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Catastrophic Maternal Healthcare expenses push 47 percent Mothers in India into Poverty: Researchers

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May 22, 2017: Catastrophic maternal healthcare expenses push 46.6 per cent mothers in India into poverty — with the illiterate being especially susceptible — according to a December 2016 study by researchers from Jawaharlal Nehru University (JNU) and Indian Institute of Technology, Roorkee (IIT-R). The expenses include childbirth, antenatal care and postnatal care expenses.

Catastrophic expenditure is greater than or equal to 40 percent of a household’s non-subsistence income, i.e. income available after basic needs have been met, according to the World Health Organisation (WHO). The threshold of 40 per cent can differ according to countries, said the WHO; the 2016 study has analyzed the data at two thresholds: 10 and 40 per cent.

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As many as 63 per cent households nationwide had a catastrophic maternal health expenditure of 40 per cent, the study — which analysed data from the National Sample Survey Office — found. Among states and Union territories (UTs), 65.7 per cent households (among those where a woman had delivered) in Telangana were pushed into poverty — more than any other state/UT — due to childbearing expenses, followed by Chhattisgarh (53.7 per cent) and Puducherry (53.4 per cent).

In the 10 years to 2014, out-of-pocket (OOP) health spending has pushed 50.6 million people back into poverty.

Households where the mothers were illiterate were the most affected, with 61 per cent of them being pushed into poverty –despite having the lowest maternal health OOP expenditure at Rs 3,600 — compared to 36.7 per cent of households where women were graduates and above, who had an OOP expenditure of Rs 19,250.

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More illiterate women prefer public hospitals for delivery in both rural (79.2 per cent) and urban areas (67.7 per cent), which possibly explains their low OOP.

Among women of different social groups, women belonging to scheduled tribes (STs) had the least maternal OOP expenditure at Rs 2,962, but 71.5 per cent of them were pushed into poverty. As many as 85 per cent ST women in rural areas delivered in public hospitals — more than any other social group.

The study holds relevance in the context of the central government announcement on May 18, 2017, that it is revising the Indira Gandhi Matritva Sahyog Yojana (Maternity Benefit Programme), announced by Prime Minister Narendra Modi on December 31, 2016, by restricting the scheme to firstborns instead of “first two live births” as applicable earlier.

The programme aims to give Rs 6,000 to pregnant women for childbearing expenses. The scheme saw an increase of 226 per cent in allocation in the 2017-18 budget from Rs 634 crore to Rs 2,700 crore. However, the government had estimated that the annual requirement for the maternity benefit scheme would be Rs 14,512 crore, according to a report in The Indian Express.

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The 2016 study revealed that, on average, a woman incurred an OOP expenditure of Rs 8,543 on childbearing. There were huge variations among states — from Rs 2,801 in Uttarakhand to Rs 15,433 in Telangana.

“The most vulnerable women who are trying to reach out for the government aid won’t be able to get it,” Tania Sheshadri, an independent community health researcher who works with rural women in Karnataka, was recently quoted as saying in news reports.

“In most parts of the country, there is a two-child norm and a scheme like this will not benefit most women. The government should concentrate on quality care for pregnant women and make available the benefits to every woman who reaches a government health care centre.”

A limitation of the 2016 study is that it does not consider the benefits of Janani Suraksha Yojana (JSY, motherhood protection scheme), a 12-year-old government programme focused specially on 10 states with low rates of institutional delivery — Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam, Rajasthan, Odisha, and Jammu and Kashmir — termed as low-performing states (LPS).

Under the programme, pregnant women in rural areas who live below the poverty line are to be given cash assistance — Rs 700 in high performing states and Rs 1,400 in LPS — irrespective of the mother’s age and number of children so that they opt for birth in a government or accredited private health facility.

The scheme has failed to cover the poorest women, according to a 2014 analysis of JSY data by researchers from Georgetown University. As many as 60 per cent women in Uttar Pradesh said they had to pay for certain public maternal health services, according to an assessment of JSY conducted by United Nations Population Fund in Bihar, Madhya Pradesh, Odisha, Rajasthan and Uttar Pradesh in 2012. (IANS/IndiaSpend)

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Atal Bihari Vajpayee: A Peace Visionary and a Man Who Believed in India’s Destiny and was Ready To Fight For It

It was precisely this persona of Vajpayee -- one merged in Hindutva ideology yet seemingly not wholly willing to bow to it -- that won him admirers cutting across the political spectrum.

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Atal Bihari Vajpayee,
Atal Bihari Vajpayee, India's peace visionary. Image: Flickr

Atal Bihari Vajpayee was a man of moderation in a fraternity of jingoistic nationalists; a peace visionary in a region riven by religious animosity; and a man who believed in India’s destiny and was ready to fight for it.

Former Prime Minister Atal Bihari Vajpayee (93), who died on Thursday, will go down in history as a person who tried to end years of hostility with Pakistan and put development on the front burner of the country’s political agenda. He was also the first non-Congress Prime Minister to complete a full five-year term.

Even though he lived the last 13 years of his life in virtual isolation, dogged by debilitating illnesses and bedridden, he has left an enduring legacy for the nation and the region where he was much loved and respected across the political spectrum and national boundaries, including in Pakistan.

Vajpayee, former Indian Prime Minister
Vajpayee stunned the world by making India a declared nuclear state. Image: Wikimedia Commons

In the tumultuous period he presided over the destiny of the world’s largest democracy, Vajpayee stunned the world by making India a declared nuclear state and then almost went to war with Pakistan before making peace with it in the most dramatic fashion.
In the process, his popularity came to match that of Indira Gandhi, a woman he admired for her guts even as he hated her politics.

He also became the best-known national leader after Indira Gandhi and her father Jawaharlal Nehru.

After despairing for years that he would never become Prime Minister and was destined to remain an opposition leader all his life, he achieved his goal, but only for 13 days, from May 16-28, 1996, after his deputy, L.K. Advani, chose not to contest elections that year.
His second term came on March 19, 1998, and lasted 13 months, a period during which India stunned the world by undertaking a series of nuclear tests that invited global reproach.

Although his tenure again proved short-lived, his and his government’s enhanced stature following the world-defying blasts enabled him to return as Prime Minister for the third time on October 13, 1999, a tenure that lasted a full five-year term.

When finally he stepped down in May 2004, after an election that he was given to believe he would win, it marked the end of a long and eventful political career spanning six decades.

Vajpayee had gone into these elections riding a personality cult that projected him as a man who had brought glory to the nation in unprecedented ways. The BJP’s election strategy rested on seeking a renewed mandate over three broad pillars of achievement that the government claimed — political stability in spite of the pulls and pressures of running a multi-party coalition; a “shining” economy that saw a dizzying 10.4 percent growth in the last quarter of the previous year; and peace with Pakistan that changed the way the two countries looked at each other for over 50 years.

The results of the elections could not have come as a greater shock to a man who was hailed for his achievements and who was named by Time magazine as one of the 100 influential men of the decade.

Success didn’t come easily to the charismatic politician, who was born on Christmas Day in 1924 in Gwalior, Madhya Pradesh, into a family of moderate means. His father was a school teacher and Vajpayee would later recall his early brush with poverty.

He did his Masters in Political Science, studying at the Victoria College in Gwalior and at the DAV College in Kanpur, Uttar Pradesh, where he first contested, and lost, elections. He began his professional career as a journalist, working with Rashtradharma, a Hindi monthly, Panchjanya, a Hindi weekly, and two Hindi dailies, Swadesh and Veer Arjun. By then he had firmly embraced the ideals of the Hindu nationalist Rashtriya Swayamsewak Sangh (RSS).
But even as he struggled to win electoral battles, his command over Hindi, the lingua franca of the North Indian masses, his conciliatory politics and his riveting oratory brought him into public limelight.

Also read: For Modi, Road To 2019 Will Be Steeper

His first entry into Parliament was in 1962 through the Rajya Sabha, the upper house. It was only in 1971 that he won a Lok Sabha election. He was elected to the lower house seven times and to the Rajya Sabha twice.

Vajpayee
Vajpayee spent months in prison when Indira Gandhi imposed Emergency rule in June 1975. Image: Wikimedia Commons

Vajpayee spent months in prison when Indira Gandhi imposed Emergency rule in June 1975 and put her political opponents in jail. When the Janata Party took office in 1977, dethroning the Congress for the first time, he became the foreign minister.

The lowest point in his career came when he lost the 1984 Lok Sabha polls, that too from his birthplace Gwalior, after Rajiv Gandhi won an overwhelming majority following his mother Indira Gandhi’s assassination. And the BJP he led ended up with just two seats in
the 545-member Lok Sabha, in what looked like the end of the road for the right-wing party.

In no time, Vajpayee was replaced and “eclipsed” by his long-time friend L.K. Advani.
Although they were the best of friends publicly, Vajpayee never fully agreed with Advani’s and the assorted Hindu nationalist groups’ strident advocacy of Hindutva, an ideology ranged against the idea of secular India.

Often described as the right man in the wrong party, there were also those who belittled him as a moderate “mask” to a hardline Hindu nationalist ideology. Often he found his convictions and value systems at odds with the party, but the bachelor-politician never went against it.

It was precisely this persona of Vajpayee — one merged in Hindutva ideology yet seemingly not wholly willing to bow to it — that won him admirers cutting across the political spectrum. It was this trait that made him the Prime Minister when the BJP’s allies concluded they needed a moderate to steer a hardliner, pro-Hindu party.

He brought into governance measures that created for India a distinct international status on the diplomatic and economic fronts. In his third prime ministerial stint, Vajpayee launched a widely acclaimed diplomatic initiative by starting a bus service between New Delhi and Pakistan’s Lahore city.

Its inaugural run in February 1999 carried Vajpayee and was welcomed on the border by his Pakistan counterpart Nawaz Sharif. It was suspended only after the 2001 terror attack on the Indian Parliament that nearly led to a war between the two nuclear-armed neighbours.

The freeze between the two countries, including an eyeball-to-eyeball confrontation on the border for nearly a year, was finally cracked in the spring of 2003 when Vajpayee, while in Kashmir, extended a “hand of friendship” to Pakistan. That led to the historic summit in January 2004 with then President Pervez Musharraf in Islamabad — a remarkable U-turn after the failed summit in Agra of 2001. Despite the two men being so far apart in every way, Musharraf developed a strong liking for the Indian leader.

His unfinished task, one that he would probably rue, would be the peace process with Pakistan that he had vowed to pursue to its logical conclusion and a resolution of the Kashmir dispute.

He was not known as “Atal-Ji”, a name that translates into firmness, for nothing. He could go against the grain of his party if he saw it deviate from its path. When Hindu hardliners celebrated the destruction of the 16th century Babri Mosque at Ayodhya, he was full of personal remorse for the apocalyptic action and called it — in a landmark interview to IANS — the “worst miscalculation” and a “misadventure”. He even despaired that “moderates have no place — who is going to listen to the voice of sanity?”

In his full five-year term, he successively carried forward India’s economic reforms programme with initiatives to improve infrastructure, including flagging off a massive national highway project that has become associated with his vision, went for massive privatisation of unviable state undertakings despite opposition from even within his own party.

While his personal image remained unsullied despite his long innings in the murky politics of this country, his judgment was found wanting when his government was rocked by an arms bribery scandal that sought to expose alleged payoffs to some senior members of his cabinet. His failure to speak up when members of his party and its sister organisations, who are accused of killing more than 1,000 Muslims in Gujarat, was questioned by the liberal fraternity who wondered aloud about his secular proclamations. He wanted then Chief Minister — now Prime Minister, Narendra Modi — to take responsibility for the riots and quit but was prevailed upon by others not to press his decision.

A day before his party lost power, Vajpayee was quoted as saying in a television interview that if and when he stepped down he would like to devote his time to writing and poetry. But fate ruled otherwise. The man who once rued that “I have waited too long to be Prime Minister” found his last days in a world far removed from the adulation and attention — though across the nation people prayed for his well-being — surrounded only by care-givers and close family whom he even failed to recognize. (IANS)