A 3,500 sq km salt marsh, LRK encompassing Kutch, Patan, Surendranagar, Banaskantha and Rajkot is crucial for inland salt production, contributing one-third of the country’s supply. It is also a key source of ginger prawn exports. Despite such unique contributions, there has hardly been any government effort to ensure dignity of life for the workforce here — one of its manifestations being in the form of medical conditions caused by lack of menstrual hygiene.

There are six salt zones in LRK, where the Scheduled Caste community of Agariyas toil for eight months of the year. During the monsoon period between June and September, the area sees saltwater ingress from the Gulf of Kutch. When the monsoon time ends, worker families arrive mainly from four neighboring districts of Surendranagar, Patan, Rajkot and Kutch and settle in makeshift sheds for the next eight months.

Water scarcity is a silent predator in LRK, birthing a cascade of health crises stemming from lack of menstrual hygiene. Jauriben Chhotabai, a salt worker in Surendranagar, attests this, so do Jalpa (18) who suffers from infections and white discharge and Vimla who deals with painful urination.

If neglected, lack of menstruation hygiene can lead to toxic shock syndrome, reproductive tract infections and other vaginal diseases. Excruciating abdominal pain, medically termed as painful cramps, accompany these conditions. Bhartben Shailbhai (19), a salt pan worker from Gosana village in Dasada taluka of Surendranagar district, has been going through it every month for the past three years. According to her, medical treatment has not helped.

“The pain begins in my lower abdomen and spreads to my back and thighs,” she says, her voice heavy with despair.

“Once trapped in an infection, liberation from it seems incredibly difficult. The lack of water prevents proper cleaning of private parts. Using the same cloth repeatedly after washing during menstruation makes their problem even more severe,” notes Jairambhai Devabhai Savalia, the secretary of Narayanpura Cooperative Society at Patdi in Dasada taluka.

Women work in salt pans for more than 10 hours a day. Those leasing salt pans enter into verbal agreements with ancestral producers, ensuring a share of salt revenue. Heenaben Jagabhai Khakariya (24) from Kesariya village of Lakhtar taluka in Surendranagar district claims that she has not been able to seek treatment for dysmenorrhea due to her demanding job. She tried traditional methods like carom seeds in lukewarm water to relieve pain, but without much effect.

Pankti Jog, an advocacy coordinator at JANPATH, a collaborative forum based in Ahmedabad, remarks that the struggles of women workers in LRK does not end with water scarcity. “They have severe menstrual hygiene management challenges due to lack of hygiene resources such as clean water, soap, sanitary pads and toilets, leading to infections and waterborne diseases,” she says.

No government medical facilities are available in LRK. However, there are primary health centres (PHCs) in Kutch, which function well. Even if they somehow get access to these PHCs, the women workers will not make use of them, thanks to the stigma surrounding menstruation and unwillingness to consult male doctors.

A duty forgotten

Dr Viren Dosi from Bhansali Trust has been serving the salt workers of Santalpur in Patan district for two decades. He stresses that providing free water is the duty of state government. Yet, Agariyas are left parched in most areas of LRK.

“In Surendranagar, water charges are based on salt production units (paatas), costing Rs 900 per month. Tankers deliver only 500 litres every five to seven days, forcing families to ration every drop. Women suffer the most, with inadequate water exacerbating menstrual hygiene struggles,” says Sahiya from Bhalot village of Kutch’s Anjar taluka.

“Bathing is a once-a-week affair; utensils are washed with the same water for days,” shares Ramaben from Patdi in Surendranagar. With no government water supply, the Agariya community is forced to rely on private tankers that charge Rs 1,200 to Rs 1,500 for 500 litres.

Speaking to 101Reporters, Dr RB Singh, Taluka Health Officer, Santalpur, highlights state’s efforts to improve menstrual health in LRK, “where a mobile medical van visits salt workers weekly”. While sanitary pads are distributed, challenges like limited water availability and infrequent visits from health units remain. The health workers try to visit at least once in 10 days, but local weather, uncertain temperature and dusty winds pose problems.

On menstrual health issues, the health department officials simply say that they are spreading awareness. When asked about the lag in capacity building, they outright refuse to acknowledge the truth.

The right approach

The Menstrual Hygiene Scheme under the National Health Mission aims at improving menstrual hygiene, especially in rural areas, by providing free or affordable sanitary pads. Despite its goals, these provisions are absent in the LRK region. Awareness programmes and safe pad disposal initiatives are conducted, with training for anganwadi workers. However, questions remain about the state’s commitment to these programmes, particularly in Agariya settlements.

The scheme aims at reducing unhealthy practices, improving health and eliminating menstruation stigma, yet environmentalist Mudita Vidrohi highlights concerns over its execution. “A multi-dimensional approach is essential. It should include information and education to address gender equality standards and the stigma surrounding menstruation,” she says.

“There must be an adequate number of safe and private toilets, easily accessible water facility for hygiene purposes, culturally appropriate menstrual products and materials [such as cloth, pads], socially and environmentally suitable methods for the disposal of used sanitary materials, private washing/drying facilities for clothes, practical information on maintaining hygiene during menstruation and supportive healthcare services,” Harinesh Pandya of Agariya Heet Rakshak Manch tells 101Reporters.

Ahmedabad-based writer Preeti Jain Agyat stresses the importance of linking anganwadi centres and midday meal workers to a system of providing sanitary napkins for women and girls.

“Regular supply of sanitary pads is essential. Corporate Social Responsibility can play a crucial role in eliminating these issues in Kutch. Activating panchayats and involving non-governmental organisations in this campaign could also make a significant impact” says Jog.

On dealing with water scarcity, Bharat Somera, a social activist based at Patdi in Surendranagar district, says, “During the British era, water was supplied through pipes over a limited distance of five to eight km in LRK. There is a need to revive and expand this pipeline. Additionally, the daily water supply needs to be ensured, and the amount of water per household should be increased.”

Asked if it is possible to effectively address the issues of water supply and women’s health in Kutch, Pandya retorts, “Why not? If the vibrant Rann Utsav flourishes in the desert, surely this challenge is within reach. What is required is the resolve of our leaders and bureaucracy.”

Amarendra Kishore is a freelance journalist and a member of 101Reporters, a pan-India network of grassroots reporters. 

Courtesy: Newsclick

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This was the situation in several villages of Bali block in Pali district of Rajasthan inhabited by the Garasia tribal community about a decade back. Women were deeply troubled by the increasing drift towards alcoholism which was partly triggered by the proliferation of illegal selling joints in remote villages in addition to the extension of legally sanctioned liquor selling shops or thekas.

In contrast, however, one positive development had also emerged. In recent times an increasing number of self-help groups had been organized in many of these villages, particularly involving women of the Garasia tribal community. While the more obvious aim was to promote savings and economic security, at the meetings of these groups the women also discussed their other serious problems and concerns and whenever they discussed serious problems including violence against women and economic crisis situations, the growing alcoholism emerged as an important cause of these problems in these discussions.

Can we do something to check this ever-increasing problem, these women asked each other in their group discussions, and in the course of these deliberations, some kind of a plan began to emerge.

The women increasingly felt that only small village-level efforts will not be adequate, a bigger impact must be created by planning something that will reveal the depth of their feelings regarding the increasing menace.

After considering many suggestions the women decided that they will get together to organize a very long march covering most of the area over which their villages are located.

To symbolize their unity and their determination for a joint effort, they decided to prepare a pink dress that they would all be wearing in the course of this march. It was also decided that other social reform issues such as reducing child marriages and preventing domestic violence will also be raised during the march to impart a wider social reform dimension to this march, although the core issue will remain that of checking the increasing alcoholism.

This decision of women from weaker section households was very courageous as the legal and illegal sellers of liquor were known to be among the most powerful and violent persons of this region.

Starting early in morning this march of women covered a distance of nearly 25 km and ended at night. As many as about 2000 women participated in this long march.

On the way they smashed up several illegal liquor making bhattis (joints) and illegal selling units. They stopped in front of legal liquor vends and shouted slogans against opening liquor shops even in remote villages.

This march made a big impact on people. The courage of the women in confronting the powerful liquor lobby and mafia was widely appreciated. The increasing drift towards alcoholism could be checked. In addition, there was a reduction in domestic violence.

There was also a lot of follow-up- action in the form of sending representations to the authorities for shutting down illegal liquor selling joints and also making community level efforts for this. There was a continuing dialogue on the highly adverse impacts of increasing alcoholism on the community. All this helped to check the increasing spread of alcoholism.

After the peak of this activity had passed, these women and their groups continued their efforts to check the spread of alcoholism at a smaller level in later years. The result has been that the earlier trend of fast drift towards alcoholism could be checked on a more stable and permanent basis. A recent visit to these villages and conversations with women here revealed that the problem has reduced compared to the worst period seen before the women’s anti-liquor march was undertaken.

Meanwhile these women and their groups have also continued to be active in taking up a range of other important social issues. They continue to remember the march as a very inspirational part of their efforts, one indication of which is that group members have permanently adopted the pink colour dress prepared at the time of the march as their regular dress by which the group members are recognized even now.

The writer is Honorary Convener, Campaign to Save Earth Now. His recent books include Protecting Earth for Children, A Day in 2071 and Man over Machine.   

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According to a report in the Lancet, more than 1.6 million deaths occurred in 2021 due to air pollution, with fossil fuels like coal and natural gas responsible for 38% of them.[1] While the exact figures may vary depending on which study one relies on, one undeniable fact remains—air pollution is a critical environmental crisis.

Despite its severity, air pollution and pollution in general have not been given the prominence they deserve in public discourse. The urgency of the issue is not adequately reflected in government messaging or public awareness campaigns.

Government initiatives and implementation challenges

In January 2019, the Central Government launched the National Clean Air Programme (NCAP) to improve air quality across Indian cities. The initiative aims to engage all stakeholders and reduce particulate matter concentrations. However, the effectiveness of such programs depends not just on their design but also on their implementation.

The NCAP aims to reduce air pollution across Indian cities by targeting a 40% reduction in PM10 levels by 2025-26. While some cities have shown improvements, the effectiveness of NCAP varies significantly. In Uttar Pradesh, cities like Bareilly, Rae Bareli, and Ghaziabad are projected to meet their targets, with Bareilly expected to see a 70% reduction in PM10 levels.[2] However, Gorakhpur and Prayagraj may see PM10 levels rise by 50% and 32%, respectively. A national study found no significant reduction in PM2.5 levels due to NCAP, suggesting that whatever observed improvements were likely influenced by COVID-19 lockdowns rather than policy effectiveness.[3]

Several factors impact air quality, including meteorological conditions, industrial emissions, vehicle pollution, and open biomass burning. While city-specific action plans exist, challenges such as data limitations, inconsistent implementation, and environmental complexities hinder progress. Machine learning models predict continued variations in air quality, highlighting the need for stricter regulations, enhanced emission controls, increased public awareness, and improved monitoring systems. Additionally, research suggests air quality improvements have been greater in wealthier areas, underscoring the need for policies that ensure equitable environmental benefits for all communities.[4]

More recently, many news houses reported on the Comptroller and Auditor General (CAG) Report on pollution control measures in Delhi. The report highlighted several shortcomings revealing issues with air quality monitoring stations, including improper placement—many were located near trees on multiple sides, affecting data accuracy. Additionally, concerns were raised over flawed pollution control certificate issuance.

Why is there no political will?

The core issue regarding pollution is not merely the weak implementation of pollution control measures but the lack of political will to do anything tangible about pollution. However, deeper inquiry would lead to another problem — the electorate does not make pollution the central issue.

Air pollution remains absent from the list of priority concerns for many citizens, despite its devastating health impacts. If people do not perceive it as a pressing issue, they will not demand stronger policies or hold policymakers accountable.

Why does air pollution fail to gain the public’s attention despite its deadly consequences? The answer lies in inadequate communication. The seriousness of air pollution is not being effectively conveyed to the masses, preventing it from becoming a major electoral issue.

Why is communication important?

When breast cancer survivor Fanny Rosenow attempted to place an advertisement in The New York Times for a support group, she was informed that the newspaper could not publish the words “breast” or “cancer”. Instead, the editor suggested using the phrase “diseases of the chest wall” prompting Rosenow to drop the idea. This was the early 1950s. From this to the call for the War on Cancer in the 1970s by the Nixon Administration in the US, there was a radical change in how cancer was perceived and understood by both the political class and the masses. A significant amount of this change was driven by the messaging campaigns spearheaded by philanthropist-activist Mary Lasker.[5]

Pulitzer-winning author Siddhartha Mukherjee writes in his book
The Emperor of All Maladies:

“The empire of cancer was still indubitably vast—more than half a million American men and women died of cancer in 2005—but it was losing power, fraying at its borders. What precipitated this steady decline? There was no single answer but rather a multitude. For lung cancer, the driver of decline was primarily prevention—a slow attrition in smoking sparked off by the Doll-Hill and Wynder-Graham studies, fuelled by the surgeon general’s report, and brought to its full boil by a combination of political activism (the FTC action on warning labels), inventive litigation (the Banzhaf and Cipollone cases), medical advocacy, and counter marketing (the ant tobacco advertisements).”

The takeaway from this is that messaging and creating a narrative over a problem that needs to be solved is an important if not the most necessary element in fighting the problem. India’s fight against pollution lacks this very element thus making it a difficult fight.

What do Indians think of pollution?

The discourse surrounding pollution in India has long been dominated by macro-level concerns—climate change, biodiversity loss, and long-term ecological degradation. While these issues are undeniably critical, their abstract nature often fails to resonate with the average citizen, who perceives them as distant or intangible.

For example, a 2022 study found that Indian farmers, while being aware of meteorological changes, were not informed enough to tie those changes to climate change and thus take action accordingly. [6]

The immediate health impacts of pollution—such as acute respiratory distress, cardiovascular crises, and developmental delays in children—are far more proximate and personally relevant. Reframing pollution narratives to foreground these immediate health risks can bridge the gap between scientific urgency and public mobilisation, transforming passive awareness into actionable engagement.

Limitations of current narratives 

The prevailing discourse on pollution in India often employs broad, depersonalised terminology— “respiratory diseases,” “air quality indices,” or “greenhouse gas emissions”—that obscures the lived experiences of affected individuals. For instance, while the term “respiratory diseases” is technically accurate, it lacks the specificity needed to convey the urgency of conditions such as asthma exacerbations, chronic obstructive pulmonary disease (COPD), or paediatric pneumonia.

Similarly, discussions of climate change tend to focus on global temperature projections or sea-level rise, which appear remote to urban residents grappling with daily air quality advisories. This abstraction creates a psychological disconnect, as individuals prioritize immediate threats over distant risks—a phenomenon well-documented in behavioural psychology.[7]

Moreover, the current narrative often frames pollution as an intractable, systemic problem, fostering a sense of fatalism rather than agency. Terms like “air pollution crisis” or “environmental degradation” evoke collective responsibility—with actionable messaging neither for the individual nor for any organized group. This passivity is exacerbated by the lack of localized, granular data on health impacts, which prevents communities from understanding their specific risks. For example, while Delhi’s annual PM2.5 levels are widely reported, few citizens are aware that exposure to these particulates increases the risk of heart attacks or that children in polluted regions face a higher risk of neurodevelopmental delays.[8] [9]

Additionally, both the narrative and the solutions to air pollution are city-centric. This approach has relegated Delhi’s Air Pollution issue, for example, to be an issue of the people of Delhi, and its government whereas in reality, it is the issue of the whole of northern India. Experts have recommended mitigation of pollution at an air shed level instead of political boundaries, but that recommendation has not been paid attention to by the governments.[10]

The imperative of immediate health impact narratives 

To overcome these limitations, pollution narratives must pivot to emphasize immediate, localized health risks. Such a shift aligns with the principles of risk communication, which prioritizes clarity, specificity, and personal relevance. By highlighting the direct consequences of pollution—e.g., “exposure to PM2.5 increases your risk of a heart attack this month” or “children in this neighbourhood face a higher risk of asthma attacks”—communicators can evoke responses that will call for accountability from the administration.

For example, in a study that examined the Health Information National Trends Survey (HINTS) of the USA, it was found that people who believed that their chance of getting cancer is high due to pollution were more likely to worry about the harms of Indoor and Outdoor pollution.[11]

Cases in Delhi and Mumbai demonstrate that spikes in PM2.5 levels correlate with an increase in hospital admissions for respiratory distress.[12] Framing pollution as a trigger for acute health crises—rather than a chronic risk—can shift the perception of people.

Fine particulate matter (PM2.5) has been linked to endothelial dysfunction and thrombosis, increasing the likelihood of myocardial infarction.[13] Communicating this risk in terms of “increased heart attack risk” can resonate with middle-aged populations, who may perceive cardiovascular health as a personal priority.

Prenatal exposure to PM2.5 is associated with low birth weight and cognitive delays, with affected children scoring lower on developmental milestones by age two and three.[14] Framing pollution as a threat to children’s futures can mobilize parental action.

Older adults with diabetes or hypertension face amplified risks from pollution, including accelerated cognitive decline and cardiovascular complications.[15] Targeted messaging to caregivers and healthcare providers can amplify awareness of these vulnerabilities.

Flip the narrative, draw in attention

Narrative and design, both are crucial to effectively reframe pollution narratives. Here’s how:

1. Localisation and personalisation: Make it about the person, local communities. Tailor messages to specific demographics and geographies. For example, in agricultural regions, emphasise the link between crop burning and paediatric asthma; in urban centres, highlight the cardiovascular risks of vehicular emissions. Use localised data—e.g., “In your district, pollution causes 500 hospitalisations annually”—to enhance relevance.

2. Behavioural Triggers: Pair health risks with actionable solutions.

For instance,

“Wearing an N95 mask reduces your PM2.5 exposure by 95%”

Or

“Switching to public transport can lower your heart attack risk by 10%.”

Such messages empower individuals with tangible steps, reducing perceived helplessness.  This would also enable the public to call for better transport systems.

3. Emotional Engagement: Leverage storytelling to humanize the issue. Profiles of affected families can evoke empathy and urgency. Media partnerships and social campaigns can amplify these narratives, fostering collective identity around pollution mitigation.

The challenge

India’s pollution crisis demands urgent public engagement, yet the entities best positioned to initiate messaging face significant barriers. The government, ostensibly responsible for leading communication, has failed to translate initiatives like the National Clean Air Programme (NCAP) into actionable, localized health advisories. NCAP’s focus on technical targets (e.g., PM10 reductions) lacks clarity on immediate health risks like heart attacks or asthma exacerbations, while political fragmentation and opaque data (e.g., poorly placed air quality monitors) erode public trust.

Organisations of citizens and civil society (CSOs), which could bridge this gap, are increasingly stifled. Government crackdowns—such as revoking Foreign Contribution (Regulation) Act (FCRA) licenses and labelling activists as “anti-national”—have crippled their ability to operate with better efficiency.

Mainstream media, another potential messenger, is compromised by ownership ties to polluting industries. Corporations that profit from fossil fuels, construction etc. often control news outlets, leading to biased or minimal coverage of pollution’s health impacts. Sensationalist reporting during Delhi’s smog crises, for instance, prioritizes political blame over data-driven narratives on cardiovascular risks.

Corporate Social Responsibility (CSR) initiatives, meanwhile, are undermined by conflicts of interest. The largest CSR spenders in environmental campaigns—such as energy conglomerates or construction firms—are often the biggest polluters. Their messaging, even when well-intentioned, risks green-washing, as seen in superficial “sustainability” ads that avoid addressing root causes like coal dependency or vehicular emissions.

In this landscape, very few credible, independent entities can consistently convey pollution’s health risks to the public. This usually leads to a communication void, leaving most citizens unaware of actionable steps to protect their health or demand policy accountability.

How do we overcome?

To address the lack of effective public messaging on pollution, it is crucial to empower grassroots leaders and enable community-driven initiatives that can advocate for change with political influence. Rather than relying solely on government agencies, civil society organizations, or corporate-backed campaigns—many of which face restrictions or conflicts of interest—mobilising of affected communities can create bottom-up pressure for policy action.

One approach is to engage farmers’ organisations by highlighting how climate change contributes to lower crop yields and how sustainable practices can help mitigate pollution. Similarly, student-led movements in schools and colleges can foster long-term engagement by equipping young citizens to push for policy reforms. Self-help groups led by women can serve as powerful advocacy networks, spreading awareness at the grassroots level. Auto-rickshaw drivers and urban workers, who are disproportionately exposed to poor air quality, can be mobilized to demand cleaner transportation policies. Low-income city dwellers, who lack access to air purifiers or private healthcare, can be organized to push for better pollution control measures. By harnessing these diverse networks, a broad and powerful coalition can be built to demand transparent air quality data, stricter enforcement of pollution controls, and citizen-focused policies that put public health first.

The driving force behind this movement should be community leaders, supported by civil society organisations and even political stakeholders. This is an opportunity for genuine grassroots leadership to emerge—one that rises to confront a pressing and tangible crisis.

What we need is an immediate coalition for change

To amplify grassroots efforts, technology and data must be democratised. Mobile apps and community-led air quality monitoring initiatives can provide hyper-localised data, enabling citizens to track pollution levels in real-time and understand immediate health risks. For instance, low-cost sensors deployed in schools and hospitals can generate actionable insights, such as linking spikes in PM2.5 to asthma exacerbations in children, empowering parents and educators to demand accountability.

Education is another critical lever. Integrating pollution’s health impacts into school curricula can cultivate a generation of informed advocates. Student-led projects, such as mapping pollution sources in their neighbourhoods or organizing drives to call for action, can foster agency and long-term engagement. Similarly, vocational training programs for urban workers—auto-rickshaw drivers, street vendors—can include modules on air quality awareness, equipping them to advocate for cleaner transportation policies.

Policy reforms must align with grassroots momentum. Governments could incentivize community-based initiatives through grants or tax breaks. Moreover, cross-sector collaboration is vital. Universities can partner with NGOs to conduct localized health studies.

Our narrative, the power of the narrative

Reframing India’s pollution crisis as a public health emergency, rather than an abstract environmental issue, is the linchpin to meaningful action. By prioritizing immediate, localized health risks—such as heart attacks, asthma attacks, and developmental delays—communicators can bridge the gap between scientific data and public mobilization. Grassroots movements, armed with technology, education, and policy support, can transform passive awareness into collective action, compelling policymakers to prioritize health over political or economic interests.

The fight against pollution is not merely about cleaner air; it is about reclaiming agency. When citizens perceive pollution as a direct threat to their families and communities, they become powerful advocates for change. India’s battle against this silent killer will be won not through top-down mandates alone, but through a bottom-up revolution—one narrative, one neighbourhood, and one life at a time.

(The author is a legal researcher with the organisation)

[1] Team, E. (2024). Human-caused air pollution led to 1.6 million deaths in 2021 in India:  Lancet report. [online] Carbon Copy. Available at: https://carboncopy.info/human-caused-air-pollution-led-to-1-6-million-deaths-in-2021-in-india-lancet-report/#:~:text=Policy%20and%20Finance-,Human%2Dcaused%20air%20pollution%20led%20to%201.6%20million%20deaths,2021%20in%20India%3A%20Lancet%20report&text=According%20to%20the%202024%20Report,%E2%82%85)%20in%202021. [Accessed 27 Feb. 2025].‌

[2] Bera, O.P., Venkatesh, U., Pal, G.K., Shastri, S., Chakraborty, S., Grover, A. and Joshi, H.S. (2024). Assessing the impact of the National Clean Air Programme in Uttar Pradesh’s non-attainment cities: a prophet model time series analysis. The Lancet Regional Health – Southeast Asia, [online] 30, pp.100486–100486. doi:https://doi.org/10.1016/j.lansea.2024.100486.

[3] Kawano, A., Kelp, M., Qiu, M., Singh, K., Chaturvedi, E., Dahiya, S., Azevedo, I. and Burke, M. (2025). Improved daily PM _2.5 estimates in India reveal inequalities in recent enhancement of air quality. Science Advances, [online] 11(4). doi:https://doi.org/10.1126/sciadv.adq1071.

[4] Anjum Hajat, Hsia, C. and O’Neill, M.S. (2015). Socioeconomic Disparities and Air Pollution Exposure: a Global Review. Current Environmental Health Reports, [online] 2(4), pp.440–450. doi:https://doi.org/10.1007/s40572-015-0069-5.

[5] Mukherjee, S., 2010. The emperor of all maladies: a biography of cancer. Simon and Schuster.

[6] Datta, P., Bhagirath Behera and Dil Bahadur Rahut (2022). Climate change and Indian agriculture: A systematic review of farmers’ perception, adaptation, and transformation. Environmental Challenges, [online] 8, pp.100543–100543. doi:https://doi.org/10.1016/j.envc.2022.100543.

[7] Mariconti, C. (2011). Understanding the Disconnect on Global Warming. APS Observer, [online] 22. Available at: https://www.psychologicalscience.org/observer/understanding-the-disconnect-on-global-warming [Accessed 27 Feb. 2025].‌

[8] Krittanawong, C., Qadeer, Y.K., Hayes, R.B., Wang, Z., Thurston, G.D., Virani, S. and Lavie, C.J. (2023). PM2.5 and cardiovascular diseases: State-of-the-Art review. International Journal of Cardiology Cardiovascular Risk and Prevention, [online] 19, p.200217. doi:https://doi.org/10.1016/j.ijcrp.2023.200217.

[9] UNICEF(2017), Danger in the Air: How air pollution can affect brain development in young children, Division of Data, Research and Policy, Available at: https://www.unicef.org/sites/default/files/press-releases/glo-media-Danger_in_the_Air.pdf

[10] Sirur, S. (2023). Exploring airshed management as a solution to India’s pollution woes. [online] Mongabay-India. Available at: https://india.mongabay.com/2023/09/exploring-airshed-management-as-a-solution-to-indias-pollution-woes/ [Accessed 27 Feb. 2025].

[11] Ammons, S., Aja, H., Ghazarian, A.A., Lai, G.Y. and Ellison, G.L. (2022). Perception of worry of harm from air pollution: results from the Health Information National Trends Survey (HINTS). BMC Public Health, [online] 22(1). doi:https://doi.org/10.1186/s12889-022-13450-z.

[12] Chakraborty, R. (2024). Mumbai’s poor AQI and erratic temperatures fuel respiratory ailments. [online] The Indian Express. Available at: https://indianexpress.com/article/cities/mumbai/poor-aqi-temperatures-respiratory-ailments-9747736/ [Accessed 27 Feb. 2025].

[13] Basith, S., Manavalan, B., Shin, T.H., Park, C.B., Lee, W.-S., Kim, J. and Lee, G. (2022). The Impact of Fine Particulate Matter 2.5 on the Cardiovascular System: A Review of the Invisible Killer. Nanomaterials, [online] 12(15), p.2656. doi:https://doi.org/10.3390/nano12152656.‌

[14] Hurtado-Díaz, M., Riojas-Rodríguez, H., Rothenberg, S.J., Schnaas-Arrieta, L., Itai Kloog, Just, A., Hernández-Bonilla, D., Wright, R.O. and Téllez-Rojo, M.M. (2021). Prenatal PM2.5 exposure and neurodevelopment at 2 years of age in a birth cohort from Mexico city. International Journal of Hygiene and Environmental Health, [online] 233, pp.113695–113695. doi:https://doi.org/10.1016/j.ijheh.2021.113695.

[15] Li, N., Chen, G., Liu, F., Mao, S., Liu, Y., Liu, S., Mao, Z., Lu, Y., Wang, C., Guo, Y., Xiang, H. and Li, S. (2020). Associations between long-term exposure to air pollution and blood pressure and effect modifications by behavioral factors. Environmental Research, [online] 182, p.109109. doi:https://doi.org/10.1016/j.envres.2019.109109.

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Related:

Noise Pollution Ban: Unequal standards for diverse practices?

Indian Coal Giants Pushed for Lax Pollution Rules While Ramping Up Operations

Pollution Control Norms for Coal-Fired Power Plants Relaxed Despite Modi’s Commitment to Environment

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Factual Background

The case arose from an FIR filed against the respondent, following allegations of possessing child pornographic material. The forensic analysis of the respondent’s mobile phone revealed two video files depicting child sexual abuse and over a hundred other pornographic files. These findings led to charges under Section 15(1) of the POCSO Act and Section 67B of the IT Act. However, the High Court of Madras quashed the criminal proceedings, reasoning that the essential elements of the offenses were not met. This prompted an appeal to the Supreme Court by child rights organizations.

Legal issues framed

The Supreme Court examined several critical questions:

1. The scope and interpretation of Section 15 of the POCSO Act, particularly the distinctions between sub-section(s) (1), (2) and (3) respectively of Section 15 of the POCSO?
2. The application of the doctrine of constructive possession and its implications for inchoate offenses.
3. The operation of the statutory presumption of culpable mental state under Section 30 of the POCSO Act.
4. Whether the High Court’s quashing of the chargesheet adhered to legislative intent and judicial principles.

Court’s reasoning

Purposive interpretation: safeguarding legislative intent

The Supreme Court adopted a purposive interpretation to align the statutory provisions with their legislative objectives. Recognizing the inadequacy of a strict textual approach, the Court emphasized the broader aim of protecting children from exploitation. Key observations included:

1. Section 15: Designed to comprehensively address the harm posed by possession, storage, and dissemination of CSEAM. It seeks to criminalize preparatory actions and omissions that contribute to child exploitation. [Paragraph 76]
2. Section 67B: Specifically targets the electronic transmission, creation, and storage of child pornographic material, focusing on acts conducted via digital platforms. [Paragraph 151]

The Court emphasized that purposive interpretation is essential to ensure the evolving challenges posed by technology and digital platforms are addressed effectively. It warned against narrow readings that could undermine legislative intent. [Paragraph 190]

The Court highlighted the complementary roles of Section 67B and Section 15 of the IT Act. Section 67B targets digital actions like creating, transmitting, or storing CSEAM, holding online platforms accountable. In contrast, Section 15 covers broader scenarios, including physical possession, constructive possession, and failure to report such content, whether stored digitally or physically.

Detailed interpretation of Section 15 as per Supreme Court:

1. Independent offenses within Section 15:
   • Section 15(1): Penalizes failure to delete, destroy, or report CSEAM to authorities in order to transmit it. No actual sharing need to occur; intention is sufficient. This provision places a legal obligation on individuals to act responsibly when they come into possession of such material, even inadvertently. The Court clarified that this applies irrespective of whether the individual intends to disseminate the material. [Paragraph 87]
   • Section 15(2): Criminalizes acts of facilitating, transmitting, or disseminating CSEAM for purpose of either transmitting, propagating, displaying or distributing the same in any manner. It highlights culpability in cases where individuals actively enable the spread of such material, including sharing via digital platforms. [Paragraph 88]
   • Section 15(3): Targets possession of CSEAM with intent for commercial exploitation. The heightened culpability under this subsection reflects the gravity of exploiting such material for monetary or other material gains. [Paragraph 79]

The Supreme Court clarified that each subsection addresses specific dimensions of harm, ensuring that both active and passive forms of involvement are penalized.

1. Constructive possession: The Court elaborated that constructive possession includes situations where an individual has control or the ability to control CSEAM without necessarily having physical possession. For instance, accessing and failing to delete such material from an online platform qualifies as constructive possession under Section 15(1). This interpretation ensures accountability in digital contexts. [Paragraph 118]
2. Mens Rea and inchoate offenses: Section 15 criminalizes preparatory acts by focusing on the intention behind possession or storage. This approach aims to deter individuals from actions that could lead to further exploitation, even if the harmful act is incomplete. The Court highlighted that the provision’s preventive framework aligns with the overarching aims of the POCSO Act. [Paragraph 81]

Statutory presumption under Section 30 of the POCSO Act

Mandatory but rebuttable presumption: Section 30 shifts the burden of proof to the accused once foundational facts—such as possession or failure to act—are established. The Court emphasized that this presumption serves as a critical tool to counteract the difficulty of proving intent in cases involving CSEAM. [Paragraph 156]

Errors in the High Court’s reasoning

The Supreme Court identified errors in the High Court’s judgment:

1. The High Court misinterpreted the scope of Section 15, treating it as reliant on actual dissemination.
2. It overlooked the doctrine of constructive possession and the statutory presumption under Section 30.

Observations and recommendations

1. Terminology Reform: The Court recommended replacing “child pornography” with “child sexual exploitation and abuse material” (CSEAM) to reflect the exploitative nature of such offenses accurately. [Paragraph 227]
2. Role of Digital Intermediaries: The Court underscored the obligations of online platforms to promptly report and remove CSEAM, emphasizing strict enforcement under the IT Act and POCSO Rules.  [Paragraph 254]
3. Awareness Initiatives: It called for nationwide campaigns, including sex education and digital literacy programs, to prevent child exploitation and equip individuals to report such offenses. [Paragraph 248]

4. Recommendation to Government

The Supreme Court urged the Union to form an Expert Committee to design programs on health, sex education, and POCSO awareness for children, ensuring robust child protection and education. It also recommended amending Section 15(1) of POCSO to enable public reporting of CSEAM through an online portal. [Paragraph 260]

Broader implications

This judgment reinforces a preventive and deterrent framework for addressing child exploitation. By adopting a purposive interpretation and emphasizing systemic reforms, the Court has paved the way for more effective enforcement of child protection laws.

Its emphasis on intent, accountability, and preventive measures ensures justice in the present case and sets a robust precedent for future interpretations of the POCSO Act and IT Act.

(The author is part of the organisations  legal research team)

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• Free cervical cancer vaccines for girls aged 9 to 16

Cervical cancer is a major public health challenge in India, ranking as one of the most common cancers among women. It accounts for a significant percentage of female cancer deaths in the country, with the human papillomavirus (HPV) identified as the primary cause. The MVA government’s proposal to provide free HPV vaccines for girls aged 9 to 16 is a proactive approach to addressing this issue. This initiative is not only a public health priority but also a critical step toward achieving health equity, particularly for families with limited financial resources. Cervical cancer disproportionately affects women in low- and middle-income countries, and India bears a large share of this global burden. The lack of access to preventive healthcare, regular screenings, and costly treatments leads to high mortality rates, especially in under-resourced communities. HPV, a sexually transmitted infection, is a significant risk factor, causing nearly all cervical cancer cases. The infection often goes undetected for years, with symptoms only surfacing in advanced stages when treatment is more challenging and outcomes are poor.

• Expansion of the Mahatma Phule Jan Arogya Scheme

The Mahatma Phule Jan Arogya Scheme (MPJAY), Maharashtra’s flagship health insurance program, has historically provided financial support for select ailments and covered certain treatments in government and empanelled private hospitals. MPJAY primarily focusses on critical and high-cost ailments rather than general health issues, covering around 1,000 types of procedures related to specific heart and kidney diseases, cancer treatments and neurological disorders, amongst others. The goal was to address life-threatening and severe medical conditions that could lead to financial catastrophe if left untreated. The scheme primarily benefited low-income families, giving them access to critical medical treatments they might not otherwise afford. 

Now, the MVA government proposes a significant expansion of MPJAY to cover all diseases, including those resulting from accidents. This transformative change aims to offer a broader safety net, shielding Maharashtra’s economically vulnerable populations from the financial hardships often associated with healthcare expenses. Expanding MPJAY is also an important step toward achieving Universal Health Coverage (UHC) for Maharashtra. In line with the goals of the National Health Mission, which advocates for accessible and affordable healthcare for all, MPJAY’s expansion contributes to creating a more inclusive healthcare system that ensures everyone can access quality medical services.

• Review and expansion of health insurance schemes

Recognising that the current health insurance schemes have limitations, the MVA manifesto proposes a thorough review to identify gaps and expand coverage accordingly. Many existing policies don’t cover all necessary treatments, and out-of-pocket expenses remain high. Enhanced insurance schemes will give citizens better access to advanced healthcare services, benefiting especially middle-income families who often struggle to cover medical costs. Expanding insurance coverage could also help the government partner with private providers to offer subsidised treatments.

• Free medicine availability in government hospitals

Access to free essential medicines in government hospitals is a cornerstone of affordable healthcare. This proposed policy would address the problem of patients not completing treatments due to high medication costs. Providing medicines for free ensures that economic barriers do not prevent people from receiving necessary care, especially for chronic conditions requiring lifelong medication. It also aligns with the National Health Policy’s goal to increase the availability of generic drugs in government facilities.

• Policy for Universal Healthcare Rights

By adopting a Universal Healthcare Rights policy, MVA envisions Maharashtra joining the global efforts to make healthcare accessible and equitable for all. This proposed policy includes a commitment to improving healthcare infrastructure, human resources, and service delivery in rural and urban areas alike. It prioritises inclusive care by ensuring that even the most remote regions of Maharashtra have access to high-quality healthcare.

• Equipping district hospitals with comprehensive facilities

Upgrading district hospitals to provide full medical services is essential for bridging healthcare disparities between urban and rural areas. District hospitals in Maharashtra lack the infrastructure to offer specialised treatments, forcing patients to travel long distances to larger cities. With comprehensive facilities, these hospitals can address a broader spectrum of health needs locally, reducing delays in critical care and improving health outcomes for rural populations.

• Lowering population criteria for Primary Health Centres (PHCs)

In Maharashtra, remote, hilly, and tribal regions often have limited access to healthcare facilities due to challenging terrains, dispersed settlements, and low population densities. By reducing the population requirement for establishing Primary Health Centres (PHCs) from 20,000 to 10,000 in these areas, the MVA aims to address these logistical challenges and bring healthcare closer to the people. This initiative is particularly significant for Maharashtra’s tribal communities, which represent around 9% of the state’s population. These communities, often located in the Sahyadri and Satpura ranges, face not only geographic isolation but also economic and educational barriers to healthcare. Increasing the number of PHCs in these regions will allow residents to access basic health services such as maternal and child health, immunisation, and treatment for common diseases within their localities. This approach helps address longstanding healthcare disparities in Maharashtra, particularly in districts like Gadchiroli, Nandurbar, and Palghar, where the need for accessible healthcare is critical.

Reducing the population threshold to 20,000 for setting up PHCs in other rural parts of Maharashtra will also potentially bring healthcare access within reach for rural communities across the state. PHCs play a crucial role in providing first-level medical care, handling outpatient services, preventive health education, and early diagnosis for common illnesses. By making these centres more widely available, the initiative reduces the need for residents to travel long distances to larger hospitals for minor ailments and preventive care. This not only saves time and costs for rural families but also alleviates the burden on district and sub-district hospitals, allowing them to focus on more complex cases. For rural districts like Ahmednagar, Solapur, and Jalgaon, where many residents rely on agriculture and face seasonal challenges with limited income, the increased accessibility of PHCs can make a significant difference in overall community health. With improved proximity to primary healthcare, early detection and prevention of diseases such as diabetes, hypertension, and respiratory illnesses can be achieved, helping reduce the need for hospitalisations and fostering a healthier rural population.

• Expansion of ambulance services to 2,000

The MVA’s promise to expand Maharashtra’s ambulance fleet to 2,000 vehicles is a commitment to strengthening emergency healthcare access across the state, especially for rural and remote communities where medical facilities can be hours away. In emergencies such as road accidents, natural disasters, childbirth complications, or sudden critical health conditions like heart attacks, timely medical intervention is often a matter of life and death. The increase in well-equipped ambulances, staffed by trained paramedics, will ensure that more people receive rapid, essential care at the scene and on the way to hospitals, significantly reducing response times and potentially lowering mortality rates in critical situations.

This expansion would make a tangible difference for Maharashtra’s rural districts and remote tribal areas, where many communities are located far from the nearest healthcare facility. Regions like Vidarbha, Marathwada, and the tribal areas of the Western Maharashtra, where emergency services are often hard to access, will benefit from the MVA’s focus on bridging these healthcare gaps. By proposing to increase the ambulance fleet, the MVA government aims not only to provide faster emergency responses but also to build a more resilient healthcare infrastructure that can serve all citizens, even in times of large-scale crises. This pledge shows a strong commitment to ensuring that life-saving healthcare is available and accessible across Maharashtra, delivering critical peace of mind to families statewide.

• Right to healthcare policy development for Maharashtra

Crafting a dedicated healthcare policy that aligns with state and national standards will set clear benchmarks for healthcare services in Maharashtra. This policy will provide a foundation for accountability, ensuring all residents have equal access to healthcare. It will also streamline government operations to ensure that healthcare services reach urban and rural populations effectively.

• Increasing the healthcare budget

An increase in healthcare spending is essential for supporting such a comprehensive healthcare program. The manifesto suggests incrementally raising the healthcare budget to 8% of the state’s total budget, aligning with recommendations in the National Health Policy. These funds will be directed towards upgrading infrastructure, expanding facilities, and ensuring sufficient medical supplies, enabling sustainable development of Maharashtra’s healthcare system.

• Construction of a 100-Bed modern hospital in each Taluka

Maharashtra’s 358 talukas represent the administrative backbone of the state, and establishing a 100-bed hospital in each taluka will create a decentralised healthcare system. These hospitals will provide emergency care, specialised services, and in-patient facilities, reducing the burden on tertiary hospitals and ensuring more timely care for residents in their communities.

• Community-based healthcare oversight

Activating community health committees will foster transparency and accountability in public healthcare. These committees will give local representatives and social organisations a voice in healthcare planning, empowering them to shape services that directly address their community’s needs. This model proposed by the MVA promotes citizen engagement, ensuring that healthcare remains responsive to changing local dynamics.

• Health workforce policy and regularisation of contractual nurses

Maharashtra faces significant challenges in maintaining a sufficient and well-trained healthcare workforce, particularly in public health facilities. The state’s healthcare system is often stretched thin, especially in rural and remote areas where the availability of medical professionals is limited. The proposal for introduction of a Health Workforce Policy by the MVA government seeks to address this critical issue by prioritising the filling of existing vacancies in both urban and rural healthcare settings. This policy will focus on recruiting doctors, nurses, paramedics, and other healthcare professionals to ensure that public health centres and district hospitals are adequately staffed. A key component of this initiative is the regularisation of contractual nurses, many of whom work in precarious conditions without job security or benefits. By transitioning these nurses into permanent roles, the policy will not only offer them the stability and financial security they need but also improve their long-term commitment and investment in patient care. Nurses play a central role in the healthcare delivery system, and providing them with permanent positions will lead to better continuity of care, reduced staff turnover, and improved morale. This move will also help Maharashtra address regional disparities, ensuring that both urban and rural areas have access to a well-supported and consistent healthcare workforce, which is essential for the quality of care and patient outcomes across the state.

• Increased remuneration for ASHA and Anganwadi Workers

Accredited Social Health Activists (ASHA) and Anganwadi workers play a critical role in grassroots health services. Maharashtra aims to increase their remuneration, recognising the demanding and often underpaid nature of their work. Despite their critical role, these workers often receive low pay, inadequate benefits, and limited job security, which has resulted in low morale and high turnover rates. Recognising their immense contribution, the MVA government has promised to increase their remuneration. This move will not only provide these workers with a fairer income but also acknowledge the demanding nature of their roles, especially in rural Maharashtra where access to healthcare facilities is limited. By improving the financial recognition of ASHA and Anganwadi workers, Maharashtra aims to ensure that these workers remain motivated and able to continue their vital work in improving community health, thereby reducing health inequalities in rural and underserved areas. Improved pay aligns with practices in states like Kerala, where higher compensation has boosted job satisfaction and led to better health outcomes in rural communities. As of March 2024, the monthly honorarium for an Accredited Social Health Activist (ASHA) worker in Maharashtra is ₹13,000, which is a ₹5,000 increase from the previous amount, bringing it to one of the highest paying states.

• Expanded generic medicine centres and free essential medicines

Offering free essential medicines and expanding generic medicine centers will make treatments more affordable, especially for marginalised communities. Generic centres reduce dependency on costlier branded medicines, encouraging patients to adhere to prescribed treatments and preventing diseases from worsening.

• ‘Stree Shakti’ initiative for women’s health

With over half of India’s women facing anemia, the ‘Stree Shakti’ initiative addresses a critical health issue that affects women’s productivity, pregnancy outcomes, and quality of life. This proposed initiative by the MVA will provide supplements and healthcare support, targeting anemia reduction and improving maternal and child health, leading to a healthier future generation.

• Malnutrition control and Tribal Health and Nutrition Missions

Malnutrition remains a challenge in India, especially in tribal regions. A dedicated Malnutrition Control Board and Tribal Health and Nutrition Mission will coordinate resources and interventions to tackle this problem. The Tribal Health and Nutrition Mission proposed by the MVA in particular, will focus on unique health challenges faced by tribal populations, such as sickle cell anemia and other genetic disorders, improving health equity across Maharashtra.

• Free medication for chronic diseases and preventive health initiatives

Chronic conditions such as diabetes and hypertension are rising in India. According to the manifesto of MVA, they will be providing free medication and encourage early screening so that complications can be prevented, hospitalisations can be reduced, and patients’ quality of life can be removed. Initiatives to control malaria, dengue, TB, and chikungunya reflect a proactive stance on public health.

• Expanded mental health services

Today, mental health issues like depression, anxiety, and digital addiction are being openly discussed and have also become a priority. Establishing counselling centres across the state will make mental health services more accessible, promoting mental well-being and helping residents manage life’s pressures more effectively.

• Transparency and accountability in healthcare services

By implementing a Patient Rights Charter and setting up grievance cells, MVA envisions Maharashtra to make healthcare services more accountable. This transparency will improve trust in public healthcare, giving patients the security of knowing their rights are protected and they have recourse if standards are not met.

• Telemedicine helpline and clean drinking water initiatives

As proposed by the MVA, the telemedicine helpline will provide a valuable resource for remote communities who face challenges accessing healthcare facilities. Clean drinking water campaigns, like ‘Nirmal Jal,’ will combat waterborne illnesses, improving health outcomes in regions such as Marathwada and Vidarbha.

• Addressing the safety of healthcare workers in Maharashtra

The safety of doctors and healthcare professionals is a growing concern in Maharashtra, as across the country, the rise in assaults on medical staff has become a significant issue. These incidents not only jeopardise the physical safety of doctors and staff but also undermine the overall healthcare system, creating an environment of fear and discouragement among medical professionals. To address this, the MVA government has recognised the need for robust measures to protect healthcare workers, emphasising the importance of maintaining a safe working environment for medical staff. The government is committed to taking necessary precautions, such as implementing stricter laws and enforcement against those who resort to violence, introducing better security systems in hospitals, and training healthcare workers in conflict resolution techniques. In addition, the creation of a more supportive environment, including the establishment of dedicated grievance redressal mechanisms for healthcare workers, can help prevent such incidents and ensure that healthcare providers can focus on delivering quality care without the fear of physical harm.

The MVA’s approach to tackling violence against healthcare workers is not just about improving security measures but also about changing the broader culture of healthcare in Maharashtra. The government’s focus on preventing assaults on doctors and medical staff involves not only legislative action but also enhancing public awareness about the importance of treating healthcare workers with dignity and respect. Public campaigns and outreach programs will educate the public on the challenges faced by doctors, especially in high-stress environments like government hospitals where the patient load is often high, and resources are limited. Moreover, strengthening hospital security through the installation of CCTV cameras, increasing the presence of trained security personnel, and enforcing protocols for handling volatile situations will create a safer space for healthcare providers. In the long run, these efforts will encourage more healthcare professionals to work in public hospitals, knowing that their safety and well-being are a priority, thereby improving the overall healthcare system in Maharashtra.

• Target to raise life expectancy to 77 years

Aiming to increase life expectancy reflects Maharashtra’s commitment to a holistic approach to health. Improved public health, accessible healthcare services, and initiatives focused on clean water, sanitation, and preventive care will contribute to a healthier, longer-living population, ultimately enhancing the state’s social and economic development.

Building an inclusive and comprehensive healthcare system for all

The MVA’s healthcare manifesto sets the stage for a transformative shift in Maharashtra’s healthcare landscape, focusing on inclusivity and equity in access to medical care. By implementing a universal healthcare policy, the government aims to ensure that no one, regardless of their economic background, geographic location, or social status, is left behind. The promise to expand primary healthcare services in rural, remote, and tribal areas—by reducing the population threshold for establishing Primary Health Centres (PHCs)—will bring essential healthcare services closer to communities that have historically faced challenges in accessing quality care. The increase in ambulance services to 2,000 vehicles ensures faster and more reliable emergency medical response, reducing delays that can be the difference between life and death in critical situations. This approach will help alleviate the burden on overextended urban hospitals, offering decentralised healthcare options that empower local communities.

Moreover, the commitment to free medicines, vaccination programs, and cancer treatment for women highlights the government’s drive to make healthcare affordable and accessible for all. The MVA’s initiatives will improve health outcomes in marginalised communities, such as the tribal regions of Vidarbha, Marathwada, and the Western Ghats, by addressing health disparities that have persisted for years. This focus on preventive healthcare, including expanding the availability of HPV vaccines, malnutrition control programs, and maternal and child health initiatives, will help reduce the long-term disease burden, improving overall population health and reducing the pressure on expensive hospital treatments. These measures form the foundation of a healthcare system where quality care is guaranteed as a right, not a privilege, contributing to the overall well-being of every citizen across the state.

Sustainable healthcare infrastructure and empowerment of medical workers

The MVA manifesto’s vision extends beyond just expanding access; it aims to build a sustainable healthcare infrastructure that is robust, resilient, and future-ready. With initiatives like equipping every sub-district hospital, building 100-bed modern hospitals in each taluka, and enhancing district hospital facilities, the MVA government is ensuring that Maharashtra’s healthcare infrastructure will be able to handle both present and future challenges. The inclusion of Mohalla clinics in urban areas will make healthcare services more accessible on a local level, while the creation of a Health Workforce Policy and the regularisation of contractual nurses will ensure that the state is equipped with a skilled and motivated healthcare workforce. By addressing the remuneration and job security of crucial grassroots workers like ASHA and Anganwadi workers, the MVA government is directly improving the quality of healthcare at the community level, empowering those who are often the first point of contact for rural and underprivileged populations.

These initiatives, which focus on both infrastructure and workforce development, are designed to create a healthcare system that can withstand future pressures, such as a growing population or emerging health crises. The promise to improve security measures for doctors and prevent assaults further strengthens the healthcare ecosystem by ensuring that medical professionals can work in a safe, supportive environment. Together, these transformative changes will not only increase the state’s healthcare coverage but also foster an environment where medical professionals, from frontline health workers to doctors, can thrive. By prioritising healthcare as a fundamental right and building a system that supports both patients and providers, MVA envisions Maharashtra to be on the path to becoming a model state for healthcare, one that sets new standards for accessibility, quality, and sustainability.

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The post The MVA promise to uphold right to healthcare in Maharashtra: A visionary approach to equitable and comprehensive health access appeared first on SabrangIndia.

The Kolkata rape and murder case, a 31-year-old trainee doctor who was brutally raped and killed by a civic volunteer at the campus of Kolkata’s RG Kar Medical College and Hospital on August 9, 2024 is only one among the recent of horrific such crimes in a country that records 86 or 87 rapes every day. (Details can be read here) The young doctor was attacked while on night duty. Her body was found the next morning, bearing severe injuries to her eyes, face, mouth, neck, limbs, and private parts. The violence and brutality that the deceased had to suffer at the hands of the accused shocked the nation and led to widespread calls for vengeance and justice. Thousands of doctors and other medical staff had, thereafter, taken to the roads to protest the increasing instances of violence against medical professions, especially women, and to demand stringent laws providing for their safety.

The Supreme Court had, on following the nationwide outrage, taken suo-moto cognisance of the Kolkata rape and murder case, on a Sunday, August 18, and the bench of comprising Chief Justice of India DY Chandrachud, Justices JB Pardiwala and Manoj Misra heard the matter on August 20 and over the next days. The Supreme Court had reportedly said that “The reason why we have decided to take this suo moto matter is because this is not a matter related to a particular murder which took place in a hospital in Kolkata. It raises systemic issues related to the safety of doctors across India.”

In the first order issued by the bench on August 20, the bench directed the prompt establishment of a “National Task Force” (NTF) comprising of medical professionals to give recommendations –within three months–on the modalities to be followed all over the country to ensure the safety of medical professionals in their work spaces. The bench noted that several states such as Maharashtra, Kerala, Telangana, West Bengal, Andhra Pradesh, Tamil Nadu etc. have framed state laws to deal with violence against doctors. However, these laws do not address deficiencies in institutional safety standards. “Therefore, we must evolve a national consensus. There must be a national protocol to create safe conditions of work. If women cannot go to a place of work and feel safe, we are denying them equal opportunity. We have to do something right now to ensure that the conditions of safety are enforced,” CJI had orally stated during the highly publicised hearings.

It is essential to note that the said National Task Force will constitute a total of ten members (details below). The order provided that the NTF will be headed by Surgeon Vice Admiral Arti Sarin AVSM, VSM. Director General Medical Services (Navy). The other members of the task force are Dr D Nageshwar Reddy, Chairman and Managing Director, Asian Institute of Gastroenterology and AIG Hospitals, Hyderabad, Dr M Srinivas, Director of Delhi-AIIMS, Dr Pratima Murthy, Director, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Dr Goverdhan Dutt Puri, Executive Director, AIIMS Jodhpur, Dr Saumitra Rawat, Chairperson, Institute of Surgical Gastroenterology, GI and HPB Onco-Surgery and Liver Transplantation and Member, Board of Management, Sir Ganga Ram Hospital, New Delhi. In addition to this, the NTF will also include Professor Anita Saxena, Vice-Chancellor, Pandit B D Sharma Medical University, Rohtak, former Dean of Academics, Chief Cardio thoracic Centre and Head Cardiology Department AIIMS, Delhi, Dr Pallavi Saple, Dean, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, and Dr Padma Srivastava, formerly Professor at the Department of Neurology, AIIMS Delhi.

The bench said the cabinet secretary and the home secretary to the Union government, secretary, Ministry of Health, chairperson, National Medical Commission and president, National Board of Examinations shall be the ex-officio members of the task force.

The bench has also directed that the NTF formulate an action plan under two sub-heads –Preventing violence, including gender-based violence against medical professionals; and providing an enforceable national protocol for dignified and safe working conditions for medical professionals.

The intervention of the SC and formation of the National Task Force has been hailed by many as a significant step towards ensuring the safety of the medical professionals as well as changing the scenario of impunity and lawlessness when it comes to committing violence against medical staff.

While it is certainly a step in the right direction, such a significant move has unfortunately excluded a large section of health care professionals hailing from the informal sector. Despite a wider definition by the World Health Organisation (WHO) on who constitutes health workers, it appears that this vast network of women health workers in urban and rural India may not figure at all, especially as their work situations are not structured and easy to find solutions for.

The order specifies that the medical professions being referred to in the order are only interns, residents, senior residents, doctors, nurses and all medical professionals. This further begs the question of The same brings us to the question of whether, by limiting the ambit of the NTF to the aforementioned medical staff, the Supreme Court has implied that the issue of violence against medial professions is an issue of concern or restricted to only middle class workspaces and urban areas, when predominantly informal workers in the cities and health workers in rural areas –such as Accredited Social Health Activists (ASHA workers) and Anganwadi workers and gender violence issues faced by them –will not be looked into by the NTF?

The World Health Organization (WHO) defines health workers as people who work to improve health, including doctors, nurses, midwives, and other professionals. The same also includes health sanitation workers. The WHO classifies health workers into five broad categories: health professionals, health associate professionals, and personal care workers in health services, health management and support personnel, and other health service providers. Despite this, the said order of the Supreme Court overlooks the equally critical and vulnerable segment of rural health workers, including Anganwadi workers and Accredited Social Health Activists (ASHA).

Who are India’s ASHA workers? Employed under the Ministry of Health and Family Welfare since 2005—over 10.52 lakh ASHAs (2022 figures) who are trained female community health activists from our village communities who are those that reach our communities on basic public health.[1] Besides Anganwadi workers and helpers are part of the union government’s “services’ programme though there have been demands for regularisation and de-casualisation of their work. They provide and reach early childhood care, pregnant women and lactating mothers, monitor children’s growth and –with healthcare professionals—also reach and provide health needs like primary healthcare, referral services and immunisation. Presently, India has close to 12,93,448 Anganwadi workers and 11,64,178 Anganwadi helpers, not an insignificant number.

These individuals, who are the backbone of rural healthcare, face not only violence but also systemic neglect, low pay, and lack of support, making their struggles invisible in the broader discourse. While formal sector medical professionals receive attention and advocacy, the plight of these rural workers remains largely unaddressed, highlighting a glaring disparity in how we value and protect different tiers of our healthcare system. With a significant section of the medical staff absent from even being considered by a task force established especially to consider the concerns raised by medical professionals. Can safety be ensured for those in the medical fraternity of India without ensuring that those who are the most marginalised, ignored and vulnerable are excluded from being granted protection?

Details of the Supreme Court order:

The Supreme Court observed in its order that Medical Associations have persistently highlighted the lack of workplace safety in healthcare institutions.  Noting that medical professionals, including doctors, nurses, and paramedic staff, have increasingly become targets of various forms of violence while carrying out their duties, the intervention of the Supreme Court thereafter outlines a solution. With hospitals and medical facilities operating 24/7, these professionals work tirelessly around the clock. The unrestricted access to all areas within healthcare institutions has further exposed them to potential threats. In moments of distress, patients’ relatives often hastily blame unfavourable outcomes on the perceived negligence of medical staff, exacerbating the vulnerability of those dedicated to saving lives.

Specifically referring to the difficulties faced by women, the order stated “Women are at particular risk of sexual and non-sexual violence in these settings. Due to ingrained patriarchal attitudes and biases, relatives of patients are more likely to challenge women medical professionals. In addition to this, female medical professionals also face different forms of sexual violence at the workplace by colleagues, seniors and persons in authority. Sexual violence has had its origins even within the institution, the case of Aruna Shanbag being a case in point. There is a hierarchy within medical colleges and the career advancement and academic degrees of young professionals are capable of being affected by those in the upper echelons. The lack of institutional safety norms at medical establishments against both violence and sexual violence against medical professionals is a matter of serious concern.” (Para 7)

According to the judges of the Supreme Court, the issue of safety of medical professionals goes beyond merely protecting doctors; rather it is to be taken as a matter of national interest to ensure the safety and well-being of all health providers. The court noted in its order that as more women enter the workforce in advanced fields of knowledge and science, it is crucial for the nation to guarantee safe and dignified working conditions. The constitutional principle of equality mandates this, leaving no room for compromise on the health, safety, and well-being of those who care for others. The bench then states that the nation cannot afford to wait for a tragedy, such as a rape or murder, before implementing real and necessary changes.

The order stated “The constitutional value of equality demands nothing else and will not brook compromises on the health, well-being and safety of those who provide health care to others. The nation cannot await a rape or murder for real changes on the ground.” (Para 7)

In the present order, the bench led by CJI Chandrachud identified several critical issues affecting medical professionals:

1. Medical staff on night duty often lack adequate rooms for rest, with no separate facilities for men and women.
2. Interns, residents, and senior residents are frequently subjected to 36-hour shifts in environments lacking basic hygiene and sanitation.
3. The absence of security personnel at hospitals is more common than not.
4. Medical professionals often face inadequate toilet facilities.
5. Housing for medical staff is often located far from hospitals, with insufficient transportation options.
6. Many hospitals lack properly functioning CCTV cameras for monitoring.
7. Patients and their attendants have unrestricted access to all areas of the hospital.
8. There is a lack of screening for weapons at hospital entrances.
9. Hospital premises are often dingy and poorly lit.

The bench has ordered the constitution of a ten-member National Task Force so that a national consensus can be reached—through thorough consultation with all stakeholders—on the urgent need to establish protocols addressing the issues being faced by the medical fraternity.

Through its order, the bench empowered the NTF to make recommendations on all aspects of the action-plan on preventing violence and providing an enforceable national protocol for dignified and safe working conditions, as well as any other aspects which the members seek to cover. The order further noted that “The NTF shall also suggest appropriate timelines by which the recommendations could be implemented based on the existing facilities in Hospitals. The NTF is requested to consult all stake-holders.” (Para 14)

The Ministry of Health and Family Welfare will provide all logistical support including making arrangements for travel, stay and secretarial assistance and bear the expenses of the members of the NTF, the order stated.

As a part of clarification of who all will fall under the phrase medical professionals, the order stated that “It is clarified that the phrase medical professionals used in this judgment encompasses every medical professional including doctors, medical students who are undergoing their compulsory rotating medical internship (CRMI) as a part of the MBBS course, resident doctors and senior resident doctors and nurses (including those who are nursing interns).” (Para 13)

The complete order may be read below:

It is pertinent to highlight here that previously, in the month of July of 2024 itself, the Supreme Court bench of Justices Sanjiv Khanna, Sanjay Karol and Sanjeev Kumar had refused to entertain a petition filed by the Delhi Medical Association (DMA) seeking measures to prevent violence against doctors by observing that legislations are already in place. Moreover, the bench had clarified that the petitioners were at liberty to approach the concerned courts in respect of particular instances of violence. Thus, within a period of a month, the Supreme Court went from dismissing the issue of violence against doctors and medical staff by observing it as individual cases to the same being a “systemic” concern, following the outrage in the Kolkatta murder-rape case.

The order may be read here:

“Systematic” exclusion?

Healthcare workers (HCWs) are individuals who deliver care and services to the sick and ailing. This involves team effort from doctors, nurses, laboratory technicians, pharmacists, ambulance drivers, medical waste handlers, Accredited Social Health Activists (ASHAs), Auxiliary Nurse Midwives (ANMs), Anganwadi workers and several others. ASHAs, ANMs and Anganwadi workers form an integral part of the grassroots-level health workers under the National Health Mission.  As part of the government’s National Rural Health Mission (NRHM), a new group of baseline health workers called Accredited Social Health Activists (ASHA workers) was formed in 2005 to address health related demands of the rural population, especially women and children, who find it arduous to access basic health services.

In the ongoing conversations about the protection and recognition of healthcare professionals, the vital contributions of ASHA (Accredited Social Health Activists) workers, Anganwadi workers and sanitation workers are often marginalised, overshadowed by the focus on urban and elite doctors. These individuals are the cornerstone of India’s rural healthcare system, delivering essential services to some of the country’s most remote and underserved populations. Yet, despite their critical role, they are largely excluded from the protections, benefits, and honour that are routinely extended to their urban and formal sector counterparts. This exclusion highlights a deep-seated inequality within the healthcare system, where the labour of rural health workers is undervalued and their safety and well-being are neglected.

ASHA workers and Anganwadi workers, who are exclusively women, operate under some of the most challenging conditions imaginable. ASHA workers, for instance, are often responsible for covering large geographic areas, traveling on foot to visit households, educate families on health practices, and provide crucial services such as immunizations, prenatal care, and family planning. These tasks are physically demanding, and ASHA workers frequently face long hours without adequate rest or compensation. In some regions, they are expected to work for less than the minimum wage, a paltry sum considering the importance and intensity of their work. Anganwadi workers, who run rural childcare centres and play a pivotal role in early childhood development, face similar hardships. They manage not only the educational needs of children but also their nutritional and health needs, often without adequate infrastructure or support.

The vulnerability of these workers is further exacerbated by the lack of formal employment status. ASHA and Anganwadi workers are often classified as “honorary” or “voluntary” workers, which means they do not receive the same benefits as formal employees, such as health insurance, pensions, or job security. This classification leaves them in a precarious position, where they are expected to perform essential public health functions without the protections that should accompany such responsibilities. In addition, they are frequently exposed to violence and harassment, both from the communities they serve and from within the healthcare system itself. Instances of ASHA workers being attacked or threatened while conducting COVID-19 tracing or vaccination drives have been reported across several states, including Uttar Pradesh, Bihar, and Maharashtra. Similarly, Anganwadi workers often face neglect and abuse from families who do not fully understand or appreciate their role, yet they continue to work under these difficult conditions with little acknowledgment.

When it comes to the violence that Anganwadi workers and ASHA workers face, the data is scarce. However, even the minimal data shows that there is a severe problem. A 2016 mixed-method study involving 396 ASHA workers from rural Northern Karnataka found that 94% of participants had experienced violent incidents in the preceding six months. Similarly, a study conducted in Kashmir during the 2010 unrest, which focused on 35 ambulance drivers, revealed that 89% of those interviewed had faced more than one incident of physical harm, 54% had suffered physical assault, and 83% had experienced job-related psychological trauma. Despite the presence of a significant number of ASHA workers, Anganwadi workers and other informal medical workers and aides in India, there is a glaring lack of comprehensive studies investigating the violence they face. The scarcity of data highlights the profound gap in understanding and addressing the risks these essential workers’ encounter. These studies also provide that the violence that these workers face stems from failures at multiple levels. Grassroots and mobile workers, who operate outside of health facilities, lack any form of security, while those stationed at health facilities receive only minimal protection. Owning to a lack of research on this issue, more recent figures could not be quoted.

Despite these overwhelming challenges, ASHA and Anganwadi workers have been resolute in their fight for better working conditions and fair treatment. Over the years, they have organized numerous protests, strikes, and campaigns to demand higher wages, job security, and formal recognition of their roles. In 2020, thousands of ASHA workers went on strike across the country, demanding a fixed monthly salary of ₹10,000 and better protective equipment during the COVID-19 pandemic. Anganwadi workers have similarly taken to the streets, protesting against the inadequate wages and lack of support from the government. Their struggles have led to some victories, such as wage increases in certain states and greater visibility of their demands in public discourse. However, these gains are often piecemeal and do not address the systemic issues that continue to marginalize these workers.

The exclusion of ASHA and Anganwadi workers from the protections and accolades afforded to doctors and other medical professionals indulged in the formal sector is indicative of a broader systemic inequality within India’s healthcare system. While doctors and hospitals that are urban and in the formal sector receive government attention and resources, the women who provide essential healthcare in rural areas are left to fend for themselves. This disparity not only undermines the health and well-being of ASHA and Anganwadi workers but also threatens the overall effectiveness of India’s public health efforts. For the healthcare system to function equitably and efficiently, it is imperative that these workers receive the recognition, protection, and compensation they deserve.

In addition to this, the exclusion of informal sanitation workers from the protections and recognition given to other healthcare professionals further underscores the deep inequities within India’s labour force. These workers, often operating in hazardous conditions with little to no safety equipment, are responsible for some of the most crucial yet dangerous tasks in maintaining public health. They handle the cleaning of sewers, public toilets, and waste disposal sites, tasks that expose them to harmful pathogens, toxic substances, and life-threatening situations daily. Despite their critical role in preventing disease outbreaks and ensuring public hygiene, they remain invisible in the broader narrative of healthcare protection and support.

Informal sanitation workers hail from the most marginalised communities and are trapped in a cycle of poverty and discrimination. They work without proper training, protective gear, or job security, making them extremely vulnerable to injuries, infections, and even death. The risks they take are immense; it is not uncommon for sanitation workers to suffocate or drown in poorly ventilated and hazardous environments such as septic tanks and sewers. One keeps hearing of there being numerous reports of sanitation workers dying due to asphyxiation while cleaning septic tanks, a task often performed manually in the absence of mechanized alternatives. Despite these dangers, they receive minimal compensation and are often denied basic rights like healthcare, insurance, and pensions. Their exclusion from national safety protocols and labour protections is a stark reminder of the systemic neglect faced by the most vulnerable workers in India’s public health infrastructure.

As India a as country continues to address the safety and well-being of medical professionals, we must also confront and correct the disparities that leave rural health workers vulnerable and marginalized. If our efforts to enhance safety and protection focus solely on more visible or privileged segments of the healthcare workforce, we risk perpetuating existing inequalities and leaving behind those who are most in need. Ensuring the protection and empowerment of ASHA workers, Anganwadi workers and informal sanitation workers is not just a moral obligation; it is crucial for the success of India’s public health system. Their work is indispensable, and their contributions should be recognized and valued as such. The time has come for a comprehensive approach that ensures their rights, safety, and dignity, aligning the nation’s healthcare system with its constitutional commitment to equality and justice for all.  For true progress, our reforms must extend beyond just some more visible and central urban centres and formal sectors to encompass semi-urban, non-formal and rural healthcare workers, such as ASHA and Anganwadi workers, and informal sanitation staff. By acknowledging and addressing the unique challenges faced by these essential yet overlooked groups, we can create a more inclusive and equitable system that genuinely safeguards all those who dedicate their lives to public health. Only through such comprehensive and compassionate measures can we hope to achieve a truly effective and just response to violence against healthcare workers.

[1] Despite long standing demands for being recognised as government workers, ASHAs are not instead classified as holding an “honorary/volunteer” position. They serve populations of approximately 1,000 in rural areas and 2,000 in urban settings.

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In response to the question posed by INC Lok Sabha MP from Rajasthan, Ummeda Ram Beniwal, on the lack of healthcare facilities and resources, affecting patients in India, the Central Government has cited the Rural Health Statistics 2022, which suggests that massive health infrastructure gaps need to be covered in rural areas. The Minister of State for Health and Family Affairs, Anupriya Patel referred to the Rural Health Statistics 2022 data in her reply to the query put forth by Beniwal on August 9 concerning the lack of health infrastructure in the country. The data given reveals that as of July 1, 2022, rural areas face a shortfall of 48060 Sub-Centres as against the requirement of 1,93,310 such centres, with the present number of Sub-Centres being at 1,57,935.

Similarly, rural India has a shortage of 9,742 Primary Health Centres (PHCs) against its required strength of 31,640 PHCs, with 24,935 PHCs presently in use. The number of Community Health Centres (CHCs) currently in use stands at 5480 against the required strength of 7894 such centres, with a shortfall of 2852 CHCs in total.

The parliamentary answer by the MoS Anupriya Patel explained that “All India Shortfall is derived by adding State-wise figures of shortfall ignoring the existing surplus in some of the states.” However, state-wise data regarding the shortage was not included in the response. Importantly, the figures provided here does not include shortage of such centres in urban areas, thus revealing the magnitude of the issue.

Patel further informed the Lok Sabha about the Union Government’s efforts at improving health infrastructure and human resource shortage, noting that the Health Ministry provides “technical and financial support including support for recruitment of health human resource (Specialists Doctors and other health workers), to the States/UTs to strengthen the public healthcare system, based on the proposals received in the form of Programme Implementation Plans (PIPs) under National Health Mission.”

She also said that under the Fifteenth Finance Commission (FC-XV) and PM-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) various initiatives have been undertaken, with “a total of 12,606 units of building-less sub-health centre, 881 units of building-less Primary Health Centre and 125 units of building-less Community Health Centre” being provisioned for the FY 2021-22 to 2023-24.

The response further stated that “Under PM-ABHIM, provisions have been made for construction/strengthening of 730 Integrated Public Health Labs (IPHLs), 3382 Block Public Health Units (BPHU), 602 Critical Care Blocks (CCBs) and 7,808 units of building-less sub-health centre-Ayushman Arogya Mandir during the scheme period FY 2021-22 to 2025-26.”

Notably, some states, including Mizoram, Nagaland, and Meghalaya have pushed back over renaming of Ayushman centres as ‘mandirs’ questioning the imposition of dominant religious nomenclature.

The parliamentary response on the subject dated August 9 can be found here:

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It wanted the government to “immediately give ration cards to 8 crore migrant/unorganised sector workers as directed by the Supreme Court.”

The Right to Food Campaign is deeply disturbed by reports of the immense distress and problems being faced by people across the country on account of the government undertaking E-KYC verification of all 81 crore people who have ration cards and are entitled to receive foodgrains under the National Food Security Act (NFSA).

From different states, the campaign is receiving reports of people rushing back to their villages because they are being informed that failure to get EKYC of the whole family will result in stoppage of ration.

At a time when crores of people have been left out of the food security net on account of the government’s failure to carry out the census of 2021, it is inexplicable that the energy and resources of the government are being spent on creating further hinderance for existing ration cardholders rather than issuing ration cards to all those excluded from the NFSA.

As per ground reports, SMSes have been received by ration cardholders or they are being informed over the phone to immediately go to the nearest ration shop with their whole family to comply with E-KYC requirements through authentication via the POS machines. Ration shopkeepers are informing cardholders that failure to get E-KYC will result in denial of food grains. Even national media has been carrying news that failure to comply with EKYC will result in stoppage of free rations.

Rolling out an authentication exercise in this manner, without providing clear and official information to people about the framework within which the EKYC is being done, the need for EKYC, the timeline and consequences is creating intense distress and anxiety among people. The requirement for the whole family to be present at the ration shop has resulted in the most marginalised sections including migrant workers, elderly and those with disabilities being the most affected and likely to be left out of the EKYC.

Further, the campaign is extremely shocked to note that ration shopkeepers have been empowered to carry out the EKYC process thereby allowing them to exercise power and discretion over it. The ration shopkeeper has absolutely no role in issuance and cancellation of ration cards as that is the prerogative of the Food Department.

The shopkeepers role is limited to distribution of foodgrains to cardholders. This is a key separation of the roles as it is critical to empower people to seek accountability from shopkeepers in the distribution of grains without fear of facing backlash in the form of cancellation of ration cards.

Allowing shopkeepers to carry out EKYC is skewing the power balance and will undermine the capacity of people in raising problems and concerns about irregularities in ration distribution.

Dipa Sinha of the RTF campaign said it is clear that right to adequate and nutritious food is not getting the priority it should. The government’s intentions are clear even if one looks at the coverage and budget allocation. The total coverage of NFSA  still being determined by census 2011 leading to exclusion of crores of people.

If the government’s own population projections are used then as of the 2024 figures, 13 crore additional people should have also been provided ration cards under the NFSA. Instead of addressing this large gap, including through increased budgetary allocation, we find the current budget has slashed the food security budget by Rs. 5,000 crore.

Further, the unleashing of the EKYC in this manner, seems to be a conspiracy to cancel ration cards of people. We have seen how in the name of verification and authentication, even in the past crores of legible people, especially those who are the most marginalised get thrown out of the social security net.

Unemployment and unprecedented inflation has made people very vulnerable and many more people need access to rations. Rations and foodgrains are a legal, constitutional right and not some revdi or dole by the government, as it is sought to be projected these days.

Anjali Bhardwaj of the RTF campaign said that anxiety and distress among people is also happening because of the unclear communication by the government. Pointing to the SMS sent by the Food Department in Delhi (pasted at the end of this document), she noted that no proper information is being provided to people regarding the rules, time-frame, necessity and process of EKYC.

This coupled with news stories that foodgrains on the ration card will be discontinued if EKYC is not done, has led to this situation where people are spending thousands of rupees to rush to the ration shops, especially migrant workers who are travelling to their home state to do the EKYC process.  She spoke of the ongoing case in the Supreme Court in which since 2021 the SC has been giving directions on increasing coverage under NFSA.

In June 2021, the Supreme Court (in xxx) directed the central government to re-determine coverage taking into account the increase in population while the coverage remains stagnant as per 2011 census numbers. Upon the central government stating that re-determination of coverage is not possible in the absence of the census and the census is indefinitely postponed.

The unleashing of the EKYC seems to be a conspiracy to cancel ration cards of people, throw out most marginalised out of the social security net

In 2022, the SC directed the government to consider the population projections figures to increase coverage and finally in April 2023, the SC gave explicit directions that 8 crore people who are registered on the E-shram portal must be immediately issued ration cards. The court has clarified that this should be done irrespective of the quotas defined in the NFSA and the central government must release additional rations to states.

In July 2024, the Court took serious note of the slow pace at which states are carrying out the exercise of verifying and issuing ration cards and directed that all states must complete the work within 4 weeks failing which the court would initiate proceedings against concerned officials.

Annie Raja of the RTF Campaign said that a government which claims to be pro women is creating unprecedented havoc in their lives by forcing them to run around for even their most basic entitlement of ration. What is the purpose of this EKYC? Will they cancel ration cards of those who are unable to comply?

This is going to be a huge blow for ordinary people. By cancelling ration cards who does the government want to benefit? The government is denying people their right to live with dignity- such high unemployment, and budget for NREGA is also wholly inadequate. Now even right to food is in crisis.

Is this the government taking revenge for their reduced numbers in the elections?

Several people spoke of the problems they are facing on account of the EKYC issue.

Sunita hails from UP and is staying on rent in a slum settlement near Malviya Nagar with her family. She has a ration card issued by the government of UP, and she received a call from the ration shopkeeper asking her to come quickly to get her EKYC done. Worried that her ration card may get cancelled she, her husband and 4 children spent around Rs. 6,000 making the round trip from Delhi to UP by bus in order to do the EKYC.

Only Sunita, her husband and one child are listed on the ration card and therefore they get only 15 kgs of grain per month. During the EKYC process the shopkeeper informed her that authentication of her only child listed on the ration card failed as the aadhaar is outdated! She was advised to get the aadhaar updated and try again at a later date. She spent more than 15 days in the village trying to get the aadhaar updated, but was unsuccessful as they were told there are some server and connectivity issues. Other than the verbal communication from the shopkeeper, she has not received any official communication from the department and is unsure of the next steps. Sunita’s husband works as a daily wager and had to missed several days of work due to the unexpected emergency travel.

Munish Devi is currently living on rent in Jagdamba Camp. She is a widow and works as a domestic worker. She is getting calls from her village in Sambhal district, Uttar Pradesh asking her to come for EKYC but she is unable to afford the trip and is worried that she will not get leave. Her family members in the village have been told that if EKYC is not done, Munish and her childrens names will be struck off.

Sumaira, a domestic worker, spent ₹ 8,000 to travel to her village in UP with 7 members of the family for the EKYC process. They ended staying for 15 days and losing their wages as the EKYC of one child was not successful and they had to wait to get it updated.

Sangeeta shared that her husband is bed ridden and there is no way to take him to Ghaziabad for EKYC. She went to the ration shop and failed to get her own EKYC done as it was too crowded.

Similar issues are coming across states- wherein inter state and intra state people are rushing for the EKYC process. From UP there are reports of ration shopkeepers are charging between Rs. 50-200 per person for the updation of EKYC.

The campaign demands that the government immediately halt the EKYC process to prevent further distress among ration cardholders. Further, the government must immediately issue ration cards to all those left out of the purview of the NFSA on account of the failure of the government to carry out the census of 2021.

Click here for NGOs and individuals endorsing the statement 

Courtesy: CounterView

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There are two others who are worth mentioning Sri Sri Ravishankar, who rampaged the Yamuna for his gala event. He was also associated with Anna Hazare’s RSS supported movement. He is in the news generally for subtly supporting Hindu nationalist politics. And then there is Baba Ramdev. He began his career as a Yoga Guru with great success and then made transition to business World with the brand of Patanjali. This firm, producing and marketing Ayurveda products has brought Baba in the line of front ranking business tycoons, with huge assets. He and his close associate Acharya Balkishan have built up a massive empire, un-challenged till lately. All his Ayurveda products were publicized with great fanfare and a large section of media went gaga for his achievements.

The academic qualifications of Acharya and Baba duo are not much known. Currently there are many Ayurveda Medical Colleges, but it is doubtful if they have any degree from these. On the pretext that they are posing an indigenous challenge to the multinational corporations, many of their methods probably went unchallenged.

Matters came to head during Covid 19. On one hand the ruling government made hefty donations for the Pune based Bharat Biotech, Covaccine. On the other hand, within a month of the outbreak of Pandemic; Baba came up with the claim that they have developed a medicine for treatment and prevention of the disease, ‘Coronil’. The claim was that it has the approval of WHO. When challenged by the Ayush ministry, they corrected themselves to say that it has been developed on the guidelines of WHO. Ayush ministry distanced itself from the claims of Baba. The Combo pack of Coronil was introduced with great fanfare in presence of two Cabinet ministers, Dr. Harshvardhan and Nitin Gadkari. Dr. Harshvardhan himself is a trained medical doctor. There is currently a blind praise of ancient systems.

Baba claimed that the medicine has been tested on 100 patients of mild to moderate severity and the Corona test became negative in a few days. He had tied up with a few doctors for the testing of medicine. The protocol of introducing the medicines in modern medicine is preceded by biochemical analysis, animal testing and clinical double blind trial of adequate size samples. This was not followed.

Overawed with his commercial success, he not only accepted the praise from most of the Godi media, he took a step further to call Allopathic as a stupid science. Irked by this the Indian Medical Association (IMA) filed a case against him, which was heard recently. First he apologized to IMA for insulting the modern medicine. Just to recall when he sat on a hunger strike against corruption, he claimed that he has a ‘Yoga body’ and he can withstand the fast for a long time. Within a few days his condition worsened and was admitted to an allopathic hospital. Similarly a year ago Acharya Balkishan was seriously ill and had to be admitted to the ICU of an allopathic hospital.

After Court’ warning, his firm continued misleading advertisements. Court summoned him. He apologized profusely. Court refused to accept his apology and has asked him to mend his ways and come back again.

The details of the whole episode apart, how come such faith based knowledge and use of medications based on that have been rising for so long, what an arrogance to downgrade the modern system of Medicine? One concedes there is lots of empirical wisdom in some traditional medicines and even in Grandma’s medicines. The point however that is the modern system of medicine is based on evidence and peer review. The knowledge is ruthlessly subjected to review and criticism. And this is what leads to improvement leading to something close to what is useful.

The faith based knowledge, and thereby treatment systems are above criticism. Many Babas have their own system of treatment. The protocol of medical systems is evolved by adapting to better systems. The likes of Ramdev take the advantage of Holiness, to be above criticism and make many statements as they like. He had proclaimed that he has treatment for Cancer, Aids and what have you. He even claimed that Homosexuality is a disease and he can cure it!

So far he has the protection of ‘system’ and that gave him the arrogance to downgrade the allopath and make irrational claims about ‘his’ system. And why are such Babas having gala time with their faith based claims?

Last few decades have seen the rise of politics in the name of religion. This also harps on the ancient Indian knowledge systems. Taking these in a critical way is what science and rationalists will demand. This is what was demanded by the likes of Dr. Dabholkar, Govind Pansare, M M Kalburgi and Gauri Lankesh. They were done away for raising rational understanding. This is a period when rational thinking and methods are being undermined in the glare of ‘faith based knowledge’. Even in our educational curriculum in the name of ‘Indian Knowledge systems’ the faith based things will form part of curriculum.

Baba Ramdev is a symptom of the society gripped by faith-blind faith combo. The Supreme Court has done well to put a small stop to this ascending ‘Baba’ trend in the field of medicine.

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“The entire country is taken for a ride! You wait for two years when the Acts says this (misleading advertisements) is prohibited,” Justice Ahsanuddin Amanullah told Additional Solicitor General KM Nataraj, and ordered the Centre to file an affidavit explaining the steps it has taken to ensure compliance.

The apex court had, in November 2023, had warned Patanjali that it would be fined Rs 1 crore if a false claim is made that its products can “cure” certain diseases. During the hearing today, Justices Hima Kohli and A Amanullah criticised Patanjali Ayurved for releasing advertisements despite previous court orders issued last year. While referring to their previous warning to Patanjali, the bench said, “Despite our warning, you are saying your products are better than chemical-based medicines.”

The bench decided to issue notices for contempt of court orders to the two people featured in the advertisements, Baba Ramdev and Acharya Balakrishnan.

The Supreme Court (SC) also sharply reprimanded the union government on Tuesday, in connection with the Patanjali Ayurved “misleading and false” advertisement case, urging the Centre representatives to address the issue of deceptive medical advertisements. Expressing displeasure and dissatisfaction, the top court remarked, “The government is sitting with its eyes closed,” highlighting the need for prompt action in tackling misleading advertising practices.

On August 23, 2022, the Supreme Court issued notices to the Union Health Ministry, Ministry of Ayush, and Patanjali Ayurved following a plea by the Indian Medical Association (IMA). The IMA alleged a smear campaign by Ramdev, the founder of Patanjali, against both the vaccination drive and modern medicine(s).

Coming down sharply on Patanjali today, Justice Ahsanuddin Amanullah said, “You had the courage and guts to come up with this advertisement after the order of this Court! And then you come up with this advertisement. Permanent relief, what do you mean by permanent relief? Is it a cure? We are going to pass a very, very strict order.”

The court issued the ban order while hearing a plea of the Indian Medical Association (IMA), alleging a smear campaign by Ramdev, founder of Patanjali, against the vaccination drive and modern medicines.

On November 21 last year, the counsel representing the company had assured the apex court that henceforth there shall not be any violation of law, especially relating to advertising or branding of products, and no casual statements claiming medicinal efficacy of Patanjali products or against any system of medicine will be released to the media in any form.

The apex court had then cautioned the company, co-founded by Ramdev and dealing in herbal products, against making “false” and “misleading” claims in advertisements about its medicines as cure of several diseases.

“All such false and misleading advertisements of Patanjali Ayurved have to stop immediately. The Court will take any such infraction very seriously, and the Court will also consider imposing costs to the extent of Rs. 1 crores on every product regarding which a false claim is made that it can “cure” a particular disease,” Justice Amanullah orally said.

Senior advocate PS Patwalia, representing the Indian Medical Association, highlighted a press conference held by Baba Ramdev. He said that Patanjali Ayurved had published advertisements in violation of the law, claiming to cure various ailments, including diabetes and asthma.

The advocate also mentioned a defamation case filed by Patanjali Ayurved against the Advertising Council.

On this, the top court stated that there can’t be any defence of advertisements showing cures for illnesses including diabetes and blood pressure. “What do you mean by permanent relief to the diseases? It means only two things – either death or cure,” the SC said, asking Patanjali Ayurved to show how they discharged their duties to tackle misleading advertisements.

During today’s brief hearing, the bench directed Patanjali Ayurved to refrain from publishing misleading claims and advertisements against modern medical systems.

Furthermore, the court also hinted at the possibility of imposing hefty fines, suggesting a penalty of Rs 1 crore for each product promoting false claims of curing specific diseases.

The Supreme Court again reiterated its call for the Centre to devise a solution to the pervasive issue of misleading medical advertisements. It specifically highlighted concerns about claims made by certain medications to provide a complete cure for various ailments.

The ongoing legal battle shows the importance of ensuring accuracy and transparency in advertising practices, particularly in the healthcare sector, to safeguard public health and prevent misinformation. This matter became especially important following the coronavirus pandemic.

The IMA Writ Petition

The writ petition was filed by the IMA, raising concerns over what the association terms as a “continuous, systematic, and unabated spread of misinformation” regarding allopathy and the modern system of medicine. The petition has also asserted that Patanjali’s misleading advertisements disparage allopathy and make false claims about curing certain diseases. The plea referred to a half-page advertisement published on July 10, 2022, titled “MISCONCEPTIONS SPREAD BY ALLOPATHY: SAVE

The IMA, therefore, contended that while every commercial entity has the right to promote its products, the unverified claims made by Patanjali are in direct violation of laws such as the Drugs & Other Magic Remedies Act, 1954, and the Consumer Protection Act, 2019.

Moreover, the writ petition also highlighted previous instances where Swami Ramdev, associated with Patanjali, made controversial statements, including calling allopathy a “stupid and bankrupt science” and making unfounded claims about the deaths of people due to allopathic medicines during the second wave of the COVID-19 pandemic.

The IMA also accused Patanjali of spreading false rumours about COVID-19 vaccines and contributing to vaccine hesitancy. Swami Ramdev’s alleged dismissal, mockery and derision of citizens searching for oxygen cylinders during the second wave are also cited in the petition. The petition emphasized that despite the Ministry of AYUSH signing a Memorandum of Understanding (MoU) with the ASCI for monitoring misleading advertisements of AYUSH drugs, Patanjali has continued its alleged disregard for the law, violating the mandate with impunity. It may be noted that during the earlier proceedings, the Court clarified that it did not wish to make the issue an “Allopathy v. Ayurveda” debate but wanted to find a real solution to the problem of misleading medical advertisements.

(With inputs from PTI, Siasat, Business Today, Business Standard and LiveLaw)

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