Two essential commitments for better days

Maternity Entitlements and Crche

Sachin Kumar Jain

Vikas Samvad
E7-226, First Floor, Opposite Dhanwantari Complex,
Arera Colony, Shahpura, Bhopal
0755-4252789, +919977704847
sachinjain.vikassamvad@gmail.com / www.mediaforrights.org
 More than a Policy, Children Need Commitment!

On 10th June 2014, Pawan Korku (4 years) and Durgesh Korku (6 years) climbed into an iron
drum in their house along with their toys presumably as part of a game they were playing, in
their house in Harrai village, District Betul, a tribal dominant district of Madhya Pradesh The
childrens father, Bheem Korku had left for his daily wage work in the morning and their
mother, had gone to the market to fetch household items. When the mother got back home,
she looked for the children but could not find them. Around the same time, Bheem Korku also
returned home. While looking for the children, he opened the lid of the iron drum and was
shocked to see the dead bodies of his children, Pawan and Durgesh. They had died due to
suffocation. One can only imagine what must have happened!

Pawan was registered in the local Anganwadi Centre, however was left home alone with his
brother as the centre was open only for a few hours in the morning. Clearly, a ghastly crime has
occurred. Two innocent lives have been lost for no reason. But, who is to blame? Who is the
criminal?

A study conducted at S. N. Hospital, Agra in the year 1992 found that out of 5031 children into
the hospital in a period of one year, 716 children were there because they had met with some
kind of an accident. Amongst these children injured in accidents, a large proportion were
children in the age group of 4 to 5 years. 44.4% children had sustained injuries due to falling! As
many as 82 children had burn injuries and 45 children had consumed poisonous substances in
their homes. It was observed that about half the accidents (48.9%) occurred during 12 noon
and 6 pm, a time when parents are usually at work.

A study on childhood injuries based on data from Bangladesh, Columbia, Egypt and Pakistan
published in the World Health Organisation (WHO) Bulletin in 2009found that of the 1559
injured children (< =12 years) across all four sites, 56% (941) cases were below 5 years of age.
Further, 872 (63%) injuries took place when the children were at their homes; and did not have
anyones protection.

Findings of a study of 788 children in Gujarat published in the Internet Journal of Family
Practice points out that 64.1% boys and 54.7% girls of age below 5 years at risk of electric
appliances within reach in their home. . As many as 91% children in the Urban slum area were
exposed to fire as it was within reach in their homes and was generally considered safe by the
parents. 61% children were at risk of household chemicals being within reach.

An important report on situation of children brought out by the Ministry of Women and Child
Development in year 2007 reports that when women go out for work, they have to leave older
girls of the family either at home so that they may look after their younger siblings. With the
proportion of women joining the workforce increasing at a steep rate, it becomes crucial to
ensure that child protection and ensuring their care and nutritious diet is ensured at every
level.

According to the national commission set up to look in to the situation of those working in
unorganised sector, there are 148 million working women in the country out of whom 142
million are in the unorganised sector. There are 310 million women in India in the age group
15-49 years. Womens work in the household and in care activities remains largely unorganized.
We are all aware that women put in long hours in household work including in child care,
household chores, unpaid work on family farms, animal care and so on. Time use studies report
that while men are engaged for 9 to 10 direct work hours daily, women effectively work for as
many as 16 hours a day. There are hardly any facilities available for women and families to
ensure care for their children while they work. In the instanceof Pawans mother, although she
had not gone for wage related work, it cannot be negated that she was very much engaged in
household work. Adequate care facilities are essential for children like Pawan and Durgesh.

Had the Anganwadi Centre at Harrai been working as a crche, Pawan could have been there
under its care and alive today. Scientific evidence shows that children attain 90% of their
mental development by the age of 5 years. It is vital that children are provided with care,
protection and safety along with nutrition, health care and early learning during these crucial
years. This is the time when children start understanding relationships and affiliations and
begin trying to learn by themselves. This is the stage when children are so curious that they try
to pick up everything, throw them, or try to feel the taste by putting things in their mouth. They
may reach any nook and corner or climb somewhere in order to satisfy their curiosity. All these
are essential activities of the child. These activities cannot and should not be prevented as
childs development evolves from them. What is needed is an alert and caring attention so that
the activities do not harm the child.

On the one hand, we have to ensure that children under 5 years of age receive adequate
nutrition, are able to learn and have access to basic health care in a hygienic setting. On the
other hand, it must be ensured that the dignity of womans work is recognised, whether she
works for her household as a homemaker or outside for an income. She must not be burdened
with triple load, rather she should be facilitated to remain free and active by providing for
community crche services. The studies referred to above clearly show that in the absence of
appropriate child care facilities children are exposed to the risks of accidents and injuries, along
with missing out care and attention that such young children require. Moreover, we cannot
keep our eyes closed to the fact that we have had 387 cases of rape inflicted on children under
5 years of age in the last 14 months!
Though the Ministry of Women and Child Development has formulated a policy on Early
Childhood Care and Education, there have been no proactive measures for putting up an
institutional structure for the efficacious implementation of the policy. Anganwadi Centres have
been operational in India under the Integrated Child Development Services since 1975. These
centres look after children for only a few hours a day and therefore are not in a position to
become an allied support mechanism for childrens development and the women. Moreover,
these centres are not open for the care of children under three years of age. At present, there
are 1.34 million Anganwadi Centres in the country. These centres have registered 84.1 million
children under the age of 5 years..

A scheme known as Rajiv Gandhi National Crche Scheme was designed for children of working
women. However, the scheme does not recognise the value of womens work and labour in
their own homes. There are 17603 crches operational under this scheme serving 387,000
children. In addition, 14700 private crches are also working. Only 1 million children (1.2%) in
the country are receiving any daily care services. Responding intensive efforts, the 12 th Five
Year Plan recognises the need to establish mandatory crches for care of children and support
to women. Crches can also help address the challenge of malnutrition by providing
appropriate local nutritional diet and an institutional arrangement for securing development of
all children. Accordingly, the Plan visualises the transformation of all Anganwadi Centres in to
crches. In practice however, it is being planned to convert only 5% centres, i.e. 70,000 centres
into anganwadi cum crches over the entire Plan period of 5 years. The Plan is also silent on the
schedule of providing a crche in every hamlet. According to the Census 2011, there are 73.7
million children between the ages of 3 and 5 years who are supposed to receive their basic right
to preschool and have yet to get the same. Out of these children, 54.5 million children reside in
rural areas. While the high-income group of the country is seeking to access these services
through the private sector, 98% children are deprived of the right to basic services, because of
caste discrimination, social neglect and exclusion.

Most people might dismiss the idea of crches for all children who require it as being too
expensive or a luxury. The fact remains that crches have multiple benefits along with
provided proper care to children in the absence of alternate adult care-givers being available at
home. They could help to recognise well in time childrens illnesses and the impediments
coming in the way of their development so that the same can be duly addressed. Crches can
help in ensuring that every child gets full immunization, growth monitoring and receives age-
appropriate nutritious diet. This can help save 200,000 childrens lives in a year and millions of
children can realise their cherished dignity. The strong Government of India at present is in the
midst of crafting a roadmap on this. Will the roadmap reflect the commitment for basic rights
for all children in a non-discriminatory manner?
 Better days without maternal entitlements?
Going by the population growth records during Census Years 2001 and 2011, on an average 19
million births take place in India every year. Presently, the Maternal Mortality Ratio (MMR) of
India is 178 (number of maternal deaths occurring in a year per 100,000 live births).
Accordingly, as many as 34000 women lose their lives due to pregnancy and delivery
complications. Further, the World Bank estimates that for every 190 deaths of women, one
woman dies due to the risks associated with motherhood in India. It means that the
fundamental maternal entitlements are not accruing to the women in our country. A 30-words
provision in National Food Security Act 2013 (NFSA, 2013) now accords this entitlement to 390
million women in the country, notably to those working in the unorganised sector and those
who manage their households (toil without any wages).

So far, the approach of the governments and the society has been replete with neglect and
disregard for womens right to survival with dignity and equality. The provision in the NFSA,
2013 commits a financial entitlement of Rs.6000/- to all eligible pregnant women and lactating
mothers (except those who are in regular employment with the Central Government or State
Governments or Public Sector Undertakings or those who are in receipt of similar benefits
under any law for the time being in force) in such instalments as may benefit them in going
through their pregnancy and delivery. This is just a beginning. The International Labour
Organisation (ILO) defines the maternal entitlement as comprising paid leave for a period of 14
weeks, daily and regular recess for rest for the mother in her work so that she may look after
the needs of the infant, health checkup, and security.

Organisations struggling for the maternal entitlements have duly proved that every woman is a
working person irrespective of working to earn an income or run the family household. With
this perspective in view, every woman has right to maternal entitlements. The National Sample
Organisation reports that 59% women in the age-group 15-49 years have primary vocation of
looking after their family household whereas only 0.4% men perceive managing the household
as their primary role. It is thus clear that household work is not valued because the women
undertake it and not the men. Two years back, a study was published about the Garhwal
Himalayan Region of Uttarakhand in the Mountain Research Journal. It was titled, Contribution
of Women in Food & Economic Security of the Family. The study points out that the women
respondents of the hilly region had told the study team that they did not do any work.
However, when the study data was analyzed, it emerged that the men worked for an average of
9 hours a day, whilst the women were engaged in work for as much as 16 hours a day! Had the
government rate of minimum wages been applied, the mens earning would be only Rs.128 per
day as against that of the women at Rs. 228 per day. Their unpaid work across the sections
(from family to community) is understood, as women do not work.

The study brings out that activities and work including fetching the firewood from the forest,
collecting the feed for the animals and rearing the children etc. are not considered as important
and income generating tasks because these do not entail any expenditure of money. However,
the fact is that these tasks too are skilled ones and place a significant demand on physical
effort. When tasks and activities like this were assessed in terms of monetized value (if
someone were to be paid a remuneration for undertaking the same or some of the items were
bought out), the family would have had to annually shell out an amount of Rs. 34168/- towards
bringing firewood, animal feed, honey, water and vegetables etc.). Since the woman in the
household undertakes all this without any remuneration, the work is considered to be devoid of
economic value. Therefore, these women too are entitled to maternity rights so that they may
be able to get over the stresses of different stages of reproduction and go through the
motherhood, in a safe and dignified manner. Life of women in India does not appear to be less
than an imaginary tale. The society known for taking pride in ensuring womans respect and
dignity does not appear to be taking any stand when it comes to accord respect to maternity
entitlements. Being pregnant is just seen as a natural and social event which keeps the society
dynamic. Towards this end, the lives of Indian women continue to remain at stake, with the
threat of (maternal) death always looming large over them. Whilst the paternalistic society
regards reproduction process as very significant, our governments are generally seen to be
positioned against the interests of the women, when debates on the needs and issues on
endowing them with concomitant rights and entitlements are flagged. Today when the people
are being sold the dreams for a better society across the plateaus of public movements and
election processes, the moot question is how one can imagine good days without taking in to
consideration the right to maternity entitlements.

Maternity entitlement include the leave without losing salaries and wages and that too without deeming
any break in work (service) so that the pregnant women can get adequate rest and can access and
receive essential healthcare services without falling into the trap of economic hardship. Alongside, right
to maternal nutrition should be deemed to be mandatory given the situation that three out of five
women suffer from anaemia. So far, the provisions for maternity entitlements have remained confined
to women engaged in the organised sector. Barring them, all other women have been excluded from
these vital entitlements despite the very progressive Act on maternal rights that was enacted in 1961.
The Act provides for right to maternity entitlements for all women working in factories, mines and shops
and establishments. However, one needs to discern that whilst a woman working in central government
is entitled to maternity leave for 6 months and that she has right to avail leave for a period up to 2 years
till her child attains the age of 18 years and further that she gets 45 days paid leave in the event of an
abortion, the entitlement for the women working in the unorganised sector provide for a leave with
wages only for a period up to 12 weeks, that too without any monitoring mechanism being in place to
check whether even this provision is being scrupulously observed or not. One does not know whether
these women are being pressurized to leave the work. There are serious apprehensions that such
situations are created in the private sector whereby the women are forced to take a call on leaving their
jobs voluntarily. Moreover, it is not that the government itself is not a party to this exploitation.
Women are being employed either on contractual or bond basis across the public sector employers
ranging from the Municipal Corporation to departments of Health Services and Education. Even if the
women have been working at a place for more than 10 years, the employers adopt every tactic to
deprive them of their maternal entitlement under the guise of non-applicability of terms of regular
employment. During the year 2012-13, the women worked for 739.40 million work day in the country.
However, many of the pregnant women were continued to be engaged in work even up to 40 hours per
week prior to their delivery. Many women returned to work just after 72 hours of child birth as they
neither get any financial assistance nor granted any paid leave with regard to their maternal
entitlements. This situation plunges the life of the mother and the new born in danger.

The national commission set up to look into the issues of those working in unorganised sector informs in
its report of 2007 that out of 148 million working women in the country 142 million come from the
unorganised sector. It goes on to show that the rights of almost all (95.94%) working women are not
assured. Another big challenge is that 106.90 million women are engaged in agriculture and allied
sectors. The Maternal Rights Act does not even apply to these sectors leaving the women agricultural
labourers to suffer from the higher probability of death due to complications associated with pregnancy
and delivery. After all, they are poor and deprived of their legal entitlements.

Stating simply, right to maternal entitlements ought to be mandatory. Consequently, the question that
arises is if a woman is not earning income in any form can she be deprived of her maternal
entitlements? Another supplementary question in this regard pertains to the women as the home
makers. Should their work be not construed as the one entailing labour? A question is generally posed
to the participants in the training programmes on women and labour issues as to who in the home gets
up first in the morning and who goes to the bed last. The invariable answer is: the woman of the house!
The families which are engaged in agricultural work are silently aware that the women members have to
bend at their waist when it comes to sowing the paddy crop. One knows it too well that the woman
does not get any wages for working in her own familys agricultural field. Should she be considered to be
unemployed or without work simply because she is working at her own familys field? One, thus, needs
to ponder as to why women as the home makers or as workers in family occupation should be deprived
of their maternal entitlements.
The National Food Security At, 2013 provides for a grant of maternal assistance of at least Rs.6000/- to
every pregnant woman. However, this amount does not appear to be justified. In effect, the woman
should get leave with wages for a period of 9 months so that she does not have to go for work 3 months
prior to delivery and 6 months after the child birth and that the wages should be computed in
accordance with applicable minimum wages. When computed thus, the amount of Rs.6000/- would turn
out to be too meagre.

Now our government needs to take an initiative to ensure that universal maternal entitlements are
safeguarded against gender disparity and maternal insecurity, whilst being in consistence with the
fundamental rights as are enshrined in sections 15 (1 and 3) and 42 of our Constitution which provide
for special provisions for the women and delivery assistance. The task is apparently tough because a
major chunk of our policy makers considers it to be an insignificant issue. The Government of India
Committee on Economic Affairs did not allow expansion of Indira Gandhi Maternity Sahyog Yojana
because it felt that it will lead to wastage of governments resources! The cause of eliminating the curse
of maternal death and maintaining respect for maternal entitlements does not seem to have gone down
well with the learning of our policy makers and governance administrators. They only know the business
of making instant profits!
 Maternal Entitlements trapped in Conditionalities

Shouldnt a laborer woman take adequate rest if she is pregnant? And in case she rests, should
she be deprived of her wages? Would she be able to receive nutritious diet if she doesnt have
or cannot have the work with wages? Is it not necessary to receive appropriate nutrition? After
the delivery, the mother needs to breastfeed the infant and provide sensitive care to the baby.
Would it be safe for the mother and infant if she has to go for work with her 15 days old infant?
It is therefore evident that the mother must be free from arduous labour for a period of at least
9 months (3 months prior to delivery and 6 months after delivery). If we cannot ensure the
deliverance of this maternal entitlement, we would and should be deemed to be an
unscrupulous and inhuman society. We will have to establish legal architecture in bringing
about universal maternal entitlements and then only we may look forward to the better days
ahead for the women. What is grievous is that the governments, in an otherwise culturally rich
India, have shown utter disregard for this critical and sensitive aspect.

It is all the more painful when the same India is found to be at par with Nigeria when it comes
to comparing the data pertaining to maternal deaths. The two countries together account for
one-third of worldwide maternal deaths. What a dubious distinction? According to the latest
report (2014) of the United Nations, there were 2, 89,000 maternal deaths around the world
arising out of complications during pregnancy and child birth in year 2013. Out of these,
1, 79, 000 (62%) deaths occurred in Sub-Saharan Africa alone, whereas 69,000 (24%) deaths
took place in South Asia. The report informs that the estimated number of maternal deaths was
50,000 (17%) in India and 40,000 (14%) in Nigeria. Further, India belongs to that group of 10
countries which account for 58% maternal deaths across the world. One may be surprised to
hear the names of the other 9 countries. These are Nigeria, Congo, Ethiopia, Indonesia,
Pakistan, Tanzania, Kenya, China and Uganda. An effort was made to reverse the situation in
the last decade via a focused thrust on promoting the use of institutional deliveries. To an
extent, it has had some effect. However, when 40% posts of Obstetrician & Gynecologists and
medical officers are lying vacant in government hospitals, only one hospital bed is available for
a population of 2500, medicines and facility for diagnostic investigations are unavailable, the
first-stage move to bring about safe motherhood through institutional deliveries has fallen flat.
What surprises the most is that even the United Nations has failed to make a vociferous
advocacy for targeting the Millennium Development Goal (MDG) pertaining to reduction in
Maternal Mortality Ratio (MMR).
Even today it is believed that if deliveries take place in hospitals, our responsibility towards the
women ceases or is fulfilled. The call of the day, however, is that the society and the
government must acknowledge the need for and responsibility for securing maternal rights for
the women. Ensuring that post-delivery, the women should remain hospitalized under medical
care for 48 hours does not conclude the call for responsiveness. What is needed is a sensitive
mechanism whereby the women get a real sense of security.

The process of reproduction is not just painful for the women but rather shakes them up from
social and economic perspectives. Our health and safe motherhood programmes entail
awareness messages highlighting the need for adequate rest to the women during the course
of pregnancy. The women working in the unorganised sector find it virtually impossible to stay
away from work even for a day as they apprehend loss of days wages. Hence, they continue to
work virtually right till the time of their delivery. Another prominent message in vogue is about
the need for ensuring nutritious dietary intake for the women during pregnancy. According to
the 68th round of the National Sample Survey, per day, a person in the rural India is able to
spend only an amount of Rs.1.31 on pulses, Rs.3.83 on milk and milk products, Rs.2.28 on eggs,
meat and fish. The situation in urban India is no better. An urban persons daily expenditures
are Rs.1.70 on pulses and Rs.3.20 on eggs-meat-fish. One can imagine as to what nutrition the
women would be getting under the poverty-ridden circumstances. We are afflicted with
economic deprivation, caste-based discrimination and feudalism, neglect and gender
victimization. Regrettably, these situations are further aggravated by the lack of accountability
and multi-dimensional corruption. This fine mesh of poverty makes the lives of women a
formidable battleground, where they are deprived of all armor of struggle. She wages not one
battle but a host of them. Safe motherhood is one of them.

Maternal entitlements never received a privileged concern in the corridors of Indias policy. The
Maternity Rights Act was framed in 1961. It was considered to be a progressive and visionary
step in many respects. However, the schemes formulated by governments of the 21st century
reflect lack of enlightenment. Provision of riders of 19 years of age of women and maximum
number of children to be restricted to two was made part of the National Maternity Benefit
Scheme which was instituted from 15th August 1995. Our government seems to be very nave
on both counts. Or else, it is pretending to not know that in our country the women do not
have a right to take a decision about getting married and to plan a baby. Further, the scheme
stipulated another condition that the benefits of the scheme would be available only to the
women belonging to Below Poverty Line (BPL) households, notwithstanding the fact that till
date the poor have not yet been identified! Following a study, the National Planning
Commission had intimated the Government of India in 1999 that the provision of an amount of
Rs.500/- under the scheme was too meagre. Despite this, the provision has not been revised
upwards!

Another scheme known as the Janani Suraksha Yojana (JSY) was instituted in April 2006. The
previous scheme of Maternity Benefit was merged with the JSY. Accordingly, should there be a
delivery at home, the woman would be given an amount of Rs.500/- and if the delivery takes
place at a health institution, the rural women would be given an amount of Rs.1400/ and the
urban ones - Rs.1000/-.. The government acted nave here too. Therefore, the women are
given the financial assistance not during the pregnancy under the Janani Suraksha Yojana (JSY)
but after the delivery. One needs to know it too well that it is during the period of pregnancy
that nutritional demand and need for rest are more pronounced. This provision has led to
widespread corruption. In effect, the Janani Suraksha Yojana (JSY) cannot be deemed to be a
programme for maternal entitlement because it essentially seeks to promote institutional
deliveries. Consequently, there are large number of instances which point out that the mother
and the infant are discharged from the hospital within 4 to 6 hours of delivery instead of
ensuring proper medical attention as an indoor patient in the first 48 hours after delivery.

The maternal rights programmes in India have a history of over 50 years. As many as 19
programmes on maternal entitlements are being implemented by the central government and
state governments. Still, neither any programme nor any legal provision has been made for the
96% of women belonging to the unorganised sector and home makers. The Tata Institute of
Social Sciences (TISS) has undertaken a study in to the existing programmes on maternity
entitlements and the terms and conditions which are regulated for the same (womans age to
be 19 years or more, benefit to be limited only up to 2 living children, making institutional
delivery mandatory, etc.). The study reports that as many as 1000 million women out of a total
of 1010 working women are pushed out as ineligible for accessing the maternity entitlements.

For the first time, the National Food Security Act of 2013 makes a provision for a grant of
financial assistance of Rs.6000/- for every pregnant woman. In this context, we should consider
the example of Tamil Nadu government where Dr. Muthulaxmi Reddy scheme of Maternity
Benefit has been operational since 1987. This scheme provides for disbursement of Rs. 12000/-
in two installments for the women belonging to Below Poverty Line (BPL) households. The
scheme rendered benefits to an average of 1600 women per day during the period 2006 to
2011. Studies have been conducted on this scheme too which encouragingly report that
corruption has not been a major issue in its implementation. Consequently, the central
government has attempted to institute the Indira Gandhi Maternity Benefit Scheme on the
lines of Tamil Nadu. However, the conditions levied for accessing benefits under the scheme
have been more of a punishment to the women. The neglect of the government becomes clear
going by the fact that the scheme pilot did not move beyond the select 52 districts.

At present, as many as 200 million women toil within the precincts of family. There is no
measure to gauge their work. Under such circumstances, securing their maternal entitlements
is a formidable and significant challenge. It will be better to enhance the provision of grant of
financial assistance of at least Rs. 6000/- available under the National Food Security Act, 2013
and relate the same with leave with wages (minimum applicable wage) for a period of 9 months
(3 months prior to delivery and 6 months after the child birth). The government needs to take a
decisive initiative. The initiative will not only bring about significant reduction in the avoidable
Maternal Mortality Ratio (MMR) but also render a newer dimension of strength and
empowerment to the women.

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{This document has been prepared by Sachin Kumar Jain for Vikas Samvad.}