India maternal health: India’s progress on maternal health, nutrition has to be faster, bigger, says UN expert


India has made significant strides on social progress indicators but its progress on nutrition, maternal and infant mortality rates needs to be “bigger and faster”, Kanni Wignaraja, United Nations (UN) Assistant Secretary-General and Director, Regional Bureau for Asia and the Pacific, United Nations Development Programme (UNDP), told ET on Saturday.

She welcomed the government’s move to raise the marriage age for women from 18 to 21, and said it would nudge women to make choices about what they want to do in life, and give them legislative support to prepare better for the challenges ahead.

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Wignaraja, who is on her first official visit to India from June 12, has met senior government officials, including health minister Mansukh Mandaviya to discuss UNDP’s work for the country’s development. She said the way the India government has responded to global data on hunger, poverty and human development indicators has led to not just “a positive and much necessary debate” but also pushed better policy to ensure better results.

Sustainable Development Goals
Talking about India’s progress on Sustainable Development Goals (SDGs), adopted by the United Nations in 2015 to work with governments to achieve goals such as ending poverty, eradicating hunger and ensuring everyone has access to clean, affordable energy by 2030, Wignaraja said although at the aggregates, poverty indicators for India show reduction, why are there still very deep pockets of poverty in the country.

“When I look at India’s numbers on access to electricity and school attendance, these are rising faster than any other country. I would have liked to see the same speed of growth in nutrition, maternal and infant mortality. Yes, it’s all going in the right direction but the improvements need to be faster and bigger because this is a country now that is out there.. It’s a leader…Look at the state of water and sanitation, ten years ago. It was a bad story. But now, you see it booming because there was political attention to it.

Women’s Participation in Labour Force
Wignaraja said: “There is no way that a country like India can say it has only something like just 18.6% participation of women in the labour force in the formal sector. That is lower than most of the world. Again it comes down to intentionality, on how to invest in women through the value chain of education, access to skills, access to industrial opportunities, ownership of businesses and assets. I know everybody says that there is huge participation of women in the informal sector. That is not enough.”

“If there is a country with 100 percent women’s participation in the labour force, what does that translate into their economic, social, societal health contribution? If that goes into billions of dollars, that will wake up a lot of policy makers. Because that is converting data into powerful, evidence based calculation,” she said.

She added it will also help to understand what are the political, social, cultural barriers that might be preventing women from joining the formal workforce. “What has worked in the last two years of Covid-19 is the necessity to have flexible working arrangements to help and support women as they carry their multiple roles. These roles — the whole care economy, service informality, family work are not given an economic value, but if they are, just imagine the cost and contribution of women.”

Proposal to Raise Women’s Marriageable age to 21
Wignaraja said the move to make the marriageable age for women 21, “would allow women, at least the ones who are interested, to finish a tertiary form of education”.

“That may not translate for a majority of the women and that may not even be the path for everyone. But it certainly puts choice in the hands of the women. This is not to say marriage is the only factor that takes the agency from them, but at least the law will be supportive,” she said.

“This matter is obviously a confluence of many factors, but it nudges towards giving women more space to make decisions about what they want to do with their lives. It balances the ability to still take on roles in the family, most importantly a child bearing role for those who want to take it, while also saying that ‘I can do this while being a professional.’ And I mean not a professional in the white collar terms, but across the board,” she said.

India’s Rebuttals on Global Indices
Wignaraja said she sees the rebuttals by India as “positive noise that has led to a much necessary debate”. “To me, a rebuttal is not a bad thing. Because it makes the international community, the UN look hard at the rigour, to examine the data sets again to see there are more learnings.”

“But remember we have to work these data sets across over 190 countries. We are not focussed on India alone, so they have to have comparability. So there are individual countries that may not like it, but they have to meet international standards, which may not be national standards,” she said.

“It is not that we are stepping back and saying we are not using this data anymore… But what has happened is India hates being low on any of these indicators, so it pushes policy and intentionality of making changes happen. The bottom line is that it pushes both policy makers both inside and outside the government, to see if things can be done better. India is the only country where we with NITI Aayog are taking the SDG indices to the ward level, and even below so that even panchayats can debate and it becomes a national conversation,” she added.

Learnings from Sri Lanka
Wignaraja said what happened in Sri Lanka was an example of a multiple set of disasters coming together. “I think during Covid-19 three major areas –– remittances of migrant workers, tourism revenue, tea trade –– came crashing down at the same time. Suddenly, you have a country that has invested heavily in subsidies and the social sector seeing its income collapsing. Add to that, some unfortunate policy choices. The war in Ukraine, fuel prices shooting up…It’s a perfect disaster,” she said.

“Other countries such as Costa Rica, Maldives that were also dependent on tourism revenues immediately created bubbles of tourism zones. They made these bubbles ready for business bringing in double vaccination quickly. It was difficult for Sri Lanka to do the same because it is a large island, but they could have created some bubbles like Thailand or Malaysia did,” she said.

The most important learning is that all countries have to hold on to more buffers of reserves. India has played an amazing role in supporting Sri Lanka, credit line and debt restructuring, special grants on medicines and fertilisers and other countries have a lot to learn from that, she added.

On India’s Covid-19 management
Wignaraja said it was quite impressive to see the overall rebound that has happened in India, particularly after the Covid-19 first and delta waves. “India is going to play a huge role in being the engine for some of the important global trade, global public goods, vaccines moving around the world. She said accelerating the energy and climate agenda and applying the learnings from Covid-19 to other parts of the health system which will have an impact on the health of a nation will remain priorities of the UNDP.



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