📰 Be wary of growing exports
The growing consumption in rich countries has come at a cost for developing countries such as India
•The uncertainties in the global economic environment, significantly driven by Russia’s invasion of Ukraine and the resultant sanctions on Russia by the West, along with Sri Lanka’s ongoing struggles to stay afloat amidst a deepening crisis, have all been believed to have created export opportunities for countries such as India. However, this well-celebrated export spike needs to be viewed with a pinch of salt.
Emissions-embodied exports
•The 2009 United Nations Climate Change Conference in Copenhagen witnessed a vociferous argument from countries such as India and China that developed countries who are consuming polluted goods produced elsewhere also have an obligation to clean up the mess. The data available from the Organisation for Economic Co-operation and Development(OECD) indicates that India is one of the leading exporters of carbon emissions-embodied products, and that there is a steady increase in the total carbon emissions embodied in exports. China is the largest exporter of carbon emissions-embodied products, followed by the U.S., Russia and India. India’s total carbon emission exports increased from 80.3 million tonnes at the time of it joining the World Trade Organization (WTO) in 1995 to 426.1 million tonnes in 2018. The sharp increase in carbon-embodied exports brought India closer to that of the U.S.’s carbon emission exports. In the case of the U.S., carbon emission exports were more or less stagnant between 1995 and 2018.
•Net CO2 exports can be calculated by taking the difference between carbon emissions-embodied exports and carbon emissions-embodied imports. The striking difference between China and India is that while China’s net exports began to decline from 2007-08, net exports in India started to steadily increase in that period. While India’s net exports of carbon emissions were observed to be the lowest in 2007 (-11.6 million tonnes), at present the net exports are 55.4 million tonnes. Another way of calculating the net export of carbon emissions is by taking the difference between domestic carbon emissions embodied in gross exports and foreign carbon emissions embodied in gross exports. By using this definition also, there is a steady increase in net exports of carbon emissions from India. In 1995, net exports were 75.8 million tonnes; it increased to 372 million tonnes in 2018.
•India’s recent export performance has been attributed to petroleum products, electronics and chemicals. Although net carbon emission exports have been declining in the case of chemicals and electronics as imports have been rising at a greater rate, the carbon emissions-embodied exports of all these products have been steadily increasing over the years. For example, the domestic carbon emissions-embodied exports of chemicals was only 2.1 million tonnes in 1995, which increased to around 9.8 million tonnes in 2018. Similarly, carbon emissions exports of electronics increased from 1.3 million tonnes to 8 million tonnes, and exports of petroleum carbon increased from 6.6 to 25.5 million tonnes during this period. The net exports of carbon emissions have also been increasing in the case of petroleum products.
•Most developed countries are the net importers of polluted goods produced elsewhere, especially in the developing countries. The largest net importers of carbon emission-intensive goods are the U.S., Japan and Germany. The U.S. net carbon imports increased from 262.3 million tonnes in 1995 to 834.1 million tonnes in 2018. The OECD member countries which are developed are net importers. Due to the stringent environmental measures adopted by developed countries, pollution-intensive industries show a tendency to relocate from developed countries to developing countries with the lowest environmental standards/weak enforcement of environmental standards in order to cut resource and labour costs — a phenomenon researchers term as ‘pollution haven hypothesis’. Thus, developing countries that are lax in enforcing environmental policies eventually become pollution havens.
•One could possibly argue that an increased GDP as a result of expansion in export revenue can be utilised for improving the environmental quality. As per the environmental Kuznets curve, there is an inverted U-shape relationship between the income of a country and its environmental degradation. This implies that as income increases, environmental quality begins to deteriorate, but improves after some time. However, there is no consensus across studies with respect to this possibility.
•Coming to the exports of agricultural and food products, India is virtually exporting some of its depleting natural resources such as water through exports. India is the leading exporter of rice in the world market. Given that rice is a water-intensive crop, India is indirectly exporting water to other countries. This virtual water trade will have an adverse impact on long-term sustainability and food security of the country although there has been an overall improvement in water-use efficiency. (As per the water use efficiency index developed as part of the sustainable development goals, water efficiency has risen from 0.95 ($/m3) during the period 1993-97 to 3 ($/m3) during the period 2018-22.) The agricultural water withdrawal as a percentage of total available renewable water resources has increased from 26.7% in 1993 to 36% in 2022. The total per capita renewable water resources have also declined from 1909 cubic metres to 1412 cubic metres during this period.
The way forward
•The growing consumption in rich countries has come at a cost for developing countries such as India. Countries have begun imposing an environmental tax to address a broad spectrum of environmental issues. For example, in OECD countries, the tax roughly constitutes 2% of the GDP. While the environmental tax in India is around 1%, the tax as a percentage of GDP has marginally come down from 1.38% in 2005 to 1.07% in 2019. In order to ensure long-term sustainability, strict environmental measures need to be explored, such as revisiting the possibilities of increasing the environmental tax, even though the short-run implications, especially on the trade front, may not be pleasant. Similarly, water-saving policies that seek to improve the water use efficiency are also the need of the hour, in order to promote sustainable production of rice and also safeguard food security in the country.
It is not just a family planning and maternal health issue, but also a sexual health and reproductive rights issue
•As two women public health practitioners who have studied and worked in India and the United States, we voice our solidarity with women in both countries at this precarious moment for abortion rights.
•Our public health journeys started with witnessing maternal deaths in India. One of us, on her first clinical rotation, saw a woman die of sepsis, infection in the blood, due to an unsafe backstreet abortion. And the other, during her rural health internship in Uttar Pradesh, witnessed a pregnant woman die on a wooden hand-pulled cart because she was unable to reach the hospital in time. The images of these two women with their swollen abdomen and pale, dying faces still haunt us, as we reflect on the privileges we enjoy as women belonging to a certain class and caste in India.
The facts
•Women, pregnant people and transgender persons in India struggle every day to exert their choice about birthing and their bodily autonomy. Yet, despite this bleak reality, netizens on social media in India claim that the country is more progressive than the U.S. on abortion rights because we have the Medical Termination of Pregnancy Act, 1971 (“MTP Act”). Such a self-congratulatory attitude is neither in good faith nor is it factually correct.
•According to the World Health Organization, six out of 10 of all unintended pregnancies end in an induced abortion. Around 45% of all abortions are unsafe, almost all of which (97%) take place in developing countries. As per a nationally representative study published in PLOS One journal in 2014, abortions account for 10% of maternal deaths in India.
•The recent round of the National Family Health Survey 2019-2021, shows that 3% of all pregnancies in India result in abortion. More than half (53%) of abortions in India are performed in the private sector, whereas only 20% are performed in the public sector — partly because public facilities often lack abortion services. More than a quarter of abortions (27%) are performed by the woman herself at home.
•In another a fact-finding study published in The Lancet in 2018, 73% of all abortions in India in 2015 were medication abortions, and even though these may have been safe — many of these are illegal as per the MTP Act, if they occur without the approval of a registered medical practitioner. Another 5% of all abortions were outside of health facilities with methods other than medication abortion. These risky abortions are performed by untrained people under unhygienic conditions using damaging methods such as insertion of objects, ingestion of various substances, abdominal pressure, etc. A recent study found that sex-selective abortions in India could lead to 6.8 million fewer girls being born between 2017 to 2030.
•Many may be unaware of these disturbing statistics and facts. But we all know of at least one adolescent girl among our family or friends or networks who had to travel to another city in order to find a ‘non-judgmental’ obstetrician or who had to arrange money to access abortion in the private sector. Or, we may have heard of someone who has aborted a female foetus because the family wanted a son; or know of a mother who escaped the pressure of such forced abortion because she did not want to lose her pregnancy.
Obstacles
•The MTP Act, first enacted in 1971 and then amended in 2021, certainly makes ‘medical termination of pregnancy’ legal in India under specific conditions. However, this Act is framed from a legal standpoint to primarily protect medical practitioners because under the Indian Penal Code, “induced miscarriage” is a criminal offence. This premise points to a lack of choice and bodily autonomy of women and rests the decision of abortion solely on the doctor’s opinion. The MTP Act also only mentions ‘pregnant woman’, thus failing to recognise that transgender persons and others who do not identify as women can become pregnant.
•Moreover, the acceptance of abortion in Indian society is situated in the context of population control and family planning. But, most importantly, after more than 50 years of the MTP Act, women and transgender persons face major obstacles in accessing safe abortion care.
•These are seven examples: First, they may not even be aware that abortion is legal or know where to obtain one safely; second, since the MTP Act does not recognise abortion as a choice, they need the approval of medical professionals even in the first few weeks of the pregnancy; third, unmarried and transgender people continue to face stigma and can be turned away from health facilities, forcing them to resort to unsafe care; fourth, mandatory reporting requirements under the Protection of Children from Sexual Offences Bill (POCSO), 2011 law against child sexual offences, impact privacy and hinder access of adolescents to safe abortion services; fifth, many are still coerced into agreeing to a permanent or long-term contraceptive method as a prerequisite for getting abortion services; sixth, health-care providers may impose their own morality by insisting on ‘husbands’ or ‘parental’ consent for abortion. Even women seeking abortion care in health facilities are often mistreated and not provided medications for pain relief; seventh, despite laws prohibiting sex determination, the illegal practice persists. The mushrooming of unregulated ultrasound clinics in India continues to facilitate the illegal practice of sex determination, resulting in unsafe abortions and female foeticide.
•It is a testament to class and caste divides when netizens talk of being ‘progressive’ when, 50 years after the MTP Act, women continue to die due to unsafe abortions. Passing one law and assuming the job is done is far from “progressive” when so many face a lack of access, systemic barriers, social norms and cultural preferences, and even criminal liability.
One law is insufficient
•There is an urgent need in our country to shift the discourse on abortions from just being a family planning and maternal health issue to one of a sexual health and reproductive rights issue. The situation in India shows that one law alone is insufficient and we must raise the bar on reproductive justice. We must improve our health systems to ensure good quality and respectful abortion care. As the focus on abortion rights in the U.S. rages, we call upon all to self reflect and to stand in solidarity with people in the U.S. and other places where reproductive rights are in jeopardy. Reproductive injustice anywhere is a threat to the lives of people everywhere.
📰 Diversifying plates for girls
Promoting dietary diversity is crucial during adolescence, especially among girls, who face more physiological demands
•Multiple studies show that adolescence is a nutritionally demanding phase of life. Even though both adolescent boys and girls face emotional changes during puberty, girls face more physiological demands and thus require a higher intake of macro and micro nutrients. Susceptibility of adolescent girls to anaemia is 40% compared to boys at 18%. This is why promoting dietary diversity is crucial during adolescence, as dietary habits are in the formative stage and evidence shows that behaviour imbibed during adolescence has a higher chance of being continued in adult life. Ensuring appropriate nutrition for adolescent girls is also paramount considering the inter-generational impact it has on combating malnutrition.
Focus on girls
•The National Family Health Survey (NFHS)-5 data (2019-20) show an increase in anaemia among adolescent girls by 5% when compared to NFHS-4. The Comprehensive National Nutrition Survey 2019 shows that even before the pandemic, consumption of diverse food groups among adolescents was low. The fallout of COVID-19 has further worsened dietary diversity, especially of women, adolescents and children. A study by the Tata-Cornell Institute for Agriculture and Nutrition showed that women’s dietary diversity in India declined by 42% during COVID-19 lockdowns as they consumed fewer fruits, vegetables, and eggs. The lockdowns also led to the loss of mid-day meals and interruptions in Weekly Iron Folic Acid Supplementation (WIFS) and nutrition education in schools for adolescent girls. This was compounded by challenges in providing nutrition services to out-of-school adolescent girls which further increased their vulnerability to poor nutrition outcomes. Adolescence is the window of opportunity where practices of dietary diversity can be built to correct nutritional deficiencies and replenish the body with much-needed nutrients, especially for girls. There are a few recommendations that emerge on strengthening the diets of adolescent girls in India.
•First, along with continued service delivery of WIFS, the government’s health and nutrition policies need to emphasise on strong compliance to diverse diets and physical activities. This includes locally sourced fruits and vegetables, seasonal diets, and the inclusion of millets. This further needs to be supplemented by strengthened nutrition counselling for adolescent girls through community workers’ home visits, by building a strong ecosystem in schools to promote healthy habits and diets, virtual counselling, and comprehensive nutrition counselling through community-based events and Village Health, Sanitation and Nutrition Days.
•We need to promote good nutrition among adolescents through Nutri-Smart schools (building kitchen gardens in schools), which are already being implemented in some States. Such initiatives will increase awareness, improve availability, and accessibility to diverse foods groups.
•Second, as service delivery platforms to tap adolescents, we need to also think beyond schools, as the diverse plates are first set at home. Young girls need to be equipped with accurate information about adequate and appropriate diets so that they can act as change agents for their families, community, and peer groups. Further, food diversification is required to be complemented with reformative steps such as the recent amendment of increasing the legal age of marriage for women from 18 years to 21 years. However, for such legislation to have the best impact, it is equally crucial to ensure that girls remain in school or formal education, their safety is ensured, and their health and nutrition are prioritised. Only then can such measures provide opportunities for girls to improve their nutritional and health outcomes.
Micro nutrient deficiencies
•Third, the adolescent’s nutritional status is related to the burden of multiple micro nutrient deficiencies. Currently, 80% of adolescents suffer ‘hidden hunger’ due to micro nutrient deficiencies. The trend is more prevalent in girls as they already suffer multiple nutritional deprivations. We need to strengthen our policy initiatives to address deficiencies of not just iron and folic acid, but also vitamin B12, vitamin D, and zinc.
•Lastly, the POSHAN Abhiyaan (now Mission POSHAN 2.0) strongly integrates the aspect of under-nutrition and anaemia among women, girls, and children. However, the design needs to be inclusive of the growing risk of non-communicable diseases and obesity among adolescents. Given that over 10% of adolescents are overweight in 12 States of India, strict action plans need to be devised against the sale and advertisement of unhealthy foods and beverages.
📰 The monkeypox virus: origins and outbreaks
How did monkeypox spread? What are the observations from genome sequencing?
•Monkeypox belongs to the poxvirus family of viruses and was first identified in monkeys way back in 1958. The present outbreak has a toll of over 220 confirmed cases spread across 19 countries.
•A number of genome sequences in recent years from Africa and across the world suggest that there are two distinct clades of the virus — the Congo Basin/Central African clade and the West African clade.
•The smallpox/vaccinia vaccine provides protection against the virus. While the vaccine has been discontinued in 1980 following the eradication of smallpox, emergency stockpiles of the vaccines are maintained by many countries.
The story so far: With cases being reported from across the world, monkeypox has caught everyone’s attention. The present outbreak has a toll of over 220 confirmed cases spread across 19 countries. U.K., Spain and Portugal are leading the pack with the highest number of confirmed cases but no deaths reported till date.
•The present outbreak has been interesting in many ways. While sporadic outbreaks have occurred in Africa and a few outside of Africa in regions which had recorded travel from areas where outbreaks have occured, such massive flare-ups spanning multiple countries simultaneously has not happened before. Additionally many of the affected patients did not travel to regions where the disease is considered prevalent and the initial cases were largely, but not exclusively among young individuals who identify themselves as men who have sex with men (MSM).
What is the monkeypox virus?
•Monkeypox is not a new virus. The virus, belonging to the poxvirus family of viruses, was first identified in monkeys way back in 1958, and therefore the name. The first human case was described in 1970 from the Democratic Republic of Congo and many sporadic outbreaks of animal to human as well as human to human transmission has occurred in Central and West Africa in the past with significant mortality. After the elimination of smallpox, monkeypox has become one of the dominant poxviruses in humans, with cases increasing over years along with a consequent reduction in the age-group affected. Since the transmission occurs only with close contact, the outbreaks have been in many cases self-limiting. Since in the majority of affected people, the incubation period ranges from five to 21 days and is often mild or self-limiting, asymptomatic cases could transmit the disease unknowingly. The outbreaks in Central Africa are thought to have been contributed by close contact with animals in regions adjoining forests. While monkeys are possibly only incidental hosts, the reservoir is not known. It is believed that rodents and non-human primates could be potential reservoirs.
Does the virus mutate?
•Monkeypox virus is a DNA virus with a quite large genome of around 2,00,000 nucleotide bases. While being a DNA virus, the rate of mutations in the monkeypox virus is significantly lower (~1-2 mutations per year) compared to RNA viruses like SARS-CoV-2. The low rate of mutation therefore limits the wide application of genomic surveillance in providing detailed clues to the networks of transmission for monkeypox, unlike what was possible for SARS-CoV-2.
•A number of genome sequences in recent years from Africa and across the world suggest that there are two distinct clades of the virus — the Congo Basin/Central African clade and the West African clade. Each of the clades further have many lineages. The Central African/Congo basin clade is thought to have a higher transmission and virulence compared to the West African clade. It is remarkable and noteworthy that the enormous capacity and expertise in sequencing and analysis of genome sequences of viral pathogens built during the COVID-19 pandemic has come in handy for investigating the present outbreaks.
What do the genomes say?
•With over a dozen genome sequences of monkeypox now available from across the world due to the current outbreak, it is reassuring that the sequences are quite identical to each other suggesting that only a few introductions resulted in the present spread of cases. Additionally, almost all genomes have come from the West African clade, which has much lesser fatality compared to the Central African one.
•This also roughly corroborates with the epidemiological understanding that major congregations in the recent past contributed to the widespread transmission across different countries. While unlike COVID-19, the slow rate of mutations preclude us from using genomic sequences for fine-tracing of the contact networks, the sequences largely belong to the West African lineage of the virus, which has shown to be associated with lesser virulence. The virus genomes also show very close similarity with those from the recent outbreak in Nigeria during the 2017-2019 period suggesting that the present outbreak is not driven by a particular new variant, but possibly related to unique transmission networks.
Does it have an effective vaccine?
•It is reassuring that we know quite a lot more about the virus and its transmission patterns. We also have effective ways of preventing the spread, including a vaccine. The smallpox/vaccinia vaccine provides protection. While the vaccine has been discontinued in 1980 following the eradication of smallpox, emergency stockpiles of the vaccines are maintained by many countries. Younger individuals are unlikely to have received the vaccine and are therefore potentially susceptible to monkeypox which could partly explain its emergence in younger individuals.
•Learning from the enormous wealth of knowledge from African countries which have effectively managed the monkeypox outbreaks in the past would go a great way in containing the present outbreak. While we have many effective ways of containing the outbreak, including contact-tracing and a vaccine, efforts to bridge the divide in health, knowledge, experience and infrastructure could contribute to long-lasting impact in preventing and managing future outbreaks and contribute to an equitable and global public health.
📰 Supreme Court recognises sex work as a ‘profession’
It says police should neither interfere nor take criminal action against adult, consenting sex workers
•In a significant order recognising sex work as a “profession” whose practitioners are entitled to dignity and equal protection under law, the Supreme Court has directed that police should neither interfere nor take criminal action against adult and consenting sex workers.
•“It need not be gainsaid that notwithstanding the profession, every individual in this country has a right to a dignified life under Article 21 of the Constitution,” the court observed.
•“Sex workers are entitled to equal protection of the law. Criminal law must apply equally in all cases, on the basis of ‘age’ and ‘consent’. When it is clear that the sex worker is an adult and is participating with consent, the police must refrain from interfering or taking any criminal action,” a three-judge Bench directed in an order which was passed after invoking special powers under Article 142 of Constitution.
•The Bench ordered that sex workers should not be “arrested or penalised or harassed or victimised” whenever there is a raid on any brothel, “since voluntary sex work is not illegal and only running the brothel is unlawful”. A child of a sex worker should not be separated from the mother merely on the ground that she is in the sex trade, the court held. “Basic protection of human decency and dignity extends to sex workers and their children,” the court noted.
•Further, if a minor is found living in a brothel or with sex workers, it should not be presumed that the child was trafficked.
•“In case the sex worker claims that he/she is her son/daughter, tests can be done to determine if the claim is correct and if so, the minor should not be forcibly separated,” the court ordered.
•The court ordered the police to not discriminate against sex workers who lodge a criminal complaint, especially if the offence committed against them is of a sexual nature. Sex workers who are victims of sexual assault should be provided every facility including immediate medico-legal care.
•The court said media should take “utmost care not to reveal the identities of sex workers, during arrest, raid and rescue operations, whether as victims or accused and not to publish or telecast any photos that would result in disclosure of such identities”.
