By Sakuntala Narasimhan
A new map of the world has just been put out by the World Health Organisation and Unicef. One feels ashamed looking at the sub-continent encompassing Pakistan, India, Bangladesh and Afghanistan, on this map. These four countries are painted an unrelieved red, which means “failed”, in terms of progress made towards the Millennium Development Goals (MDG) that the world adopted in the year 2000, with specific targets to be met by 2015 (halving the number of people living in poverty, reducing Infant Mortality by two thirds and Maternal Mortality Rates MMR by 75 percent, and halving the percentage of population without access to safe drinking water and basic sanitation).
UN agencies, the World Bank, and global NGOs have in recent months come out with assessments of the progress made globally, till the midpoint of the 15-year time frame leading to 2015, and Harvard Law School hosted an international symposium in March 2010 to discuss these assessments. The consensus was that globally those targets will not be met, on most counts. Since the subcontinent accounts for nearly a quarter of the world’s population, the extent of our failure will influence the global record too.
Some interesting examples came up to show how an unremitting focus on GDP growth rates alone can erode, instead of improve, living conditions. Most developing countries have seen an exodus from rural to urban areas, because returns from agriculture are diminishing. The farm labourer who migrates to the city and becomes a construction worker, may earn more in money terms, but if he lives in a slum or roadside shack as an uprooted migrant, without water, and his children develop respiratory illnesses due to the pollution in the metropolis, would his incremental money income make amends for the deterioration of his living conditions? Poverty reduction is an incontrovertible goal, but poverty has many dimensions — socio-cultural alienation and loss of traditional support systems.
As World Bank Vice-President Otaviano Canuto points out, “The process and outcomes of development must both be good,” for development to be sustainable and meaningful. How we reach the destination is as important as the destination itself, because all development is ultimately for the people.
What the officials, economists and human rights activists (including the UN Human Rights Commission, Amnesty International, the Norwegian Centre for Human Rights, and Realising Rights headed by former president of Ireland, Mary Robinson) were discussing at the symposium, was the primacy of non-economic indices for measuring ‘progress’ and ‘development’, and whether we need to re-shape out developmental discourse to explore alternative pathways, to reach not merely ‘targets’ in terms of percentage reductions in mortality and morbidity, but a more comprehensive goal of “well-being” encompassing economic as well as non-economic dimensions of human needs.
The biggest gap between target and ground realities is in maternal mortality reduction. The second largest gap is in infant mortality reduction. Increasing the number of institutional deliveries (in hospitals) is one of the MDG ‘goals’ for reducing maternal mortality, but take the case of Uzma, 32, from a poor family: “Yes, I delivered in hospital, but they wanted me to stay on for four days. How could I, who would look after my other child at home? So I got myself discharged on the second day. The doctor was angry, she said not to come to her again, if I or my child required treatment Tell me, sister, what we should do?”
To this, Asiya (name changed) adds, “My first two children are daughters, my husband wants a son badly, because that will be our only support in our old age, daughters will marry and move away, we cannot expect them to look after us. My husband is a watchman and if I don’t work we don’t have enough to survive on….”
Her third child turned out to be another daughter, and she is greatly worried about the expense of marrying off three daughters. This is the reality, despite political decisions to reduce birth rates, maternal mortality (MMR) and infant mortality (IMR). Her children are all malnourished, as are 49 percent of children under 5, in the subcontinent. Poverty, combined with socio-cultural handicaps (son preference, which forces her to conceive repeatedly, despite her anemia, because we do not have a social safety net for the aged) together make for a deadly combination, when it comes to ensuring basic human rights for the disadvantaged sections of the populace.
When one disaggregates the data, the rural areas in both India and Pakistan lag far behind in MMR and IMR while urban communities have reaped the benefits of progress. If the MDG are about lifting the poorest sections into the mainstream to share in the fruits of development, w e need to go beyond national averages (which show a reduction in MMR but mask the reality of rural deprivation)
India’s Haryana and Punjab states, with high per capita incomes and economic growth rates, have actually seen a rise in maternal mortality for 2003-06. Its MMR is 16 times that of Russia and 10 times that of China In focusing on MDG target of 75 percent reduction in MMR we have lost sight of the fact that maternal mortality is higher among the poor and the Dalits. Can we then, decide that social transformation is “low priority” compared to reaching MDGs’ physical targets?
Now for the second item that paints the subcontinent “red” — India has the highest infant mortality rate (IMR) in the world (134 in global ranking in 2009). Pakistan is not far behind. One infant dies every 15 seconds in the subcontinent. Of these, 90 percent are “preventable” if basic healthcare facilities were available. Average IMR statistics again mask the fact that rural incidence is more than 150 per cent of the urban fatalities. If the rural areas account for 70 per cent of India’s population (64 in Pakistan) and IMR is higher in this sector, what does this say except that development is ‘non-inclusive’ and therefore ethically unacceptable?
Item 7 C of the MDG enjoins governments to reduce by half, by 2015, the number of people living without access to safe drinking water and basic sanitation. 2008 was the International Year of Sanitation. No matter. The “world is off track on this count too,” says the WHO-Unicef report. Millions in the subcontinent still line up daily for a pot of water from a roadside tap. Even in metropolitan areas with water treatment plants, ground water is mostly polluted. The fastest growing and most profitable beverage industry is that of bottled water, because we have not addressed the issue of access to safe water.
The countries of the subcontinent have done better in terms of GDP growth, compared to the recession-hit West. (where growth has actually been negative in 2007-09) — but our incremental GDP has not got translated into a reduction in poverty, under the export-driven developmental model that we have followed, at the behest of experts from the West. Globally, the richest 1 per cent enjoys 57 percent of incomes, while the poorest 40 per cent receive just 5 percent.
The big challenge is not resources, or lack of plans, but rising inequalities. India now boasts of having 100,000 millionaires, but it is also home to the largest number of people (628 million, out of the global total of 1.1 billion) who are forced to defecate in the open. Pakistan has 48m with 5th rank globally, while Brazil (population same as Pakistan) has only 13m without toilets, and Sri Lanka — pop. 20 m and by no means a ‘developed’ or rich country — has just 1 percent of rural population without toilets, thanks to high literacy and less disparities. Of the 2.6 billion people worldwide without proper sanitation, 1.07 billion (72 per cent) are in South Asia. The Caribbean too have smaller rural-urban disparities, and are “on course” for reaching MDG targets. Tajikistan, a poor country, has a MMR of just 8 per 100,000 live births (even better than the US figures).
We need to focus therefore, more on disparity reduction. We go by numbers, forgetting that human beings with a right to a life with dignity, are the raison d’etre for all national plans. As Mary Robinson, former UN High Commissioner for Human Rights puts it, the world is today connected by trade and technology, but not by human values.
“What people need is a dispensary, a health center or hospital where they can get satisfactory service, free from payment and corruption, stocked reliably with essential drugs,” says Khartoum based pediatrician Massimo Servanti of the global People’s Health Movement, pointing out that an expensive private health system flourishes because the state-run institutions fail to provide the service they ought to. “We need to improve the performance of those that are already in place, not new projects or cadre,” he adds.
What we have seen globally in the first half (2000-2008) of the MDG time frame, is that economic growth has actually widened the gap between the rich and the poor. The number of people worldwide who are poor, hungry and malnourished, has risen from 800 million in 2006 to one billion today, despite economic growth in money terms during this period. If development results in higher GDP but leaves the poor, the underprivileged and the marginalised (including women, minority communities and the differently-abled) worse off, or barred from sharing in the benefits of development, we need to recast our developmental strategies and take “egalitarianism” on board too, as a “target”. Amnesty International, which participated in the Harvard symposium, plans to release a report focusing on these issues, in May so that these inputs can go into the UN MDG Summit scheduled for September 2010.
The writer is an award-winning columnist and author, specialising in gender and development
