Posts Tagged ‘anganwadi’
There have in 2016 been several occasions when the work of the Ministry of Women and Child Development has come into the public glare. Not for reasons concerned with the welfare of women and children but instead for the words and actions of its minister, Maneka Sanjay Gandhi, on matters such as abuse of women in social media and paternity leave.
It is however with regard to the subjects that this ministry is concerned with – women and children of Bharat – that the most serious questions arise. As a separate ministry it is only a little over ten years old, having earlier been a department in the Ministry of Education (as the Ministry of Human Resources Development was earlier known) and with the department having been created in 1985.
What does this ministry do? In its own words: “The Ministry was constituted with the prime intention of addressing gaps in State action for women and children for promoting inter-Ministerial and inter-sectoral convergence to create gender equitable and child-centred legislation, policies and programmes.” The programmes and schemes run and managed by the ministry deal with welfare and support services for women and children, training for employment and the earning of incomes, gender sensitisation and the raising of awareness about the particular problems faced by women and children.
The ministry says that its work plays “a supplementary and complementary role to the other general developmental programmes in the sectors of health, education, rural development etc” so that women are “empowered both economically and socially and thus become equal partners in national development along with men”.
In my view there are several problems afflicting this ministry, not only in terms of what it says its work is, but also in how it goes about its work. As was the case in other countries that were once called the Third World (later called “under-developed” or “developing” countries and now called “emerging markets”), the creation of such departments or ministries came about as an adjunct to the worldwide concern about population growth, and which in Bharat had been through a particularly contentious phase in the 1970s.
That in our case a department was turned into a ministry needs to be considered against a background that has become very relevant now, for the year was 2006 and the Millennium Development Goals (or MDGs) had gone through their first set of comprehensive reviews and ‘corrections’. It is relevant because the problems concerning how the Ministry of WCD is now going about its work has to do with the successor to the MDGs, the Sustainable Development Goals (SDGs).
Looking back even only as far as recent weeks, the view, conduct and agency of this ministry calls into question, in my view, the need for it to continue as a separate ministry. Do read TS Ranga who provides a trailer into the bewildering whims and fancies of the minister. And here is a short list of the very substantial problem areas:
1. “Healthy Food to Pregnant Women-Integrated Child Development Services (ICDS)”. This means provision of supplementary nutrition to children (6 months to 6 years), pregnant women and lactating mothers. A variety of measures are needed to ensure provision: ‘Take Home Ration’, a conditional cash transfer scheme to give maternity benefit, ‘Village Health and Nutrition Days’ held monthly at anganwadi centres, tackling iron deficiency anaemia, a national conditional cash transfer to incentivise institutional delivery at public health facilities.
2. “Universal Food Fortification”. Fortification of food items like salt, edible oil, milk, wheat and rice with iron, folic acid, Vitamin-D and Vitamin-A “to address the issue of malnutrition and to evolve a policy and draft legislation/regulation on micronutrient fortification”.
3. “Beneficiaries of Supplementary Nutrition Programme under ICDS”. The increase in the number of beneficiaries is linked to the “Development Agenda for 2016-2030 of the United Nations” (the SDGs). The ministry delivers three of six ICDS services through the public health infrastructure under the Ministry of Health & Family Welfare.
4. “National Plan of Action for Children 2016”. The draft plan is based on principles contained in the National Policy for Children 2013 and categorises the rights of the children under four areas. The draft is being developed by ministries, state governments, and civil society organisations.
5. “ICDS Being Completely Revamped To Address The Issue Of Malnutrition”. The ministry is undertaking a complete revamp of the ICDS programme as the level of malnutrition in the country continues to be high. The digitisation of anganwadis is being taken up for real-time monitoring of every child and every pregnant and lactating mother. The ministry wants supplementary nutrition to be standardised through both manufacturing and distribution.
6. “WCD Ministry and Bill & Melinda Gates Foundation sign Memorandum of Cooperation”. The memorandum is for technical support to strengthen the nutrition programme in Bharat and includes ICT-based real-time monitoring of ICDS services. The motive is for national and state capacities to be strengthened to deliver nutrition interventions during pre-conception, pregnancy and first two years of life. There will be technological innovation, sharing best practices and use of data and evidence.
7. “ICT enabled Real-Time Monitoring System of ICDS”. The web-enabled online digitisation “will strengthen the monitoring of the service delivery of anganwadis, help improve the nutrition levels of children and help meet nutrition goals”. This will help draw the nutrition profile of each village and address the problem of malnutrition by getting real-time reports from the grassroot level. It will start with a project assisted by International Development Association (IDA) in 162 high burden districts of eight states covering 3.68 lakh anganwadis.
8. “Draft National Policy for Women, 2016”. The policy is being revised after 15 years and is expeceted to guide Government action on women’s issues over the next 15-20 years. “Several things have changed since the last policy of 2001 especially women’s attitude towards themselves and their expectations from life”.
9. “Stakeholders Consultations Held For Policy On Food Fortification“. A consultation with stakeholders was held to evolve a comprehensive policy including draft regulations on micronutrient fortification.
What do these tell us?
a) The ministry does not consider either women or children to be part of a family, or an extended family, or a joint family, nor are they part of a village community consisting of peers and elders. The extremely essential months during which women conceive, the post natal period, and the life of the infant until the age of two or three is – under this view – to be monitored and governed by the ministry and its agents. There is in neither of the draft plans mentioned in the points above the briefest mention of culture or community.
b) Such a view, distasteful and profoundly disruptive as it is to the institution of family, has come about because of the influences upon the ministry. Women and children are seen in this view as factors of consumption even within the family, and the decisions pertaining to what they consume, how much and when are to be controlled for lengthy periods of time by implementers and partners of the ministry’s programmes and schemes, which themselves are shaped by an international list called the SDGs in whose framing these women, children and their families played no part.
c) Sheltering behind the excuse of delivering the services of the ICDS, the ministry through its association with the Gates Foundation plans to collect at an individual level the medical data of millions of infants and mothers, for use as evidence. By whom? By the partners of the Gates Foundation and its allies which are the multi-national pharmaceutical industry, the multi-national agriculture and crop science industry and the multi-national processed foods industry. Hence we see the insistence on biofortification, micronutrients, ready-to-eat take-home rations and the money being provided (by the government through cash transfers) to buy these substances. The ICDS budget for the duration of the Twelfth Five Year Plan which ends in March 2017 is Rs 1,23,580 crore – a gigantic sum distributed amongst several thousand projects with a few hundred local implementing agencies including NGOs.
d) These objectives alone are reason enough to have the officials concerned, including the minister, immediately suspended and charge-sheeted for conspiracy against the public of Bharat. It is far beyond shameful that the valid reasons of malnutrition and gaps in the provision of essential services are being twisted in a manner that can scarcely be grasped. The 10.3 million children and women that are in the ICDS ‘supplementary nutrition’ net today form potentially the largest legitimised medical trial in the world, but with none of the due diligence, informed consent and independent supervision required for such trials in the so-called developed countries.
e) The ministry is entirely in thrall to its foreign ‘development partners’ – UNICEF, World Bank, DFID, WFP and USAID. For this reason the ministry has had the closest and cosiest of arrangements, from amongst all central ministries, with non-government organisations (NGOs) foreign and national. The international bodies such as UNICEF and the World Food Program (WFP) and the large national aid agencies (Britain’s DFID and the USA’s USAID) provide programme funding to NGOs international and national who work with and advise the WCD ministry. In the 2000s this was in order to comply with the Millennium Development Goals, now it is for the SDGs, and this is why the policy view of the ministry aligns with the UN SDGs rather than with the needs of our families whether rural or urban.
What is the remedy? The ministry manages several programmes that are critical for a large number of families all over Bharat. However these are programmes that have much in common with the aims and programmes of three ministries in particular: the Ministry of Health and Family Welfare, the Ministry of Consumer Affairs, and the Ministry of Human Resources Development (for matters pertaining to regulation and policy, the Ministry of Law and justice). These three ministries become the natural recipients of the responsibilities borne thus far by the Ministry of Women and Child Development and when such a transfer of allied duties is effected, some of the most important years in the lives of the children and women of Bharat will not become data points and consumption instances for corporations but return to being families.
Agenda, which is the journal of the excellent development news website Infochange India, has issued its new number, themed on hunger and malnutrition. The articles in this collection are a mix of reportage from amongst the poorest rural regions of India, insightful explorations into the nature of nutrition and the change in food systems, and critical views on food and agriculture policy in India.
“Forty-eight per cent of all children under 5 in India are stunted for their age – the impact of longstanding hunger which, in turn, is a result of sheer poverty, marginalisation and a government that clearly does not care,” explained the introductory essay by the issue editor. “Twenty per cent of children are wasted – they are stick-thin because a drought or other crisis has forced the family to further cut back on food. And an outrageous 43% of all children under 5 are underweight – a composite index of chronic or acute deprivation.”
Children in India are especially severely affected. The Integrated Child Development Services (ICDS) programme is supposed to address this extreme deprivation by providing supplementary food, rations and growth monitoring through community-level anganwadis for children under the age of six years. However, though a whopping 70% of children in India between six months and five years are anaemic, 74% of children under 6 do not receive any supplementary food from the anganwadi in their region. Convert those numbers into more than 100 million children who don’t get enough to eat.
I am privileged to have contributed three articles to this issue of Agenda. They are:
What individuals spend on a monthly food basket – Though the amounts spent on cereals are largely the same, there are clear differences between the spending of rural and urban consumers on milk and milk products, sugar and oil. Urban consumers spend 104% more than rural consumers on beverages, refreshments and processed foods.
Approaches to malnutrition and the writ of a compartmented government – The absence of inter-sectoral programmes covering the entire life-cycle of women and children in particular and requiring coordination between different ministries such as women and child development, health and family welfare, agriculture, food processing and human resource development, is the reason why, at the start of the Twelfth Five-Year Plan period (2012-17), the fundamental causes of malnutrition in India remain as they were during the First Five-Year Plan.
Micro, bio and packaged — how India’s nutrition mix is being reshaped – Crop and food multinationals, ably assisted by government, are using the ‘reduce hidden hunger’ platform to push hunger-busting technologies that best suit them — including biofortification of crops, the use of supplementation, and of commercial fortification of prepared and processed foods.
This book is as much about the lives and times of ordinary people as it is about social medicine. It is a doctor’s story about her practice, which lets her extrapolate about the realities of rural India for all Indians. Set in Gadchiroli, a district in central India, known for being an underdeveloped and backward area.
The introduction to ‘Putting Women First: Women and Health in a Rural Community’, tells us that this district is where Dr Rani Bang and her husband, Dr Abhay Bang, set up the clinic for the Society for Education, Action and Research in Community Health (SEARCH) and practised medicine that explicitly catered to the Raj Gond, Madiya Gond, Pardhan and Halibi, the dominant tribal groups, along with non-tribal poor people who live in the area.
This settlement goes back to prehistory and is a part of the ancient Dandakaranya forest mentioned in the Mahabharata and the Ramayana. Rani Bang’s research found that 92 percent of women in this region had no access to treatment for gynaecological disorders in the absence of women doctors. Such neglect was exacerbated by ‘development’ since rural families were, and remain, unprepared for the rapid changes wrought in the spheres of education, information, material enhancement and changes in lifestyle, which impact on relationships and health.
The book plays many roles: a commentary on the ‘chronic myopia’ of a planning process that refuses to see millions of Indians or to think of the ways in which their lives could be bettered; careful observations on the enormous social changes that impact on tribal society where traditional kinship and ecological systems being sorely stressed; and a logbook of case medicine.
In their own way, the Bangs have set in motion a type of revolution that equips people, communities and administrators with the tools to ‘build an indigenous expression of development, one in which the fundamentals of healthcare, interdependence and sustainable economics are paramount’. The last chapter of the book summarises the author’s views on recommendations for policy makers.
I was associated in a small way with the early work that went into ‘Putting Women First: Women and Health in a Rural Community’, and was then asked to write the foreword, a signal honour. I have extracted a few paragraphs of the foreword below, and you can read the full foreword [pdf] here. You can order the book directly from the publisher, Stree Samya, here.
From the foreword:
In shifting to another section of the Gadhiroli (and indeed of the rural Indian) canvas, ‘Putting Women First’ speaks sagely of the manifold aspects of the care our population needs: of regional disparities and critical gaps in the health care delivery system, of infant mortality, obstetric care, maternal and child health, of ‘dais’ and anganwadis, medical termination of pregnancy, and the desperate need for better-staffed primary health centres. “Meeting health needs of women through a system that is sensitive to the differential needs of men and women and their differential access to health care also needs to be taken into account,” recommended the National Commission on Population. Bang-bai’s clinic practices that sensitivity, day in and day out.
The differentials that Search grapples with routinely are daunting. The very premise of girls’ education, especially education of poor girls, is based on an understanding that education is critical to social development, that it leads to lower fertility rates and better child-rearing practices for example. On the one hand, the benefits of women’s education are compelling yet all too often, the struggle for the right of girls and women to education gets reduced to issues of access alone. In general, it has been easier for women’s groups and voluntary groups to work with girls outside the system of formal education, especially the government system of education which is notoriously inflexible.
If one was to describe a large circle around the Search campus, of say 50 kilometres, one would see in the nearby settlements of Aheri, Brahmapuri and on the Raipur road the assembly-line blocks that in rural India purport to be schools. What does it mean to be ‘schooled’ in one of these miserable containers? Conditions in these schools are hardly conducive to meaningful learning – none possesses the very basic set of facilities such as adequate classrooms, toilets and drinking water, teaching-learning materials and libraries. As is the case elsewhere in India, physical inaccessibility, irrelevance of curricula, repeated ‘failure’ and harsh treatment in schools contribute to children dropping out or never enrolling. According to a National Sample Survey Organisation survey (1998), about 26 per cent of those who had dropped out of government schools cited reasons other than poverty – unfriendly school environment, doubts about the usefulness of schooling and an inability to cope with studies. Among girls in rural areas these factors accounted for over 75 per cent of dropouts.