The Hindu Editorial Analysis | 25th July’19 | PDF Download

• On July 11, World Population Day, a Union Minister expressed alarm, in a Tweet, over what he called the “population explosion” in the country, wanting all political parties to enact population control laws and annulling the voting rights of those having more than two children. Just a month earlier, a prominent businessman-yoga guru wanted the government to enact a law where “the third child should not be allowed to vote and enjoy facilities provided by the government”. This, according to him, would ensure that people would not give birth to more children.
• Both these demands are wayward and represent a warped thinking which has been rebutted rather well in the Economic Survey 2018-19. The Survey notes that India is set to witness a “sharp slowdown in population growth in the next two decades”. The fact is that by the 2030s, some States will start transitioning to an ageing society as part of a well-studied process of “demographic transition” which sees nations slowly move toward a stable population as fertility rates fall with an improvement in social and economic development indices over time.

Dangerous imagery

• The demand for state controls on the number of children a couple can have is not a new one. It feeds on the perception that a large and growing population is at the root of a nation’s problems as more and more people chase fewer and fewer resources. This image is so ingrained in the minds of people that it does not take much to whip up public sentiment which in turn can quickly degenerate into a deep class or religious conflict that pits the poor, the weak, the downtrodden and the minorities against the more privileged sections. From this point to naming, targeting and attacking is a dangerous and short slide. The implications of such an approach are deep and wide but not easily understood because the argument is couched in sterile numbers and a rule that, it would seem, applies to all sections equally. On the contrary, what is suggested is the ugliest kind of discrimination, worse than physical attacks or social prejudice because it breaks the poor and the weak bit by bit, and in a very insidious way.

Policy of choice

• The fig leaf of population control allows for the outrageous argument to be made that a family will be virtually ostracized and a citizen will be denied his or her basic rights if he or she is born as the third child. This has of course never been public policy in India.
• In fact, a far-sighted and forward-looking National Population Policy (NPP) was introduced in 2000 when Atal Bihari Vajpayee was the Prime Minister. The essence of the policy was the government’s commitment to “voluntary and informed choice and consent of citizens while availing of reproductive health care services” along with a “target free approach in administering family planning services”. This is a position reiterated by various governments, including the present government on the floor of both Houses of Parliament. For example, in March 2017, the then Minister of State (Health and Family Welfare), Anupriya Patel, in a written reply in the Lok Sabha noted that the “family Planning programme in India is target free and voluntary in nature and it is the prerogative of the clients to choose a family planning method best suited to them as per their reproductive right”.
• The then Health Minister, J.P. Nadda, has said pretty much the same thing. About a year ago, he articulated the “lifecycle framework” which looks to the health and nutrition needs of mother and child not merely during pregnancy and child birth but “right from the time of conception till the child grows… carrying on till the adolescent stage and further”. This argument is not about denying services but about offering choices and a range of services to mother and child on the clear understanding that the demographic dividend can work to support growth and drive opportunity for ordinary people only when the population is healthy.

Crucial connections

• Thus, family health, child survival and the number of children a woman has are closely tied to the levels of health and education of the parents, and in particular the woman; so the poorer the couple, the more the children they tend to have. This is a relation that has little to do with religion and everything to do with opportunities, choices and services that are available to the people. The poor tend to have more children because child survival is low, son preference remains high, children lend a helping hand in economic activity for poorer households and so support the economic as well as emotional needs of the family. This is well known, well understood and well established.
• As the National Family Health Survey-4 (2015-16) notes, women in the lowest wealth quintile have an average of 1.6 more children than women in the highest wealth quintile, translating to a total fertility rate of 3.2 children versus 1.5 children moving from the wealthiest to the poorest. Similarly, the number of children per woman declines with a woman’s level of schooling. Women with no schooling have an average 3.1 children, compared with 1.7 children for women with 12 or more years of schooling. This reveals the depth of the connections between health, education and inequality, with those having little access to health and education being caught in a cycle of poverty, leading to more and more children, and the burden that state control on number of children could impose on the weakest. As the latest Economic Survey points out, States with high population growth are also the ones with the lowest per capita availability of hospital beds.
• In fact, demographers are careful not to use the word “population control” or “excess population”. The NPP 2000 uses the world “control” just thrice: in references to the National AIDS Control Organisation; to prevent and control communicable diseases, and control of childhood diarrhoea. This is the spirit in which India has looked at population so that it truly becomes a thriving resource; the life blood of a growing economy. Turning this into a problem that needs to be controlled is exactly the kind of phraseology, mindset and possibly action that will spell doom for the nation. It will undo all the good work that has been done and set the stage for a weaker and poorer health delivery system — exactly the opposite of what a scheme such as Ayushman Bharat seeks to achieve. Today, as many as 23 States and Union Territories, including all the States in the south region, already have fertility below the replacement level of 2.1 children per woman. So, support rather than control works.

Scars of the past

• The damage done when mishandling issues of population growth is long lasting. Let us not forget that the scars of the Emergency are still with us. Men used to be part of the family planning initiatives then but after the excesses of forced sterilisations, they continue to remain completely out of family planning programmes even today. The government now mostly works with woman and child health programmes. Mistakes of the Emergency-kind are not what a new government with a robust electoral mandate might like to repeat. So it is time to ask some of the prejudiced voices within the government and ruling party not to venture into terrain they may not fully understand.
• The U.S. President Donald Trump’s latest gaffe has introduced another thorn in what is now clearly an unsettled India-U.S. relationship. His claim, on Monday, that India sought U.S. mediation in Kashmir will pinch the Narendra Modi government more because it strikes at a vital interest: India’s territorial integrity. But if we had been more attuned to international shifts, we would have noticed that structural trends in South Asia have been changing over the past several years. While India’s hand is not as strong as we sometimes believe it to be, there might be opportunities to leverage the international situation further down the road.

Perceived advantage

• If we step back and evaluate the India-Pakistan equation over the past five years, what stands out is that both sides proceeded from a perception that each holds an advantageous position. India’s confidence emanated from Mr. Modi’s electoral victory in 2014 that yielded a strong Central government and expectations of stable ties with all the major powers. Mostly overlooked in India, Pakistani leaders too have displayed confidence that the international environment was moving in a direction that opened options for Pakistan that were unavailable in the previous decade. This included the renewed patterns of Pakistan’s ties with the U.S. and China, with the latter reassuring Pakistan and, most importantly, the Army on their respective strategic commitments and bilateral partnerships. In the U.S.’s case, this appears to have been undertaken discreetly to avoid ruffling India’s feathers, with the result that the enduring aspects of U.S.-Pakistan ties remained obscure, but still very real. In the past few days, the resilience of that relationship has come out into the open. Let us not ever forget that this is a military alliance forged in the 1950s. Historically, U.S. policymakers have always sought to restore the alliance with Pakistan whenever Islamabad’s ties with China became stronger. India has borne the brunt of this recurring geopolitical dynamic.
• Much of Pakistan’s contemporary leverage can of course also be traced to the ongoing phase of the Afghan conflict. It fended off the most dangerous phase when U.S. policy might have shifted in an adversarial direction, or instability in the tribal frontier areas might have completely exploded. Thus, the Pakistan Army perceives itself in a position of strength where Washington, Beijing, and even Moscow have recognized Pakistan’s role in a future settlement on the conflict in Afghanistan. So, both India and Pakistan perceive themselves to be in a comfortable strategic position. At any rate, the evolving roles and interests of third parties are becoming significant again, and how Delhi leverages the international environment will determine the success of its overall policy.

Pakistan’s benefactors

• Both the U.S. and China have overlapping interests in regional stability and avoidance of a major subcontinental conflict. While each maintains deep ties with Pakistan for different reasons, it is unclear to what extent their longer term interests coincide with India, which seeks a structural transformation in Pakistan’s domestic politics and external behaviour. The U.S. and China appear content with, or probably prefer, a Pakistan with a strong Rawalpindi, along with competent civilian governance structures and an elite with a wider world view. A Pakistan that looks beyond South Asia could be a useful potential partner in burden sharing, ironically for both the U.S. and China. For Washington, the Pakistan Army is an insurance card for persisting security challenges such as regime survival for U.S. client states in West Asia as well as for the containment of Iran. For China, a stable Pakistan can be a partner in the Belt and Road initiative and future continental industrial and energy corridors. As the writer Andrew Small underlines, Beijing’s large economic investments “come with some clear expectations about the choices that Pakistan’s political and military leadership make about their country’s future”.
• In sum, both the U.S. and China seek a strong, stable and secure Pakistan that controls its destabilizing behavior because that undermines their wider regional interests. For the U.S., a revisionist Pakistan pulls India inward and away from potential India-U.S. cooperation on Asian geopolitics. For China, it undermines its industrial and connectivity projects in Pakistan, while negatively impacting India-China ties. Hence, evolving interests of the great powers in South Asia might not necessarily portend an adverse geopolitical setting for India in the medium term. This is even more plausible if the widening comprehensive national power gap between a rising India and an unstable Pakistan make the latter’s traditional role as a balancer or spoiler unattractive in the eyes of the great powers. As Pakistani scholar Hussain Haqqani predicts, “You can try to leverage your strategic location as much as you like, but there will come a time… when strategic concerns change.”
• So, while it is reasonable to forecast that both the U.S. and China benefit from a more normalized Pakistan, India’s policymakers should also remain clear-eyed that neither country would be willing to expend much strategic capital in an ambitious policy to reorder the domestic scene or civil-military relations in Pakistan. In any case, Indian statecraft is essential to reorient perceptions of the great powers. Maintaining that India has the right and the capacity to adopt an active defence posture — that is, blocking the flow of cross-border terror by proactive operations on the Line of Control (LoC) along with reserving the option for more ambitious punitive strikes in response to major terrorist attacks on Indian military targets — would play an important part in shaping how third parties view Indian interests and thereby assume constructive roles in managing Pakistani behaviour.
• If India ever asks third parties to assist in the region, it should be for a cessation of Pakistan’s proxy war in Kashmir, and, once an atmosphere of peace has been established, to persuade Pakistan to accept the LoC as part of a final territorial settlement similar to the offer by Indira Gandhi in the 1972 Shimla negotiations.
• On July 9, Sri Lanka became the fourth country in the Asian region — after Bhutan, The Maldives and Timor-Leste — to eliminate measles. Amidst an increase in the number of cases worldwide, especially in Europe, this came as an encouraging development. Measles is considered as eliminated when a country interrupts transmission of an indigenous virus for three years.
• However, the viral infection has, since the beginning of 2018, seen a resurgence in 49 of the 53 countries in the World Health Organization (WHO)’s European Region. A total of 1,60,000 cases and more than 100 deaths were reported from these 49 countries between January 1, 2018 and May 30 this year.
• The number of cases reported last year in the European Region, the highest in this decade, was thrice the number reported in 2017 and 15 times the number for 2016. With nearly 78,000 cases reported in the first five months of this year, indications are that the number will surpass last year’s. • Ironically, the sharp increase in the region came despite vaccination coverage for the second dose being at a record-high of 91% in 2018. So what could have caused the spike? According to the WHO, the vaccination coverage has “not been uniform across the region nor high enough to ensure herd immunity” to break the transmission cycle.

Pockets of low coverage

• Further, though the coverage is high at the national level in many countries, there are pockets of low coverage in them, causing an “accumulation of susceptible individuals” that goes largely unnoticed till such time an outbreak occurs.
• So how did Sri Lanka manage to accomplish this at this juncture even though, worldwide, there has been a 300% increase in the number of cases in the first three months of this year, compared to 2018?
• The answer lies in an increased, and a wider, vaccination coverage for both doses.
• While global coverage for the first dose of vaccine has remained stagnant at 85% and for the second dose, it is still at 67%, the coverage for Sri Lanka has been above 95% for both the first and second doses. The vaccine is provided to children under the routine national immunization programme.
• Regular vaccination campaigns
• The island nation, where measles is a notifiable infection, has also carried out periodical mass vaccination campaigns to reach the small pockets of unimmunised children. Sri Lanka also has strong surveillance in place.
• However, the country did encounter a few bumps in its path. In 1984, it introduced measles vaccine in the national immunisation programme and set the goal of eliminating the infection. Though local outbreaks were reported, the annual incidence declined till the year 1999.
• During Sri Lanka’s measles epidemic of 1999-2000, nearly 15,000 cases were reported following which a two-dose vaccine schedule was introduced, resulting in a sharp decline in incidence. The country reached an elimination target of less than five per one million people in 2011.
• But in 2012, the measles immunisation schedule was changed following which babies no longer received measles vaccine at the age of nine months but a measles, mumps and rubella (MMR) vaccine on completing 12 months. Following this, in 2013, the country witnessed its last major measles epidemic. Besides other reasons, the change in immunisation schedule was seen as a possible cause.
• The MMR vaccine schedule was again changed following a sero-survey data. Babies now began receiving the first dose at nine months and second dose at the age of three years. The country reported its last case of measles caused by an indigenous virus in May 2016.

Chandrayaan-2 gets first orbit boost

• To head for the moon on August 14
• The lunar craft Chandrayaan-2 had its first orbit raising manoeuvre on Day 3 since its launch on Monday, July 22.
• At 2 p.m. on Wednesday, teams handling the spacecraft’s movement did a 1.5-hour-long burn of an on-board motor.
• They raised the orbit to the present 241.5 km x 45,162 km around earth, the Indian Space Research Organisation said. Engineers conducted the exercises from ISTRAC (ISRO Telemetry, Tracking & Command Network) at Peenya in Bengaluru.
• Chandrayaan-2, which is carrying a lander and a rover, will head for the moon on August 14.
• “The spacecraft is scheduled to reach moon by August 20,” the update said.
• ICMR’s new move to aid data collection
• The Indian Council of Medical Research (ICMR)’s National Institute for Medical Statistics (ICMR-NIMS), in partnership with Population Council, launched the National Data Quality Forum (NDQF) here on Wednesday.
• NDQF will integrate learnings from scientific and evidence-based initiatives and guide actions through periodic conferences. Its activities will help establish protocols and good practices of data collection, storage, use and dissemination that can be applied to health and demographic data, a note from ICMR said.
• The launch was attended by representative from academic institutions, technology partners and others.
• The Indian Council of Medical Research (ICMR), the apex body in India for the formulation, coordination and promotion of biomedical research, is one of the oldest and largest medical research bodies in the world.
• The ICMR is funded by the Government of India through the Department of Health Research, Ministry of Health and Family Welfare. [1][2] ICMR’s 26 national institutes address themselves to research on specific health topics like tuberculosis, leprosy, cholera and diarrhoeal diseases, viral diseases including AIDS, malaria, kala-azar, vector control, nutrition, food & drug toxicology, reproduction, immuno-haematology, oncology, medical statistics, etc. Its 6 regional medical research centres address themselves to regional health problems, and also aim to strengthen or generate research capabilities in different geographic areas of the country
• In 1911, the Government of India set up the Indian Research Fund Association (IRFA) with the specific objective of sponsoring and coordinating medical research in the country. After independence, several important changes were made in the organisation and the activities of the IRFA. It was redesignated the Indian Council of Medical Research (ICMR) in 1949, with considerably expanded scope of functions.
• The governing body of the council is presided over by the Union Health Minister. It is assisted in scientific and technical matters by a scientific advisory board comprising eminent experts in different biomedical disciplines. The board, in its turn, is assisted by a series of scientific advisory groups, scientific advisory committees, expert groups, task forces, steering committees etc. which evaluate and monitor different research activities of the council.
• The council promotes biomedical research in the country through intramural as well as extramural research. Over the decades, the base of extramural research and also its strategies have been expanded by the council.
• Intramural research is carried out currently through the council’s 30 permanent research institutes/centres which are mission-oriented national institutes located in different parts of India. The institutes pursue specific areas of research such as tuberculosis, leprosy, cholera and diarrhoeal diseases, viral diseases including Rotavirus, dengue, Ebolavirus, Influenza, Japanese encephalitis, AIDS, malaria, kala-azar, vector control, nutrition, food & drug toxicology, reproduction, immunohaematology, oncology, and medical statistics. Six Regional Medical Research Centres address regional health problems, and also aim to strengthen or generate research capabilities in different geographic areas of the country. It has also been involved in research related to rare diseases like Handigodu Syndrome

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