pregnancy Scheme, which aims to provide free and comprehensive care on the ninth day of every month during pregnancy. Pregnant women are provided special, free ante-natal checks in their second or third trimester at government health care facilities, including ultrasounds, blood and urine tests.

Yet, getting these facilities to women is a challenge, especially in poorer states. No more than 3.3 per cent of pregnant women in Bihar reported receiving full antenatal care, lowest among states. Full ANC refers to at least four antenatal visits, at least one tetanus toxoid (TT) injection and iron folic acid tablets or syrup taken for 100 or more days.

IndiaSpend looked at some of the WHO recommendations and evaluated India’s ability to implement them:

1. Minimum of eight antenatal contacts with pregnant women
A minimum of eight contacts for antenatal care can reduce perinatal deaths by up to eight per 1,000 births, compared to a minimum of four visits, said WHO.

Despite the emphasis to antenatal care under government health programmes, India is not close to universal antenatal care, according to a 2016 study, which analysed data from the National Sample Survey Office (NSSO).

The study found that women belonging to disadvantaged communities, particularly scheduled-caste (SC), scheduled-tribe (ST) and rural areas, received sparser ante-natal care. SC/ST women contribute to the highest proportion of pregnant women without antenatal care.

The proportion of mothers who had at least four antenatal visits varied considerably: While states such as Bihar, Madhya Pradesh and Uttarakhand reported four visits to 14.4 per cent, 35.7 per cent and 30.9 per cent, respectively, of mothers, richer states, such as Tamil Nadu (81.2 per cent), Maharashtra (72.2 per cent) and Andhra Pradesh (76 per cent), did better.

2. Daily oral iron, folic acid supplements
The WHO guidelines recommend daily oral iron and folic acid supplements with 30 mg to 60 mg of elemental iron and 400 µg (0.4 mg) of folic acid for pregnant women to prevent maternal anaemia, puerperal sepsis, low birth weight, and preterm birth.

Anaemia was the top cause of maternal deaths in India (50 per cent) and the associated cause in 20 per cent of maternal deaths, and India reported that 45 per cent of pregnant women were anaemic — the highest proportion in the world.

Only 9.7 per cent of mothers in Bihar consumed iron and folic acid for 100 or more days when they were pregnant, followed by Tripura (13.4 per cent) and Rajasthan (17.3 per cent), according to NFHS-4 data.

In the 2017-18 budget, the Indira Gandhi Matritva Sahyog Yojna (Maternal Benefit Scheme) saw an allocation increase from Rs 634 crore ($94.6 million) in 2016-17 to Rs 2,700 crore ($298 million).

This allocation, however, isn’t enough to cover all expectant mothers. The government itself had estimated that the the annual requirement for this maternity benefit scheme would be Rs 14,512 crore ($2.1 billion).

Since there isn’t enough funding, the ministry plans to provide maternity benefit only to first-borns.

3. Tetanus toxoid vaccination
The WHO guidelines recommend a tetanus toxoid vaccination for pregnant women to prevent neonatal mortality from tetanus.

India reduced neonatal tetanus mortality by 99.76 per cent over three decades in 2015, which was described as a “significant public health milestone” by the WHO, which declared the country free of neonatal tetanus in May 2015.

However, to mitigate the threat of a resurgence, experts recommend that at least 80 per cent of expectant mothers must be immunised and at least 70 per cent of births must take place in hygienic conditions. Institutional deliveries rose by 15 per cent over a decade from 2004 to 2014, but the rise isn’t translating into fewer maternal deaths.

4. One ultrasound scan before 24 weeks’ gestation
An early ultrasound is recommended for pregnant women to estimate gestational age, improve detection of foetal anomalies and multiple pregnancies, reduce induction of labour for post-term pregnancy, and improve a woman’s pregnancy experience.

Ultrasounds should be done by radiographers at community health centres (CHCs) in rural areas. But CHCs nationwide are 66 per cent short of radiographers, and as many as 13 states and Union Territories are 75 per cent short, according to the Rural Health Statistics (RHS) 2016.

5. Counselling about healthy eating and keeping physically active during pregnancy
The role of gynaecologists and paediatricians is critical in counselling pregnant women. However, there is a 77 per cent shortage of obstetricians and gynaecologists and 80 per cent shortage of paediatricians in CHCs nationwide. Nearly 62 per cent of government hospitals — which include CHCs, district hospitals and sub-district hospitals — don’t have a gynaecologist on staff.

6. Health-care providers should ask all pregnant women about use of alcohol and other substances at every antenatal visit
Gynaecologists and auxiliary nurse midwives (ANMs) are the frontline of the battle against infant and maternal mortality. In 30 per cent of districts, sub-centres with ANMs serve double the patients they are meant to and an estimated 22 per cent of sub-centres are short of ANMs.

(In arrangement with, a data-driven, non-profit, public interest journalism platform. Devanik Saha is with the University of Sussex. The views expressed are those of IndiaSpend. Feedback at [email protected])


Global sell-off drags Indian equities to 5-month lows




Mumbai, March 24 : A global sell-off triggered by trade protectionist measures imposed by major world economies unleashed the bears in the Indian equity markets during the week, pushing the key indices — NSE Nifty50 and BSE Sensex — to their 5-month lows.

Apart from the prospects of escalating trade wars, the risk-taking appetite of investors was marred by rising crude oil prices, the ongoing turmoil in the domestic banking system as well as the uncertainty on the political situation in the country.

On a weekly basis, the barometer 30-scrip Sensitive Index (Sensex) of the BSE shed 579.46 points or 1.75 per cent to close at 32,596.54 points — its lowest closing level since October 23, 2017.

On the National Stock Exchange (NSE), the wider Nifty50 ended below the psychologically important 10,000-mark and closed trade at 9,998.05 points — down 197.1 points or 1.93 per cent from its previous week’s close — its lowest closing level since October 11, 2017.

“Benchmark indices Sensex and Nifty fell 1.75 per cent and 1.93 per cent respectively during the week, posting their longest stretch of weekly losses in 16 months as the domestic market joined a global sell-off triggered by prospects of a trade war,” Arpit Jain, Assistant Vice President at Arihant Capital Markets, told IANS.

According to D.K. Aggarwal, Chairman and Managing Director of SMC Investments and Advisors, the global stock market traded lower after US President Donald Trump announced sweeping tariffs on Chinese goods, a move that has heightened concerns that the global trade war will escalate.

“Back at home, dragged by escalating trade tensions among global economies, the Indian stock market too witnessed selling pressure amid other domestic factors. Since the beginning of the year domestic market witnessed some hiccups on the back of imposition of LTCG (long term capital gains) tax, liquidity issues, rising bond yields and volatile global markets,” Aggarwal told IANS.

“Also, a surge in crude oil prices impacted the market sentiment. The Indian rupee, too, witnessed a volatile move ahead of Fed rate-hike and global trade war concerns,” he added.

On the currency front, the rupee weakened by eight paise to close at 65.01 against the US dollar from its previous week’s close at 64.93.

“Sentiments were affected by rising crude oil prices, bond yields and a troubled domestic banking system. Uncertainty around the political situation in the country added to the woes, and collectively dragged the sentiment across the street,” Gaurav Jain, Director at Hem Securities, told IANS.

Provisional figures from the stock exchanges showed that foreign institutional investors purchased scrips worth Rs 2,524.13 crore and the domestic institutional investors (DIIs) scrips worth Rs 211.91 crore during the week.

Figures from the National Securities Depository (NSDL) revealed that foreign portfolio investors invested in equities worth Rs 2,060.04 crore, or $316.99 million, during March 19-23.

“The market breadth was negative in three out of the five trading sessions of the week. The top sectoral losers were realty, metal, Bank Nifty and pharma indices. There were no gainers,” said Deepak Jasani, Head – Retail Research, HDFC Securities.

The top weekly Sensex gainers were: NTPC (up 2.90 per cent at Rs 170.15); IndusInd Bank (up 1.36 per cent at Rs 1,750.20); Power Grid (up 1.04 per cent at Rs 194.25); Hindustan Unilever (up 0.05 per cent at Rs 1,299.75); and Larsen and Toubro (up 0.01 per cent at Rs 1,267.75).

The losers were: Yes Bank (down 8.37 per cent at Rs 286.70); ICICI Bank (down 7.48 per cent at Rs 275.80); State Bank India (down 7.13 per cent at Rs 234.60); Tata Steel (down 5.65 per cent at Rs 566.60); and Axis Bank (down 4.29 per cent at Rs 501).

(Porisma P. Gogoi can be contacted at [email protected])

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24% scheme performance indicators of Delhi government ‘off track’



Manish Sisodia

An average 23.7 per cent of output and outcome indicators for various programmes and schemes of the Delhi government departments were “off track” till December last year, analysis of a report tabled in the Delhi Assembly on Wednesday suggested.

The 23.7 per cent of indicators were off track for schemes and programmes of 14 major departments, including Health, Social Welfare and Education, for which funds were allocated in the Delhi Budget 2017-18, according to an IANS analysis of Status Report of the Outcome Budget 2017-18.

The Status Report was presented by Deputy Chief Minister Manish Sisodia.

In the report, the indicators — output and outcome of schemes and programmes — of a department were used to denote whether their schemes were on or off track. Here off track implies the performance or progress of indicators of major schemes of a particular department (till December 2017) was less than 70 per cent of the expected progress.

With 45 per cent indicators off track, the Public Works Department’s schemes performed worst, followed by the Transport Department and the Environment Department, each having 40 per cent of indicators for schemes off track.

The departments whose schemes performed well include the Directorate of Education with 89 per cent indicators of schemes on-track, followed by the Delhi Urban Shelter Improvement Board (DUSIB) with 87 per cent schemes on track and the Delhi Jal Board with 82 per cent programmes on track.

Sisodia said that idea behind the Outcome Budget was to bring a high degree of accountability and transparency in public spending.

The Outcome Budget, which coveres 34 departments of the government, was termed as the “first of its kind” in the country.

Citing an example of Mohalla Clinics, Sisodia said a regular budget tells only about the money allocated for the construction of clinics, while Outcome Budget is about the number of clinics built and the number of people expected to benefit from it.

The Outcome Budget measures each scheme using two indices: output and outcome.

The infrastructure created or services offered due to spending on a particular scheme is termed as output, whereas the number of people benefited and how is termed as outcome.

(Nikhil M. Babu can be contacted at [email protected])

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Will Drabu’s ouster impact PDP-BJP alliance in J&K?

While even Mehbooba’s political adversaries, including the National Conference President, Dr. Farooq Abdullah, have welcomed her decision, her allies in the BJP are not happy at all about her decision.



Jammu, March 15 : The decision by Jammu and Kashmir Chief Minister Mehbooba Mufti to drop Haseeb Drabu from her council of ministers for his remarks at a business meet in Delhi is being hotly debated in political circles – especially what its consequences could be on the state’s PDP-BJP ruling coalition.

By doing what she has done, the Chief Minister has proved that she is prepared take political risks — and taking her for granted is something her colleagues and allies should learn not to do.

Peoples Democratic Party (PDP) leaders were aghast after Drabu, who was the Finance Minister, was quoted as telling a meeting organised by the PHD Chamber of Commerce and Industry in New Delhi that Kashmir was not a political problem and a conflict state but a “social problem”. He said this while seeking investments in the state from businessmen and saying the conditions in the state were conducive to business “where you will find some very interesting opportunities” not just to make money but also to have “a lot of fun and enjoy yourselves”.

PDP Vice President Sartaj Madni had said this was something which negated the very existence of the PDP because it is the firm belief of the party that Kashmir is political problem that needed political remedies to resolve.

Interestingly, instead of voices being raised in Drabu’s favour by his own party men, leaders of the PDP’s coalition unlikely partner Bharatiya Janata Party (BJP) seem to be more worried about the decision to drop him.

Some senior BJP leaders have rushed to Delhi to discuss the development and its fallout on the ruling coalition with the central leadership of the party.

How important Drabu had been for the PDP was proved not once, but many times in the past. The late Mufti Muhammad Sayeed trusted him to work out the terms of the agenda of alliance with BJP National Secretary Ram Madhav that finally paved the way for the present PDP-BJP coalition.

“Mufti Sahib always loved him and would overlook what some of his party men would say about Drabu Sahib,” said a PDP insider, not wishing to be identified.

In a letter released to the media after he was dropped from the cabinet, Drabu expressed sorrow for not being told by the Chief Minister or her office about the decision to drop him.

“I read it on the website of daily ‘Greater Kashmir’. I tried to call the Chief Minister, but was told she was busy and would call back. I waited, but my call was never returned,” he rued.

He also said in his letter that he had been quoted out of context by the media and that he what he had said was that Kashmir is not only a political problem, but that “we must also look beyond this”, Drabu clarified.

Sayeed made Drabu his economic advisor during his 2002 chief ministerial tenure and later made him the chairman of the local Jammu and Kashmir Bank. In fact, Drabu became the point man between the PDP and the BJP after the 2014 assembly elections.

The problem is that many PDP leaders had of late started saying that Drabu was more of “Delhi’s man in Kashmir rather than Kashmir’s man in Delhi”. Drabu is reportedly very close to Ram Madhav, the powerful BJP leader who is in-charge of Kashmir affairs, which many say “cost him his job”. It is this image that has been floating around in the PDP that finally cost him his berth in the state cabinet.

While even Mehbooba’s political adversaries, including the National Conference President, Dr. Farooq Abdullah, have welcomed her decision, her allies in the BJP are not happy at all about her decision.

“What did he say? He said it is a social problem and Kashmir is a society in search of itself. Is this wrong? We don’t think this is something for which such a harsh decision should have been taken,” a senior BJP leader told IANS, not wanting to be named.

His successor, Syed Altaf Bukhari, who has been assigned the finance portfolio, took a major decision immediately after taking over. Bukhari announced that the decision to replace the old treasury system by the Pay and Accounts Office (PAO) has been put on hold. The ambitious PAO system was Drabu’s brainchild.

Bukhari’s decision has been welcomed by hundreds of contractors in the state who had been on strike during the last 13 days demanding their pending payments and suspension of the PAO system at least till March 31.

Would Drabu’s ouster be a storm in a teacup or would it have repercussions on the PDP-BJP ruling alliance in the immediate future? Ironically, Drabu’s PDP colleagues say it won’t be, while the BJP leaders in the state say it would.

By : Sheikh Qayoom

(Sheikh Qayoom can be contacted at [email protected])

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