Content :
- Fostering a commitment to stop maternal deaths
- Rising seas, shifting lives and a test of democratic values
- Batting for prevention
Fostering a commitment to stop maternal deaths
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 “natural” process.
- 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.
Rising seas, shifting lives and a test of democratic values
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 India’s commitment to both climate justice and constitutional morality.
Batting for prevention
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.”
