More than a Policy, Children Need Commitment!
On 10th June 2014, Pawan Korku (4 years) and Durgesh Korku (6 years) climbed into an iron drum in their house along with their toys presumably as part of a game they were playing, in their house in Harrai village, District Betul, a tribal dominant district of Madhya Pradesh The children’s father, Bheem Korku had left for his daily wage work in the morning and their mother, had gone to the market to fetch household items. When the mother got back home, she looked for the children but could not find them. Around the same time, Bheem Korku also returned home. While looking for the children, he opened the lid of the iron drum and was shocked to see the dead bodies of his children, Pawan and Durgesh. They had died due to suffocation. One can only imagine what must have happened!
Pawan was registered in the local Anganwadi Centre, however was left home alone with his brother as the centre was open only for a few hours in the morning. Clearly, a ghastly crime has occurred. Two innocent lives have been lost for no reason. But, who is to blame? Who is the criminal?
A study conducted at S. N. Hospital, Agra in the year 1992 found that out of 5031 children into the hospital in a period of one year, 716 children were there because they had met with some kind of an accident. Amongst these children injured in accidents, a large proportion were children in the age group of 4 to 5 years. 44.4% children had sustained injuries due to falling! As many as 82 children had burn injuries and 45 children had consumed poisonous substances in their homes. It was observed that about half the accidents (48.9%) occurred during 12 noon and 6 pm, a time when parents are usually at work.
A study on childhood injuries based on data from Bangladesh, Columbia, Egypt and Pakistan published in the World Health Organisation (WHO) Bulletin in 2009found that of the 1559 injured children (< =12 years) across all four sites, 56% (941) cases were below 5 years of age. Further, 872 (63%) injuries took place when the children were at their homes; and did not have anyone’s protection.
Findings of a study of 788 children in Gujarat published in the Internet Journal of Family Practice points out that 64.1% boys and 54.7% girls of age below 5 years at risk of electric appliances within reach in their home. . As many as 91% children in the Urban slum area were exposed to fire as it was within reach in their homes and was generally considered safe by the parents. 61% children were at risk of household chemicals being within reach.
An important report on situation of children brought out by the Ministry of Women and Child Development in year 2007 reports that when women go out for work, they have to leave older girls of the family either at home so that they may look after their younger siblings. With the proportion of women joining the workforce increasing at a steep rate, it becomes crucial to ensure that child protection and ensuring their care and nutritious diet is ensured at every level.
According to the national commission set up to look in to the situation of those working in unorganised sector, there are 148 million working women in the country out of whom 142 million are in the unorganised sector. There are 310 million women in India in the age group 15-49 years. Women’s work in the household and in care activities remains largely unorganized. We are all aware that women put in long hours in household work including in child care, household chores, unpaid work on family farms, animal care and so on. Time use studies report that while men are engaged for 9 to 10 direct work hours daily, women effectively work for as many as 16 hours a day. There are hardly any facilities available for women and families to ensure care for their children while they work. In the instanceof Pawan’s mother, although she had not gone for wage related work, it cannot be negated that she was very much engaged in household work. Adequate care facilities are essential for children like Pawan and Durgesh.
Had the Anganwadi Centre at Harrai been working as a crèche, Pawan could have been there under its care and alive today. Scientific evidence shows that children attain 90% of their mental development by the age of 5 years. It is vital that children are provided with care, protection and safety along with nutrition, health care and early learning during these crucial years. This is the time when children start understanding relationships and affiliations and begin trying to learn by themselves. This is the stage when children are so curious that they try to pick up everything, throw them, or try to feel the taste by putting things in their mouth. They may reach any nook and corner or climb somewhere in order to satisfy their curiosity. All these are essential activities of the child. These activities cannot and should not be prevented as child’s development evolves from them. What is needed is an alert and caring attention so that the activities do not harm the child.
On the one hand, we have to ensure that children under 5 years of age receive adequate nutrition, are able to learn and have access to basic health care in a hygienic setting. On the other hand, it must be ensured that the dignity of woman’s work is recognised, whether she works for her household as a homemaker or outside for an income. She must not be burdened with triple load, rather she should be facilitated to remain free and active by providing for community crèche services. The studies referred to above clearly show that in the absence of appropriate child care facilities children are exposed to the risks of accidents and injuries, along with missing out care and attention that such young children require. Moreover, we cannot keep our eyes closed to the fact that we have had 387 cases of rape inflicted on children under 5 years of age in the last 14 months!
Though the Ministry of Women and Child Development has formulated a policy on Early Childhood Care and Education, there have been no proactive measures for putting up an institutional structure for the efficacious implementation of the policy. Anganwadi Centres have been operational in India under the Integrated Child Development Services since 1975. These centres look after children for only a few hours a day and therefore are not in a position to become an allied support mechanism for children’s development and the women. Moreover, these centres are not open for the care of children under three years of age. At present, there are 1.34 million Anganwadi Centres in the country. These centres have registered 84.1 million children under the age of 5 years..
A scheme known as Rajiv Gandhi National Crèche Scheme was designed for children of working women. However, the scheme does not recognise the value of women’s work and labour in their own homes. There are 17603 crèches operational under this scheme serving 387,000 children. In addition, 14700 private crèches are also working. Only 1 million children (1.2%) in the country are receiving any daily care services. Responding intensive efforts, the 12th Five Year Plan recognises the need to establish mandatory crèches for care of children and support to women. Crèches can also help address the challenge of malnutrition by providing appropriate local nutritional diet and an institutional arrangement for securing development of all children. Accordingly, the Plan visualises the transformation of all Anganwadi Centres in to crèches. In practice however, it is being planned to convert only 5% centres, i.e. 70,000 centres into anganwadi cum crèches over the entire Plan period of 5 years. The Plan is also silent on the schedule of providing a crèche in every hamlet. According to the Census 2011, there are 73.7 million children between the ages of 3 and 5 years who are supposed to receive their basic right to preschool and have yet to get the same. Out of these children, 54.5 million children reside in rural areas. While the high-income group of the country is seeking to access these services through the private sector, 98% children are deprived of the right to basic services, because of caste discrimination, social neglect and exclusion.
Most people might dismiss the idea of crèches for all children who require it as being too expensive or a luxury. The fact remains that crèches have multiple benefits along with provided proper care to children in the absence of alternate adult care-givers being available at home. They could help to recognise well in time children’s illnesses and the impediments coming in the way of their development so that the same can be duly addressed. Crèches can help in ensuring that every child gets full immunization, growth monitoring and receives age-appropriate nutritious diet. This can help save 200,000 children’s lives in a year and millions of children can realise their cherished dignity. The ‘strong’ Government of India at present is in the midst of crafting a roadmap on this. Will the roadmap reflect the commitment for basic rights for all children in a non-discriminatory manner?
Better days without maternal entitlements?
Going by the population growth records during Census Years 2001 and 2011, on an average 19 million births take place in India every year. Presently, the Maternal Mortality Ratio (MMR) of India is 178 (number of maternal deaths occurring in a year per 100,000 live births). Accordingly, as many as 34000 women lose their lives due to pregnancy and delivery complications. Further, the World Bank estimates that for every 190 deaths of women, one woman dies due to the risks associated with motherhood in India. It means that the fundamental maternal entitlements are not accruing to the women in our country. A 30-words provision in National Food Security Act 2013 (NFSA, 2013) now accords this entitlement to 390 million women in the country, notably to those working in the unorganised sector and those who manage their households (toil without any wages).
So far, the approach of the governments and the society has been replete with neglect and disregard for women’s right to survival with dignity and equality. The provision in the NFSA, 2013 commits a financial entitlement of Rs.6000/- to all eligible pregnant women and lactating mothers (except those who are in regular employment with the Central Government or State Governments or Public Sector Undertakings or those who are in receipt of similar benefits under any law for the time being in force) in such instalments as may benefit them in going through their pregnancy and delivery. This is just a beginning. The International Labour Organisation (ILO) defines the maternal entitlement as comprising paid leave for a period of 14 weeks, daily and regular recess for rest for the mother in her work so that she may look after the needs of the infant, health checkup, and security.
Organisations struggling for the maternal entitlements have duly proved that every woman is a working person irrespective of working to earn an income or run the family household. With this perspective in view, every woman has right to maternal entitlements. The National Sample Organisation reports that 59% women in the age-group 15-49 years have primary vocation of looking after their family household whereas only 0.4% men perceive managing the household as their primary role. It is thus clear that household work is not valued because the women undertake it and not the men. Two years back, a study was published about the Garhwal Himalayan Region of Uttarakhand in the Mountain Research Journal. It was titled, “Contribution of Women in Food & Economic Security of the Family”. The study points out that the women respondents of the hilly region had told the study team that ‘they did not do any work’. However, when the study data was analyzed, it emerged that the men worked for an average of 9 hours a day, whilst the women were engaged in work for as much as 16 hours a day! Had the government rate of minimum wages been applied, the men’s earning would be only Rs.128 per day as against that of the women at Rs. 228 per day. Their unpaid work across the sections (from family to community) is understood, as women do not work.
The study brings out that activities and work including fetching the firewood from the forest, collecting the feed for the animals and rearing the children etc. are not considered as important and income generating tasks because these do not entail any expenditure of money. However, the fact is that these tasks too are skilled ones and place a significant demand on physical effort. When tasks and activities like this were assessed in terms of monetized value (if someone were to be paid a remuneration for undertaking the same or some of the items were bought out), the family would have had to annually shell out an amount of Rs. 34168/- towards bringing firewood, animal feed, honey, water and vegetables etc.). Since the woman in the household undertakes all this without any remuneration, the work is considered to be devoid of economic value. Therefore, these women too are entitled to maternity rights so that they may be able to get over the stresses of different stages of reproduction and go through the motherhood, in a safe and dignified manner. Life of women in India does not appear to be less than an imaginary tale. The society known for taking pride in ensuring woman’s respect and dignity does not appear to be taking any stand when it comes to accord respect to maternity entitlements. Being pregnant is just seen as a natural and social event which keeps the society dynamic. Towards this end, the lives of Indian women continue to remain at stake, with the threat of (maternal) death always looming large over them. Whilst the paternalistic society regards reproduction process as very significant, our governments are generally seen to be positioned against the interests of the women, when debates on the needs and issues on endowing them with concomitant rights and entitlements are flagged. Today when the people are being ‘sold’ the dreams for a better society across the plateaus of public movements and election processes, the moot question is how one can imagine good days without taking in to consideration the right to maternity entitlements.
Maternity entitlement include the leave without losing salaries and wages and that too without deeming any break in work (service) so that the pregnant women can get adequate rest and can access and receive essential healthcare services without falling into the trap of economic hardship. Alongside, right to maternal nutrition should be deemed to be mandatory given the situation that three out of five women suffer from anaemia. So far, the provisions for maternity entitlements have remained confined to women engaged in the organised sector. Barring them, all other women have been excluded from these vital entitlements despite the very progressive Act on maternal rights that was enacted in 1961. The Act provides for right to maternity entitlements for all women working in factories, mines and shops and establishments. However, one needs to discern that whilst a woman working in central government is entitled to maternity leave for 6 months and that she has right to avail leave for a period up to 2 years till her child attains the age of 18 years and further that she gets 45 days paid leave in the event of an abortion, the entitlement for the women working in the unorganised sector provide for a leave with wages only for a period up to 12 weeks, that too without any monitoring mechanism being in place to check whether even this provision is being scrupulously observed or not. One does not know whether these women are being pressurized to leave the work. There are serious apprehensions that such situations are created in the private sector whereby the women are forced to take a call on leaving their jobs ‘voluntarily’. Moreover, it is not that the government itself is not a party to this exploitation. Women are being employed either on contractual or bond basis across the public sector employers ranging from the Municipal Corporation to departments of Health Services and Education. Even if the women have been working at a place for more than 10 years, the employers adopt every tactic to deprive them of their maternal entitlement under the guise of non-applicability of terms of regular employment. During the year 2012-13, the women worked for 739.40 million work day in the country. However, many of the pregnant women were continued to be engaged in work even up to 40 hours per week prior to their delivery. Many women returned to work just after 72 hours of child birth as they neither get any financial assistance nor granted any paid leave with regard to their maternal entitlements. This situation plunges the life of the mother and the new born in danger.
The national commission set up to look into the issues of those working in unorganised sector informs in its report of 2007 that out of 148 million working women in the country 142 million come from the unorganised sector. It goes on to show that the rights of almost all (95.94%) working women are not assured. Another big challenge is that 106.90 million women are engaged in agriculture and allied sectors. The Maternal Rights Act does not even apply to these sectors leaving the women agricultural labourers to suffer from the higher probability of death due to complications associated with pregnancy and delivery. After all, they are poor and deprived of their legal entitlements.
Stating simply, right to maternal entitlements ought to be mandatory. Consequently, the question that arises is if a woman is not earning income in any form can she be deprived of her maternal entitlements? Another supplementary question in this regard pertains to the women as the home makers. Should their work be not construed as the one entailing labour? A question is generally posed to the participants in the training programmes on women and labour issues as to who in the home gets up first in the morning and who goes to the bed last. The invariable answer is: the woman of the house! The families which are engaged in agricultural work are silently aware that the women members have to bend at their waist when it comes to sowing the paddy crop. One knows it too well that the woman does not get any wages for working in her own family’s agricultural field. Should she be considered to be unemployed or without work simply because she is working at her own family’s field? One, thus, needs to ponder as to why women as the home makers or as workers in family occupation should be deprived of their maternal entitlements.
The National Food Security At, 2013 provides for a grant of maternal assistance of at least Rs.6000/- to every pregnant woman. However, this amount does not appear to be justified. In effect, the woman should get leave with wages for a period of 9 months so that she does not have to go for work 3 months prior to delivery and 6 months after the child birth and that the wages should be computed in accordance with applicable minimum wages. When computed thus, the amount of Rs.6000/- would turn out to be too meagre.
Now our government needs to take an initiative to ensure that universal maternal entitlements are safeguarded against gender disparity and maternal insecurity, whilst being in consistence with the fundamental rights as are enshrined in sections 15 (1 and 3) and 42 of our Constitution which provide for special provisions for the women and delivery assistance. The task is apparently tough because a major chunk of our policy makers considers it to be an insignificant issue. The Government of India Committee on Economic Affairs did not allow expansion of Indira Gandhi Maternity Sahyog Yojana because it felt that it will lead to wastage of government’s resources! The cause of eliminating the curse of maternal death and maintaining respect for maternal entitlements does not seem to have gone down well with the learning of our policy makers and governance administrators. They only know the business of making ‘instant profits’!
Maternal Entitlements trapped in Conditionalities
Shouldn’t a laborer woman take adequate rest if she is pregnant? And in case she rests, should she be deprived of her wages? Would she be able to receive nutritious diet if she doesn’t have or cannot have the work with wages? Is it not necessary to receive appropriate nutrition? After the delivery, the mother needs to breastfeed the infant and provide sensitive care to the baby. Would it be safe for the mother and infant if she has to go for work with her 15 days old infant? It is therefore evident that the mother must be free from arduous labour for a period of at least 9 months (3 months prior to delivery and 6 months after delivery). If we cannot ensure the deliverance of this maternal entitlement, we would and should be deemed to be an unscrupulous and inhuman society. We will have to establish legal architecture in bringing about universal maternal entitlements and then only we may look forward to the better days ahead for the women. What is grievous is that the governments, in an otherwise culturally rich India, have shown utter disregard for this critical and sensitive aspect.
It is all the more painful when the same India is found to be at par with Nigeria when it comes to comparing the data pertaining to maternal deaths. The two countries together account for one-third of worldwide maternal deaths. What a dubious distinction? According to the latest report (2014) of the United Nations, there were 2, 89,000 maternal deaths around the world arising out of complications during pregnancy and child birth in year 2013. Out of these, 1, 79, 000 (62%) deaths occurred in Sub-Saharan Africa alone, whereas 69,000 (24%) deaths took place in South Asia. The report informs that the estimated number of maternal deaths was 50,000 (17%) in India and 40,000 (14%) in Nigeria. Further, India belongs to that group of 10 countries which account for 58% maternal deaths across the world. One may be surprised to hear the names of the other 9 countries. These are – Nigeria, Congo, Ethiopia, Indonesia, Pakistan, Tanzania, Kenya, China and Uganda. An effort was made to reverse the situation in the last decade via a focused thrust on promoting the use of institutional deliveries. To an extent, it has had some effect. However, when 40% posts of Obstetrician & Gynecologists and medical officers are lying vacant in government hospitals, only one hospital bed is available for a population of 2500, medicines and facility for diagnostic investigations are unavailable, the first-stage move to bring about safe motherhood through institutional deliveries has fallen flat. What surprises the most is that even the United Nations has failed to make a vociferous advocacy for targeting the Millennium Development Goal (MDG) pertaining to reduction in Maternal Mortality Ratio (MMR).
Even today it is believed that if deliveries take place in hospitals, our responsibility towards the women ceases or is fulfilled. The call of the day, however, is that the society and the government must acknowledge the need for and responsibility for securing maternal rights for the women. Ensuring that post-delivery, the women should remain hospitalized under medical care for 48 hours does not conclude the call for responsiveness. What is needed is a sensitive mechanism whereby the women get a real sense of security.
The process of reproduction is not just painful for the women but rather shakes them up from social and economic perspectives. Our health and safe motherhood programmes entail awareness messages highlighting the need for adequate rest to the women during the course of pregnancy. The women working in the unorganised sector find it virtually impossible to stay away from work even for a day as they apprehend loss of day’s wages. Hence, they continue to work virtually right till the time of their delivery. Another prominent message in vogue is about the need for ensuring nutritious dietary intake for the women during pregnancy. According to the 68th round of the National Sample Survey, per day, a person in the rural India is able to spend only an amount of Rs.1.31 on pulses, Rs.3.83 on milk and milk products, Rs.2.28 on eggs, meat and fish. The situation in urban India is no better. An urban person’s daily expenditures are Rs.1.70 on pulses and Rs.3.20 on eggs-meat-fish. One can imagine as to what nutrition the women would be getting under the poverty-ridden circumstances. We are afflicted with economic deprivation, caste-based discrimination and feudalism, neglect and gender victimization. Regrettably, these situations are further aggravated by the lack of accountability and multi-dimensional corruption. This fine mesh of poverty makes the lives of women a formidable battleground, where they are deprived of all armor of struggle. She wages not one battle but a host of them. Safe motherhood is one of them.
Maternal entitlements never received a privileged concern in the corridors of India’s policy. The Maternity Rights Act was framed in 1961. It was considered to be a progressive and visionary step in many respects. However, the schemes formulated by governments of the 21st century reflect lack of enlightenment. Provision of riders of 19 years of age of women and maximum number of children to be restricted to two was made part of the National Maternity Benefit Scheme which was instituted from 15th August 1995. Our government seems to be very ‘naïve’ on both counts. Or else, it is pretending to not know that in our country the women do not have a right to take a decision about getting married and to plan a baby. Further, the scheme stipulated another condition that the benefits of the scheme would be available only to the women belonging to Below Poverty Line (BPL) households, notwithstanding the fact that till date the poor have not yet been identified! Following a study, the National Planning Commission had intimated the Government of India in 1999 that the provision of an amount of Rs.500/- under the scheme was too meagre. Despite this, the provision has not been revised upwards!
Another scheme known as the Janani Suraksha Yojana (JSY) was instituted in April 2006. The previous scheme of Maternity Benefit was merged with the JSY. Accordingly, should there be a delivery at home, the woman would be given an amount of Rs.500/- and if the delivery takes place at a health institution, the rural women would be given an amount of Rs.1400/ and the urban ones – Rs.1000/-.. The government acted naïve here too. Therefore, the women are given the financial assistance not during the pregnancy under the Janani Suraksha Yojana (JSY) but after the delivery. One needs to know it too well that it is during the period of pregnancy that nutritional demand and need for rest are more pronounced. This provision has led to widespread corruption. In effect, the Janani Suraksha Yojana (JSY) cannot be deemed to be a programme for maternal entitlement because it essentially seeks to promote institutional deliveries. Consequently, there are large number of instances which point out that the mother and the infant are discharged from the hospital within 4 to 6 hours of delivery instead of ensuring proper medical attention as an indoor patient in the first 48 hours after delivery.
The maternal rights programmes in India have a history of over 50 years. As many as 19 programmes on maternal entitlements are being implemented by the central government and state governments. Still, neither any programme nor any legal provision has been made for the 96% of women belonging to the unorganised sector and home makers. The Tata Institute of Social Sciences (TISS) has undertaken a study in to the existing programmes on maternity entitlements and the terms and conditions which are regulated for the same (woman’s age to be 19 years or more, benefit to be limited only up to 2 living children, making institutional delivery mandatory, etc.). The study reports that as many as 1000 million women out of a total of 1010 working women are pushed out as ineligible for accessing the maternity entitlements.
For the first time, the National Food Security Act of 2013 makes a provision for a grant of financial assistance of Rs.6000/- for every pregnant woman. In this context, we should consider the example of Tamil Nadu government where Dr. Muthulaxmi Reddy scheme of Maternity Benefit has been operational since 1987. This scheme provides for disbursement of Rs. 12000/- in two installments for the women belonging to Below Poverty Line (BPL) households. The scheme rendered benefits to an average of 1600 women per day during the period 2006 to 2011. Studies have been conducted on this scheme too which encouragingly report that corruption has not been a major issue in its implementation. Consequently, the central government has attempted to institute the Indira Gandhi Maternity Benefit Scheme on the lines of Tamil Nadu. However, the conditions levied for accessing benefits under the scheme have been more of a punishment to the women. The neglect of the government becomes clear going by the fact that the scheme pilot did not move beyond the select 52 districts.
At present, as many as 200 million women toil within the precincts of family. There is no measure to gauge their work. Under such circumstances, securing their maternal entitlements is a formidable and significant challenge. It will be better to enhance the provision of grant of financial assistance of at least Rs. 6000/- available under the National Food Security Act, 2013 and relate the same with leave with wages (minimum applicable wage) for a period of 9 months (3 months prior to delivery and 6 months after the child birth). The government needs to take a decisive initiative. The initiative will not only bring about significant reduction in the avoidable Maternal Mortality Ratio (MMR) but also render a newer dimension of strength and empowerment to the women.
