Bhubaneswar (Women’s Feature Service) – In her ninth month of pregnancy, Laxmi Bhatra from Orissa’s Anchala village in the tribal dominated Kosagumuda block of Nawrangpur district, suddenly felt unwell. On seeing his wife’s condition, Kamlochan, a landless worker, got on to his bicycle, tied a hapless Laxmi loosely to him, and peddled 15 kilometres along a hilly pathway to a six-bed health facility. When he got there, instead of admitting the visibly suffering woman, the local doctor gave her some medication and sent her home. Laxmi delivered a stillborn male child soon after, and died a week later.

Laxmi’s story is so common in a state with one of the highest levels of infant mortality in India that it hardly figures as the tragedy that it is. But it is a reminder that if India is to come closer to achieving the Millennium Development Goal (MDG) of reducing its under-five mortality rate by two-thirds by the year 2015, it must focus urgently on child mortality.

In September, heads of state will gather at the United Nations to review progress on the MDGs – the set of promises they made in the year 2000 to eradicate extreme poverty and its root causes by 2015. As UN Secretary General Ban Ki-moon recently observed, “We must not fail the billions who look to the international community to fulfill the promise of the Millennium Declaration for a better world.” He was speaking about people like Laxmi, in regions like Orissa. More babies die in this state than almost anywhere in the country. The state has an Infant Mortality Rate of 71 deaths per 1,000 live births — as compared to the national figure of 55, with neonatal deaths (those that occur in the first four weeks of life) accounting for 69 per cent of these deaths, according to the 2008 Sample Registration Survey 2008. Most babies, especially those born into tribal communities, have a very low birth weight (less than 2,500 grams), indicating widespread malnutrition and the high anaemia levels of their mothers.

Poverty and malnutrition make a deadly combination. Majhibani Sikaka, 50, a panchayat ward member from Sargipayu village, Rayagada district, says “malnourished pregnant women continue to work right till the day of delivery, sometimes bearing heavy loads on their heads.” Sikaka estimates that at least three out of ten newborns die in her Dongria Kondh community. Mini Majhi, a Trained Birth Attendant, adds that “families in tribal regions are so poor they cannot afford to miss a day’s earnings to visit health centres for regular check ups. They also have no money to spend on childbirth.” Majhi should know. She has been working for 10 years in the interiors of Kandhamal, another predominantly tribal district.

Making the situation more complex is the general illiteracy. Pregnancy complications are generally treated by the local ‘bejuni’ or witch doctor. He dispenses herbal potions and chants magic words to chase away the evil eye believed to have caused the problem. But this dependence on the ‘bejuni’ is in itself a comment on the poor health delivery system.

In fact, improving mother and child survival in poverty-stricken regions was a central objective of the National Rural Health Mission (NRHM) when it was set up in 2005. Its key human resource is the trained female community health activist, called the Accredited Social Health Activist (ASHA). ASHAs are recruited from the villages they serve and are expected to visit expectant mothers, explain the benefits of giving birth in a health institution, and impart advice on immunisation, sanitation and nutrition. Financial incentives are also meant to play a part. After delivery, a mother is supposed to receive Rs 1,400 (US $31) to compensate for lost wages and general expenses.

But even the best plans go awry when faced with administrative failure. Health facilities in rural Orissa are poorly equipped and understaffed, with even the health workers on the rolls choosing to live in nearby towns rather than at their supposed place of work. Sushanta Garada of the Nawrangpur Democratic Action, a member group of the community-based monitoring of health services under NRHM, says “if there is some risk, doctors at the first referral at block levels will not even touch these patients. They are referred to the district hospital.”

Garada cites the example of a primary health centre in his area where a notice on the wall reads that the doctor will be available for three hours, two days per week. “Childbirth does not wait for a doctor’s availability,” comments Garada.

As in Laxmi’s case, topography also contributes to this familiar tragedy. Nawrangpur is hilly and has only fair weather roads or footpaths. These too turn risky during the monsoons, and can be navigated only by foot or at best by bicycles. Garada explains, “In Nawrangpur, which has one of the highest IMR levels in Orissa, women nearing their delivery date, even if they have complications, have to sometimes travel 70 kilometres to the district hospital through terrain that can be crossed only on foot and could even entail crossing rivers. There exists no other mode of transport.”

In such a situation, the role of the ASHA can make all the difference between life and death. According to Pramila Swain, president of the Bhubaneswar based National Alliance of Women, ASHAs have contributed to bringing down the number of neo-natal deaths, but the system needs improvement. There are problems in the selection of these women. The village panchayats that take these decisions are often influenced by vested interests. The recruits are sometimes too young, with little knowledge about child bearing. They also find it difficult to travel long distances to isolated hamlets in order to accompany patients at night to health facilities. Petty corruption is a problem, too. In the Daringibadi block of Kandhamal, for instance, cases of women having their deliveries at home but getting their names into hospital registers in order to get the Rs 1,400 given for institutional deliveries have surfaced. Doctors and health workers also sometimes connive to cheat bona fide patients of their dues.

In Orissa’s capital city, Bhubhaneswar, Dr P.K. Senapati, State Maternal Health Programme Manager, believes things are improving despite the odds. For instance, institutional childbirths have risen in Orissa from 23 to 39 per cent between 1999 and 2006. Says Dr. Senapati, “While institutional childbirths are rising, we realise that a poor state like Orissa has to also focus on home delivery and strengthening home-based care by training grassroots health workers.” According to Dr. Senapati, health workers are also being instructed to keep track of pregnancies – from inception to delivery – for the timely detection of complications.

Such efforts are paying off. The Infant Mortality Rate dropped 20 points between 2001 and 2008, according to reliable data. The pace of change, however, needs to be urgently hastened. The Government of India estimates that, at the present rate of change, the country is likely to fall short by 28 percentage points on its MDG commitment to reduce child mortality.

In fact, South Asia is one of the worst performing regions in the world when it comes to child mortality and maternal mortality, according to the ‘Millennium Development Goals Report, 2009. In September, when the international community reviews progress on the MDGs, the concern of babies dying because of poverty and lack of medical care will once again come on the global radar.

This is why Laxmi’s story – and the lessons learnt from it – are so important.

Orai, Uttar Pradesh (Women’s Feature Service) – Orai, the nondescript headquarters of Jalaun district in Uttar Pradesh (UP), has an amazing story to tell the world. Lying in the neglected Bundelkhand region, Orai, which has a large Dalit (‘downtrodden’) population, not only experiences acute water scarcity, its literacy levels are low and unemployment levels, high.

Yet, it is in this unlikely environment that the Dalit community here is asserting its right to education. Children who have been denied schooling over generations are now waving Right To Education cards before the faces of the authorities. In a region where daughters have never been sent to school, there is a spirited campaign focusing on girls’ education.

Spearheading this unique social inclusion movement is Kuldeep Kumar, 21, a Dalit student. The son of a mason, who is preparing for his Bachelor of Education degree, Kuldeep decided to do his bit. For two years now, he has been taking the message of universal education to the people through his organisation, the Prayaas Jan Uthan Samiti.

Kuldeep was 18 when he participated in an international research project and observed the plight of the local people. The experience stayed with him. Today, sitting in a two-room rented apartment in Jalaun, which functions as an office-cum-hostel for the girls in the group, he observes, “The root cause of poverty is illiteracy and unemployment. The best way to empower the poorest is to give them access to education.”

Popularising the idea of education was, however, a huge task, and Kuldeep realised it could not be done alone. That is when he set up Prayaas Jan Uthan Samiti with a core team of nine youngsters, including three girls. Most of the volunteers are less than 30 years old, come from very poor Dalit households and have experienced discrimination at first-hand.

Support for Prayaas first came in the form of Baldan Singh and his wife Alka, who work on issues of anti-Dalit violence in Orai. Soon other groups, such as the Aasha Mahila Adhikar Manch and Dr B.R. Ambedkar Yuva Samaj Sudhar Samiti, came forward. Together they formed the Bundelkhand Dalit Manch (BDM), an umbrella body of Dalit NGOs which had the twin agendas of education and employment. Presently, there are nearly 35 organisations that work as part of BDM.

Convinced that lasting social awareness can stem only from “informed” communities, this larger team began chalking out ways by which Dalit children could be brought into the educational mainstream. Supported by National Confederation of Dalit Organizations (NACDOR), they soon came up with the idea of Right to Education rallies. India, incidentally, has committed itself to ensuring that all children, boys and girls, get primary schooling by year 2015 under the Millennium Development Goals (MDGs). If this has to happen it is in places like Orai that children should be in schools.

Organising these meets proved far tougher than anticipated. “The area of our work was the tribal belt, where ignorance, disparity and discrimination were huge,” says Kuldeep. But the youngsters were optimistic. A team of 21, including five girls, representing three regions of Jhansi, Jalaun and Lalitpur in Bundelkhand, was trained for three days before they embarked on a month long journey to spread literacy awareness here. NACDOR volunteers from Delhi provided the training. The first rally was at Hiya village in Jhansi.

While Kuldeep personally visited 20 villages, his team ended up covering a whopping 103 villages! Instead of one, they visited three villages in a day with their message: Every child had a right to education. The team members found that many children had been denied school admission outright. Others were admitted but were not attending classes largely because of the caste discrimination they encountered, both from teachers and upper-caste students. Cattle grazed in the premises of many schools, and the dispensing of mid-day meals was irregular.

“First we had to tell people that education was their children’s right and that they cannot be denied it because of their caste or religion. We had to build up confidence in both parents and children,” reveals Baldan Singh.

The children who were refused admission were handed Right to Education cards. They were told to show these cards to any school authority that denied them admission. Taking caste prejudices head on worked. Recalcitrant school officials found themselves cornered. In one instance, children demonstrated outside the home of an absentee teacher, holding placards that read, “Teacher, aao aur padho” (“Teacher, come and teach.”). When storerooms for the mid-day meal provisions were found locked, Prayaas members had them opened and ensured that meal schedules were followed. They left behind their mobile numbers so that they could be contacted if there were such disruptions again.

In most places, the team also noticed that parents and teachers blamed each other. While the parents argued that teachers were absenting themselves, the teachers accused the parents of not sending their wards to school. To solve this problem, triangular Parent-Teacher-Student associations were formed, where everybody could together sort out their differences.

The team also wrote simple slogans on village walls: ‘Ghar ghar vidya deep jalao’ (‘light the lamp of education in each home’); ‘Bachcha bachee sabhi padhao’ (‘teach both son and daughter’); Padhee likhee ladki roshni ghar ki (‘an educated girl is the light of a home’) were just some of the inspiring messages.

Information on education was combined with entertainment. Skits, highlighting the importance of schooling, were enacted for local communities. Public discussions on school education were conducted, so that views could be freely expressed or countered. This was followed by a two-month-long Dalit Shiksha Jagrukh Abhiyyan (Dalit Education Awareness Campaign).

The female members of the team were entrusted with a special task of acting as motivators for girls’ education. Explains Shilima Gautam, 23, a Prayaas member, who is preparing for her Bachelor of Education exam, “Take Pattipura village in Jalaun. It has a 100 per cent Dalit population and none of the girls went to school. So we spent a lot of time here stressing on the importance of educating daughters.” Shilima, who has three sisters, works as a ‘kisaan mita’ (friend of farmer — a semi government post — who provides local farmers with information about good farming practices) and earns Rs 1,000 (US$1=Rs 44.6) per month. With this she supports herself and her college-going sister, Neelima, who dreams of becoming a police officer. The sisters – trained as motivators – live independently in Jalaun in a rented room about 55 kilometres away from their village, Gohan. They are fortunate to have an enlightened father. Says Shilima, “My father, a watch repairer, supports girls’ education. He believes that no development – whether individual or national – is possible without education.”

Interestingly, not only has Kuldeep helped to motivate teachers, parents and students, he has inspired many youngsters like him. Sometimes Kuldeep is a bit embarrassed by the attention. But he is clear that school education is the first step to addressing growing social disparities and poverty. “I ask everyone just one question: How many officers put their children into government schools? I tell them that in this question is hidden the answer to improving government schooling and ensuring the Right to Education of every child,” he says. It is precisely such awareness raising that will help in the implementation of the newly passed Right to Education Act, in both letter and spirit.

Young Kuldeep is confident that Orai is slowly moving towards achieving Millennium Development Goal Two: Universal primary education. Because it is only when the poorest, most socially disempowered communities access schooling can there be lasting change. By flashing their Right To Education cards and demanding that the lamp of education be lit in every home, Orai’s children are signalling change in a forgotten region of the country.

New Delhi (Women’s Feature Service) – The world is in a race against time. In the year 2000,192 United Nations (UN) member states, including India, set for themselves eight developmental goals, ambitiously entitled the ‘Millennium Development Goals’ (MDGs). By 2015, they pledged to eradicate extreme poverty and hunger among a slew of other promises that include achieving universal primary education and reducing child mortality. Today, the MDGs have emerged as the dominant framework of development internationally.

The year 2010 presents a crucial moment to assess the ground covered over the last decade and the distance that remains to be traversed over the next five years. In fact, that is just what the United Nations General Assembly will do when it meets this September. How well is India placed to catch the MDG bus? The Government of India has just done its own assessment. The picture that emerges in this document, entitled the ‘Millennium Development Goals: India Country Report 2009’, is a very mixed one.

According to the Report, as many as 25 States/Union Territories in India are likely to have halved their 1990 levels of poverty around 2015 or earlier. There is optimism that the country will be able to achieve universal primary education by 2015 and eliminate the enrolment gap between boys and girls in schools by then. The government also claims that it is on course in controlling the incidence of HIV/AIDS, malaria and tuberculosis and expects to achieve the MDGs target for sustainable access to safe drinking water by the designated year.

Grounds for some cautious cheer? Well, there are many who would contest even the basic assumption that India will be able to peg down its poverty levels in a meaningful way. On one issue, however, everybody agrees, including the government: Among the gravest challenges facing India today is its persistently high Infant Mortality Rate (IMR).

Change on this score has been tragically sluggish. The Report estimates that going by present trends, the country would have achieved, by 2015, an IMR of 46 per 1,000 live births, as against the required 26.7 per 1,000 live births. It also notes that the “incidence of neo-natal deaths has not changed over the last seven years in the heartland states.”

Expectant mothers in the country are not doing too well either, although things have improved immeasurably since 1990, when the country’s Maternal Mortality Rate (MMR) was 437 per 100,000 live births. According to the Country Report’s projections, India is expected to bring down its MMR to 135 per 100,000 live births by 2015, which falls short of the required 109 per 100,000 live births.

The deaths of these innumerable children and mothers are a severe indictment of the country and point to significant and overlapping inequalities of gender, class, caste and region. Not surprisingly, it is the poorest states – like Bihar, Jharkhand, Chhattisgarh, Madhya Pradesh, Orissa and Uttar Pradesh – constituting India’s heartland, and the most marginalised communities – whether Dalits, Tribals or the Minorities – that report the highest mortality levels.

If India’s IMR and MMR are to be pegged down, the country will have to focus urgently on three central concerns: hunger/malnutrition; health care; and sanitation. Malnutrition is directly related to poverty and food security. According to the National Family Health Survey – 3 (2005-2006), about half the children in India are stunted, and more than a third of our women have a Body Mass Index below 18.5 per cent, an indicator of serious nutritional deficiency and the inter-generational transfer of malnutrition from mother to child.

Health care remains another huge concern. According to a recent Planning Commission assessment, the shortfall of primary health centres and sub-centres in 2008 has remained almost the same as in 2005, and the number of auxiliary nurse midwives has, in fact, decreased over the same period. Today, there is a 50 per cent shortfall in trained health workers, radiographers, lab technicians and doctors. At the existing rate, only 62 per cent of deliveries will be attended by skilled personnel by 2015 – with rural areas being particularly under-serviced.

Sanitation, unfortunately, has never been a policy priority for India, despite that fact that drinking water contaminated by fecal matter is a major cause of child deaths. The Report admits that India has the lowest sanitation coverage in the world – in 2007-08, an estimated 66 per cent of rural households did not have toilet facilities.

“The more we wait, the more difficult it will be to address such concerns and achieve the MDGs,” predicts Siba Sankar Mohanty, National Campaign Coordinator, Wada Na Todo Abhiyan (Keep the Promise movement), a national campaign to hold the government accountable for its promises, that involves more than 4,000 civil society organisations across 29 States and Union Territories in the country.

Mohanty argues that since the Suresh Tendulkar Committee has assessed the actual population living below poverty in India at 37 per cent instead of the earlier figure of 27 per cent, it means that achieving the targets will be that much more difficult. He also argues that the government needs to get back to delivering basic services, like health and education, instead of linking their access to the vagaries of the market.

According to Bhopal-based Yogesh Kumar, Executive Director of the Samarthan Centre for Development Support, there has been a huge governance failure. “My state, Madhya Pradesh, has the highest level of malnutrition in the country, especially among Scheduled Castes and Scheduled Tribes, but the government has just not woken up to the issue. Forget additional resources; even the resources that are available are not being put to best use. As for the affected people, they are so disempowered they do not even know they have the right to demand better government accountability,” says Kumar.

The irony, according to Alok Vyas of the Jaipur-based CECOEDECON, a group working for the last 27 years among Rajasthan’s farmers, is that while agriculture continues to be the main source of livelihood for at least 60 per cent of Indians – in Rajasthan the figure is around 70 per cent – there has been precious little investment in the sector. “Farmers have been squeezed out, and many have sold their assets to become migrant workers in the cities. Nobody in government is taking agriculture seriously,” he says.

Achieving the MDGs will not only change the face of the country; it could go some way in addressing the million mutinies that are raging, or will rage in the near future. All insurgencies, after all, are fuelled by a sense of grievance and powerlessness among ordinary people, whether in the Northeast or in Chhattisgarh.

In September, the governments of the world will meet at the UN to present their assessments on the status of MDGs in their respective countries. Annie Raja, General Secretary of the National Federation of Indian Women, wants the Government of India to make an effort to understand the concerns of civil society. “Before the Government of India makes its presentation on MDGs at the UN, we demand that our views be taken into consideration,” says Raja.

The clock is ticking. If India does not get its act together now, 2015 will go down as the year of broken promises.