Editorials/Opinions Analysis For UPSC 08 July 2025
Content : Fostering a commitment to stop maternal deaths Rising seas, shifting lives and a test of democratic values Batting for prevention Fostering a commitment to stop maternal deaths The Big Picture: Maternal Mortality in India MMR (2019–21): 93 deaths per 1,00,000 live births (SRS data). Trend: Downward trajectory → 103 (2017–19) → 97 (2018–20) → 93 (2019–21). Yet, 93 maternal deaths per lakh live births remain unacceptably high for a growing economy. Definition (WHO-aligned): Maternal death is death during pregnancy or within 42 days of termination, excluding accidental/incidental causes. Relevance : GS 2(Health , Social Issues) Practice Question : Despite significant improvements, maternal mortality remains unacceptably high in many parts of India. Discuss the major reasons behind the persistence of maternal deaths. Suggest a multi-pronged strategy to achieve the SDG target of reducing Maternal Mortality Ratio (MMR) below 70 by 2030.(250 Words) Inter-State Disparities: India’s Fragmented Maternal Health Map Southern States (Generally Lower MMR) Kerala: 20 (Lowest in India; benchmark state) Tamil Nadu: 49 Andhra Pradesh: 46 Telangana: 45 Karnataka: 63 (Highest among Southern States) Empowered Action Group (EAG) States (High MMR) Assam: 167 (Highest in the country) Madhya Pradesh: 175 Uttar Pradesh, Bihar, Chhattisgarh, Odisha, Rajasthan, Uttarakhand: 100–151 range Jharkhand: 51 (Surprisingly lower than average for EAG) Other States Maharashtra: 38 (Performs better than some Southern states) Gujarat: 53 Punjab: 98 Haryana: 106 West Bengal: 109 The “Three Delays” Framework (Deborah Maine Model) Delay in decision to seek care Ignorance about complications → Perception of childbirth as a “natural” process. Gender bias, family neglect, or economic constraints. Illiteracy, patriarchy, and poor women’s autonomy. Solutions: ASHA–ANM networks, women’s SHGs, financial incentives (JSY), community awareness. Delay in reaching a health facility Rural remoteness: forests, islands, hamlets. Lack of public transport or unaffordable private options. Solutions: 108 ambulance service, NHM-supported emergency transport systems. Delay in receiving adequate care at facility Staff absenteeism or lack of trained personnel. Delay in blood transfusion, OT preparation, lab support. Shortage of obstetricians, anaesthetists, paediatricians. 66% specialist vacancies in CHCs; poor FRU functioning. Medical Causes of Maternal Death Postpartum Hemorrhage (PPH): Most lethal; caused by uterine atony post-delivery. Severe blood loss + untreated anaemia → shock & death. Solution: Immediate transfusion, uterine artery clamp, uterotonics, suction cannula. Obstructed Labour: Small pelvis of stunted, undernourished adolescent mothers. Can lead to uterine rupture and foetal distress. Solution: Timely Caesarean section by skilled surgeons. Hypertensive Disorders of Pregnancy (e.g., eclampsia): Often unrecognized → convulsions, coma. Very narrow window to medically control. Unsafe Abortions & Sepsis: Caused by quack practitioners or failure of contraception. Delay in hospital admission and lack of antibiotics cause death. Infections in Home Deliveries: Puerperal sepsis, often due to untrained birth attendants. Co-morbidities in EAG States: Malaria, tuberculosis, chronic UTIs increase risk. Systemic & Infrastructure Gaps Non-functional FRUs (First Referral Units): Required: 4 per 2 million population. Out of 5,491 CHCs, 2,856 designated as FRUs — but many lack: Blood storage units Anaesthetists Round-the-clock OTs Emergency obstetric care Human Resource Crisis: 66% vacancy rate of specialists across CHCs. Inadequate Antenatal Coverage: Missed anaemia detection, nutritional deficiencies go untreated. Late Detection of High-Risk Pregnancies: No routine high-risk pregnancy flagging system in many districts. Best Practices: The Kerala Model MMR of 20 → India’s best performer. Confidential Review of Maternal Deaths: Developed by Dr. V.P. Paily. Data-rich, analytical, and leads to action points. Innovative Practices: Uterine artery clamps, suction cannula for uterine atony. Surveillance for rare causes: amniotic fluid embolism, DIC, hepatic failure. Routine mental health screening for antenatal depression & postpartum psychosis. Comprehensive Audit Culture: Each death studied → individual and systemic learning. Policy Interventions & Missions Janani Suraksha Yojana (JSY): Cash incentive scheme to promote institutional deliveries. National Health Mission (NHM): 108 Ambulance, maternal death audits, ASHA training. LaQshya (Labour Room Quality Improvement Initiative): Improving safety and hygiene in labour rooms. PM POSHAN & Anemia Mukt Bharat: Tackle nutritional deficiencies among adolescent girls. Midwifery Initiative: Introducing trained nurse-midwives for low-risk deliveries. What States Must Prioritise EAG States: Focus on basic institutional care first. Fill vacancies in CHCs/FRUs. Expand access in tribal and underserved regions. Improve antenatal outreach and anaemia control. Southern + Progressive States (e.g., Maharashtra, Gujarat, Jharkhand): Enhance quality of emergency care (C-section, ICU). Introduce maternal mental health care. Shift from reactive to proactive risk detection. All States: Mandatory maternal death audits with accountability. Local recruitment of specialists via state cadre services. Strengthen referral chains: PHC → CHC → District Hospitals. Way Forward: Zero Preventable Maternal Deaths Maternal death is often preventable, not inevitable. India must treat every maternal death as a public health failure. With political will, community awareness, skilled care, and accountability: India can reduce MMR to <70 by 2030 (SDG 3.1 Target). The goal should not be just safe delivery, but safe motherhood. Rising seas, shifting lives and a test of democratic values Context : Sea-level rise, saline intrusion, and erosion are displacing entire coastal communities. Coastal India faces a dual crisis: ecological destruction + socio-economic dislocation. Displacement hotspots include: Satabhaya (Odisha): Submerged under rising seas; villagers resettled with inadequate livelihood options. Honnavar (Karnataka): Fishing communities uprooted by port and tourism projects. Nagapattinam (Tamil Nadu), Kutch (Gujarat), lowlands of Kerala — facing escalating climate threats. Relevance : GS 3(Climate Change ) , GS 2(Social Justice) Practice Question : Rising seas are not only an ecological crisis but also a humanitarian and democratic challenge. Examine the implications of climate-induced displacement on coastal communities in India. How can a rights-based and resilient framework address the emerging socio-economic vulnerabilities?(250 Words) ROOT CAUSES: Development vs Ecology Ecological Degradation by Human Activity Sagarmala Programme, energy corridors, commercial aquaculture accelerating habitat loss. Mangroves, wetlands, dunes — natural buffers against storms and floods — are being cleared. Cumulative environmental impacts are ignored in fragmented project-level assessments. CRZ Notification 2019: A Regulatory Setback Diluted zoning norms allow ports, hotels, and industries in ecologically fragile zones. Environmental clearance regime prioritises “ease of doing business” over environmental justice. Local communities are often excluded from decision-making despite legal rights to consultation. DISPLACEMENT → URBAN VULNERABILITY Displacement Patterns Forced migration to cities like Bhubaneswar, Chennai, Mumbai, Hyderabad. Migrants absorbed into informal economy: construction sites, domestic work, brick kilns. Vulnerabilities in Cities Lack of legal protection under labour laws (e.g., BOCW Act rarely enforced). Debt bondage due to wage advances. Gendered exploitation: Displaced women face abuse, trafficking risks in domestic work. Absence of social security nets, identity documentation, or urban inclusion. LEGAL AND POLICY GAPS No Legal Recognition of Climate Migrants No specific law addresses slow-onset climate displacement. Article 21 (Right to life and dignity) exists, but no statutory enforcement mechanism for climate-induced displacement. Existing Laws Inadequate Disaster Management Act (2005): Focused on sudden events, not slow-onset sea-level rise. Environment Protection Act (1986), CRZ rules: Limited to conservation, not human displacement. NAPCC/SAPCCs: Recognise vulnerability but lack rehabilitation strategies. Labour Codes: Silent on migrants displaced due to climate change. SUPREME COURT JURISPRUDENCE: RIGHTS + ENVIRONMENT Landmark cases: M.C. Mehta vs Union of India (1987): Environmental protection part of right to life. Indian Council for Enviro-Legal Action (1996): Polluters must be held accountable. But… jurisprudence has not translated into community-centric legal frameworks for climate displacement. GRASSROOTS RESISTANCE AND RESILIENCE Community Movements Ennore Creek (Tamil Nadu): Fisherfolk protest Adani port expansion. Save Satabhaya (Odisha): Fight for livelihood and relocation rights. Pattuvam Mangrove Protection (Kerala): Resistance against ecological destruction. Challenges to Environmental Defenders Intimidation, criminalisation, surveillance of activists. Violation of constitutional rights to protest (Article 19(1)(a), 19(1)(b)). MISSING PIECES: What Needs Urgent Attention Recognise Climate-Induced Displacement in Law Amend migration and disaster policies to classify climate migrants. Integrate climate displacement in urban planning and housing policies. Build Legal Protections for Migrant Workers Extend labour law coverage (e.g., BOCW Act, Domestic Workers’ Welfare schemes) to displaced workers. Enforce minimum wage, identity cards, portability of entitlements. Inclusive Coastal Zone Governance Revoke dilution of CRZ norms that exclude communities. Institutionalise prior informed consent and participatory coastal planning. STRUCTURAL STRATEGIES: Way Forward Reimagine Development Along the Coast Shift from port/tourism-centric growth to resilience-based planning. Promote eco-sensitive livelihoods (sustainable fishing, eco-tourism, mangrove protection). Link Climate Action with Labour Rights Align with SDG 8.7: Eliminate forced labour and promote decent work. Integrate climate resilience into skilling missions, especially for displaced youth and women. Strengthen Institutional Capacity Create dedicated cells on climate migration in MoEFCC, MoRD, and MoLE. Ensure climate-sensitive infrastructure in resettlement colonies. GLOBAL PARALLELS & RESPONSIBILITY India must acknowledge climate displacement as a domestic human rights issue. Draw from UN Guiding Principles on Internal Displacement. Lead by example in Global South for rights-based climate adaptation. CONSTITUTIONAL AND DEMOCRATIC TEST Climate displacement is not just an environmental issue — it is a human dignity issue. It tests the soul of Indian democracy: Can the Constitution protect the voiceless? Can development be inclusive and equitable? Protecting displaced coastal communities is a litmus test for India’s commitment to both climate justice and constitutional morality. Batting for prevention Context : Nipah Virus outbreak in Kerala (July 2025) Two confirmed cases in Kerala: Malappuram: Adolescent girl — fatal Palakkad: 38-year-old woman — critical 425 contacts traced across 3 districts: Malappuram: 228 (12 under treatment, 5 in ICU) Palakkad: 110 (1 isolated) Kozhikode: 87 140+ health workers under surveillance Contact tracing, isolation, containment, and treatment are underway; lab results awaited for remaining suspected cases. Relevance : GS 2(Health , Governance) Practice Question : The recurrence of the Nipah virus outbreak in India underscores the urgent need to institutionalise a “One Health” approach. Critically examine the systemic and ecological gaps that allow zoonotic diseases to emerge. Suggest a comprehensive strategy to prevent such spillovers in the future.(250 Words) WHY NIPAH TRIGGERS HIGH ALERT Extremely high case fatality rate: 40%–75% No vaccine or definitive treatment as of 2025. Airborne and contact transmission potential among humans. History of deadly outbreaks in: West Bengal (2001): 45 deaths out of 66 infections Kerala (2018): 17 deaths out of 19 cases Recurring outbreaks since then THE ZOONOTIC NATURE OF NIPAH Reservoir host: Fruit bats (Pteropus genus) Transmission pathways: Direct contact with bat-contaminated fruits (licked or bitten) Animal-to-human via intermediate hosts (e.g., pigs in Malaysia, 1998) Human-to-human via droplets, contact with body fluids CLIMATE CHANGE & ECOSYSTEM DEGRADATION: ROOT CAUSES Deforestation and habitat destruction → bats migrate closer to human settlements. Urban expansion into forested areas increases human-wildlife contact. Climate change alters bat feeding and migration patterns → changes virus shedding behaviour. Fruit trees near human habitation act as bridges for zoonotic spillover. SYSTEMIC GAPS IN PREVENTION Lack of a centralised, integrated One Health framework. Inadequate public awareness about zoonotic risks from bats. Poor enforcement of wildlife habitat protection laws. Limited disease surveillance in animal populations. Fragmented coordination between health, veterinary, forestry, agriculture departments. THE ONE HEALTH APPROACH: A National Imperative One Health = Integration of human, animal, and environmental health India’s draft National One Health Mission (2021) still lacks full rollout. A robust One Health policy must: Create multi-sectoral task forces at central and state levels. Enable joint surveillance of pathogens in wildlife, livestock, and humans. Institutionalise wildlife–livestock–human interface studies. Promote early warning systems for zoonotic outbreaks. SCIENTIFIC & PUBLIC HEALTH ACTION PLAN A. Surveillance & Preparedness Continuous virus surveillance in bat colonies, livestock, and high-risk regions. Monitor ecological disturbances around human settlements. Develop early detection kits and set up regional genomic surveillance labs. B. Community Awareness Public education on avoiding bat-bitten fruits or partially eaten produce. Training farmers, tribal communities, and children in zoonotic disease prevention. Introduce school-level One Health education modules. C. Biosecurity & Food Safety Regulate fruit markets and pig farming practices in bat-dense areas. Promote safe agricultural practices and discourage bat roosting in residential zones. Surveillance in wet markets and commercial animal chains. LEGAL & POLICY INTERVENTIONS NEEDED Strengthen enforcement of Wildlife Protection Act to preserve bat habitats. Revise Environmental Impact Assessment (EIA) rules to include zoonotic risk evaluation. Enact a Zoonotic Diseases Act that mandates: Multi-departmental risk audits Mandatory ecological assessments before land conversion Integrate climate adaptation policies with pandemic preparedness plans. GLOBAL PARALLELS & Scientific Collaboration Learn from Bangladesh (recurrent Nipah outbreaks) — use of bamboo netting over date palm sap. Collaborate with WHO, FAO, OIE to build zoonotic surveillance systems. Fund Indian Council of Medical Research (ICMR) for Nipah-specific antivirals and vaccine R&D. TOWARDS A RESILIENT FUTURE Long-Term Strategy to Prevent Zoonotic Spillover: Institutionalise One Health from panchayat to national level. Invest in research, field epidemiology, and wildlife monitoring. Mainstream zoonotic prevention into climate and development planning. Strengthen health systems to respond to high-fatality emerging diseases. “Preventing the next pandemic begins not in the ICU, but in the forests, fields, and farms of India.”