EDITORIAL : THE HINDU, INDIA

Pilgrims’ distress

As the number of Amarnath yatra pilgrims rises by the year, the casualty figures appear set to create a distressing record. Over the first four weeks of the 39-day yatra period, 97 pilgrims have died. There are 10 days left in the window for the year, and it is feared that the final toll may outstrip that of 2011 when 107 people died — which marked a spike over the 68 deaths in 2010 and 45 in 2009. The trip to the venerated Himalayan shrine involves an arduous trek in extreme cold conditions along a narrow path to reach an altitude of about 12,755 feet. Most of the deaths have been attributed to cardiac arrest and pulmonary problems. Dearth of oxygen in the rarefied high-altitude atmosphere is the biggest cause. The Shri Amarnath Ji Shrine Board, which is in charge of the arrangements, has made it mandatory for each pilgrim to carry a medical certificate. However, it turns out that in their eagerness to qualify, some pilgrims obtain fake fitness certificates. The devout set out on an empty stomach after an ice-cold bath. Chief Minister Omar Abdullah, who linked the high number of deaths to issues of age, poor fitness levels and lack of acclimatisation, may have hit the nail in the head. There is a case to put in place a fool-proof system involving multi-stage health screening — ensuring that those who have not registered through the proper process are not allowed to risk their lives. The CRPF and the BSF have created a network of medical camps that are functional round-the-clock along the two yatra routes, and there are medical aid posts set up by the State government, but their efficacy in handling life-threatening situations remain to be assessed. In the event of an emergency, there should be arrangements for swift evacuation to base camps, and thereafter to specified hospitals in Srinagar.

The Supreme Court’s decision to appoint a high-power committee to look into the deaths reflects concerns that have been widely felt. Taking suo motu note of reports, it has sought an explanation from the Central and Jammu and Kashmir governments on the medical and other facilities made available en route. It has also directed that the committee examine issues including the widening of the pilgrim passage route and provision of amenities. The court has asked the committee to visit the shrine. The state cannot be impervious to the pilgrims’ distress. The findings of the committee should form the basis for a protocol that would minimise deaths from accidents as well as from health emergencies along the yatra route at least from next year on.

Contraception, but no coercion

Rich countries pledged large financial resources to expand access to contraception to some 120 million women and girls in the developing world at the recent London Summit on Family Planning. Such promises seem audacious, especially when many G8 countries — having reneged on their aid commitments for years — are now pulling back even more under the domestic drive of austerity. The fresh commitments announced also come close on the heels of the perceived failure of the June 2012 U.N. conference on sustainable development in Rio de Janeiro. The Rio declaration was criticised as having failed to restore lost momentum on gender equality in recent years owing to reduced resource allocation and diminishing political support. The positive fallout of the global impetus on family planning in the 1980s and 1990s is there for all to see. According to World Health Organisation estimates, the number of women who died annually due to pregnancy and childbirth related deaths declined by one-third between 1990 and 2008. Over this period, deaths among newborns declined from 3.5 to 3.2 million annually. The U.N. Population Fund estimates that doubling current investments to $24.6 billion would reduce the still unacceptably high rates of maternal and neonatal deaths, especially in the developing world.

Family planning lies at the heart of a host of politically contentious and divisive issues surrounding human development. The issue of women’s reproductive rights has acquired immense political potency given the backlash from the religious right in the United States and some orthodox Muslim and Christian countries where issues around family planning get mixed up with abortion. Then, it is also tainted by association with the much discredited ‘population control’ policies and the resort to coercive use of sterilisation at the expense of women’s agency and autonomy. In India and other Asian countries, attempts to enforce the so-called two-child norm to determine family size, against the cultural backdrop of a preference for boys, has already resulted in skewed sex ratios. The Indian government must actively move away from the recourse to incentives and disincentives to influence healthy fertility outcomes and instead promote measures to augment women’s overall well-being and gender equality. In addition to access to appropriate contraception services, a policy framework is needed that would empower women to control pregnancies, and space and limit child-births. The absence of such an environment is said to be the reason why the international community is farthest from reaching targeted reductions in rates of maternal mortality under the Millennium Development Goals.