Proposed surrogacy law: Does it address all concerns?
Guests: Shailaja Chandra, Former Secretary, Health and Family welfare, Govt of India ; Dr. Nayana Patel, Medical Director, Akanksha Research and Medical Institute, Anand, Gujarat ; Sunita Reddy, Associate Professor, Centre for Social Medicine, JNU ; Hari. G. Ramasubramanian, Chief Consultant, Indian Surrogacy Law Centre, Chennai ; Sushmi Dey, Assistant Editor, The Times of India.
Anchor: Girish Nikam
Air date: Aug 25, 2016
India’s population stabilisation programmes require the dedicated attention of the CMs of Bihar, UP and Rajasthan.
Written by Shailaja Chandra | Published:July 15, 2016 12:03 am
Scared off by the popular backlash to family planning excesses during the Emergency, India’s political and social leadership abandoned the subject of population growth decades ago. The 10-year goals set out in the Population Policy 2000 were mostly neglected. So when Shanta Kumar, Himachal Pradesh’s former chief minister, resurrected this long forgotten issue and even sought the prime minister’s intervention, it came as a surprise. His fears are genuine but his idea of an all-party meeting is off-track. The problem does not need a political solution. It needs the dedicated attention of the chief ministers of three states — Bihar, Rajasthan and Uttar Pradesh — in whose hands lie the attainment of a goal that 24 states have already realised: Reducing fertility rates to replacement level.
With over 26 million births each year, the country’s population momentum is akin to a super-fast train which cannot be stopped. With determination, it can, however, be slowed down. Stopping the momentum is impossible: It is like telling generations of Indians, including newly-weds, to not have children or to mandate a small family norm. Fortunately, neither strategy is feasible in a democracy.
But chief ministers can certainly encourage people towards an optimum family size and provide couples with the tools to space and limit the arrival of their children — but voluntarily. Such an approach — soft and easy-going as it may sound — has, by and large, succeded.
But what is “optimum”? Demographers agree that if women in child-bearing years produce an average of 2.1 children per head — so as to replace both parents — the population gets stabilised. This number is referred to as the total fertility rate (TFR). Both low and high TFR can pose problems. With Japanese and European couples opting for fewer children, TFR in Europe and Japan has fallen below 1.5; that raises fears of societies disappearing. India’s TFR is presently at 2.3 with huge variations between states.
Kerala and Tamil Nadu achieved the ideal TFR of 2.1 in 1989 and 1992. The good news is that since then, several big states — Andhra Pradesh, Himachal Pradesh, Jammu and Kashmir, Karnataka, Maharashtra, Odisha, Punjab and West Bengal — have brought down fertility rates to replacement levels. Three other states — Gujarat, Haryana and Assam — are poised to join them in a year. The TFR in some states like Goa and West Bengal has fallen to nearly European levels.
Bihar, Rajasthan and Uttar Pradesh (30 per cent of India’s population) are, however, responsible for pulling the country back. Their neighbours, Madhya Pradesh, Chhattisgarh and Jharkhand (10 per cent of the country’s population) have also been tardy but they are moving towards the 2.1 TFR goal; for them the target looks attainable by 2020. The National Family Health Survey and the District Level Health Surveys show that most poor families if assured of two living children do not want more. But this is not the case in Bihar, Uttar Pradesh and Rajasthan where poor parents consciously want more than two children; it is also ironical that the unmet need for contraception is also the highest in these states. Higher fertility levels, early marriages, repeated pregnancies and mothers giving birth in their 40s are exacerbating the problem. Contraception is not used by 50 per cent of those who need it the most.
According highest primacy to population stabilisation in these three states is, therefore, essential. By tracking every married couple in underserved villages, a lot can be achieved. One strategy would be to give incentives to the local health volunteers who should be remunerated for every year’s delay in child birth after the age of 19 (the legal age for women to marry being 18), promoting a gap of three years between children and facilitating family planning methods.
The health minister has recently announced that his ministry will focus on high TFR districts, mostly in Bihar, Uttar Pradesh, Madhya Pradesh and Rajasthan. While this is a good strategy, the engagement of the top leadership is indispensable.
Only chief ministers carry the authority to extract work from the state health bureaucracies. As Tamil Nadu’s example shows, they can requisition the workforce of every department as well that of the private sector. At stake is not just population stabilisation but more importantly women’s liberation and a greater chance for the unborn children to live, learn and become employable. Such reasons to reduce population can swing elections, if presented intelligently.
India’s “demographic dividend” boast is sounding more and more clichéd when one sees the abysmal impact of health and education on millions of young men and women, particularly in the northern states. In the West, the term is used to signify the proportion of working people vis-a-vis the retirees. In India, the so-called dividend is actually represented by disproportionately high number of young people in six high fertility states, many of whom are unemployable. Malnutrition and illiteracy persist.
Shanta Kumar has shown initiative by raising the population issue. He should now find a way of making it worthwhile for the CMs of the lagging states to give primacy to population stabilisation. He should also distinguish between natural growth and population growth caused by unplanned in-migration from other states which is largely responsible for the polluted, slum-ridden picture that he has painted for urban India. That, however, is a matter for another story on how appeasement politics is replacing basic governance.
The writer is former executive director of the National Population Stabilisation Fund.
Indigenous Medicine in India
Country’s first Ayurvedic college started in 1889 at Thiruvananthapuram ( Ernakulum) in Kerala
Indigenous medicine denotes the use of traditional health practices by people in different cultures. While the effectiveness of such knowledge and healing skills is generally inexplicable in terms of cause and effect, traditional medicine continues to be accepted for a variety of reasons. From 2010 to 2013, I was commissioned to write two reports on the Status of Indian Medicine and Folk Healing for the Ministry of Health & Family Welfare.This gave me an opportunity to travel to all parts of the country and observe how three indigenous medical systems in particular had developed over time, besides other tribal and folk healing practices. Ranging from well-equipped National Institutions and highly sought-after hospitals and medical colleges for Ayurveda, Unani and Siddha medicine, to the healing practices of a wide variety single practitioners, traditional healers and bone-setters, my study was facilitated by the state Governments but I had the freedom to select whatever I wished to see. These two paradigms represent two entirely different approaches to indigenous medicine.
The first consists of three codified systems of medicine, firmly locked by complex concepts and elaborate treatises. So impressive is the array of this knowledge that six patent offices in the world have treated the stanzas scanned from the ancient texts to be evidence of “prior art” which had been in the public domain for centuries. India’s Traditional Knowledge Digital Library which is available to patent examiners in six UN languages enabled patent examiners to reject patent claims by referring to the textual evidence rendered into a patent compatible format. Over the last decade hundreds of patent applications have been successfully foiled because the World Intellectual Property Organisation has accepted that the description of plants and diseases given in the ancient Indian texts is clear evidence of the knowledge having been in the public domain and in use for centuries.
India is thus the fountainhead of codified indigenous medicine. Ayurveda, which accounts for some 85% of this sector is practiced throughout the Indian sub-continent and is based upon the balance of three doshas (vaata, pitta and kapha) and the certainty that it is the imbalance between the doshas which is the root cause of the disturbance which then manifests as illness. India is perhaps the only country in the world which recognises four drug-based systems under the Drugs and Cosmetics Act. A separate chapter in the Act regulates the licensing and manufacture of Ayurvedic, Unani (a system which had its origins in Yunaan or Greece) and Siddha medicine – (based on another ancient system but confined to Tamil Nadu and parts of Kerala.
The practitioners of these three systems undergo a five and a half year degree course which is governed by registration requirements exactly at par with those set out for allopathic doctors by the Medical Council of India. Homoeopathy, though a system of German origin, is also regulated by independent statutory bodies which govern education, practice and drug manufacture. Taken together with Yoga and Naturopathy (which have no texts or drugs but which greatly enhance good health,) the group of six is widely known by the acronym AYUSH.
In 1970, the Government enacted a law that created a body for regulating medical education for the AYUSH sector, making college education with a common syllabus and examinations mandatory. The Act did however permit traditional healers who had passed specified examinations prior to a cut-off date to diagnose, treat and medicate individuals who chose to consult them. Many such non-institutionally trained practitioners are no longer alive today. Their progeny, students and unfortunately a few self-styled practitioners continue to treat patients although the law does not recognise such practice. Due to poor enforcement of the law in many parts of the country, unscrupulous quacks claiming to practice indigenous medicine have often cheated unsuspecting patients, thereby bringing a bad name to the sector and its practitioners.
“India is perhaps the only country in the world which recognises four drug-based systems under the Drugs and Cosmetics Act.”
The hope that laws and institutionally qualified practitioners can stop medical malpractice does however risk losing the last vestiges of classical Ayurveda in its purest form. The Ashtavaidyas of Kerala are an institution in themselves. They are families of highly respected Brahmin scholar physicians who hail from a long lineage of vaidyas who have undergone rigorous scholarship and apprenticeship. That kind of Ayurvedic education once had three distinct parts – five years of textual study in Sanskrit, followed by five years of learning about medicinal plants in the forest, and finally five years of apprenticeship under a guru who tested a student’s perception and skills before he was allowed to come into his own. Those who understand the strength of such tutelage question the wisdom of excluding this time-honoured classical approach in the zeal to set standards and bring uniformity.
On another plane, families of Hakims who had practiced Unani medicine for generations now face the prospect of ending a family tradition. Hakim Zafar in Sambhal in Western Uttar Pradesh is an example of a traditional healer who sees more than 300 patients every morning prescribing a combination of dried herbs, which are to be boiled and drunk as a decoction. People visit him regardless of age, gender, religion and language and it appeared to me that they came only for a kind word and to collect the special herbs which created a salubrious effect. A research officer who accompanied me on this particular visit observed considerable commonality with herbs used in Ayurveda. He had however never heard of silk cocoons being a part of any potion!
At the other end of the spectrum of indigenous medicine lies a wide variety of tribal and folk healing practices which continue to be the mainstay of millions of people in remote areas. In the North-eastern states and many tribal areas in India, even when regular health facilities are available, the local people rely on local healers. I took the help of the National Institute of Folk Medicine at Pasighat in Arunachal Pradesh and had the folk healing practices in all the states studied. Although the healers are secretive about the plants they use, every state has its band of well-known practitioners who tend to everyday problems with great confidence.
At the family level, reliance on medicinal plants is a part of family tradition almost everywhere in India. “Gharelu nuske” or home remedies are routinely used for dozens of afflictions – even affecting infants, children, pregnant women and the elderly – in fact the most vulnerable members of a family because the safety and healing properties of these home remedies are well known. The use of ginger and holy basil (tulsi) in a tea-based decoction, eating fenugreek (methi) seeds in yoghurt (dahi) and drinking water in which roasted cumin has been soaked overnight are all time-honoured remedies for colds, coughs, an upset stomach, loss of appetite and general fatigue. The surprising part is that with very little variation, such home remedies are used in almost all regions of the country. Decoctions, teas,the use of grape wine (drakshasava) and an application of medicated oils, condiments and spices is commonplace. Even in nuclear families young people have begun checking the properties and dosage of medicinal plants like Ashwagandha (withania somnifera,), tulsi and ginger by combing internet sites. Indigenous medicine then, is no longer the preserve of vaidyas and hakims. A young, modern clientele, including foreigners in search of “natural products” has begun to use shatavari, triphala and brahmi to name only three products from scores that are available over the counter. Indigenous medicine’s time has come but in a guise that one could not have imagined was possible.
Recent studies are showing another trend with the use of indigenous medicine. Patients are combining modern medical treatment with indigenous medication-believing that this can alleviate symptoms, reduce drug dosage and mitigate the side effects caused by chemical drugs. This is being seen in the treatment of hypertension, diabetes, chikangunya and skin ailments and even tuberculosis and cancer. No one disputes that the drugs manufactured by reputable ASU companies and dispensed by good practitioners have positive effects on quality of life including good sleep, appetite, the most vulnerable members of a family because the improved metabolism and a sense of well-being.
However, self- medication and integration of systems is a new phenomenon largely promoted by literature on the healing properties of plants. There has been little effort to validate this approach and sometimes the positive outcomes baffle both patients and physicians.
Against this backdrop, challenges beset the sector. First,there is the issue of safety and quality. Drugs manufactured by leading companies like Himalaya, Dabur, Charak, and Baidyanath to name just a handful have earned a sound reputation and their products are manufactured, labelled and sold much as modern drugs are. Rarely if ever, are there complaints or questions about quality. The same goes for Unani products manufactured by companies like Hamdard. Family concerns like Dhoot Papeshwar in Maharashtra, Aryavaidyashala in Kottaikal and the Ayurvedic Pharmacy in Coimbatore have a time-honoured reputation built over scores of years – in some cases, the firms have been in existence for more than a century. Some of them have modernised their equipment and processes without compromising on the essentials recounted in the ancient texts. But howsoever good the quality of the products, beyond a point the indigenous systems require a physician who can recognise the signs and symptoms of affliction by diagnosing the constitution or the individual “prakriti “of the patient. That requires patience, skill, insight and experience and naturally the first challenge is to find a practitioner who combines these qualities. Considering the wide range of practitioners and an absence of bench-marking, often this boils down to an individual’s good fortune in finding a competent physician- a factor which deters many from using indigenous medicine. The canvas is much too large and the choice much too varied to find one correct answer.
Photo gallery of interviews with the healers and patients
At one end of the spectrum stand the National institutions for Ayurveda, Unani and Siddha medicine (located at Jaipur, Bengaluru and Chennai respectively) where high standards of teaching and clinical practice are pursued while following a syllabus set out by the Central Council of Indian Medicine which has been patterned on the Medical Council of India. In the process, the Guru-Shishya parampara – personalised, teaching and learning under the tutelage of a teacher has been given up entirely. Almost all Indian medicine a doctor and starting practice has overtaken the need the National Institutes have modelled themselves on allopathic medical colleges and the need to standardise and modernise has replaced the individualised approach which had been the mainstay of traditional medicine for centuries.
The Southern States like Kerala, Tamil Nadu, Andhra Pradesh and Karnataka have some fine institutions which taken together with the Gujarat Ayurvedic University at Jamnagar, the Benares Hindu University at Varanasi and the Choudhury Brahm Prakash Ayurved Charak Sansthan at Kheda Dabur Delhi, still produce practitioners who are confident of practising their system without falling back on allopathic drugs for quick results. This however, is not a uniform story when one goes to the second and third rung of colleges and hospitals across the country where the goal of becoming a doctor and starting practice has overtaken the need to master the classics and diagnostic techniques.
Finally, there is the future of integration at the tertiary level. Towards the end of 2012 when I was completing the second report, I was astounded to find that Medanta a super-speciality conglomerate in Gurgaon had an Ayurvedic doctor working collaboratively with an oncologist, a robotic surgeon and even the cardiologists. The experiences of these super-specialists have been captured in an exhaustive seminar which was organised at the India International Centre in Delhi and is available on you-tube at – https://over2shailaja.wordpress.com/2013/05/05/panel-discussion-at-india-international-centre-on-status-of-indian-medicine-folk-healing-part-ii-on-22th-april-2013/ Medanta’s difference is in catapulting integration to the tertiary level. Ironically, it is here that physicians from two different systems talk to and treat the patient according to his preferences. It is happening on a small but impressive scale but could be the harbinger of things
to come if patients remain satisfied.
During my visit to Bengaluru, I was pleasantly surprised to find an Ayurvedic doctor treating infertility cases referred by a London trained gynaecologist working in one of the city’s speciality hospitals. The gynaecologist, to whom I spoke, could not explain how the Ayurvedic doctor had succeeded in helping some 10 couples to beget a child out of 80 cases referred by her. Examples like this give the hope that barriers can be broken through traditional medicine approaches but the diversions on the way are often daunting.
Traditional & Folk Healing Practices in Manipur
Most people identify Ayurveda as being synonymous with body massage, the slow stream of oil relaxing and cooling the brain and as a process of detoxifying and rejuvenating the body. The five star hotel and spa massages embellished with soothing aromas and rose petals are a miniscule part of the panchakarma regimen which involves over 16 different procedures which are used to treat patients suffering from paralysis, mental affliction, arthritis and spinal injury. Such panchakarma treatment can be observed in every Ayurvedic hospital in the country but it is quite different from the relaxation techniques used for rejuvenation of healthy people. Both fulfil a felt need as it should be.
Although India has achieved a lot, there remains immense scope to rise as a world leader. The way indigenous medicine has adapted itself to modern times has been remarkable. It is time to build on these strengths – not for the survival of practitioners or to meet narrow sectoral interests, but to preserve a heritage which is undeniably unique, efficacious and entirely indigenous. The day that happens indigenous medicine will come into its own!
Traditional and folk Healing Practices in Mizoram
Experts talk about the successes and failures of Kejiwal’s AAP government after as it completes a year.
Guests: Shailaja Chandra (Former Secretary, Delhi Govt.) ; S. Mukherjee (Congress) ; Nalin Kohli (BJP Leader); Badshah Sen (Sr. Journalist) ;Ashish Khetan (AAP) and Anchor: Karan Thapar, Consulting Editor.
Amid the blame game and confrontation between the Aam Aadmi Party-led Delhi government and the Bharatiya Janata Party-led municipal corporations, the indefinite strike of the civic body employees entered its tenth day on Friday. Despite the Delhi High Court’s intervention and a stern warning by commissioners of North and East MCDs to employees to call off the strike and resume duties with “immediate effect or face action”, the striking doctors, paramedical staff, engineers, teachers and sanitation workers are not ready to bow down. They are demanding a “permanent solution” to their salary problem.
Firstpost spoke to former Delhi Chief Secretary Shailaja Chandra and sought to know from her the origin of the present crisis. She said every year the commissioners of the corporation – during her time it was a single entity – would plead for a grant or a soft loan to clear the salaries of the employees, citing reasons why the corporation had run short of funds. Invariably, the lament from the corporation even then was that the finance and urban development departments had not taken important factors into account and omitted making provisions for supporting MCD.
“It was a regular feature and had happened during my tenure as chief secretary as well. But it used to be resolved with some give and take on both sides. The effort being to harmonise the points of view of the finance department and the municipal corporation. Politics never came into the picture. If the impasse continued, the discussions were raised at the level of the chief minister and there would invariably get resolved.
“In no case did the differences reach the media and certainly not the streets by allowing mounds of garbage to accumulate everywhere. The bottom line was very simple: a solution had to be found and citizens should not be harassed, come what may. It was an unwritten understanding and the political executive and officers from the government and the MCD understood this,” she said.
“This dispute is an annual feature and is something that can be resolved. If there are anomalies caused by trifurcation, these have to be addressed and solutions found. The answer does not lie in blaming each other and stopping salaries,” she said.
Asked how the issues used to be resolved earlier, she explained, “There was always disagreement. Either the finance secretary or the chief secretary would take a call. Or if that did not work, the corporation commissioner would raise the level by meeting the chief minister (CM) or the lieutenant governor (LG) and seek their intervention because the matter was not receiving due attention at the official level. Despite the NCT government and the central government being from different and opposing political parties, the CM or the LG always used to give a hearing and take an administrative decision.”
Why is the same not happening now?
Because unfortunately, according to the former bureaucrat, it has become a subject for political grandstanding in full public view. Also worrying is the fact that officers do not seem to be exerting themselves perhaps because their advice is not heeded. “Officers find solutions when they are asked to do it. But if they are told to stay away, why will they give any suggestion and how will anything ever get done? After all, you may have any number of advisers but if you don’t rely on precedents and the institutional memory available confusion will take over,” she added.
Moreover no one, said Chandra, is exerting themselves to raise revenue. “If some drastic improvement is promised through taxation, public will go along but first they must see a tangible benefit which will come in a time-bound manner. If such an approach is adopted, the government may also not mind doing some temporary hand-holding. But one does not find that vision in the corporations,” she said.
The former chief secretary is not convinced that funds of the order claimed have been denied by the Delhi government “because from the figures put out in the press, which have not been contradicted by anybody, it is apparent that the government has been incrementally raising the amount of money given every year. And in no way has it gone down this year”.
It means, according to Chandra, the corporations – particularly the North and the East – have failed to raise property taxes, which is very irresponsible.
When the unit area method of tax calculation was introduced, the understanding was that a Municipal Valuation Committee would be set up every two years which would recommend raising house tax proportionately. There are A to F category colonies and the number of dwelling units is known.
“In such a legislation, one can tax the colonies having more facilities at a higher rate and reduce it as one moves downwards to less affluent areas. But you cannot maintain status quo for more than 12 years, which is what they have done from 2003 (when the Act came into effect). Definitely if the scope of revenue collection is skewed in favour of South MCD (which is considered rich), it has to be set right through discussion and if that fails through legislation. But first the anomalies and the reasons for it have to be pinpointed leaving no room for claims and counter-claims as is happening now,” she said.
Of course, she said, South MCD is the newer part of the city with large organised residential colonies, expensive properties. But always saying that they are rich and we are poor is not a “tenable argument” because it is just a statement.
“Nobody so far has actually given the exact number of properties within the tax net in all the three corporations and the numbers that have been ignored either because of apathy or connivance. For any financial decision, one must have a figure on the number of dwelling units falling in categories A to H and how many dwellers are actually paying you taxes. Whole of the Walled City in North Delhi is also very congested and raising taxes there may not be easy or practical,” she said.
“Another argument is that East DMC has less income because it has too many unauthorised colonies but what proportion of their populace resides in these colonies? Are the regularised ones paying taxes? East DMC must declare the number of the taxable properties lying in its jurisdiction which are not being taxed. If they are in so much in the red, they should think of innovative measures to raise money,” she said and suggested few measures:
Why are people being permitted to park their vehicles on the roads at night? All the three civic bodies can independently or collectively frame policies to charge people heavily for using public space for private use. The same goes for cars and sentry boxes parked on pavements. As for those who display merchandise on the market pavements, they should be liable to be fined heavily or rent taken if they are being permitted to display or sell goods from public spaces.
It needs regulation and enforcement – but neither is being done. In all markets in the city, the pavements have completely been encroached upon. The fine is too low. Why? What steps are the Delhi government and the MCDs taking to increase income?
“I think that there may be a little truth in the fact that when it was a unified MCD, it was easier to take money from one pocket and put it into another and have some sort of equity. But it cannot become a lifetime excuse,” she added.
Asked why the Fourth Finance Commission, as demanded by the BJP, was not implemented and how legal is the Delhi government’s response that it would accept it only if the panel’s recommendation for handing over the DDA is accepted by the Centre, she replied “The recommendations of the Finance Commission could have been considered and implemented during President’s rule but perhaps being a complex and contentious matter, it was left for an elected government to take a view.”
She added: “When the government took over, it took the approach that the Finance Commission’s recommendations should be implemented fully. Along with the devolution of a percentage of the Delhi government’s resources on the MCDs, it has been stated by AAP spokesmen on TV channels that there were recommendations relating to handing over DDA to the Delhi government. But so far, no one has belled the cat. On a broader plane, if the report has indeed made recommendations relating to the DDA (I have not read the report ) but if it is correct, it is totally outside the purview of the Finance Commission. DDA deals with land, which is not constitutionally under the Delhi government. So, in a way, the AAP government is asking for a constitutional amendment while highlighting the narrow recommendation relating to the DDA. Therefore, it is not implementable and the whole matter has remained up in the clouds.”
Speaking from Bengaluru, where he is undergoing naturopathy treatment, Chief Minister Kejriwal on Wednesday announced a bailout package of Rs 693 crore in a bid to woo the agitating workers of the municipal corporations. He also said, “You cannot tell us to give the money and not give us DDA which is our due and integral to the Finance Commission’s recommendation.”
एमसीडी कर्मचारियों की हड़ताल जब 8वें दिन पंहुची, तब जाकर दिल्ली के मुख्यमंत्री अरविंद केजरीवाल और उप-राज्यपाल हरकत में आए। केजरीवाल ने बेंगलुरु से ही कॉन्फ्रेंस की और एमसीडी में भ्रष्टाचार और तनख्वाह के पैसों की हेराफेरी का आरोप लगाया है। बहरहाल दिल्ली सरकार ने हल निकालने का दावा करते हुए 693 करोड़ रुपये का इंतजान कर दिया है।
Guests: Shailaja Chandra (Former Bureaucrat) ; Alka Lamba (APP) ; Ravindra Gupta (Mayor, NDMC BJP); and Nidhi Kulpati, Anchor .
As the Delhi Municipal Corporation employees’ strike entered its 8th day, thousands of sanitation workers protested on the capital’s roads, dumped garbage and choked roads. They allege they haven’t been paid their salaries for over 2 month. 16,000 teachers, 7,000 doctors of civic body-run organisations also joined the strike as schools and hospitals ceased to function. The Delhi Chief Minister, Arvind Kejriwal, has accused the BJP of instigating the strike and alleged massive corruption in BJP-led civic bodies. He also said he would loan Rs. 550 crores to agencies so they could pay what they owe the workers.