The key findings from the National Family Health Survey-5 (NFHS-5) of selected states have reminded us that India is facing a crisis of poor nutrition outcomes.
Prevalence of stunting among children has remained stagnant or increased in most of these states. The appalling under-nourishment of children reflects poor maternal nutrition, widespread anaemia and insufficient breastfeeding. Anaemia among women also remains very high and has, in fact, increased in several states.
Clearly, there is an urgent need to boost maternal well-being through comprehensive maternity protection, including health services, supplementary nutrition and wage compensation for the period during late pregnancy, childbirth and exclusive breastfeeding. The existing arrangements for maternity entitlements are inadequate as the Maternity Benefit Act (2017) addresses only those women who work in establishments with 10 or more workers.
The Periodic Labour Force Surveys (2019) show that labour force participation rates among women aged 15 and above is only 25% and among them only 12% work in such establishments. For all other women, the only maternity entitlement available is through the Pradhan Mantri Matru Vandana Yojana, a cash transfer scheme of only ₹5,000, grossly under-budgeted, and barely addressing 25% of pregnant women.
Women in agriculture, scheme workers such as anganwadi workers and ASHAs, street vendors and domestic workers are not even included in the Act. There was a possibility for addressing these lacunae in the Code on Social Security (2020) for which rules are being drafted. Unfortunately, this Code has missed the opportunity for creating a framework for universal maternity entitlements.
The Code and the draft rules are exclusionary in the provisions for maternity benefits, which are a cut-and-paste from the Maternity Benefit Act, 2017, where only women who are in formal employment are eligible. The Code specifies that to be entitled for a maternity benefit, a woman should have worked in an establishment for a period of at least 80 days in the 12 months preceding her expected date of delivery, which makes it further difficult to avail the benefit given the precarity of work.
The Code is further discriminatory towards women with more than two children and deprives the third or later child of the care and breastfeeding from their mother as she would get only 12 weeks leave instead of the recommended period of six months (World Health Organization). The maternity benefits are also limited to only three months in the case of adoptive and surrogate mothers. In fact, maternity benefits should be gender neutral as “parental benefit”, since sometimes men may need to care for the child, or the adoptive parent may not be a woman/mother.
Even for women who are eligible, the onerous documentation requirements as laid out in the draft rules include a certificate from a medical officer and a notice to the employer, as well as making submission of Aadhaar details mandatory for unorganised sector workers, and digital application is the norm. This puts an unnecessary burden on the pregnant woman. It would be simpler to rely on the registration of pregnancy with the health department or the Integrated Child Development Services, by just adding a column in the Mother and Child Protection Card, which can be the document used to make her automatically eligible for the payment of a maternity benefit.
While the amended Maternity Benefit Act as well as the Code specify that establishments that have 50 employees shall have a creche facility, the draft rules dilute this provision by stating that “in every establishment where fifty or more women employees are ordinarily employed”. This not only reduces the availability of these facilities of children, but it is likely to make employers reluctant about employing more women. In reality, what was required was expanding the creche provision to all children with a locality-based arrangement that permit the mother to go and breastfeed close to the workplace.
Given the fragile nature of social protection for these working women, all provision of maternity protection should be universally applicable to all working women regardless of the consistency or duration of work and independent of their current status of employment. If we recognise that maternity protection is essential to ensure that women have enough to eat, can rest and breastfeed the baby, and to improving the nutrition indicators, India must make it a universal entitlement.
The coverage of the maternity should neither be establishment-specific nor should it depend on the number of children. In fact, we would be penalising women for no fault of theirs, since during the pandemic and lockdown, lakhs of women went through unwanted pregnancy with no access to contraception or abortion services. Maternity benefits should be a right of all workers regardless of their employment status, or the number of children.
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Steve Ovett, the famous British middle-distance athlete, won the 800-metres gold medal at the Moscow Olympics of 1980. Just a few days later, he was about to win a 5,000-metres race at London’s Crystal Palace. Known for his burst of acceleration on the home stretch, he had supreme confidence in his ability to out-sprint rivals. With the final 100 metres remaining,
[wptelegram-join-channel link=”https://t.me/s/upsctree” text=”Join @upsctree on Telegram”]Ovett waved to the crowd and raised a hand in triumph. But he had celebrated a bit too early. At the finishing line, Ireland’s John Treacy edged past Ovett. For those few moments, Ovett had lost his sense of reality and ignored the possibility of a negative event.
This analogy works well for the India story and our policy failures , including during the ongoing covid pandemic. While we have never been as well prepared or had significant successes in terms of growth stability as Ovett did in his illustrious running career, we tend to celebrate too early. Indeed, we have done so many times before.
It is as if we’re convinced that India is destined for greater heights, come what may, and so we never run through the finish line. Do we and our policymakers suffer from a collective optimism bias, which, as the Nobel Prize winner Daniel Kahneman once wrote, “may well be the most significant of the cognitive biases”? The optimism bias arises from mistaken beliefs which form expectations that are better than the reality. It makes us underestimate chances of a negative outcome and ignore warnings repeatedly.
The Indian economy had a dream run for five years from 2003-04 to 2007-08, with an average annual growth rate of around 9%. Many believed that India was on its way to clocking consistent double-digit growth and comparisons with China were rife. It was conveniently overlooked that this output expansion had come mainly came from a few sectors: automobiles, telecom and business services.
Indians were made to believe that we could sprint without high-quality education, healthcare, infrastructure or banking sectors, which form the backbone of any stable economy. The plan was to build them as we went along, but then in the euphoria of short-term success, it got lost.
India’s exports of goods grew from $20 billion in 1990-91 to over $310 billion in 2019-20. Looking at these absolute figures it would seem as if India has arrived on the world stage. However, India’s share of global trade has moved up only marginally. Even now, the country accounts for less than 2% of the world’s goods exports.
More importantly, hidden behind this performance was the role played by one sector that should have never made it to India’s list of exports—refined petroleum. The share of refined petroleum exports in India’s goods exports increased from 1.4% in 1996-97 to over 18% in 2011-12.
An import-intensive sector with low labour intensity, exports of refined petroleum zoomed because of the then policy regime of a retail price ceiling on petroleum products in the domestic market. While we have done well in the export of services, our share is still less than 4% of world exports.
India seemed to emerge from the 2008 global financial crisis relatively unscathed. But, a temporary demand push had played a role in the revival—the incomes of many households, both rural and urban, had shot up. Fiscal stimulus to the rural economy and implementation of the Sixth Pay Commission scales had led to the salaries of around 20% of organized-sector employees jumping up. We celebrated, but once again, neither did we resolve the crisis brewing elsewhere in India’s banking sector, nor did we improve our capacity for healthcare or quality education.
Employment saw little economy-wide growth in our boom years. Manufacturing jobs, if anything, shrank. But we continued to celebrate. Youth flocked to low-productivity service-sector jobs, such as those in hotels and restaurants, security and other services. The dependence on such jobs on one hand and high-skilled services on the other was bound to make Indian society more unequal.
And then, there is agriculture, an elephant in the room. If and when farm-sector reforms get implemented, celebrations would once again be premature. The vast majority of India’s farmers have small plots of land, and though these farms are at least as productive as larger ones, net absolute incomes from small plots can only be meagre.
A further rise in farm productivity and consequent increase in supply, if not matched by a demand rise, especially with access to export markets, would result in downward pressure on market prices for farm produce and a further decline in the net incomes of small farmers.
We should learn from what John Treacy did right. He didn’t give up, and pushed for the finish line like it was his only chance at winning. Treacy had years of long-distance practice. The same goes for our economy. A long grind is required to build up its base before we can win and celebrate. And Ovett did not blame anyone for his loss. We play the blame game. Everyone else, right from China and the US to ‘greedy corporates’, seems to be responsible for our failures.
We have lowered absolute poverty levels and had technology-based successes like Aadhaar and digital access to public services. But there are no short cuts to good quality and adequate healthcare and education services. We must remain optimistic but stay firmly away from the optimism bias.
In the end, it is not about how we start, but how we finish. The disastrous second wave of covid and our inability to manage it is a ghastly reminder of this fact.