Tamil Diaspora - Tamil Nadu

Tamil Nadu, the southernmost state in India, recently published its first Human Development Report, and became only the sixth Indian state to do so. The report pegs Tamil Nadu’s Human Development Index (HDI) at 0.657, an improvement on the national average of 0.571. TN also bettered the national average in the Gender Development Index (GDI). That, however, is the good news.

The bad news is that the report has sounded a cautionary note on issues that affect some of the most vulnerable sections of the population: addressing the problems of the poor, the issue of gender inequality, care for AIDS victims who number the highest in the country, and a sensitive policy for the elderly.

HDI is a tool recommended for developing countries by the United Nations Development Programme (UNDP). It seeks to define development objectives not just in terms of an increase in the GDP, but in terms of enhancement of human well-being - how well and how much of a population has benefited from development.

Earlier in the year, a report of the Central Union Planning Commission had placed Tamil Nadu third in a list of 15 major states. The state HDI is based on 8 parameters: population, sex ratio, density of population, per capita income, Below Poverty Line, Infant Mortality Rate, Literacy Rate and the national HDI.

The State HDI has been constructed for all of its 29 districts. Chennai, also the capital city, takes the top position, while the backward district of Dharmapuri, infamous for female infanticide/ feticide, ranks last.

No Money…No Food

65% of the state’s population of 62 million (as per the 2001 census) live in rural areas. But the primary sector’s (agriculture and allied activities) contribution to the State Domestic Product declined form 24.82% in 1993-94 to 18.16% in 1999-2000. The Report warned, “Generating employment or enhancing income levels should center around the primary sector.” The Report also said that poverty had a significant and adverse impact on girls’ education.

Says Professor M. S. Swaminathan, the country’s legendary agricultural scientist named by TIME magazine as one of the twenty most influential Asians of the 20th century, “25-26% of our population are chronically undernourished, what we call endemic hunger, the lack of adequate sustenance. This is not because there isn’t enough food. You have a large variety of food available in the market, provided you have the money to buy it. So the key question, why don’t we have the money? Because there are no jobs. This is the job famine. The livelihood famine.”

Public Health Care Lacking

Public health care is another weak area. The state has been hogging publicity for being a ‘medical tourism’ destination with its impressive growth in sophisticated private sector health care. But, although the state’s subsidies for corporate hospitals have grown, they have not been matched by a similar dedication to enhancing public health facilities. A regulation in standards, particularly in terms of quality of cost and care, is seriously lacking.

Also, private medical institutions and super specialty hospitals are largely located in metropolitan or bigger cities. The National Sample Survey data of 1997-98 pointed out that the poor in Tamil Nadu were more likely to use a public facility than a private one, given the right opportunity.

Nevertheless, mothers like Jaya, a 32-year-old wage earner in the unorganized domestic help sector, spend large sums of money on quacks or neighborhood ‘nursing homes’ of dubious merit. She says, “I spent 3,000 rupees with different doctors in the last two months for my two children, who were coughing all the time. The GH (Government Hospital) will take me an hour to reach and they will make me wait the whole day. I will have to bribe everyone from the peon to the pharmacist there. Also, I won’t be able to go to work so I will lose my earnings. In reality, it is cheaper to go to private doctors, even though I know they are not good.”

Resources are also severely in short supply. The Government Hospital in Chennai, the state’s apex public facility, has a waiting list of 5,000 for open-heart surgeries. For a great majority of the parents of the 9,000 children born every year with defective hearts that require surgery, it is simply not possible to afford the private price tag of Rs.100,000.

Female Infanticide/Feticide a Stark Reality

Gender inequality is another issue requiring extra attention. The state’s sex ratio has been improving steadily, from 977 (per one thousand males) in 1981 to 974 in 1991, and now, a significant 986 in 2001. But little that has changed the ground reality in the worst affected districts of Dharmapuri, Salem, Namakkal, Madurai, Erode and Theni, where female infanticide/infanticide continues unabated.

Says P. Pavalam, State-level Convenor of the Campaign Against Sex Selective Abortion (CASSA) in Madurai, “Instead of general infant mortality rates, the state and national HDI must include the gender differential infant mortality figures (that shows how many baby girls died as infants, as opposed to boys). Secondly, sex ratio at birth (how many girls were born as opposed to boys) must be included as a fundamental indicator. Only then will the HDI be more meaningful. Otherwise, it will not reflect the true reality.”

The sex ratio at birth continues to be below the biological average in the backward districts of TN. Access to technology and punitive punishment imposed on the perpetrators of female infanticide has led to a shift from infanticide (killing healthy female infants) to feticide (aborting female fetuses before birth).

AIDS Victims Left Out

Tamil Nadu is home to 22,826 PLWHA (People Living With HIV/AIDS), or over half of the AIDS victims in this country. But, at the office of the Tamil Nadu AIDS Control Society, the state’s nodal agency set up supposedly to monitor and disseminate information related to AIDS in the State, officials take hours to provide current information, leave alone help. Says one bitter NGO activist who would prefer to remain unnamed, “In the time they take, we could well die.”

AIDS workers say that women continue to face discrimination in health care settings. Critical areas of concern include advice on abortions, testing without consent, refusal of health care providers to deliver the child of a positive woman, denial of adequate medical attention and medical information, administration of medicines without assessment of viral load, and negative attitudes of medical professionals.

According to Geetha Ramaseshan, a leading Chennai-based women’s rights lawyer, “Activists need to examine public health policies that affect people living with HIV to ensure that their rights to life are not violated.”

Says P. Kausalya, AIDS activist and President of the South India PWN+ (Positive Women’s Network), “Most Western funds and government support is specifically earmarked for promoting awareness and for prevention measures. For those of us who already have AIDS, there is virtually nowhere to go.”

Recognition of the Elderly and Their Needs

Finally, the HDR made more than a passing reference to the need for social security for the aged. The elderly are expected to number 11.43% of the population by 2011. There is no specific policy in place for them. Says Annie Kurien, State Vice Chairperson of the Dignity Foundation, one of the few NGO agencies working for the aged, “The Government is doing practically nothing for its senior citizens. They need medical attention, improved transportation, a range of concessions as applicable in the Western countries and a policy that understands their basic needs. The feeling that ‘they are useless’ is reflected in the lack of sensitivity in the State’s policy towards them, which is virtually nonexistent. Just because they are helpless, you can’t put them all in the gas chamber!”