|TOI INTERVIEW - I'm seeing the most progress in Bihar, says Melinda Gates|
The Times Group- April 22, 2015
At a time when foreign funded NGOs are under the government's scanner , Melinda Gates, Padma Bhushan awardee and cofounder of the Bill and Melinda Gates Foundation, says NGO activism is needed for society to thrive. She was speaking to TOI's Sagarika Ghose
Is enough being done on the beti bachao, beti padhao campaign?
The government should make continued investments in health if they want progress for women and children. They've a commitment to India's Early Newborn Action Plan but continued investments will be important. I was in Bihar and saw they've the right goals on newborn and child health but there are gaps in supplies. There's plenty of work to be done.
Your response to the fact that many NGOs are under the government scanner
A thriving society needs thriving NGOs and thriving governments. NGOs should work hand in hand with governments. Sometimes they nudge governments. That helps move things. NGOs have an important role.
Why are you so keen that family planning is put back on the development agenda?
When a woman is educated and has the choice about when, if and how to space births, it transforms her and her family's life. In India we know that 1 in 2 girls are married before age 18. If a girl has a baby between 15 and 19 she's twice as likely to die. Why's India one of the 10 countries with the highest maternal mortality?
Target-oriented family planning can be coercive?
Yes. But the focus now is on how to put the woman at the centre and let it be voluntary , not having targets, like in the 1970s. Today 77% women here get sterilized. Wealthier women go for other options, and space their children. We must ensure all women have those choices. The government is now putting out postcards on IUDs and training people on how to insert those in young women. I'd like to see the government offer injectibles or even implants.Injection is good if you want to wait 6-9 months, IUD is better if you'd wait 5 years. Let women decide.
Is justice for women still a remote ideal here?
Indian society is having the right conversation. The fact that there is more cases of reporting of rape is a sign of progress. I was in a tribal community in Jharkhand where there's domestic violence but even some women don't realize it's unacceptable. Women's self-help groups have become empowering but you need more of that kind of empowerment.
How can India win the battle against maternal mortality?
By getting women into the facility , making sure the right things are done at the facility level. That's key to bringing down maternal mortality along with family planning.We've a Better-Birth checklist: Things you ought to do when the woman comes in.One of the first things you should do is take her blood pressure. Many women die because blood pressure goes up quickly . Hand washing, making sure there's a warmer so the newborn immediately goes into a simple warming plate: Those make a difference.
You visited Maoist-hit areas? Is lack of development, not ideology, driving Naxalism?
I was there to see women's self-help groups. The organization I was there with, Pradan, has 350,000 self-help groups. The women are so vociferous. They now live in situations where they get crops round the year. This changes the trajectory of their family . They can count on food supply and put a bit on the local market. They said I had one sari before. I washed my one sari in ashes.Now I've a bit of soap and two saris. My mother-in-law gave me the worst part of the house when I moved in.Now my husband and I have built another room. They've become empowered. It's huge change. They're acting against rape and drinking as a group. They see the power of the group.
Which is the most responsive state as far as social indicators are concerned?
Kerala is a model. One amazing thing India has going for it is competition among states. But the place I'm seeing the most progress is Bihar. They're bringing down infant and maternal mortality , nutrition rate is improving. They're taking a strong stand to eliminate Kala-azar, it's great to see.
What about UP?
UP is incredibly hard because of its number of people. It's huge. They've inefficiencies in the health system that should be addressed.
Are there mindset issues in bringing change among the poorest?
We must bring change through ASHA workers-community health workers-because they're accepted by villagers. A functioning healthcare system needs a community healthcare worker system, a cadre India has.Many countries don't have community health workers.Need to keep investing in training them.
Are things getting better or worse here?
Things are getting better.Bill and I call ourselves impatient optimists. Childhood deaths used to be 12100 in India in 1990s. That's down to 5100. But 56% die in the first month. So we're impatient.
What motivates you?
I went to a Catholic school.My high school had liberal nuns who taught us the Catholic Church's vision on social justice, that the world should be equitable. Bill's from a community service background. We agreed the majority of Microsoft resources would go back to society.Should more Indian corporate groups get into philanthropy?
The Tata family is an amazing example, Azim Premji, Rohini and Nandan Nilekani too. We talk about how philanthropy can be a catalytic wedge. It can take risks where governments can't or won't, and shine a light on public policy issues. Swati Piramal and her husband are doing incredible work.