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Editorials/Opinions Analysis For UPSC 08 July 2025

  1. Fostering a commitment to stop maternal deaths
  2. Rising seas, shifting lives and a test of democratic values
  3. Batting for prevention


The Big Picture: Maternal Mortality in India

  • MMR (2019–21): 93 deaths per 1,00,000 live births (SRS data).
  • Trend: Downward trajectory → 103 (2017–19) → 97 (2018–20) → 93 (2019–21).
  • Yet, 93 maternal deaths per lakh live births remain unacceptably high for a growing economy.
  • Definition (WHO-aligned): Maternal death is death during pregnancy or within 42 days of termination, excluding accidental/incidental causes.

Relevance : GS 2(Health , Social Issues)

Practice Question : Despite significant improvements, maternal mortality remains unacceptably high in many parts of India. Discuss the major reasons behind the persistence of maternal deaths. Suggest a multi-pronged strategy to achieve the SDG target of reducing Maternal Mortality Ratio (MMR) below 70 by 2030.(250 Words)

Inter-State Disparities: India’s Fragmented Maternal Health Map

Southern States (Generally Lower MMR)

  • Kerala: 20 (Lowest in India; benchmark state)
  • Tamil Nadu: 49
  • Andhra Pradesh: 46
  • Telangana: 45
  • Karnataka: 63 (Highest among Southern States)

Empowered Action Group (EAG) States (High MMR)

  • Assam: 167 (Highest in the country)
  • Madhya Pradesh: 175
  • Uttar Pradesh, Bihar, Chhattisgarh, Odisha, Rajasthan, Uttarakhand: 100–151 range
  • Jharkhand: 51 (Surprisingly lower than average for EAG)

Other States

  • Maharashtra: 38 (Performs better than some Southern states)
  • Gujarat: 53
  • Punjab: 98
  • Haryana: 106
  • West Bengal: 109

The “Three Delays” Framework (Deborah Maine Model)

Delay in decision to seek care

  • Ignorance about complications → Perception of childbirth as a naturalprocess.
  • Gender bias, family neglect, or economic constraints.
  • Illiteracy, patriarchy, and poor women’s autonomy.
  • Solutions: ASHA–ANM networks, women’s SHGs, financial incentives (JSY), community awareness.

Delay in reaching a health facility

  • Rural remoteness: forests, islands, hamlets.
  • Lack of public transport or unaffordable private options.
  • Solutions: 108 ambulance service, NHM-supported emergency transport systems.

Delay in receiving adequate care at facility

  • Staff absenteeism or lack of trained personnel.
  • Delay in blood transfusion, OT preparation, lab support.
  • Shortage of obstetricians, anaesthetists, paediatricians.
  • 66% specialist vacancies in CHCs; poor FRU functioning.

Medical Causes of Maternal Death

Postpartum Hemorrhage (PPH):

  • Most lethal; caused by uterine atony post-delivery.
  • Severe blood loss + untreated anaemia → shock & death.
  • Solution: Immediate transfusion, uterine artery clamp, uterotonics, suction cannula.

Obstructed Labour:

  • Small pelvis of stunted, undernourished adolescent mothers.
    • Can lead to uterine rupture and foetal distress.
    • Solution: Timely Caesarean section by skilled surgeons.

Hypertensive Disorders of Pregnancy (e.g., eclampsia):

  • Often unrecognized → convulsions, coma.
    • Very narrow window to medically control.

Unsafe Abortions & Sepsis:

  • Caused by quack practitioners or failure of contraception.
    • Delay in hospital admission and lack of antibiotics cause death.

Infections in Home Deliveries:

  • Puerperal sepsis, often due to untrained birth attendants.

Co-morbidities in EAG States:

  • Malaria, tuberculosis, chronic UTIs increase risk.

Systemic & Infrastructure Gaps

  • Non-functional FRUs (First Referral Units):
    • Required: 4 per 2 million population.
    • Out of 5,491 CHCs, 2,856 designated as FRUs — but many lack:
      • Blood storage units
      • Anaesthetists
      • Round-the-clock OTs
      • Emergency obstetric care
  • Human Resource Crisis:
    • 66% vacancy rate of specialists across CHCs.
  • Inadequate Antenatal Coverage:
    • Missed anaemia detection, nutritional deficiencies go untreated.
  • Late Detection of High-Risk Pregnancies:
    • No routine high-risk pregnancy flagging system in many districts.

Best Practices: The Kerala Model

  • MMR of 20 → India’s best performer.
  • Confidential Review of Maternal Deaths:
    • Developed by Dr. V.P. Paily.
    • Data-rich, analytical, and leads to action points.
  • Innovative Practices:
    • Uterine artery clamps, suction cannula for uterine atony.
    • Surveillance for rare causes: amniotic fluid embolism, DIC, hepatic failure.
    • Routine mental health screening for antenatal depression & postpartum psychosis.
  • Comprehensive Audit Culture:
    • Each death studied → individual and systemic learning.

Policy Interventions & Missions

  • Janani Suraksha Yojana (JSY):
    • Cash incentive scheme to promote institutional deliveries.
  • National Health Mission (NHM):
    • 108 Ambulance, maternal death audits, ASHA training.
  • LaQshya (Labour Room Quality Improvement Initiative):
    • Improving safety and hygiene in labour rooms.
  • PM POSHAN & Anemia Mukt Bharat:
    • Tackle nutritional deficiencies among adolescent girls.
  • Midwifery Initiative:
    • Introducing trained nurse-midwives for low-risk deliveries.

What States Must Prioritise

EAG States:

  • Focus on basic institutional care first.
  • Fill vacancies in CHCs/FRUs.
  • Expand access in tribal and underserved regions.
  • Improve antenatal outreach and anaemia control.

Southern + Progressive States (e.g., Maharashtra, Gujarat, Jharkhand):

  • Enhance quality of emergency care (C-section, ICU).
  • Introduce maternal mental health care.
  • Shift from reactive to proactive risk detection.

All States:

  • Mandatory maternal death audits with accountability.
  • Local recruitment of specialists via state cadre services.
  • Strengthen referral chains: PHC → CHC → District Hospitals.

Way Forward: Zero Preventable Maternal Deaths

  • Maternal death is often preventable, not inevitable.
  • India must treat every maternal death as a public health failure.
  • With political will, community awareness, skilled care, and accountability:
    • India can reduce MMR to <70 by 2030 (SDG 3.1 Target).
  • The goal should not be just safe delivery, but safe motherhood.


Context :

  • Sea-level rise, saline intrusion, and erosion are displacing entire coastal communities.
  • Coastal India faces a dual crisis: ecological destruction + socio-economic dislocation.
  • Displacement hotspots include:
    • Satabhaya (Odisha): Submerged under rising seas; villagers resettled with inadequate livelihood options.
    • Honnavar (Karnataka): Fishing communities uprooted by port and tourism projects.
    • Nagapattinam (Tamil Nadu), Kutch (Gujarat), lowlands of Kerala — facing escalating climate threats.

Relevance : GS 3(Climate Change ) , GS 2(Social Justice)

Practice Question : Rising seas are not only an ecological crisis but also a humanitarian and democratic challenge. Examine the implications of climate-induced displacement on coastal communities in India. How can a rights-based and resilient framework address the emerging socio-economic vulnerabilities?(250 Words)

ROOT CAUSES: Development vs Ecology

Ecological Degradation by Human Activity

  • Sagarmala Programme, energy corridors, commercial aquaculture accelerating habitat loss.
  • Mangroves, wetlands, dunes — natural buffers against storms and floods — are being cleared.
  • Cumulative environmental impacts are ignored in fragmented project-level assessments.

CRZ Notification 2019: A Regulatory Setback

  • Diluted zoning norms allow ports, hotels, and industries in ecologically fragile zones.
  • Environmental clearance regime prioritises “ease of doing business” over environmental justice.
  • Local communities are often excluded from decision-making despite legal rights to consultation.

DISPLACEMENT → URBAN VULNERABILITY

Displacement Patterns

  • Forced migration to cities like Bhubaneswar, Chennai, Mumbai, Hyderabad.
  • Migrants absorbed into informal economy: construction sites, domestic work, brick kilns.

Vulnerabilities in Cities

  • Lack of legal protection under labour laws (e.g., BOCW Act rarely enforced).
  • Debt bondage due to wage advances.
  • Gendered exploitation: Displaced women face abuse, trafficking risks in domestic work.
  • Absence of social security nets, identity documentation, or urban inclusion.

LEGAL AND POLICY GAPS

No Legal Recognition of Climate Migrants

  • No specific law addresses slow-onset climate displacement.
  • Article 21 (Right to life and dignity) exists, but no statutory enforcement mechanism for climate-induced displacement.

Existing Laws Inadequate

  • Disaster Management Act (2005): Focused on sudden events, not slow-onset sea-level rise.
  • Environment Protection Act (1986), CRZ rules: Limited to conservation, not human displacement.
  • NAPCC/SAPCCs: Recognise vulnerability but lack rehabilitation strategies.
  • Labour Codes: Silent on migrants displaced due to climate change.

SUPREME COURT JURISPRUDENCE: RIGHTS + ENVIRONMENT

  • Landmark cases:
    • M.C. Mehta vs Union of India (1987): Environmental protection part of right to life.
    • Indian Council for Enviro-Legal Action (1996): Polluters must be held accountable.
  • But… jurisprudence has not translated into community-centric legal frameworks for climate displacement.

GRASSROOTS RESISTANCE AND RESILIENCE

Community Movements

  • Ennore Creek (Tamil Nadu): Fisherfolk protest Adani port expansion.
  • Save Satabhaya (Odisha): Fight for livelihood and relocation rights.
  • Pattuvam Mangrove Protection (Kerala): Resistance against ecological destruction.

Challenges to Environmental Defenders

  • Intimidation, criminalisation, surveillance of activists.
  • Violation of constitutional rights to protest (Article 19(1)(a), 19(1)(b)).

MISSING PIECES: What Needs Urgent Attention

Recognise Climate-Induced Displacement in Law

  • Amend migration and disaster policies to classify climate migrants.
  • Integrate climate displacement in urban planning and housing policies.

Build Legal Protections for Migrant Workers

  • Extend labour law coverage (e.g., BOCW Act, Domestic Workers’ Welfare schemes) to displaced workers.
  • Enforce minimum wage, identity cards, portability of entitlements.

Inclusive Coastal Zone Governance

  • Revoke dilution of CRZ norms that exclude communities.
  • Institutionalise prior informed consent and participatory coastal planning.

STRUCTURAL STRATEGIES: Way Forward

Reimagine Development Along the Coast

  • Shift from port/tourism-centric growth to resilience-based planning.
  • Promote eco-sensitive livelihoods (sustainable fishing, eco-tourism, mangrove protection).

Link Climate Action with Labour Rights

  • Align with SDG 8.7: Eliminate forced labour and promote decent work.
  • Integrate climate resilience into skilling missions, especially for displaced youth and women.

Strengthen Institutional Capacity

  • Create dedicated cells on climate migration in MoEFCC, MoRD, and MoLE.
  • Ensure climate-sensitive infrastructure in resettlement colonies.

GLOBAL PARALLELS & RESPONSIBILITY

  • India must acknowledge climate displacement as a domestic human rights issue.
  • Draw from UN Guiding Principles on Internal Displacement.
  • Lead by example in Global South for rights-based climate adaptation.

CONSTITUTIONAL AND DEMOCRATIC TEST

  • Climate displacement is not just an environmental issue — it is a human dignity issue.
  • It tests the soul of Indian democracy:
    • Can the Constitution protect the voiceless?
    • Can development be inclusive and equitable?
  • Protecting displaced coastal communities is a litmus test for Indias commitment to both climate justice and constitutional morality.


Context : Nipah Virus outbreak in Kerala (July 2025)

  • Two confirmed cases in Kerala:
    • Malappuram: Adolescent girl — fatal
    • Palakkad: 38-year-old woman — critical
  • 425 contacts traced across 3 districts:
    • Malappuram: 228 (12 under treatment, 5 in ICU)
    • Palakkad: 110 (1 isolated)
    • Kozhikode: 87
    • 140+ health workers under surveillance
  • Contact tracing, isolation, containment, and treatment are underway; lab results awaited for remaining suspected cases.

Relevance : GS 2(Health , Governance)

Practice Question : The recurrence of the Nipah virus outbreak in India underscores the urgent need to institutionalise a One Health” approach. Critically examine the systemic and ecological gaps that allow zoonotic diseases to emerge. Suggest a comprehensive strategy to prevent such spillovers in the future.(250 Words)

WHY NIPAH TRIGGERS HIGH ALERT

  • Extremely high case fatality rate: 40%–75%
  • No vaccine or definitive treatment as of 2025.
  • Airborne and contact transmission potential among humans.
  • History of deadly outbreaks in:
    • West Bengal (2001): 45 deaths out of 66 infections
    • Kerala (2018): 17 deaths out of 19 cases
    • Recurring outbreaks since then

THE ZOONOTIC NATURE OF NIPAH

  • Reservoir host: Fruit bats (Pteropus genus)
  • Transmission pathways:
    • Direct contact with bat-contaminated fruits (licked or bitten)
    • Animal-to-human via intermediate hosts (e.g., pigs in Malaysia, 1998)
    • Human-to-human via droplets, contact with body fluids

CLIMATE CHANGE & ECOSYSTEM DEGRADATION: ROOT CAUSES

  • Deforestation and habitat destruction → bats migrate closer to human settlements.
  • Urban expansion into forested areas increases human-wildlife contact.
  • Climate change alters bat feeding and migration patterns → changes virus shedding behaviour.
  • Fruit trees near human habitation act as bridges for zoonotic spillover.

SYSTEMIC GAPS IN PREVENTION

  • Lack of a centralised, integrated One Health framework.
  • Inadequate public awareness about zoonotic risks from bats.
  • Poor enforcement of wildlife habitat protection laws.
  • Limited disease surveillance in animal populations.
  • Fragmented coordination between health, veterinary, forestry, agriculture departments.

THE ONE HEALTH APPROACH: A National Imperative

One Health = Integration of human, animal, and environmental health

  • India’s draft National One Health Mission (2021) still lacks full rollout.
  • A robust One Health policy must:
    • Create multi-sectoral task forces at central and state levels.
    • Enable joint surveillance of pathogens in wildlife, livestock, and humans.
    • Institutionalise wildlife–livestock–human interface studies.
    • Promote early warning systems for zoonotic outbreaks.

SCIENTIFIC & PUBLIC HEALTH ACTION PLAN

A. Surveillance & Preparedness

  • Continuous virus surveillance in bat colonies, livestock, and high-risk regions.
  • Monitor ecological disturbances around human settlements.
  • Develop early detection kits and set up regional genomic surveillance labs.

B. Community Awareness

  • Public education on avoiding bat-bitten fruits or partially eaten produce.
  • Training farmers, tribal communities, and children in zoonotic disease prevention.
  • Introduce school-level One Health education modules.

C. Biosecurity & Food Safety

  • Regulate fruit markets and pig farming practices in bat-dense areas.
  • Promote safe agricultural practices and discourage bat roosting in residential zones.
  • Surveillance in wet markets and commercial animal chains.

LEGAL & POLICY INTERVENTIONS NEEDED

  • Strengthen enforcement of Wildlife Protection Act to preserve bat habitats.
  • Revise Environmental Impact Assessment (EIA) rules to include zoonotic risk evaluation.
  • Enact a Zoonotic Diseases Act that mandates:
    • Multi-departmental risk audits
    • Mandatory ecological assessments before land conversion
  • Integrate climate adaptation policies with pandemic preparedness plans.

GLOBAL PARALLELS & Scientific Collaboration

  • Learn from Bangladesh (recurrent Nipah outbreaks) — use of bamboo netting over date palm sap.
  • Collaborate with WHO, FAO, OIE to build zoonotic surveillance systems.
  • Fund Indian Council of Medical Research (ICMR) for Nipah-specific antivirals and vaccine R&D.

TOWARDS A RESILIENT FUTURE

Long-Term Strategy to Prevent Zoonotic Spillover:

  • Institutionalise One Health from panchayat to national level.
  • Invest in research, field epidemiology, and wildlife monitoring.
  • Mainstream zoonotic prevention into climate and development planning.
  • Strengthen health systems to respond to high-fatality emerging diseases.

“Preventing the next pandemic begins not in the ICU, but in the forests, fields, and farms of India.”


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