<html xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns="http://www.w3.org/TR/REC-html40">
<head>
<meta http-equiv=Content-Type content="text/html; charset=iso-8859-1">
<meta name=ProgId content=Word.Document>
<meta name=Generator content="Microsoft Word 9">
<meta name=Originator content="Microsoft Word 9">
<link rel=File-List href="cid:filelist.xml@01C4AD2C.A4BE07A0">
<!--[if gte mso 9]><xml>
<o:OfficeDocumentSettings>
<o:DoNotRelyOnCSS/>
</o:OfficeDocumentSettings>
</xml><![endif]--><!--[if gte mso 9]><xml>
<w:WordDocument>
<w:View>Print</w:View>
<w:EnvelopeVis/>
<w:DoNotOptimizeForBrowser/>
</w:WordDocument>
</xml><![endif]-->
<style>
<!--
/* Font Definitions */
@font-face
{font-family:Times;
panose-1:2 2 6 3 5 4 5 2 3 4;
mso-font-charset:0;
mso-generic-font-family:roman;
mso-font-format:other;
mso-font-pitch:variable;
mso-font-signature:3 0 0 0 1 0;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{mso-style-parent:"";
margin:0cm;
margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";}
p.MsoFootnoteText, li.MsoFootnoteText, div.MsoFootnoteText
{margin:0cm;
margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:10.0pt;
font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-fareast-language:ZH-CN;}
p.MsoFooter, li.MsoFooter, div.MsoFooter
{margin:0cm;
margin-bottom:.0001pt;
mso-pagination:widow-orphan;
tab-stops:center 216.0pt right 432.0pt;
font-size:12.0pt;
font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";}
span.MsoFootnoteReference
{vertical-align:super;}
span.MsoEndnoteReference
{vertical-align:super;}
p.MsoEndnoteText, li.MsoEndnoteText, div.MsoEndnoteText
{margin:0cm;
margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:10.0pt;
font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";}
p.MsoBodyText, li.MsoBodyText, div.MsoBodyText
{margin:0cm;
margin-bottom:.0001pt;
text-align:justify;
line-height:150%;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-font-kerning:14.0pt;}
p.MsoBodyText2, li.MsoBodyText2, div.MsoBodyText2
{margin:0cm;
margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
mso-bidi-font-size:10.0pt;
font-family:"Times New Roman";
mso-fareast-font-family:"Times New Roman";
mso-fareast-language:ZH-CN;}
@page Section1
{size:612.0pt 792.0pt;
margin:72.0pt 90.0pt 72.0pt 90.0pt;
mso-header-margin:36.0pt;
mso-footer-margin:36.0pt;
mso-even-footer:url("cid:header.htm@01C4AD2C.A4BE07A0") ef1;
mso-footer:url("cid:header.htm@01C4AD2C.A4BE07A0") f1;
mso-paper-source:0;}
div.Section1
{page:Section1;}
/* List Definitions */
@list l0
{mso-list-id:1328512914;
mso-list-type:hybrid;
mso-list-template-ids:1502093028 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;}
@list l0:level1
{mso-level-tab-stop:36.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;}
ol
{margin-bottom:0cm;}
ul
{margin-bottom:0cm;}
-->
</style>
</head>
<body lang=EN-US style='tab-interval:36.0pt'>
<div class=Section1>
<p class=MsoNormal style='margin-left:36.0pt;text-align:justify;text-indent:
36.0pt;line-height:150%'><b><font size=3 face="Times New Roman"><span
style='font-size:12.0pt;font-weight:bold'><![if !supportEmptyParas]> <![endif]><o:p></o:p></span></font></b></p>
<p class=MsoNormal style='text-align:justify;line-height:150%'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'>From Dr Mohan Rao</span></font></p>
<p class=MsoNormal style='text-align:justify;line-height:150%'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'><![if !supportEmptyParas]> <![endif]><o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:36.0pt;text-align:justify;text-indent:
36.0pt;line-height:150%'><b><font size=3 face="Times New Roman"><span
style='font-size:12.0pt;font-weight:bold'>On CMP Health and Population Policy
Initiatives<o:p></o:p></span></font></b></p>
<p class=MsoNormal style='text-align:justify;line-height:150%'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'>Over the last fifteen
years India has witnessed a sharp decline in the state’s commitment to public
health. Thus today our country has the fifth lowest public health expenditure
in the world. As the National Health Policy admitted, this is, at 0.9 per cent
of the GDP, lower than the average in even Sub Saharan Africa. Along with
decreasing state spending on health, increasingly policy measures have
encouraged the growth of the private sector in health care so that today we
have the largest and least regulated private health care industry in the world.
Evidence from across the country indicates that access to health care has
declined sharply over this period. The policy of levying of user fees has impacted
negatively upon access to public health facilities, especially for poor and
marginalized communities and to women. As health care costs have increased
sharply, it is not surprising that medical expenditure is emerging as one of
the leading causes of indebtedness. At the same time, this has been accompanied
by policies that have reduced access of the poor to public distributions
systems of food so that per capita availability of food has shown an alarming
decrease.</span></font></p>
<p class=MsoNormal style='text-align:justify;line-height:150%'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'><![if !supportEmptyParas]> <![endif]><o:p></o:p></span></font></p>
<p class=MsoNormal style='text-align:justify;line-height:150%'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'>It is thus not surprising
that in addition to starvation deaths, the huge load of preventable and
communicable diseases remains substantially unchanged. <span style='mso-font-kerning:
14.0pt;mso-bidi-font-weight:bold'>Infant and Child mortality take an
unconscionable toll of the lives of 22 lakh children every year.</span><b
style='mso-bidi-font-weight:normal'><span style='mso-font-kerning:14.0pt;
font-weight:bold'> </span></b><span style='mso-font-kerning:14.0pt'>We are yet
to achieve the National Health Policy 1983 target to reduce the Infant
Mortality Rate to less than 60 per 1000 live births. More serious is the fact
that the rate of decline in the Infant Mortality Rate, which was significant in
the 1970s and 80s, <span style='mso-bidi-font-style:italic'>has remarkably
decelerated in the 1990s.<b style='mso-bidi-font-weight:normal'><span
style='font-weight:bold'> </span></b></span><span style='mso-bidi-font-weight:
bold'>130,000 mothers die during childbirth every year. </span>The NHP 1983
target for 2000 was to reduce Maternal Mortality Rate to less than 200 per
100,000 live births. However, 407 mothers die due to pregnancy related causes,
for every 100,000 live births even today. As per the National Family Health Surveys
in the last decade, the MMR has increased from 424 to 540 maternal deaths per
100,000 live births. Partially as a result of population policies, the
disincentives and the two-child norm contained in them – at variance with the
National Population Policy (2000) and the commitments made at the ICPD in Cairo
– there is a massive shortfall of girls in the 0-6 years age group due to Sex
Selective Abortions (SSA). Violence against women has grown, and taken many new
forms, including a huge increase in so-called “honour killings”. Indeed it
would be no exaggeration to state that population policies have added to this
violence.<o:p></o:p></span></span></font></p>
<p class=MsoNormal style='text-align:justify;line-height:150%'><font size=3
face="Times New Roman"><span style='font-size:12.0pt;mso-font-kerning:14.0pt'><![if !supportEmptyParas]> <![endif]><o:p></o:p></span></font></p>
<p class=MsoBodyText><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>It is thus with hope that we looked forward to the
United Progressive Alliance government to initiate policy measures to arrest
these trends. Although the Common Minimum Programme was committed to a
substantial increase in health spending, this is not evident in the financial
allocations made: the budget outlay for 2004-05, adjusted for inflation, shows
no increase in the outlay for health and an 11.9 per cent increase for family
planning, clearly indicating skewed priorities.</span></font></p>
<p class=MsoNormal style='text-align:justify;line-height:150%'><font size=3
face="Times New Roman"><span style='font-size:12.0pt;mso-font-kerning:14.0pt'><![if !supportEmptyParas]> <![endif]><o:p></o:p></span></font></p>
<p class=MsoNormal style='text-align:justify;line-height:150%;tab-stops:225.0pt'><font
size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-font-kerning:
14.0pt'>However, more alarmingly, the single line, </span><font color=black><span
style='color:black;mso-bidi-font-weight:bold'>“A sharply targeted population
control programme will be launched in the 150-odd high-fertility districts”,
from the CMP has been acted upon to unveil </span></font><span
style='mso-font-kerning:14.0pt'>policy measures for 209 districts in </span><font
color=black><span style='color:black'>the country. This is a truly unfortunate
move, with grave consequences for thousands of women and children from the
poor, marginalized communities, especially dalits and adivasis, who along with
deprivation, suffer higher levels of morbidity and mortality, and a high unmet
need for health and family planning services.<o:p></o:p></span></font></font></p>
<p class=MsoNormal style='text-align:justify;line-height:150%;tab-stops:225.0pt'><font
size=3 color=black face="Times New Roman"><span style='font-size:12.0pt;
mso-bidi-font-size:10.0pt;mso-fareast-font-family:Times;color:black'><![if !supportEmptyParas]> <![endif]><o:p></o:p></span></font></p>
<p class=MsoNormal style='text-align:justify;line-height:150%;tab-stops:36.0pt'><font
size=3 color=black face="Times New Roman"><span style='font-size:12.0pt;
color:black'>These 209 districts in which the “sharply targeted population
control programme’’ are to be launched are precisely the same districts with
poor indicators for social development, especially female literacy, infant and
child survival, maternal morbidity and mortality and other indicators of human
and gender development.<span style="mso-spacerun: yes"> </span>Instead of
a package of health and development measures, what is being proposed</span></font><b
style='mso-bidi-font-weight:normal'><font color=black><span style='mso-bidi-font-size:
10.0pt;mso-fareast-font-family:Times;color:black;font-weight:bold'> </span></font></b><font
color=black><span style='mso-bidi-font-size:10.0pt;mso-fareast-font-family:
Times;color:black;mso-bidi-font-weight:bold'>is c</span></font><span
style='mso-font-kerning:14.0pt'>oncentrating on a sharply targeted population
control programme in these districts in five states. This profoundly regressive
policy relies on targets for sterilization, coercive incentives and
disincentives, and massive subsidies to the private sector, recalling the worst
days of India’s family planning history.</span><font color=black><span
style='color:black'> </span></font>Not only do such measures violate basic
human rights, they have also been shown to be demographically unnecessary in
bringing down population growth rates.<b style='mso-bidi-font-weight:normal'><span
style='font-weight:bold'> </span></b><span style='mso-bidi-font-size:10.0pt;
mso-fareast-font-family:Times'><o:p></o:p></span></p>
<p class=MsoNormal style='text-align:justify;line-height:150%'><font size=3
face="Times New Roman"><span style='font-size:12.0pt;mso-font-kerning:14.0pt'><span
style="mso-spacerun: yes"> </span><o:p></o:p></span></font></p>
<p class=MsoNormal style='text-align:justify;line-height:150%'><font size=3
face="Times New Roman"><span style='font-size:12.0pt;mso-font-kerning:14.0pt'>The
declining Child Sex Ratio(CSR) is one deeply worrying indicator of the outcomes
of such short-sighted population policies. Between 1991 and 2001, in urban
areas, the CSR has declined from 935 to 903 and in rural areas from 948 to 934.
More ominously, between January and June this year, in Delhi the Sex Ratio at
Birth indicates 819 females being born for every 1000 males; in the prosperous
and educated South Delhi zone, where demographic transition has by and large
been completed, only 762 females were born for every 1000 males. A recent study
by the Ministry of Health also indicated the dolorous outcome of the imposition
of the two-child norm for contesting elections. A large majority of those
disqualified on this ground were dalits, the adivasis and women from poor
families, defeating the very purpose of democratic decentralization. Further,
the study indicated that this norm had acted as an incentive for SSA. Clearly
then population stabilization in this form cannot be the goal since it leads to
profoundly unbalanced populations.<o:p></o:p></span></font></p>
<p class=MsoNormal style='text-align:justify;line-height:150%'><font size=3
face="Times New Roman"><span style='font-size:12.0pt;mso-font-kerning:14.0pt'><![if !supportEmptyParas]> <![endif]><o:p></o:p></span></font></p>
<p class=MsoNormal style='text-align:justify;line-height:150%'><font size=3
face="Times New Roman"><span style='font-size:12.0pt;mso-font-kerning:14.0pt'>We
therefore demand that the programme measures for these 209 districts be
unreservedly scrapped. We cannot have a population policy that does not hinge
on equity and gender justice. There should thus be no National Population
Mission. <b style='mso-bidi-font-weight:normal'><span style='font-weight:bold'>Issues
concerning women’s health and reproductive rights can only be part of a larger
package of a health and social development policy.<o:p></o:p></span></b></span></font></p>
<p class=MsoNormal style='text-align:justify;line-height:150%'><font size=3
face="Times New Roman"><span style='font-size:12.0pt;mso-font-kerning:14.0pt'><![if !supportEmptyParas]> <![endif]><o:p></o:p></span></font></p>
<p class=MsoNormal style='text-align:justify;line-height:150%'><font size=3
face="Times New Roman"><span style='font-size:12.0pt;mso-font-kerning:14.0pt'>We
welcome the UPA’s commitment to increasing state spending on health, but this
should be entirely devoted to strengthening the universal and comprehensive
primary health care (PHC) system. Increasing state spending cannot become the
vehicle to increasing public subsidy to the private or NGO sectors, which in
fact require regulation. It is evident from the CSRs that the private sector
has played a deeply regressive role in health care provision.<o:p></o:p></span></font></p>
<p class=MsoNormal style='text-align:justify;line-height:150%'><font size=3
face="Times New Roman"><span style='font-size:12.0pt;mso-font-kerning:14.0pt'><![if !supportEmptyParas]> <![endif]><o:p></o:p></span></font></p>
<p class=MsoNormal style='text-align:justify;line-height:150%'><font size=3
face="Times New Roman"><span style='font-size:12.0pt;mso-font-kerning:14.0pt'>The
Tenth Plan proposals for health and nutrition need to be reviewed keeping
epidemiological priorities in mind. <b style='mso-bidi-font-weight:normal'><span
style='font-weight:bold'>A basket of technologically determined vertical
programmes cannot substitute for a systematic strengthening of a comprehensive,
universal, integrated PHC system.<o:p></o:p></span></b></span></font></p>
<p class=MsoNormal style='text-align:justify;line-height:150%'><b
style='mso-bidi-font-weight:normal'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt;mso-font-kerning:14.0pt;font-weight:bold'><![if !supportEmptyParas]> <![endif]><o:p></o:p></span></font></b></p>
<p class=MsoNormal style='text-align:justify;line-height:150%'><font size=3
face="Times New Roman"><span style='font-size:12.0pt;mso-font-kerning:14.0pt'>Ten
years after Cairo, if the commitments made there have to have meaning, it is
clear that we cannot have RCH without PHC; nor indeed can we have gender-just
population policies without the enabling conditions of health and development.
What we have demanded is the minimum and non-negotiable.<span
style="mso-spacerun: yes"> </span>We are still hopeful that the UPA
government promises something new.<o:p></o:p></span></font></p>
<p class=MsoNormal style='text-align:justify;line-height:150%'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'><![if !supportEmptyParas]> <![endif]><o:p></o:p></span></font></p>
<p class=MsoNormal style='text-align:justify;line-height:150%'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'>Signed</span></font></p>
<ol style='mso-margin-top-alt:0cm' start=1 type=1>
<li class=MsoNormal style='text-align:justify;line-height:150%;mso-list:l0 level1 lfo1;
tab-stops:list 36.0pt'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>Action India</span></font></li>
<li class=MsoNormal style='text-align:justify;line-height:150%;mso-list:l0 level1 lfo1;
tab-stops:list 36.0pt'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>All India Democratic Women’s Association (AIDWA)</span></font></li>
<li class=MsoNormal style='text-align:justify;line-height:150%;mso-list:l0 level1 lfo1;
tab-stops:list 36.0pt'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>Centre for Social Medicine and Community Health
(CSMCH), JNU</span></font></li>
<li class=MsoNormal style='text-align:justify;line-height:150%;mso-list:l0 level1 lfo1;
tab-stops:list 36.0pt'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>Centre for Women’s Development Studies (CWDS)</span></font></li>
<li class=MsoNormal style='text-align:justify;line-height:150%;mso-list:l0 level1 lfo1;
tab-stops:list 36.0pt'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>Delhi Science Forum (DSF)</span></font></li>
<li class=MsoNormal style='text-align:justify;line-height:150%;mso-list:l0 level1 lfo1;
tab-stops:list 36.0pt'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>Jan Swasthya Abhiyan (JSA)</span></font></li>
<li class=MsoNormal style='text-align:justify;line-height:150%;mso-list:l0 level1 lfo1;
tab-stops:list 36.0pt'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>Joint Women’s Programme (JWP)</span></font></li>
<li class=MsoNormal style='text-align:justify;line-height:150%;mso-list:l0 level1 lfo1;
tab-stops:list 36.0pt'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>Medico-Friend’s Circle (MFC)</span></font></li>
<li class=MsoNormal style='text-align:justify;line-height:150%;mso-list:l0 level1 lfo1;
tab-stops:list 36.0pt'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>National Federation of Indian Women (NFIW)</span></font></li>
<li class=MsoNormal style='text-align:justify;line-height:150%;mso-list:l0 level1 lfo1;
tab-stops:list 36.0pt'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>Saheli</span></font></li>
<li class=MsoNormal style='text-align:justify;line-height:150%;mso-list:l0 level1 lfo1;
tab-stops:list 36.0pt'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>Sama</span></font></li>
<li class=MsoNormal style='text-align:justify;line-height:150%;mso-list:l0 level1 lfo1;
tab-stops:list 36.0pt'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>Young Women’s Christian Association (YWCA)</span></font></li>
</ol>
<p class=MsoNormal style='text-align:justify;line-height:150%'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'><![if !supportEmptyParas]> <![endif]><o:p></o:p></span></font></p>
</div>
</body>
</html>