Society & Social justice

All (4049)Current Affairs (4038)Mains Practice (126)Mains PYQs by Subjects (40)

Maternal Health

Context: In May, a United Nations report showed that India was among the 10 countries that together accounted for 60% of global maternal deaths, stillbirths and new born deaths. India accounted for over 17% of such deaths in 2020.

Reasons for Poor Maternal Health:

Malnutrition: Undernourished girls have a greater likelihood of becoming undernourished mothers who in turn have a greater chance of giving birth to low-birth-weight babies, perpetuating an intergenerational cycle of undernourishment.
Low literacy: According to 2011 census, around 35% of female is illiterate in India. Lack of adequate literacy deprives women awareness about nutrient-rich diet, good feeding practices and personal hygiene which ultimately impacts their maternal health.
Child Marriages: According to NFHS-5, about 25% of women aged 18-29 got married before reaching the minimum legal age of marriage. Increasing incidences of teenage pregnancies due to child marriages and inadequate access to contraceptives impacts their maternal health and one of the leading causes for Maternal mortality in India.
Climate change:

Studies shows that soaring temperatures due to heatwaves severely impact the maternal health of pregnant women. Women suffer more from yeast infections and UTIs (Urinary Tract Infections) in hot summers. Dietary habits that keep changing according to temperatures also impact Menstrual cycle.
Rapid climate changes globally have given rise to climate-driven food insecurities which disproportionately impacts the nutritional health of women in a patriarchal society.

A special bulletin was released by Registrar general of India on Maternal mortality ratio. Key findings of the report are:

Maternal mortality ratio (MMR) of India has declined by 10 points. It has declined from 113 in 2016-18 to 103 in 2017-19, an 8.8% decline.
The country has been witnessing a progressive reduction in the MMR from 130 in 2014-16, 122 in 2015-17 and 113 in 2016-18 to 103 in 2017-19.
With this persistent decline, India is on the verge of achieving the National Health Policy (NHP) target of 100 per lakh live births by 2020 and certainly on the track to achieve the Sustainable Development Goal (SDG) target of 70 per lakh live births by 2030.

This improvement has been possible due to continued efforts of government of India like

Janani suraksha yojana:

Implemented by Ministry of Health and family welfare
It is a safe motherhood intervention under the National Health Mission. It is being implemented with the objective of reducing maternal and neonatal mortality by promoting institutional delivery among poor pregnant women.
Cash incentives are given to beneficiaries for undergoing institutional deliveries.
The scheme focuses on poor pregnant woman with a special dispensation for states that have low institutional delivery rates, namely, the states of Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam, Rajasthan, Orissa, and Jammu and Kashmir. While these states have been named Low Performing States (LPS), the remaining states have been named High Performing states (HPS).

Janani shishu suraksha karyakram:

A scheme under MoH&FW
It is an initiative to provide completely free and cashless services to pregnant women including normal deliveries and caesarean operations.
Free entitlements to pregnant women under this scheme are

Free and cashless delivery
Free c-section
Free drugs and consumables
Free diagnostics
Free diet during stay in the health institutions
Free transport from home to health institutions

Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA):

launched by the Ministry of Health & Family Welfare (MoHFW)
Under PMSMA, all pregnant women in the country are provided fixed day, free of cost assured and quality Antenatal Care.
As part of the campaign, a minimum package of antenatal care services (including investigations and drugs) is being provided to the beneficiaries on the 9th day of every month.
The Abhiyan also involves Private sector’s health care providers as volunteers to provide specialist care in Government facilities.

LaQshya:

Labour Room & Quality Improvement Initiative (LaQshya) program will benefit every pregnant woman and newborn delivering in public health institutions. Program will improve quality of care for pregnant women in labour room, maternity Operation Theatre and Obstetrics Intensive Care Units (ICUs) & High Dependency Units (HDUs).

National food security act:

Special provisions have been made for pregnant women and lactating mothers by entitling them to receive nutritious meal through a wide network of ICDS centres.
Pregnant women and lactating mothers are further entitled to receive cash maternity benefit of not less than Rs. 6000 to partly complement the wage loss during the period of pregnancy and also to supplement nutrition.

Integrated Child Development Services (ICDS) Scheme:

Under Ministry of women and child development
The scheme provides Supplementary nutrition, immunizations and regular health check-ups of pregnant and lactating mothers.

PM Matru Vandana yojana:

Pradhan Mantri Matru Vandana Yojana (PMMVY) is a Maternity Benefit Programme that is implemented in all the districts of the country in accordance with the provision of the National Food Security Act, 2013.
All eligible Pregnant & Lactating Mothers would receive a Cash incentive of Rs 5000 in three instalments for first childbirth. Conditions attached to these instalments are

Early registration of pregnancy at the Anganwadi Centre (AWC)
Receiving at least one ante-natal check-up (ANC)
Registration of childbirth and vaccination of first cycle vaccines (BCG, OPV, DPT and Hepatitis-B).

Maternity Benefit Amendment Act:

Duration of the maternity leave increased to 26 weeks from 12 weeks.
Maternity leaves were extended to adopting and commissioning mothers. A commissioning mother is defined as a biological mother who uses her egg to create an embryo implanted in another woman.
The act provided that the employer may permit a nursing woman (after 26 weeks of maternity leave) to work from home if the nature of work permits.
All organizations with 50 or more employees are required to provide a Creche facility and during working hours, the concerned female employee must be allowed four visits to the crèche.

Sexual Harassment at Workplace [POSH Act]

Context: Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, 2013 (POSH Act) is framed to provide protection to women at workplace against sexual harassment. The Act lays down rules for prevention and redressal of sexual harassment complaints by female workers.

Salient features of the act

The act defines sexual harassment at the work place and creates a mechanism for redressal of complaints. It also provides safeguards against false or malicious charges.
Every employer is required to constitute an Internal Complaints Committee (ICC) at each office with 10 or more employees. The District Officer is required to constitute a Local Complaints Committee at each district, and if required at the block level.
The Complaints Committees have the powers of civil courts for gathering evidence.
Summoning and requiring the attendance of any person and interrogating him under oath;
Requirement to discover and produce documents.
The Complaints Committees are required to provide for conciliation before initiating an inquiry, if requested by the complainant.
Non-compliance with the provisions of the Act shall be punishable with a fine of up to Rs 50,000. Repeated violations may lead to higher penalties and cancellation of licence or registration to conduct business.

Issues with the implementation of the act:

Legal shortcomings:

Powers of civil court have been given to Internal Complaints Committee without specifying if members need to have a legal background.
Very modest fine of Rs 50,000 for non-compliance with the act is not enough deterrent.
Employer nominates members to Internal Complaints Committee (Conflict of Interest).
Prior internal inquiry and mandate for is misused promotes a culture of suppression of legitimate complaints to avoid the concerned establishment falling into disrepute.
Provision of conciliation in the act treats a criminal act as a civil dispute.
Law provides a punishing a woman if she is found to have filed a false or malicious complaint which is completely abusive provision intended to nullify the objective of law.
No data: Government maintains no centralised data relating to cases of harassment of women at workplaces, do not publicly compile and release data on how many companies and districts comply with guidelines and have committees, number of complaints filed and outcome of these complaints.
Local Complaints Committee dysfunctional: 95% of India's women workers are employed in informal sector, but Local Committees to be formed under POSH Act have either been not formed in most districts or is not well publicised about leaving women in informal sector with no avenue to report.
Social challenges: Women are discouraged to report sexual harassment incidents because of fear of being forced to withdraw from work by the family members.
Digital divide: Women can also file complaints through Women and Child Development Ministry's SHeBox, an online complaint platform for all women workers. But most India's women workers find it difficult to access these redressal methods, especially SHeBox, given the low number of women who use the internet in India is low.

Way forward:

Empowering National Commission of Women with power to summon people and carry out independent investigations, impose fines, search and seizure in matters of sexual harassment at workplace.
Awareness about the act should be increased among females, added to school and college curriculums. Discussions should be organised around these issues in civil society.
Special attention should be given towards sectors where women are most vulnerable to sexual harassment. E.g., Garment sector, Domestic workers.
Law needs to be made gender neutral as sexual harassment challenges can be faced even by transgenders and males.
Nationwide audit of functioning of Internal Complaints Committee and Local Complaints Committee. Earmarking of budget for the functioning of Local Complaints Committee.

Changes proposed in law:

Removal of penalty for false complaints.
Removal of a need for conciliation between complainant and respondent.
Formation of Local Complaints committee should be at block or tehsil level and not district level.
Justice Verma committee noted that Internal Complaints Committee system should be replaced by Employment Tribunal, as dealing with such complaints in-house could discourage women from coming out.

Rehabilitation Council of India (RCI)

Context: Rehabilitation Council of India (RCI) is conducting a seminar to facilitate the effective implementation of the National Education Policy and human resource development specifically targeting the empowerment of persons with disabilities.

About Rehabilitation Council of India

Rehabilitation Council of India (RCI) is a statutory body established by the Rehabilitation Council of India Act, 1992.
The body functions under the Department of Disability under Ministry of Social Justice & Empowerment.
Main mandate of RCI is to standardise, regulate and monitor training programs in the field of special education and disability and prescribe minimum standards of education and training for 16 categories of professionals and personnel allocated for RCI.

Objectives of Rehabilitation Council of India

Regulate & monitor training programs in the field of disability rehabilitation & special education.
Prescribe minimum standards of education & training for various categories of human resources dealing with persons with disabilities.
Regulate these standards in all training institution to bring about uniformity throughout India.
Make recommendations to the Ministry regarding recognition of qualification granted by Training Institution, Universities etc. in India for rehabilitation professionals/personnel.
Make recommendations to Ministry regarding recognition of qualification granted by institution outside India under the scheme of reciprocity.
Maintain Central Rehabilitation Register (CRR) of persons possessing recognised rehabilitation qualification.
Encourage continuing rehabilitation education program at approved institution.
Promote research in disability rehabilitation and special education.

Functions of Rehabilitation Council of India

Qualifications granted by any University or other institution in India that are included in the schedule shall be recognised qualifications for rehabilitation professionals/personnel.
Registration of Rehabilitation Professionals/Personnel in the Central Rehabilitation Register (CRR) of persons possessing the recognised qualifications.
Prescribe the minimum standards of education required for granting recognised rehabilitation qualification by Universities/Institutions of India.
Prescribe standards of professional conduct, etiquette and code of ethics for rehabilitation professional/personnel.
Assess & grant approval to institution/universities for training of professionals in the field of rehabilitation and to facilitate their recognition and its withdrawal by Government.
Appoint visitors to inspect any University or Institution where education for rehabilitation professional is given or attend any examination for the purpose of granting recognised rehabilitation qualifications.

16 Categories of Rehabilitation Professionals/Personnel covered under RCI Act

Audiologists & Speech Therapists
Clinical Psychologists
Hearing & Ear Mould Technicians
Rehabilitation Engineers & Technicians
Special Teachers for Educating & Training Persons with Disabilities
Vocational counsellors, employment officers & placement officers dealing with Persons with Disabilities
Multipurpose Rehabilitation Therapists & Technicians
Speech Pathologists
Rehabilitation Psychologists
Rehabilitation Social Workers
Rehabilitation Practitioners in Mental Retardation
Orientation & Mobility Specialists
Community based Rehabilitation Professionals
Rehabilitation Counsellors/Administrators
Prosthetists & Orthotists
Rehabilitation Workshop Managers
Any other category of professionals included from time to time.

Poshan Bhi, Padhai Bhi’: Anganwadi scheme for early childhood care, education launched

Context: Union Minister for Women and Child Development, launched the Centre’s flagship programme ‘Poshan Bhi, Padhai Bhi’, which will focus on Early Childhood Care and Education (ECCE) at anganwadis across the country.

About Poshan Bhi Padhai Bhi campaign

Poshan Bhi Padhai Bhi is a pathbreaking ECCE program to ensure that India has the world’s largest, universal, high-quality preschool network, as the National Education Policy suggests.
Close to 13.9 lacks operational Anganwadi centres across the country are providing supplementary nutrition and early care and education to around 8 crore beneficiary children under the age of 6 years, making it the largest public provisioning of such services in the world.
Considering global evidence on 85% of brain development being achieved by the age of 6, the Anganwadi eco-system becomes a critical access point for building our children’s base to secure their future.
The government will target children’s development in every domain mentioned in the National Curriculum Framework, viz., physical and motor development, cognitive development, socio-emotional-ethical development, cultural/artistic development, and the development of communication and early language, literacy, and numeracy.
All States will follow the national ECCE task force recommendations for a play-based, activity-based learning pedagogy, targeted specifically at developmental milestones of 0-3-year olds as well as 3-6-year olds, including special support for Divyang children.
Through the changes introduced by the “Poshan bhi, Padhai bhi” ECCE policy, every child would be provided with at least two hours of high-quality preschool instruction on a daily basis.
As stated in the NEP, Anganwadi Centres will be strengthened with high-quality infrastructure, play equipment, and well-trained Anganwadi workers/teachers.
Poshan bhi Padhai bhi will focus on promoting holistic and quality early stimulation and pre-primary education for children, ensuring the use of developmentally appropriate pedagogies and emphasizing the links with primary education as well as early childhood health and nutrition services.
Poshan Bhi, Padhai Bhi program will provide for the mother tongue as primary teacher instruction medium, different types of teaching-learning material (visual aids, audio aids, audio-visual and bodily-kinesthetic aids) to Anganwadi Sewikas, and help build a Jan Andolan, to involve communities in strengthening the foundations of the country’s future generations.

A top-down code

Context: The central government has codified 29 labour laws into 4 labour codes but, labour legislation is under the concurrent list so the responsibility of framing the rules related to these codes lies with states but they have not framed the rules yet which is defeating the very purpose of these codes.

Labour Code (Wage Code) – 2019

After 73 years of independence, work is being done to provide wage security, social security and health security to 50 crore workers, covering organized and unorganized sectors.
The guarantee of minimum wages is available to 50 crore workers in organized and unorganized sectors.
Review of minimum wages every 5 years.
Guarantee of timely payment of wages to all workers
Equal remuneration to male and female workers.
For the first time, around 40 crore workers of the unorganized sector in the country have got this right.
To remove regional disparity in minimum wages the provision of floor wage has been introduced.
The determination of minimum wages has been made easy. It will be based on criteria such as skill level and geographical area.
From 28.08.2017 Payment of Wages Act has increased the wage ceiling from Rs. 18000 to Rs. 24000.

Social security code 2020

Through a small contribution, the benefit of free treatment is available under hospitals and dispensaries of ESIC.
The doors of ESIC will now be opened for the workers of all sectors and the unorganised sector workers.
Expansion of ESIC hospitals, dispensaries and branches up to the district level.
This facility is to be increased from 566 districts to all 740 districts of the country.
Even if a single worker is engaged in hazardous work, he would be given ESIC benefit.
Opportunity to join ESIC for platform and gig workers engaged in new technology.
Plantation workers get the benefit of ESIC.
Institutions working in hazardous areas are to be compulsorily registered with ESIC.

Expansion of Social Security

The benefit of a pension scheme (EPFO) to all workers of organized, unorganized and self-employed sectors.
Creation of social security fund for providing comprehensive social security to the unorganized sector.
The requirement of minimum service has been removed for payment of gratuity in the case of fixed-term employees.
Employees engaged on fixed terms get the same social security benefit as permanent employees.
Creating a national database of workers of the unorganized sector through registration on Portal.
Employers employing more than 20 workers to mandatorily report vacancies online.
A Universal Account Number (UAN) for ESIC, EPFO and Unorganised Sector workers.
Aadhaar-based Universal Account Number (UAN) to ensure seamless portability.

OSH Code (Occupational, Safety, Health and Working Conditions Code) - 2020

Various provisions in the OSH Code will ease the lives of the Inter-State Migrant Workers.
Anomalies of the Inter-State Migrant Workers Act, of 1979 have been comprehensively addressed in the OSH Code. Earlier only workers appointed by a contractor were recognized as Inter-State Migrant Workers. However, under the new provisions of the Code, workers can be Aatmanirbhar as they can now register themselves as Inter-State Migrant Workers on the national portal. By this provision, the worker would get a legal identity which would enable them to get the benefits of all social security schemes.
A provision has been made for employers to provide a travelling allowance annually to an Inter-State Migrant Worker for undertaking a to-and-fro journey to his native place.
Providing of appointment letters to the workers has been made mandatory.
Mandatory, free annual health check-ups of the workers to be provided by the employers.
For a worker engaged in building and other construction work in one State and moving to another State, benefit from the Building and Other Construction Workers’ Cess fund will be provided.
Under the “One Nation - One Ration Card”, an Inter-State Migrant Worker would get a ration facility in the State he is working in and the remaining members of his family would be able to avail of the ration facility in the State where they reside.
Mandatory helpline facility in every State for the resolution of Inter-State Migrant Workers’ grievances.
A national database is to be created for the Inter-State Migrant Workers.
Instead of 240 days, now if a worker has worked 180 days, he shall be entitled to one-day leave for every 20 days of work done.
Women’s Empowerment through the Labour Codes
Right to women workers to work in all types of establishments.
Women have been given the right to work at night with their consent and it has also been ensured that the employer would make adequate arrangements to provide safety and facilities to women workers at night.
The Maternity Benefit Act was amended in 2017 to increase the paid Maternity leave for women workers from 12 to 26 weeks and ensure mandatory crèche facility in all establishments having 50 or more workers.

Industrial Relations (IR) Code, 2020

In case of job loss, a worker will get benefits under the Atal Bimit Vyakti Kalyan Yojna.
Under the Atal Bimit Vyakti Kalyan Yojna, a worker of the organized sector who loses his job gets financial aid from the Government. This is a type of unemployment allowance, the benefit of which is admissible to the workers covered under the ESI Scheme.
At the time of retrenchment, a worker would Chapter 8 New Labour Code For New India 20 be provided 15 days’ wages for re-skilling. The wages would be credited directly into the bank account of the worker so as to enable him to learn new skills.
Faster justice for the workers through the Tribunal.
Workers’ disputes are to be resolved within a year in the Tribunal.
Industrial Tribunals to have 2 members to facilitate faster disposal of cases.
In industrial establishments, a Trade Union having 51 per cent votes shall be recognised as the sole negotiating union which can make agreements with employers.
In industrial establishments in which no trade union gets 51 per cent votes, a negotiating council of trade unions shall be constituted for making agreements with employer.

AISHE report and low Muslim participation in higher education

Context: The Ministry of Education, Government of India has released All India Survey on Higher Education (AISHE) 2020-2021. The Ministry has been conducting All India Survey on Higher Education (AISHE) since 2011, covering all higher educational institutions located in Indian Territory and imparting higher education in the country. The survey collects detailed information on different parameters such as student enrollment, teacher’s data, infrastructural information, financial information etc.

Key findings of AISHE 2020-21:

The total enrollment in higher education has increased to nearly 4.14 crore in 2020-21 from 3.85 crore in 2019-20. Since 2014-15, there has been an increase of around 72 Lakh in the enrolment (21%).
Higher education's Gross Enrolment Ratio (GER) has also surpassed 27.3%. The GER measures the proportion of adults between the ages of 18 and 23 who are enrolled in college. It was determined using data from the 2011 Census.
The Female enrolment has increased to 2.01 crore from 1.88 crore in 2019-20. There has been an increase of around 44 Lakh (28%) since 2014-15.
Female GER has overtaken Male GER since 2017-18. Gender Parity Index (GPI), the ratio of female GER to male GER, has increased from 1 in 2017-18 to 1.05 in 2020-21.
There has been a noticeable increase in the enrolment of students from Scheduled Caste (SC), Scheduled Tribe (ST), and Other Backward Classes (OBC) in higher education institutions between 2014–15 and 2020–21. ST students have seen the largest growth, with a nearly 47% increase.

Government universities constitute contribute 73.1% of total enrolment of students. Whereas, private universities account for only 26.3% of the total enrolment.

Declining representation of Muslim minority groups in Higher education:

One contrasting trend observed in the recent AISHE report is the declining representation of Muslims in higher education. Enrollment of Muslim students dropped by 8 per cent from 2019-20 – that is, by 1,79,147 students. This level of absolute decline has never happened in the recent past for any group.

Possible reasons:

Bias in labour markets: As per Centre for Monitoring Indian Economy (CMIE) report, unemployment rate of Muslims is comparably lower than other religious groups. This data is partly a reflection of some discrimination in the job market.
Barriers to female education: Economic and social backwardness of the minority community and other cultural barriers inhibited participation of Muslim women in higher education.
Violence: Increased violence against Muslims has restricted their spatial mobility and has forced them to withdraw into their shells, a development evident from the ongoing process of ghettoization in almost all Indian cities.

This increased marginalisation of Muslims in higher education and public employment, which was also reflected in Sachar committee and Ranganath Mishra reports, calls for need to extend affirmative action policies to Muslims.

Tread a new path, one that prioritises social justice

Context: May 1 is widely known as the Labour Day, a day when we celebrate the contribution of workers worldwide. It is a moment of pride, celebration and hope. Three years after the COVID-19 crisis, followed by inflation, conflict, and food and fuel supply shocks, we badly need this. But the promises of renewal made during the pandemic, of ‘building back better’, have so far not been delivered for the great majority of workers worldwide.

Labour Day & its Concerns

The erosion of hard-won labour rights Reverse the hard reality, mistrust Globally, real wages have fallen, poverty is rising, and inequality seems more entrenched than ever.
Enterprises have been hard hit.
Many could not cope with the cumulative effects of recent unexpected events.
Small and micro-enterprises were particularly affected, and many have ceased operations.
People feel that the sacrifices they made to get through COVID-19 have not been recognised, let alone rewarded.
Their voices are not being heard clearly enough.
This, combined with a perceived lack of opportunities, has created a disturbing level of mistrust.

Way forward

Realise the Declaration of Philadelphia 1944: Our policies and actions must be human-centred, to allow people to pursue both their material well-being and their spiritual development in conditions of freedom and dignity, economic security and equal opportunity.

Focusing on ‘decent work’

To set out guiding principles for our economic and social systems, that they should not be turned exclusively to hitting specific growth rates or other statistical targets, but to address human needs and aspirations. This means focusing on inequality, poverty alleviation and core social protection.
The most effective way to do this is by providing quality jobs so that people can support themselves and build their own futures — ‘Decent Work for All’, as Sustainable Development Goal 8 terms it.
It means realistically addressing the long-term structural transformations of our time;
Ensuring that new technology creates and supports employment;
Pro-actively facing the challenges of climate change and ensuring we offer the jobs,
Skills training and
Transition support necessary for workers and businesses to benefit from the new low-carbon era;
Treating demographic changes as a ‘dividend’ rather than a problem, with supporting action on skills, migration and social protection, to create more cohesive and resilient societies.
We also need to reassess and refashion the architecture of our social and economic systems, so that they support this change of course towards social justice, rather than continuing to channel us into a policy ‘doom loop’ of inequality and instability.
Reinvigorate labour institutions and organisations so that social dialogue is effective and vigorous.
Review laws and regulations affecting the world of work, so that they are relevant and up-to-date and able to protect workers and support sustainable businesses.
Labour rights are in free fall Create a global platform to make all this happen, we need to recommit to international cooperation and solidarity.
We must enhance our efforts and create greater policy coherence, particularly within the multilateral system.

Improve Global Coalition for Social Justice.

This coalition will create a platform to bring together a broad range of international bodies and stakeholders.
It will position social justice as the keystone of the global recovery so that it is prioritised in national, regional and global policies and actions.
It will ensure that our future is human-centred.

Recall and fulfil the promises made under different ILO conventions

Sr. No.	Convention	Convention number	India’s Position
1.	Forced labour convention, 1930	29	Signed& Ratified
2.	Freedom of association and protection of the right to organise convention, 1948	87	Not Signed
3.	Right to Organise and collective bargaining convention, 1949	98	Not Signed
4.	Equal remuneration convention, 1951	100	Signed& Ratified
5.	Abolition of forced labour convention, 1957	105	Signed& Ratified
6.	Discrimination (Employment and Occupation) Convention, 1958	111	Signed& Ratified
7.	Minimum age convention, 1973	138	Signed& Ratified
8.	Occupational Safety and health convention, 1981	155	Not Signed
9.	The worst form of child labour convention, 1999	182	Signed& Ratified
10.	Promotional Framework for occupational safety and health convention, 2006	187	Not Signed

Preparedness & Resilience for Emerging Threats Initiative (PRET Initiative)

Context: World Health Organisation (WHO) launched PRET initiative to improve pandemic preparedness.

PRET Initiative

PRET Initiative is an innovative approach launched by World Health Organisation (WHO) for improving disease pandemic preparedness and prevention by providing guidance on integrated planning for responding
Uses a mode of transmission approach to guide countries in pandemic planning.
Aims to strengthen existing systems and capacities and fill gaps in existing systems.
PRET's first module will aim at boosting pandemic preparedness for respiratory pathogens such as influenza, coronaviruses or respiratory syncytial virus. The process for identifying next group of pathogens like arboviruses is underway.
Recognises three tiers of systems and capacities relevant for pandemic preparedness:

Cross-cutting for all or multi-hazards
Relevant for groups of pathogens (respiratory arboviruses)
Specific to a pathogen

RESPIRATORY PATHOGENS PARTNERS ENGAGEMENT FORUM (R-PEF)

It is an informal coordination forum convened by WHO to strengthen networking for respiratory pathogen preparedness planning.
R-PEF enables WHO and partners to exchange information on planned activities, lessons learnt, gaps and needs, reviews and other developments relating to pandemic preparedness for respiratory pathogens.
R-PEF will focus on elements common to respiratory pathogen preparedness. It does not advise or provide inputs for purposes of norms and standards setting to WHO.

Respiratory Pathogens Pandemic Resource Pack (R-PRP)

Updated resources for respiratory pathogens with pandemic potential will be collectively houses in R-PRP, web-portal.
Objective of R-PRP is to support a harmonised approach to planning for future pandemics caused by respiratory pathogens.
This resource pack will:

Incorporate lessons learned from respiratory pathogen epidemics and pandemics such as influenza, MERS-CoV-2, SARS-CoV-2
Provide a broader respiratory pathogen focus with pathogen specific elements where needed.
Leverage new modalities for partner engagement and shared learning.
Capitalise on current momentum to strengthen national functional capacities for preparedness and response.

Significance of PRET Initiative

Given the ongoing COVID-19 pandemic and possible threat of avian influenza, this module will enable countries to critically review, test and update their respiratory pandemic planning efforts to ensure they have functional capacities and capabilities in place.
One-Health Approach: PRET is based on the philosophy of One Health which recognises that most new pathogens originate first in animals and that preventing, preparing and responding to emerging threats requires multi-sector action.
Focus on Mode of Transmission: PRET focuses on Mode of Transmission of pathogens to guide countries in pandemic planning, rather than a focus on specific diseases.
Makes way for Pandemic Accord: PRET can also serve to operationalise the objectives and provisions of the Pandemic Accord, which is currently being negotiated by Member States of WHO.

Surrogacy

Context: The Supreme Court on Tuesday questioned whether a single, unmarried woman having a child through surrogacy is an “accepted norm” in Indian society or not.

The act defines surrogacy as a practice where a woman gives birth to a child for an intending couple with the intention to hand over the child after the birth to the intending couple.

Surrogacy can be classified into altruistic and commercial.

True to the meaning of the word, altruistic surrogacy entails no financial compensation for the surrogate.
In contrast, commercial surrogacy involves paying the surrogate for bearing the child, implying a profit,
while a third type i.e. compensated surrogacy simply involves covering the incurred expenses and loss of wages.

Surrogacy (Regulation) Act, 2021

It defines the surrogacy as we have discussed earlier.
The Act prohibits commercial surrogacy, but allows altruistic surrogacy.
It provides for Eligibility criteria for intending couples:
Further, this act also specifies the eligibility criteria:
- Surrogacy is permitted only for those intending married Indian couples who suffer from proven infertility.
- An Indian woman who is a widow or divorcee between the age of 35 to 45 years and who intends to avail the surrogacy.
Further it lays eligibility criteria for the surrogate mother also which specifies that she must be close relative of the intending couple, she must be a surrogate only once in her lifetime; and the surrogate mother cannot provide her own gametes for surrogacy.

Concerns

Exclusionary: The provisions deny this opportunity to LGBTQ+ persons, live-in couples, unmarried women and single parents.
Altruistic surrogacy is paternalistic - It expects a woman to go through the physical and emotional tolls of surrogacy free of cost and only out of ‘compassion’. Thus reinforcing age old patriarchal norm of no economic value to the women’s work.
It doesn’t respect the bodily autonomy of women - By shifting from right based to need based approach it snatches away the right of a women to decide upon her reproductive choices. Further it is and violative of her fundamental rights under Articles 14 (right to equality) and 21 (right to life) of the Constitution.
Impetus to Black marketing- Blanket ban on commercial surrogacy may lead to creation of unregulated, exploitative underground/black markets.
Does not defines close relative - The act didn’t define ‘close relative’, which is a condition to be fulfilled by the surrogate mother. Thus scope for confusion and exploitation of loop holes is always there.
Reproductive liberty to the couples - Several restriction in form of eligibility criteria etc restricts the surrogacy option to intending couple which is a denial of reproductive liberty to them.
No power to make decision on abortion - Intending couple don’t have final say in the consent to abort a surrogate child, even if the child being born out of a surrogacy arrangement is at the risk of physical or mental abnormalities.
Identity and emotional aspect - Several times couples do not want to reveal their plans of oping for surrogacy, now putting the condition of close relative to be a surrogate clearly ignores this aspect and restricts the choices. Further, familial bonds and interaction may involve high emotional complications between surrogate mother and intended parents.

Way ahead

It is essential that, in the process of addressing the exploitation of surrogate mothers, the act should be revised to establish a comprehensive and inclusive procedure. This revised procedure should aim to make surrogacy readily accessible to the deserving citizens of India.

National Health Accounts

Context: The Health Ministry released the National Health Accounts Estimates for India (2019-20) and noted that there has been significant decline in share of out-of-pocket expenditure (OOPE) in total health expenditure.

National Health Accounts Estimates for India (2019-20):

Total Health Expenditure (THE) for India is estimated to be around 3.3% of GDP and ₹4,863 per capita.
Share of Out-of-Pocket Expenditure (OOPE) in Total Health Expenditure declined from 62.6% in 2014-15 to 47.1% in 2019-20.
Share of Government Health Expenditure in Total Health Expenditure increases from 29% (2014-15) to 41.4% (2019-20).
Government Health Expenditure’s share in country’s total GDP increases from 1.13% (2014-15) to 1.35% (2019-20).

Government Health Expenditure and Out-of-pocket expenditure as % of Total Health Expenditure (%)

Government Health Expenditure as % of GDP

Despite the significant increase in government expenditure on Health, it is still way below the target of National Helath Policy (2017)- 2.5% of GDP.

Need for Government Health expenditure

Preventive Healthcare: Unlike private Health expenditure, public spending invests heavily on preventive health care services like Immunization and Nutrition which ultimately reduces the expenditure burden on curative Healthcare.
Reduce Catastrophic expenditure: In a country like India whose workforce is predominantly concentrated in informal sector and devoid of social security net, there is more probability for incidence of catastrophic health expenditure on its population. Hence, significant public spending on health is necessary to reduce catastrophic health expenditure and incidence of poverty as a result of it.

Limitations of Private participation

Affordability: Since private institutions require heavy investment in infrastructure, advanced equipment and quality professionals, health services are not affordable. This causes heavy out-of-pocket expenditure by households, especially in secondary & tertiary care.
Issues in Private insurance: Adverse selection (asymmetric information between buyer and insurer) and moral hazard (reckless attitude of insured consumers), lead to higher pay-out by insurance companies. This cost is adjusted by increasing premium prices, which makes health insurance less attractive for the majority of Indians.
Issues with private participation in public-funded health protection schemes:

Supply-induced demand: When patients are protected under schemes like PMJAY, private hospitals can resort to over-prescription of medication, non-standardised tests, and a longer duration of therapy to generate additional revenue.
Low-reimbursement tariffs set by the government deter genuine private hospitals to be part of such schemes.
Overpriced drugs: Private firms have invested heavily in R&D for new drugs, especially for secondary and tertiary care; hence, the price of patented drugs is passed on to consumers.

Hence, private participation can only complement but can’t replace public spending on Health to achieve the goal of Universal Health Coverage.

Female labour force participation

Studies shows that Female labour force participation rate (FLFPR) exhibits a U-shape during the process of economic development. The downward trend in ‘U’ was due to rise in Household incomes because of expansion of markets and shift from farm activities to factory work.

However, when educational level rises and as value of women’s time in the market increases further, they move back into the paid labour force.

However, despite experiencing structural changes such as decline in fertility rates and expansion of women’s education, Indian FLFPR has been stagnated. While NSSO found that 25.9% of all women worked in 1999-2000, female labour force participation rate in 2020-21, according to PLFS report, is only 25.1%.

The female labour force participation rate of Muslim women in the country is 15%, as compared to 26.1% for Hindu women. Over the past three years, Muslim women have had the lowest LFP rate amongst all religious groups in the country.

Reasons for low female labour force participation

Rising Household Incomes: Rising incomes allow women to escape harsh labour on farms and construction sites and focus on their families.
Agrarian crisis: Declining farm sizes, rising mechanisation and agrarian crisis are pushing women out of agricultural workforce.
Lack of Rural connectivity: Lack of transport network to villages may prevent women from taking non-agricultural work in Neighbouring towns. Lack of transport services effect women more than men.
Increased Education levels of women: Growing enrolment of women in Higher education and lack of adequate well paid formal jobs in the market.
Nuclear families: Growing trend of nuclear families keeping childcare left to women with no support from elders of the family.
MSME crisis: MSME sector offers significant employment opportunities to women. But rigid labour laws and other protective policies of govt hindered the growth of MSMEs.
Patriarchal norms: Patriarchal norms of society determines Domestic division of labour. Women are expected to take care of domestic chores while men go out for work.
Childcare: Most education drop out of labour force due to childbirth and care.
Other factors: Glass ceiling at workplace which limits work opportunities for females at senior levels, sexual harassment at workplaces inducing fear among females. Lack of access to marketable skills in an economy which is driven by service class.

Measures to be taken

Promote gender-responsive employment policies particularly through macroeconomic, sectoral and labour market policies that address effectively the gender-specific effects of the COVID- 19 crisis and support the creation of full and productive employment for women.
Promote appropriate public and private investment in the care sector, which has the strong potential not only to expand decent work opportunities – especially for women – but also strengthen the resilience of economies and societies and enable workers with family responsibilities to engage in employment.
Closing the gender skills gap by gender-responsive upskilling and reskilling policies that enable women to take full advantage of the decent job opportunities on offer.

About National Ayush Mission: