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Time of India
2 days ago
- Health
- Time of India
Policy should focus on well-being than population control: Experts
1 2 Bhubaneswar: Ahead of World Population Day, experts said here on Wednesday that there is a pressing need to revise population control strategies according to demographic indices. The shift must be towards well-being and healthy ageing rather than population control, they observed. Binod Kumar Patro, professor of community medicine and family medicine at AIIMS Bhubaneswar, said India achieved the total fertility rate (TFR) targets by 2022. "India's TFR stands at 2.0, as per the 2022 Sample Registration System (SRS) report released in June this year. This means, on average, a woman in India is expected to give birth to two children during her reproductive years," he added. "While it is a remarkable achievement for India to have a fertility rate below the replacement level of 2.1, it masks significant differences across the states that demand state-specific policy approaches rather than blanket solutions," said Patro. A TFR of below 2.1 children per woman indicates that the population is declining. States like Bihar, Uttar Pradesh, and Madhya Pradesh have TFRs above the replacement level, whereas Sikkim has the lowest TFR of 1.1. by Taboola by Taboola Sponsored Links Sponsored Links Promoted Links Promoted Links You May Like One of the Most Successful Investors of All Time, Warren Buffett, Recommends: 5 Books for Turning... Blinkist: Warren Buffett's Reading List Click Here Undo Similarly, Tamil Nadu, West Bengal and Odisha have TFRs of 1.3, 1.4 and 1.7, respectively. "The one-size-fits-all approach to population policy has outlived its utility. While the country has successfully stabilised overall population growth, with an average TFR of 2.0, which is below the replacement level, the complex challenge now is to manage different demographic stages across various states. It requires tailored approaches that address each region's specific needs and challenges," said Patro. Amarendra Das, an associate professor of humanities and social sciences at NISER Bhubaneswar, said India will have to worry about decline in population by 2047. "We need to think about and prepare a policy to tackle the problem. TFR of 11 states, including Odisha, is decreasing, which means population growth is stabilising there," he added. He said a support system should be provided to couples to encourage having a second child. "A crèche system at different govt and private offices should be made mandatory. Govt support in terms of leaves and other assistance should be given to couples having a second child," he added. B M Otta, former professor of population studies at Fakir Mohan University, Balasore, said the govt should consider preparing tailor-made policies, keeping in mind the TFR rate of the states. "When policies were framed for population control, we were struggling to bring down the increasing population of the country. But now the situation is changing fast," he added.
The Hindu
5 days ago
- Health
- The Hindu
Fostering a commitment to stop maternal deaths
In childbirth in India, why should 93 women lose their life while one lakh women have a safe delivery? For the time period 2019-21, the Maternal Mortality Ratio (MMR) estimate for India was 93, in other words, the proportion of maternal deaths per 1,00,000 live births, reported under the Sample Registration System (SRS). 'Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes'. But the MMR in India has declined over the years — it was 103 in 2017-19, then 97 in 2018-20 and now 93 in 2019-21. To understand the maternal mortality situation better, States have been categorised into three: 'Empowered Action Group' (EAG) States that comprise Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan, Uttar Pradesh, Uttarakhand and Assam; 'Southern' States which include Andhra Pradesh, Telangana, Karnataka, Kerala and Tamil Nadu; and 'Other' States that cover the remaining States/Union Territories. In the group of 'Southern' States, Kerala has the lowest MMR (20) and Karnataka the highest (63). The rest of the data is Andhra Pradesh (46) Telangana (45) and Tamil Nadu (49). In the EAG States, Assam has a very high MMR (167); the rest of the data is Jharkhand (51), and Madhya Pradesh (175). Bihar, Chhattisgarh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand are in the 100-151 range. In the category of 'Other' States. Maharashtra is 38 and Gujarat 53; the rest of the data is Punjab 98, Haryana 106 and West Bengal 109. We need to have a differential approach in strategy to reduce maternal deaths in the different clusters of States. In this, addressing three issues is fundamental. There are 'three delays' that lead to a mother dying, according to Deborah Maine of Columbia University — I had incorporated this in the training module on 'Safe Motherhood in India' in 1992. Key factors that endanger a life The first delay is in recognising impending danger and making a decision to rush and seek expert care. The husband and other family members often experience inertia, thinking that all deliveries are a natural process and so the mother-to-be can wait. Or they may not have enough money or other issues at the family level that prevent them from going to a hospital. If the educational level of family members and their financial position are weak, delaying decision making is detrimental. But empowered, neighbourhood mothers and women's self-help-groups have resulted in a remarkable change; no longer is a mother-to-be neglected by lethargic family members. Ever since Accredited Social Health Activists (ASHA) began networking with Auxiliary Nurse Midwives (ANM) since 2005 (when the National Rural Health Mission (NHRM) was launched), institutional over home deliveries have become the better option. The financial incentives for the mother and ASHA were the turning point. The second delay is in transportation. From remote rural hamlets and forest settlements or faraway islands it may take many hours, or an overnight journey for a mother-to-be to reach a health facility with a skilled birth attendant (midwife/staff nurse) or a doctor or an obstetrician. Many women die on the way. However, the 108 ambulance system and other Emergency transport mechanisms under the National Health Mission has made a difference. Other problems The third delay, an unpardonable one, is in initiating specialised care at the health facility. The excuses are plenty and difficult to justify — a delay in attending to a woman in the emergency room; a delay in reaching the obstetrician; a delay in getting a blood donor, in laboratory support, the operation theatre not being ready, an anaesthetist not being available is a list that can go on. The concept of the operationalisation of a 'minimum four FRUs [first referral units] per district of two million population, is crucial. The 'first level referral unit' with specialists such as an obstetrician, anaesthetist, paediatrician, blood bank and operation theatre was aimed at preventing maternal death at the doorstep of a hospital. Unfortunately, this has not worked out as expected since 1992. There are problems such as 66% vacancies of specialists in 5,491 community health centres out of which 2,856 are supposed to be FRUs in 714 districts. The lack of blood banks or blood storage units in these designated FRUs was another reason for many mothers not receiving adequate blood transfusion within two hours of the onset of massive bleeding after delivery, leading to fatalities. The biggest killer is bleeding after delivery. This could be due to inadequate and timely contraction of an overstretched uterus with a baby of three-kilogram weight floating in amniotic fluids. When the placenta is separated after delivery, the raw opened surfaces of the uterine wall will bleed profusely unless it immediately contracts. From a total reserve of five litres of blood, more than half is lost in such a short duration, resulting in the mother going into shock and death. If there is underlying anaemia, which has not been treated with iron folic acid supplements in pregnancy, it will also result in tragedy. Thus, there is a need for immediate blood transfusion and emergency surgical care. The next emergency is obstructed labour where the contracted bony pelvis of an already stunted young mother (who is also malnourished and has low body mass index) does not allow the normally grown baby to emerge. Prolonged labour can lead to foetal distress and a lethal rupture of the uterus. This can be avoided by a Caesarean section. Thus, there is a need for a well-equipped operation theatre and obstetrician/ surgeon and an anaesthetist on call. The third medical cause is hypertensive disorders of pregnancy that are not recognised and treated on time. They can result in a dire emergency with convulsions and coma and very little time to medically control high blood pressure. There are some home deliveries by untrained birth attendants which lead to trauma and puerperal infection, resulting in sepsis and death. Antibiotics could have saved their lives, but the patient is admitted to hospital late. A failure of contraceptive devices, resulting in unwanted pregnancies and crude abortion techniques by quacks, also leads to sepsis and death. In EAG States, associated illnesses such as malaria, chronic urinary tract infections and tuberculosis are also high risk factors. The focus areas for States The prescription for averting maternal deaths is early registration and routine antenatal care and ensuring institutional delivery. Many of these systemic deficiencies will be highlighted in the mandatory reporting and audit of all maternal deaths under the NHM. While the EAG States have to focus on the implementation of basic tasks, the southern States group and probably Jharkhand, Maharashtra and Gujarat need to fine tune the quality of their emergency and basic obstetric care. The Kerala model of a Confidential Review of Maternal deaths, initiated by Dr. V.P. Paily, has some analytical leads on how Kerala can further reduce its already low MMR of 20. It is a model other southern States can emulate. The use of uterine artery clamps on the lower segment, application of suction canula to overcome atonicity of the uterus, and a sharp lookout for and energetic management of amniotic fluid embolism, diffused intravascular coagulation, hepatic failure secondary to fatty liver cirrhosis are strategies taught to obstetricians, which even developed countries have yet to practise routinely. They even address antenatal depression and post-partum psychosis as there were a few cases of pregnant mothers ending their life. Finally, if there is a commitment and a will to stop preventable maternal deaths there is no limit to the varieties of proactive interventions. Dr. K.R. Antony is a Public Health Consultant in Kochi, Kerala, and drafted the first Safe Motherhood module for the Ministry of Health on behalf of UNICEF. The writer acknowledges inputs on the Confidential Review of Maternal Deaths in Kerala from Dr. Smithy Sanel, a Spokesperson of the Kerala Federation of Obstetrics and Gynaecology
Time of India
03-07-2025
- Health
- Time of India
Suicide is killing young Indians more than cancer, diabetes, or heart disease
Suicide is killing young Indians more than cancer, diabetes, or heart disease Bansri Shah Jul 3, 2025, 23:32 IST IST One in six deaths among India's young is by suicide — a rate that hasn't budged in two decades. Are we underestimating the scale of this tragedy? A recent study shows that of all the deaths in the age group 15 to 29 in India, one in six is due to suicide. The number, alarmingly high for a country with a very large young population, has remained stubbornly consistent over the past two decades. This figure, drawn from the Sample Registration System (SRS) Cause of Death Report for 2020–2022, offers grim proof that India's youth are in crisis.
The Hindu
30-06-2025
- Politics
- The Hindu
Voter verification drive in Bihar: too little time, too many hurdles
The Election Commission of India (ECI) recently issued an order for holding Special Intensive Revision of Electoral Rolls for Bihar. This exercise will then be carried out in all the States. The order is antithetical to the tradition of this august institution. From the first election held in independent India, the ECI has played a heroic role in seeding democracy through active voter enrolment and protection of the right to vote of the disadvantaged. Though the ECI is facing a credibility crisis of late, this initiative is surprisingly radical. And unless it is substantially modified, it will disproportionately disenfranchise the poor and deprived electors irrespective of their party preference. We will leave the thorny questions of legality to the experts and just focus on the scale of the venture and its practicability within the proposed timeline. As per the directive, all individuals who have not been featured in the electoral rolls of 2003 need to prove their citizenship as per the Citizenship (Amendment) Act, 2003, and Rules. Broadly, if the 2003 electoral roll features nearly all individuals who were 18 years or older then, these individuals, now 40 years and older, get a direct entry into the proposed electoral roll. How many then have to go through the hoops? The affected population In 2020, the Ministry of Health and Family Welfare published a report, Population Projections for India and States 2011-36. The report estimates the current voting age population of Bihar to be 8.08 crore. About 59% of this population (4.76 crore individuals) is 40 years old and under. The ECI, from July 1 to July 31, requires this staggering number to prove citizenship. In its press note of June 28, the ECI stated that the electorate count in Bihar is 7.9 crore. As per the ECI, as '4.96 crore of the 7.9 crore already have their names in the last intensive revision of electoral rolls' in 2003, just 2.94 crore individuals will need to submit their eligibility documents. This is clearly an oversight. The electoral roll of 2003 for Bihar did have around 4.96 crore individuals. By our calculations from the reports of the Sample Registration System, around 1.1 crore of them are dead. The ECI has taken them off the rolls. Plus, there is sizeable number of people who have permanently migrated out of Bihar. As per a paper by Pinak Sarkar, Professor at the Tata Institute of Social Sciences, deriving from the Census, 93 lakh people permanently migrated out of Bihar between 2001 and 2011. Even if migration has slowed a bit after 2011, an average of 8 lakh out-migrants a year from Bihar in the period 2003-24 would mean a total of 1.76 crore out-migrants. If the share of those over 18 years of age in the 1.76 crore group is the same as the proportion in the Bihar population, this amounts to 94 lakh voters who have migrated out of Bihar permanently. If even one fourth of them remain electors in Bihar, 70 lakh are no longer electors in Bihar and are voting elsewhere in India. The ECI would have taken them off the Bihar electoral rolls. Hence, of the 4.96 crore electors in the 2003 list, if we remove those who are dead and those who have migrated from Bihar permanently, around 3.16 crore electors remain in the present count of Bihar's electorate. These 3.16 crore people who were also on the 2003 list do not need to submit any eligibility documents. The rest of the 4.74 crore individuals (7.9 crore-3.16 crore) need to submit their documents. This figure is very similar to our 4.76 crore estimate based on population projections. The ECI requires this staggering magnitude to prove its eligibility to vote within a month. Proof of citizenship What is this proof of eligibility? The ECI says a copy of one document in a list of 11 needs to be presented. Seems simple? Perhaps for some other State, but certainly not for a document-scarce State such as Bihar. Let us list the 11 documents and look at the data that is publicly available for our demographic of 18-40 years. The first is identity card/pension card of State government/ Central government/public sector undertaking. As per the 2022 caste census, 20.47 lakh Biharis have government jobs. Fewer than half of them will be from the 18-40 age group and pertain to less than 2% of this group. The second is an identity card issued before July 1, 1987. This is not applicable. The third is a birth certificate. As per the National Family Health Survey-3, 2.8% of Bihar's population born between 2001 and 2005 possess a birth certificate. Much of our age group of interest was born before 2001, so a negligible proportion possesses this document. The fourth is a passport. Around 2.4% of Bihar's population possess a passport. The share would be higher in the 20-40 age group but would not reach double digits. The fifth is a matriculation certificate. Deriving from the National Family Health Survey-2 and National Family Health Survey-5, around 45-50% of 18-40-year-olds are matriculate. As of 2019-20, there is a 10% point gap overall between male matriculates and female matriculates: females are at a definite disadvantage The sixth is domicile. In-migrants in Bihar are an insignificant proportion of the population. The seventh is a forest rights certificate. The share of Scheduled Tribes (ST) in Bihar is 1.3%, according to the 2011 Census. Of them, those living in forests form a much lower share. The eighth is an Other Backward Classes (OBC)/Scheduled Castes (SC)/ST certificate. Data from the India Human Development Survey-2, analysed by Professor Ashwini Deshpande and Rajesh Ramachandran in The India Forum, notes that around 20% of SCs, 18% of OBCs, and 38% STs had a caste certificate. Considering that almost no upper castes possess caste certificates, around 16% of Biharis possessed a caste certificate in 2011-12 when this survey was conducted. Those eligible individuals who are 30-40 years of age today would already have obtained a caste certificate by 2012 had they wished; even if the rest obtain caste certificates in a higher proportion, overall not more than one in four households are likely to possess this document. The ninth is the National Register of Citizens. This is applicable solely to Assam. The tenth is the family register. This is also not applicable to Bihar. The last is a land/house allotment certificate by the government. There is no data available on land allotment certificates. House allotment certificates seem applicable to government employees availing government housing. No such certificate is given to beneficiaries of schemes such as the Pradhan Mantra Gram Awas Yojana. Most people without a matriculation certificate are unlikely to apply for a passport, a government job, or a caste certificate. By the ECI's new rule, the matriculation certificate has effectively become the main eligibility proof for voters aged 18 to 40. This shifts us from adult franchise to a system that favours only matriculates. As a result, around 2.4 crore-2.6 crore people who had to leave school due to poverty may now be left out of the voters' list. The final number of people disenfranchised will be even larger than this if we add the over 40-year-olds who have been missed in the 2003 voters' list and those over 40 whose present names don't match with those in the 2003 voting list. These hundreds of lakhs of people will lose their constitutional right to vote not because they are illegal migrants but because they are illegible to a State which lacked the capacity to issue birth certificates, render basic education, or issue caste certificates to the deprived castes. A State cannot penalise so many people for its own shortcomings. Why not Aadhaar? This also begs a simple question: if the ECI allows for OBC/SC/ST certificates, why is Aadhaar not allowed if the proof of identity document for a caste certificate is Aadhaar? It should not be that Aadhaar's major flaw is that it is more available — around 9/10th of the Bihar population possess it. Does the ECI believe that it has issued voter cards to non-citizens? Also, why not allow ration cards? Yet, even if the list of allowable documents is modified to be more inclusive, the project will disenfranchise people or become a bureaucratic waste because of the sheer paucity of time. Let us suppose that all the 4.76 crore who are asked to submit documents do so: that is, on an average, 1.95 lakh per constituency. Each constituency has one electoral registration officer (ERO) who has numerous other important duties. (The ECI website has no information on there being any assistant EROs in Bihar.) In the 62 days between July 1 and August 31, they have to scrutinise almost 2 lakh applications, prepare a draft roll, issue a notice, and launch a suo moto enquiry to each elector whose eligibility is doubted. That is a superhuman task. Rahul Shastri is a researcher associated with Bharat Jodo Abhiyan
The Hindu
30-06-2025
- Politics
- The Hindu
Bihar has consistently lagged in registering births, shows govt. report
According to the 2009 Civil Registration System (CRS) report compiled by the Registrar General of India (RGI), the level of registration of births in Bihar in 2000 stood at 3.7% compared to the national average of 56.2% the same year. The total number of births registered across the country in 2000 was 1,29,46,823. For those born in 2004 and 2005, the level of registration in the State was 11.5% and 16.9% respectively. The countrywide registration was 60.4% in 2004 and 62.5% in 2005. The total registered births in 2004 and 2005 were 1,57,77,612 and 1,63,94,625 respectively. The 2009 report said that 'in order to quantify the impact of Bihar and Uttar Pradesh, which are performing abysmally poor for the last so many years, the level of registration for the country excluding these two States have been worked out,' which rose to 78.3% in 2005. Significant gap 'On comparison of estimated and registered births, it is found that there is significant gap in estimated and registered births in Bihar, Uttar Pradesh and Andhra Pradesh,' the report said. The Special Intensive Revision (SIR) of electoral rolls, which is currently going on in Bihar, stipulates that those born in India after December 2, 2004 would have to provide any 11 documents, which include birth certificates, establishing their date of birth and/or place and furnish similar documents belonging to the father and mother of the applicant also. There were over 7.72 crore electors in Bihar during the 2024 Lok Sabha election. The Election Commission of India (EC) on Monday said 4.96 crore electors do not need to submit any documents as they can verify their details from the 2003 electoral rolls when the last such exercise was carried out. The Union Home Ministry amended the Registration of Births and Deaths Act, 1969 in 2023 that mandated digital birth certificates for those born after October 1, 2023 for admissions in schools, colleges and for updating electoral rolls. However, periodic CRS reports show that not all births are registered. On March 17, the RGI office cautioned private and government hospitals to report incidents of births and deaths within 21 days after it was found that many medical institutions were flouting the law adding that nearly 10% births were not getting registered. 'To get an idea as to the coverage of civil registration in the country, the data generated from the Civil Registration System (CRS) has been compared with corresponding estimates thrown up by the Sample Registration System (SRS),' the 2009 report said. CRS and SRS While CRS is the actual numbers, SRS is the largest demographic survey in the country mandated to provide annual estimates of fertility and mortality indicators at the State and national level. The EC's move to conduct SIR has invited criticism from Opposition parties terming it as a move to bring the National Register of Citizens (NRC) through the backdoor. All India Majlis-e-Ittehadul Muslimeen (AIMIM) president Asaduddin Owaisi said the government should furnish the data on total number of illegal migrants in the country. 'How is the BLO (Booth Level Officer) going to scrutinise the documents? Why should people pay penalty for government not keeping a check on illegal migrants. The officials can also report people if they doubt their citizenship. We want to know the criteria that was followed during the SIR in 2003,' Mr. Owaisi said. In 2022, as many as 2,54,39,164 births were registered. In 2022, Bihar was among 14 States where the 50%-80% births were registered in the stipulated 21-day period. The State registered 71% births within the prescribed limit of 21-days.
