Dear sir,
We herewith report effects of disruptions on maternal and child health services in Maharashtra, India.
Covid 19- collateral damage on nutrition of women and children, in Maharashtra, India
Phadke M1,Nair R2,Menon P3,Jotkar R4, Saunik S5
India has been battling the Covid 19 pandemic like most other countries of the world. The first two waves, particularly the second wave produced devastating effects on many aspects of human health and welfare .Disease mortality and morbidity was unparalleled. In addition to these direct effects of Covid 19 disease itself, a number of indirect effects of Covid 19 on women, adolescent girls and children occurred. Lockdowns, loss of jobs, decrease in salaries, migration, supply chain disruption, inadequacy and inaccessibility of foods, green vegetables, stoppage of midday meals due to school closures, inadequate distribution of iron folic acid tablets from anganwadis impacted women and children’s nutrition.
Disruptions in maternal health services have been reported 1. We report two observations on occurrence of Neural tube defects and severe acute malnutrition in children during the years from 1st January to 31st December of 2020 and 2021. A team of doctors under the national health program of RBSK(Rashtriya Bal Swasthya Karyakram), examined children for '4Ds' i.e. Defects at birth, Diseases in children, Deficiency conditions and Developmental delays including disabilities. The year...
Dear sir,
We herewith report effects of disruptions on maternal and child health services in Maharashtra, India.
Covid 19- collateral damage on nutrition of women and children, in Maharashtra, India
Phadke M1,Nair R2,Menon P3,Jotkar R4, Saunik S5
India has been battling the Covid 19 pandemic like most other countries of the world. The first two waves, particularly the second wave produced devastating effects on many aspects of human health and welfare .Disease mortality and morbidity was unparalleled. In addition to these direct effects of Covid 19 disease itself, a number of indirect effects of Covid 19 on women, adolescent girls and children occurred. Lockdowns, loss of jobs, decrease in salaries, migration, supply chain disruption, inadequacy and inaccessibility of foods, green vegetables, stoppage of midday meals due to school closures, inadequate distribution of iron folic acid tablets from anganwadis impacted women and children’s nutrition.
Disruptions in maternal health services have been reported 1. We report two observations on occurrence of Neural tube defects and severe acute malnutrition in children during the years from 1st January to 31st December of 2020 and 2021. A team of doctors under the national health program of RBSK(Rashtriya Bal Swasthya Karyakram), examined children for '4Ds' i.e. Defects at birth, Diseases in children, Deficiency conditions and Developmental delays including disabilities. The year 2020 was a reflection of health and nutrition status of adolescent girls, who were married in the pre-Covid years and delivered babies in the year 2020 and children in precovid time. The year 2021 reflected the health and nutrition status of women in the Covid year of 2020 . It also reflected the status of nutrition in children in 2020 i.e. precovid times and 2021 reflecting nutritional insult in 2020.
2121564 children were examined in 2020. 112(0.005%) were detected to have neural tube defects ( NTDs). In 2021, 101(0.02%) had neural tube defects in 516655 babies which are four times that of 2020.(p<0.001). The number of babies born with NTDs were probably affected by Covid induced collateral nutrition insult i.e. folic acid deficiency in women during periconceptional period. Severe acute malnutrition was detected by measuring weight for height below -3SD on WHO growth charts. 7482 children had SAM (0.353%) in 2020 and 7148 (1.38%) children had SAM in 2021. (p<0.001).
Occurrence of SAM is a measure of acute nutritional insult to children . Inadequate nutrition in 2020 manifested in more children developing SAM and the number is four times more than previous year.
We declare no conflict of interest.
1. Sr. Adv, Ex-VC MUHS, Mumbai,
2. Nutrition Specialist, UNICEF, Mumbai,
3. Assoc. Prof, Ped and Med Edu, DYP. Med college, Pune,
4. Sr. Consultant, Pub.health, RJNM,Mumbai,
5. Addl Chief Sec. Govt of Mah,Mumbai, India.
References
1.Zeus Aranda, Thierry Binda, Katherine Tashman,Ananya Tadikon Daniel Maweu,Emma Jean Boley6,Isaac Mphande, Isata Dumbuya, Mariana Montaño, Mary Clisbee, Mc Geofrey Mvula,
Melino Ndayizigiye Meredith Casella Jean-Baptiste, Prince F Varney,Sarah Anyango Karen Ann GrépiJean Bethany Hedt-Gauthier, Isabel R Fulcher on behalf of the Cross-site COVID-19 Syndromic Surveillance Working Group. Disruptions in maternal health service use during the COVID-19 pandemic in 2020: BMJ Global Health 2021 Vol7 issue1http://dx.doi.org/10.1136/bmjgh-2021-007247)
I am extremely puzzled by the lack of any response regarding my proposed comments regarding this article. I've submitted my comments twice, but they have not been published. I cannot imagine why. It appears to be a discretionary censorship, which is of course contrary to BMJ's published editorial policies which generally favor respectful discourse. I would greatly appreciate an explanation and an appeal to a larger panel of BMJ editors.
To repeat...for the third time,... regarding this article:
There is a growing interest in developing evidenced based standards for public health policy initiatives.[1] In response to this effort, Burris et al have put forward their own initial effort to identify the potential effects of laws regulating abortion on women’s health.[2] Unfortunately, they apparently failed to include in their research team anyone with familiarity with the literature regarding the negative physical and psychological effects of coerced and unnecessary abortions. This is not a minor oversight.
Regarding the issue of women’s autonomy, increasing legal access to abortion is a double-edged sword. Easier access makes it easier for women to choose abortion for their own self-interests, but it also makes it easier for those pressuring women into unwanted abortions to abuse women’s rights.[3]
Coerced abortions are especially common among women enslaved in sex trafficking.[4,5] But it is also common within...
I am extremely puzzled by the lack of any response regarding my proposed comments regarding this article. I've submitted my comments twice, but they have not been published. I cannot imagine why. It appears to be a discretionary censorship, which is of course contrary to BMJ's published editorial policies which generally favor respectful discourse. I would greatly appreciate an explanation and an appeal to a larger panel of BMJ editors.
To repeat...for the third time,... regarding this article:
There is a growing interest in developing evidenced based standards for public health policy initiatives.[1] In response to this effort, Burris et al have put forward their own initial effort to identify the potential effects of laws regulating abortion on women’s health.[2] Unfortunately, they apparently failed to include in their research team anyone with familiarity with the literature regarding the negative physical and psychological effects of coerced and unnecessary abortions. This is not a minor oversight.
Regarding the issue of women’s autonomy, increasing legal access to abortion is a double-edged sword. Easier access makes it easier for women to choose abortion for their own self-interests, but it also makes it easier for those pressuring women into unwanted abortions to abuse women’s rights.[3]
Coerced abortions are especially common among women enslaved in sex trafficking.[4,5] But it is also common within households precisely because every pregnancy impacts not just the pregnant woman, but also male partners, parents, employers, and society at large . . . as evidenced by advocates of population control who have sought and implemented public policies that discourage birth.[3]
As many as 64% of American women acknowledging a history of abortion report having felt pressured to abort by others.[6] Similarly, a 2021 study of women seeking abortion found that only 42% described their pregnancy as never wanted.[7] The pressure to abort a pregnancy that might otherwise be welcomed typically comes from their male partners, parents, employers and social services officials.[8]
As might be imagined, negative psychological reactions to abortion are more common when women feel pressured into an abortion or have other conflicting maternal interests and moral beliefs.[6,9] These are just a few of the 15 risk factors identified by the APA for negative psychological reactions. They include: terminating a pregnancy that is wanted or meaningful; perceived pressure from others to terminate a pregnancy; perceived opposition to the abortion from partners, family, and/or friends; lack of perceived social support from others; various personality traits (e.g., low self-esteem, a pessimistic outlook, low-perceived control over life); a history of mental health problems prior to the pregnancy; feelings of stigma; perceived need for secrecy; exposure to antiabortion picketing; use of avoidance and denial coping strategies; feelings of commitment to the pregnancy; ambivalence about the abortion decision; low perceived ability to cope with the abortion; history of prior abortion; and late term abortion.[9] The best evidence indicates that the vast majority of women undergoing abortion have one or more of these risk factors.[9]
Even assuming that the negative psychological associated with abortion, including increased risk of substance abuse,[9] postpartum psychiatric risks,[10] sleep disorders,[11] posttraumatic stress disorder,[9] and suicidal ideation and other risk taking behaviors[9] are entirely due to coerced and unwanted abortions, the importance of laws intended to prevent unwanted abortions should not be ignored…but that is precisely what Burris et al have done.
For example, one of the reasons for laws requiring parental involvement or notification are to help prevent a minor from undergoing a coerced abortion at the behest of the male partner or his family. They are also intended to prevent a minor from fearfully consenting to an otherwise unwanted or unnecessary abortion because of a mistaken fear that the minor’s parents will reject her because of her sexual activity and will not support her desire to keep the pregnancy.
But in Table 1, the benefit of “prevention of unwanted, unnecessary or unsafe legal abortions” is not identified in the list of “plausibly related outcomes” for any of the types of laws considered. Nor is there any consideration of “saved costs” and in regard to fewer treatments for the negative health effects associated with unwanted abortion.[9]
Numerous studies have also found a strong link between induced abortion and subsequent pre-mature and low-birth weight deliveries.[12] In the context of the United States, the increased medical costs in treating subsequently pre-maturely born children just to the point of hospital discharge apportions out to approximately $100,000 per 100,000 abortions. Therefore, any reduction in abortion rates that may result from laws that reduce the risk of coerced and unwanted abortions would produce significant health care savings, would reduce the risk of lifelong health complications associated with premature and low birth weight deliveries, and would save numerous lives among later planned pregnancies. But again, none of these benefits appear in Table 1.
Moreover, literally every record linkage study (eleven in total) examining reproductive outcomes associated with mortality has shown that abortion is associated with an increased risk of premature death among women exposed to abortion.[13] There is even a dose effect, with each abortion increasing the risk of an early death by approximately 50 percent.[13] At least a part of this increased risk is due to the increased risk of within a year of an abortion.[14,15] But even if we again assume that all these risks attach only to unwanted abortions (presuming that if a woman truly wants an abortion according to her own guiding lights, she will experience no psychological harm), the fact remains that any law which may help to reduce the rate of unwanted abortions is likely to reduce mortality rates and thereby increase work productivity and gross national product. But, yet again, the positive plausible outcomes have been omitted from Table 1
Notably, “unintended childbirth” is one plausible outcome that Burris et al have associated with every type of law identified in Table 1. But that outcome is poorly defined. When, and how often, is “unintended childbirth” a benefit to women and when is it a harm? Countless women report great satisfaction and blessing from their subsequent delivery of unplanned pregnancies. In fact, the Turnaway Study found that among all the women who were denied a late term abortion, 60% reported being happy about continuing their pregnancies, and by the time the child was born, only 12% still wished they could have had the abortion.[16] The bottom line is that many “unintended” and even “unwanted” pregnancies are associated with a mix of feelings, a mix that in the long run often result in a “welcomed” child, one that is valued not because the child was planned but simply it is the woman’s and her family’s child. Given that Burris et al are arguing for better research to support policy decisions, the importance of better research to identify when and how often unintended pregnancies result in a welcomed child should be a priority, as well as research to identify public policies that can help to make it easier for families to welcome unintended children.
Finally, Burris et al have failed to identify in the list of potential legal interventions laws governing informed consent, risk disclosure and pre-abortion screening for risk factors identifying women who may be at greater risk of being coerced or may feel pressured by social circumstance to agree to an abortion contrary to their moral beliefs and/or maternal desired.
In short, Burris et al’s analysis has failed to fully describe or analyze the plausible effects of statutes and public policies intended to protect women from unwanted, unnecessary and unsafe legal abortions. Simply declaring abortion legal does not necessarily render them safe and effective for all women in any and all circumstances of an “unintended” pregnancy.
Unfortunately, “unintended” pregnancies are often more unwanted by others (including population control activists) than they are by the pregnant themselves. In many cases, women are resiliently willing to embrace their unintended pregnancies as a welcomed-children. Often, it is only the hostility of others, and the accompanying pressure to submit to unwanted abortions, that is the true attack on women’s rights and autonomy.
Laws designed to identify and alleviate the pressures on women to undergo unwanted and unnecessary abortion should be pursued and implemented to save lives, reduce costs, and increase the well-being of both women and their children.
Competing Interest
David Reardon is the Director the Elliot Institute which sponsors peer reviewed medical research, promotes post-abortion healing programs, and advocates for laws requiring pre-abortion screening for coercion and other risk factors associated with negative outcomes for women.
References
1. Rehfuess EA, Stratil JM, Scheel IB, Portela A, Norris SL, Baltussen R. The WHO-INTEGRATE evidence to decision framework version 1.0: integrating WHO norms and values and a complexity perspective. BMJ Glob Heal [Internet]. 2019 Jan 1 [cited 2022 Jan 13];4(Suppl 1):e000844. Available from: https://gh.bmj.com/content/4/Suppl_1/e000844
2. Burris S, Ghorashi AR, Cloud LF, Rebouché R, Skuster P, Lavelanet A. Identifying data for the empirical assessment of law (IDEAL): A realist approach to research gaps on the health effects of abortion law. BMJ Glob Heal [Internet]. 2021 Jun 1 [cited 2022 Jan 13];6(6):e005120. Available from: https://gh.bmj.com/content/6/6/e005120
3. Reardon DC. Abortion decisions and the duty to screen: clinical, ethical, and legal implications of predictive risk factors of post-abortion maladjustment. J Contemp Health Law Policy. 2003;20(1):33–114.
4. Coyle C. Sex Trafficking. In: MacNair RM, editor. Peace Psychology Perspectives on Abortion. Kansas City. MO: Feminism & Nonviolence Studies Association; 2016.
5. Lederer L, Wetzel C. The Health Consequences of Sex Trafficking and Their Implications for Identifying Victims in Healthcare Facilities. Ann Heal Law. 2014;23(1):61.
6. Rue VM, Coleman PK, Rue JJ, Reardon DC. Induced abortion and traumatic stress: A preliminary comparison of American and Russian women. Med Sci Monit. 2004;10(10):SR5–16.
7. Biggs MA, Neilands TB, Kaller S, Wingo E, Ralph LJ. Developing and validating the Psychosocial Burden among people Seeking Abortion Scale (PB-SAS). Vaingankar JA, editor. PLoS One [Internet]. 2020 Dec 10 [cited 2021 Feb 8];15(12 December):e0242463. Available from: https://dx.plos.org/10.1371/journal.pone.0242463
8. Elliot Institute. Forced Abortion in America: A Special Report [Internet]. Springfield IL; 2004. Available from: https://afterabortion.org/new-elliot-institute-report-exposed-americas-f...
9. Reardon DC. The abortion and mental health controversy: A comprehensive literature review of common ground agreements, disagreements, actionable recommendations, and research opportunities. SAGE Open Med [Internet]. 2018;6:205031211880762. Available from: http://journals.sagepub.com/doi/10.1177/2050312118807624
10. Reardon DC, Craver C. Effects of pregnancy loss on subsequent postpartum mental health: A prospective longitudinal cohort study. Int J Environ Res Public Health [Internet]. 2021 Feb 2 [cited 2021 Mar 17];18(4):1–11. Available from: https://pubmed.ncbi.nlm.nih.gov/33672236/
11. Reardon DC, Coleman PK. Relative treatment rates for sleep disorders and sleep disturbances following abortion and childbirth: a prospective record-based study. Sleep. 2006;29(1):105–6.
12. Calhoun BC, Shadigian E, Rooney B. Cost consequences of induced abortion as an attributable risk for preterm birth and impact on informed consent. J Reprod Med. 2007;52(10):929–37.
13. Reardon DC, Thorp JM. Pregnancy associated death in record linkage studies relative to delivery, termination of pregnancy, and natural losses: A systematic review with a narrative synthesis and meta-analysis. SAGE Open Med [Internet]. 2017 Dec 13 [cited 2018 Aug 15];5:205031211774049. Available from: http://journals.sagepub.com/doi/10.1177/2050312117740490
14. Gissler M, Berg C, Bouvier-Colle M-H, Buekens P. Injury deaths, suicides and homicides associated with pregnancy, Finland 1987-2000. Eur J Public Health. 2005 Oct;15(5):459–63.
15. Reardon D, Strahan T, Thorp … J. Deaths Associated with Abortion Compared to Childbirth-A Review of New and Old Data and the Medical and Legal Implications [Internet]. J. Contemp. Health …. 2003. Available from: http://heinonlinebackup.com/hol-cgi-bin/get_pdf.cgi?handle=hein.journals...
16. Foster DG. The Turnaway Study: ten years, a thousand women, and the consequences of having--or being denied--an abortion. New York, NY: Scribner; 2020. p. 360.
It is a humble request if you could kindly specify the names of villages and areas that you surveyed, as it would be of immense help and guidance.
Thank you
A very informative and well-round study that gives a somewhat comprehensive explantation (as a pioneer study) on how scientists from different fields interact with policymakers during the COVID19-pandemic. It gives a good explanation of how difficult the “sandwich position” seems to be when you have to work in a field requiring interdisciplinary competencies.
Some critique points might include the fact that one of the interviewed scientists mentioned, that wearing a mask was not effective (P4, the Netherlands on page 5). Given the view from a very European perspective, a view over to the Asian neighbours would have or could have clarified this point. (1)
The European point is another thing that needs to be taken into consideration. Although the authors mentioned that the result might not apply to other parts of the world, it is crucial to mention that this issue needs to be addressed if we talk about a better interdisciplinary workforce globally during a pandemic.
Moreover, could a quantitative approach would have led to different results? Maybe the purview or range among scientists would have been more applicable with a fitting survey so that more scientists in related fields and positions could have been reached.
Fears and reservations about anonymity could be eradicated by this study design over a potentially large(r) study population.
However, I would like to thank you for this paper and hope that broader research on the field could bring...
A very informative and well-round study that gives a somewhat comprehensive explantation (as a pioneer study) on how scientists from different fields interact with policymakers during the COVID19-pandemic. It gives a good explanation of how difficult the “sandwich position” seems to be when you have to work in a field requiring interdisciplinary competencies.
Some critique points might include the fact that one of the interviewed scientists mentioned, that wearing a mask was not effective (P4, the Netherlands on page 5). Given the view from a very European perspective, a view over to the Asian neighbours would have or could have clarified this point. (1)
The European point is another thing that needs to be taken into consideration. Although the authors mentioned that the result might not apply to other parts of the world, it is crucial to mention that this issue needs to be addressed if we talk about a better interdisciplinary workforce globally during a pandemic.
Moreover, could a quantitative approach would have led to different results? Maybe the purview or range among scientists would have been more applicable with a fitting survey so that more scientists in related fields and positions could have been reached.
Fears and reservations about anonymity could be eradicated by this study design over a potentially large(r) study population.
However, I would like to thank you for this paper and hope that broader research on the field could bring also global perspectives and answers into account.
(1) Galvin CJ, Li YJ, Malwade S, Syed-Abdul S. COVID-19 preventive measures showing an unintended decline in infectious diseases in Taiwan. Int J Infect Dis. 2020 Sep;98:18-20. DOI: 10.1016/j.ijid.2020.06.062. Epub 2020 Jun 23. PMID: 32585283; PMCID: PMC7308751.
Vaccines are our only promising key to minimizing the spread of the virus and returning to a normal life. Lockdowns and quarantines have a negative impact on people’s mental health and social lives. Vaccine passports can allow us to participate in certain activities such as traveling without having to go through extreme channels such as quarantining for weeks when you travel into or outside of a country. This can helps us transition back to life before COVID-19 while minimizing the fears of spreading the virus globally.
Dear Authors, very interesting and convincing study. It is known that smallpox and polio have no human reservoirs (only infecting Humans) making the vaccine strategy very efficient. However, what about the animal reservoirs of covid-19 ? If such animal reservoirs of covid-19 exists it (highly likely, and proposed as the initial step of the pandemy: infection of an human from an animal carrying covid-19 in Wuhan...) will make the eradication of the virus impossible, except if you vaccinate those animals also or kill them simply...Did you take into account animal reservoirs in your study (the big difference with smallpox and polio used as exemple). Regards. M Maresca
In the BMJ Global Health article, “Is the cure really worse than the disease? The health impacts of lockdowns during COVID-19“, Meyerowitz-Katz et al. (1) seek to assess the impact of lockdowns on population health. However, any comprehensive evaluation of the impacts of lockdown may benefit from including the broader effects that such restrictions may have on health due to environmental changes - particularly in regard to air pollution and greenhouse gas (GHG) emissions and the flow-on effects these have on human health due to climate change.
As described by the authors, lockdowns are associated with broad detriments to human health and are generally undesirable. However, there is now considerable evidence that lockdowns result in noticeable decreases in air pollution. The 6th IPCC Assessment Report deems with high confidence that air quality improved as a result of COVID-19 lockdowns (2). When global lockdowns reached their most widespread point in April 2020, global CO2 emissions decreased by 17% (3), while global NOx emissions decreased by 30% (4), representing reductions in both long-lived and short-lived climate forcers.
Unfortunately, though these variations are measurable, the effect of such fluctuations on climate change are likely to be negligible (4) and transitory in nature (5, 6). Despite the popular perception that “nature is healing” as a result of lockdowns, the effects are unlikely to mitigate climate change on their own.
In the BMJ Global Health article, “Is the cure really worse than the disease? The health impacts of lockdowns during COVID-19“, Meyerowitz-Katz et al. (1) seek to assess the impact of lockdowns on population health. However, any comprehensive evaluation of the impacts of lockdown may benefit from including the broader effects that such restrictions may have on health due to environmental changes - particularly in regard to air pollution and greenhouse gas (GHG) emissions and the flow-on effects these have on human health due to climate change.
As described by the authors, lockdowns are associated with broad detriments to human health and are generally undesirable. However, there is now considerable evidence that lockdowns result in noticeable decreases in air pollution. The 6th IPCC Assessment Report deems with high confidence that air quality improved as a result of COVID-19 lockdowns (2). When global lockdowns reached their most widespread point in April 2020, global CO2 emissions decreased by 17% (3), while global NOx emissions decreased by 30% (4), representing reductions in both long-lived and short-lived climate forcers.
Unfortunately, though these variations are measurable, the effect of such fluctuations on climate change are likely to be negligible (4) and transitory in nature (5, 6). Despite the popular perception that “nature is healing” as a result of lockdowns, the effects are unlikely to mitigate climate change on their own.
Yet even so, they have demonstrated that behavioural change is possible, and that it is within human behaviour to reduce greenhouse gas emissions (2, 5). Behavioural pattern shifts from the pandemic – away from motor vehicle use and with decreased output from emissions-intensive industries – will cause a short-term decrease in CO2 emissions of 5% over 5 years - a change we should strive to build upon (7, 8). Lockdowns demonstrate that reducing emissions can indeed produce tangible effects on the environment.
Therefore, more than any numerical reduction in emissions, lockdowns may have given the global effort against climate change something altogether more powerful: strong evidence that widespread behavioural changes in favour of emissions reductions are possible. In short, it has given us hope. Hope that governments can – when determined – take rapid, drastic action to meet oncoming global crises. Hope that we can make a difference, and it is not beyond our collective, concerted efforts to improve our environment.
The pandemic itself, meanwhile, has been a timely wake-up call to societies that we are not invulnerable to the forces of nature – and the devastating consequences of inaction.
Together they have delivered us both a stern warning and the confidence that we can address such crises. Lockdowns are detrimental to human health, yes. But as the biggest disruption to “business as usual” in decades, they also offer all of humanity an inflection point for action, that with appropriate behavioural changes we can reduce our GHG emissions and curtail climate change’s effects in order to protect global health (9).
I do not contend that lockdowns should be employed as a solution to the climate crisis. But governmental responses to COVID-19 should serve as a blueprint for climate action, with similar resources and impetus mustered to address a comparable global threat. In the same way that economic incentives and stimulus measures such as Australia’s JobKeeper were leveraged to protect vulnerable segments of society and ease economic disruption (10, 11), so too should similar fiscal levers be utilised to incentivise clean energy transitions, retraining programs for fossil fuel-dependent communities, and the adoption of sustainable technologies and systems.
To conclude, though lockdowns exact a toll, any comprehensive evaluation of their effects on health should consider their associated reductions in air pollution and greenhouse gas emissions, and the potential ramifications they may have for the climate crisis. The drastic alteration of human behaviour – appropriately supported and facilitated by government intervention - offers humanity an inflection point to prevent climate change and a timely call to action that we must not squander.
References:
1. Meyerowitz-Katz G, Bhatt S, Ratmann O et al. Is the cure really worse than the disease? The health impacts of lockdowns during COVID-19. BMJ Global Health 2021;6:e006653. doi:10.1136/bmjgh-2021-006653
2. Intergovernmental Panel on Climate Change (IPCC), 2021. Climate Change 2021: The Physical Science Basis. Contribution of Working Group I to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge University Press. In Press. Available from: https://www.ipcc.ch/report/ar6/wg1/downloads/report/IPCC_AR6_WGI_Full_Re...
3. Le Quéré C, Jackson R, Jones M et al. Temporary reduction in daily global CO2 emissions during the COVID-19 forced confinement. Nature Climate Change 2020;10:647-653. doi:10.1038/s41558-020-0797-x
4. Forster P, Forster H, Evans M et al. Current and future global climate impacts resulting from COVID-19. Nature Climate Change 2020;10:913-919. doi:10.1038/s41558-020-0883-0
5. Li L, Li Q, Huang L et al. Air quality changes during the COVID-19 lockdown over the Yangtze River Delta Region: An insight into the impact of human activity pattern changes on air pollution variation. Science of The Total Environment 2020;732:139282. doi:10.1016/j.scitotenv.2020.139282
6. Shi Z, Song C, Liu B et al. Abrupt but smaller than expected changes in surface air quality attributable to COVID-19 lockdowns. Science Advances 2021;7. doi:10.1126/sciadv.abd6696
7. Shan Y, Ou J, Wang D et al. Impacts of COVID-19 and fiscal stimuli on global emissions and the Paris Agreement. Nature Climate Change 2020;11:200-206. doi:10.1038/s41558-020-00977-5
8. Le Quéré C, Peters G, Friedlingstein P et al. Fossil CO2 emissions in the post-COVID-19 era. Nature Climate Change 2021;11:197-199. doi:10.1038/s41558-021-01001-0
9. Venter Z, Aunan K, Chowdhury S et al. COVID-19 lockdowns cause global air pollution declines. Proceedings of the National Academy of Sciences 2020;117:18984-18990. doi:10.1073/pnas.2006853117
10. Kent K, Murray S, Penrose B et al. Prevalence and Socio-Demographic Predictors of Food Insecurity in Australia during the COVID-19 Pandemic. Nutrients 2020;12:2682. doi:10.3390/nu12092682
11. Bryson H, Mensah F, Price A et al. Clinical, financial and social impacts of COVID-19 and their associations with mental health for mothers and children experiencing adversity in Australia. PLOS ONE 2021;16:e0257357. doi:10.1371/journal.pone.0257357
Since long, the debate on meritocracy has been in the academic circle which originated from academicians, researchers, professionals and students belonging to ‘lower and/or backward’ castes. However, not much attention was paid to such discussions by the privileged and elite majorly because of their vested interests associated with it or due to the fact that we considered this caste as an uneducated, uncivilized and voiceless community unless they are educated and speak for themselves their voice become a part of the politicization of caste system.
This uncomfortable point is time and again raised by many on several instances like suicide of Rohith Vemula (Leonard, 2019: 52), hurling abuses by Prof Seema Singh to the marginalized caste students in IIT Kg (Datta, 2021), etc. however, meritocracy becomes a topic of intense discussion when a globally recognized political philosopher Michael Sandel put them into words and problematizing the way the elites think.
Once again, the lateral entry in UPSC was criticised at various fronts ranging from students’ protests to policy researchers. The connection of meritocracy with public policy and public health is due to technocracies and the policy decisions which were not so fruitful in the recent past. However, this was the same danger which dissenters were warning the world. That reminds us of Avengers Endgame when Tony Stark said to Steve Rogers that we are Avengers and not “pre-vengers”.
Since long, the debate on meritocracy has been in the academic circle which originated from academicians, researchers, professionals and students belonging to ‘lower and/or backward’ castes. However, not much attention was paid to such discussions by the privileged and elite majorly because of their vested interests associated with it or due to the fact that we considered this caste as an uneducated, uncivilized and voiceless community unless they are educated and speak for themselves their voice become a part of the politicization of caste system.
This uncomfortable point is time and again raised by many on several instances like suicide of Rohith Vemula (Leonard, 2019: 52), hurling abuses by Prof Seema Singh to the marginalized caste students in IIT Kg (Datta, 2021), etc. however, meritocracy becomes a topic of intense discussion when a globally recognized political philosopher Michael Sandel put them into words and problematizing the way the elites think.
Once again, the lateral entry in UPSC was criticised at various fronts ranging from students’ protests to policy researchers. The connection of meritocracy with public policy and public health is due to technocracies and the policy decisions which were not so fruitful in the recent past. However, this was the same danger which dissenters were warning the world. That reminds us of Avengers Endgame when Tony Stark said to Steve Rogers that we are Avengers and not “pre-vengers”.
Similarly, scientists believing in the perfect ‘built-in’ of science is objectifying the pillars of science which are in the language of Thomas Kuhn a scientist cannot rely on objectivism because science relies on subjective worldview, with the new scientific methods, inventions, discoveries for developing new paradigm it is important to redefine corresponding science wherein old problems could become relegated or considered unnecessary, hence thriving on endless subjective possibilities (Kuhn, 2012: 103). Through this, shifting from the linear path to a new paradigm may occur. Hence, believing in one ‘built-in’ and ‘structure’ are not scientific but fulfilling some interests of the ‘rock stars of science’.
The problematization of meritocracy can be viewed from various aspects in this country. The current social structure makes it challenging to develop an inclusive, long term and decentralizing policy whereas the present policy approach is short-sighted non-participatory in nature. The most intriguing instances of the current policy approach are: (1) India being one of the biggest exporter of wheat and millions of people are facing shortage of food; (2) Maharashtra is high performing state in NRHM and women in Palgarh region are suffering from Severe Acute Malnutrition.
The above mentioned problems may look grim but the author also portrays a dim light of hope in the form of collection of extraordinary stories by Dr R Balasubramaniam. These stories represent people who may not come to mainstream education system but with their wit and will they have made a path breaking journey.
Moreover, their remarkable leadership stories tell us about the state of the country. At one hand, unsuccessful implementation of public policies has made the condition of tribal population dreadful, leaving them with limited resources, and on the other hand, the tribals under specific circumstances build up pathways for a better life. These stories make the mainstream meritocrats think about their compassion to uplift others twice and demand introspection. In Dr Srinivas’ words, “authors’ lessons emerge from multiple grounded experiences, many of which were failures of his imagination, which he gladly accepts and learns from, all the while being open to learning more and bowing more”. Thus, the humility which Dawkins asked for. With this, author is challenging the top to bottom approach and demands meritocrats to learn from the grassroots social innovations.
References:
1. Datta, Sayantan. (2021, May 22). Caste and Meritocracy Keep India’s Top Institutions Running. At What Cost? Science The Wire. https://science.thewire.in/education/seema-singh-iit-kharagpur-students-...
2. Kuhn, T. S. (2012). The structure of scientific revolutions: With an Introductory Essay by Ian Hacking. The Structure of Scientific Revolutions (pp. 1–128). The University of Chicago Press.
3. Leonard, D. (2019). Towards a caste-less community :Dalit experience and thought as “movement.” Economic and Political Weekly, 54(21), 47–54.
An additional factor of importance in the perception of a gender imbalance is the consequence of an age difference between partners (e.g. groom and bride) and the growth rate of the respective society. If, for example, there was a constant age difference of 5 years between (older) men and (younger) woman, and around 2% of annual population growth, leading to an increase of 10% in the number of births over each 5 years, that in its effect would just counterbalance a 10:9 sex imbalance (around 47.5% women to 52.5% men). In a shrinking society with a similar preference for younger women, the two effects would add and the imbalance in birth rates would feel even worse for men.
The imbalance would ultimately affect the “market power” of the respective genders in partnerships and/or the “marriage market”. If women actually prefer a partner of similar age, and woman of one cohort can start to pursue that preference due to the “oversupply” of men, this would further enhance the marriage squeeze for men, as even more of the older bachelors would be left out while the women turn to the younger competitors of the older men. Certainly, in the advent of such transition, some men will overlook that effect and thus be left out unmarried once the patterns have changed.
A gradual increase of the age of marriage may also trigger or enhance that effect: Young women (or their parents, to the extent they are participating in the choice of their daughters partner or life partner)...
An additional factor of importance in the perception of a gender imbalance is the consequence of an age difference between partners (e.g. groom and bride) and the growth rate of the respective society. If, for example, there was a constant age difference of 5 years between (older) men and (younger) woman, and around 2% of annual population growth, leading to an increase of 10% in the number of births over each 5 years, that in its effect would just counterbalance a 10:9 sex imbalance (around 47.5% women to 52.5% men). In a shrinking society with a similar preference for younger women, the two effects would add and the imbalance in birth rates would feel even worse for men.
The imbalance would ultimately affect the “market power” of the respective genders in partnerships and/or the “marriage market”. If women actually prefer a partner of similar age, and woman of one cohort can start to pursue that preference due to the “oversupply” of men, this would further enhance the marriage squeeze for men, as even more of the older bachelors would be left out while the women turn to the younger competitors of the older men. Certainly, in the advent of such transition, some men will overlook that effect and thus be left out unmarried once the patterns have changed.
A gradual increase of the age of marriage may also trigger or enhance that effect: Young women (or their parents, to the extent they are participating in the choice of their daughters partner or life partner) may prefer a somewhat older partner that has gained some experience in life and some economic wellbeing and thus can provide safety for a family. If women decide to marry later, partner of their own age will already be established in the workplace and thus deem adequate. The transitory effect, e.g. a cohort of women marrying around 20 combining with men around 25, to be followed by a cohort women that prefers to marry men of similar age when the marry at an age of around 25 or 30 will again contribute to a male shortfall.
Conversely, a surplus of male bachelor could also lead to them turning to increasingly young women or girls as wives, where local legislation allows, to offset the shortfall. That could, however, never be a permanent remedy and it should be investigated if such an effect is statistically visible at all among effects that provide for a lower age difference.
Effects to the other direction probably occurred when a significant proportion of men died in wars, as happened in Germany during the world wars, and led to a deficiency of men. As the age difference to their partner preferred by men gradually increase with age, and a male deficit makes it easier to pursue their preferences, a relative surplus of younger women can be absorbed rather easily: Even if every second man would disappear due to war, a relative balance could still be maintained if x% of all men of 20 to 29 combine with x% of women of 20 to 24, y% of the (remaining) men of 30 to 39 combine with y% of women of 25 to 29, and so on;
It can be assumed that a surplus or deficit in men or woman also affects the difference in age at marriage.
A statistical analysis should there look if the causing events “loss of young men in war” or “loss of female births due to prenatal sex selection” leads to a shift in the age difference between (first-time) grooms and brides. The evolution of dowries (payments by the bride’s parents) and of bride prices (payments to the bride’s parents) as a result of prenatal sex selection or other changes would also warrant attention.
A more elaborate investigation would also look at effects of male or female surplus in different social strata of society. Under conventional attitudes, it could be expected that in a male surplus situation, men marry “downwards” the social ladder and poorer men remain involuntary bachelors, while upward mobility through marriage becomes easier for women. In systems that allow some identification of the social status of persons by aspects like the Caste system in India and the Hukou system in China, these effects possibly can be identified more easily. Men belonging to one of the higher strata can be expected to fare better under male surplus conditions.
If parents are made to learn earlier that the prospects of male and female descendants are changing, that should reduce their tendencies for prenatal sex selection.
The authors report a reduction in transmission in households regularly disinfecting with chlorine or ethanol based agents, but what is being disinfected is quite vague. Does this include household that, for example, only use bleach in the bathroom? Was this limited to household disinfecting ALL non-porous contacted surfaces? Did this include the use of bleach on laundry? If the authors could clarify what cleaning practices this actually encompasses, that would be appreciated.
Dear sir,
We herewith report effects of disruptions on maternal and child health services in Maharashtra, India.
Covid 19- collateral damage on nutrition of women and children, in Maharashtra, India
Phadke M1,Nair R2,Menon P3,Jotkar R4, Saunik S5
India has been battling the Covid 19 pandemic like most other countries of the world. The first two waves, particularly the second wave produced devastating effects on many aspects of human health and welfare .Disease mortality and morbidity was unparalleled. In addition to these direct effects of Covid 19 disease itself, a number of indirect effects of Covid 19 on women, adolescent girls and children occurred. Lockdowns, loss of jobs, decrease in salaries, migration, supply chain disruption, inadequacy and inaccessibility of foods, green vegetables, stoppage of midday meals due to school closures, inadequate distribution of iron folic acid tablets from anganwadis impacted women and children’s nutrition.
Show MoreDisruptions in maternal health services have been reported 1. We report two observations on occurrence of Neural tube defects and severe acute malnutrition in children during the years from 1st January to 31st December of 2020 and 2021. A team of doctors under the national health program of RBSK(Rashtriya Bal Swasthya Karyakram), examined children for '4Ds' i.e. Defects at birth, Diseases in children, Deficiency conditions and Developmental delays including disabilities. The year...
Dear Editor,
I am extremely puzzled by the lack of any response regarding my proposed comments regarding this article. I've submitted my comments twice, but they have not been published. I cannot imagine why. It appears to be a discretionary censorship, which is of course contrary to BMJ's published editorial policies which generally favor respectful discourse. I would greatly appreciate an explanation and an appeal to a larger panel of BMJ editors.
To repeat...for the third time,... regarding this article:
There is a growing interest in developing evidenced based standards for public health policy initiatives.[1] In response to this effort, Burris et al have put forward their own initial effort to identify the potential effects of laws regulating abortion on women’s health.[2] Unfortunately, they apparently failed to include in their research team anyone with familiarity with the literature regarding the negative physical and psychological effects of coerced and unnecessary abortions. This is not a minor oversight.
Regarding the issue of women’s autonomy, increasing legal access to abortion is a double-edged sword. Easier access makes it easier for women to choose abortion for their own self-interests, but it also makes it easier for those pressuring women into unwanted abortions to abuse women’s rights.[3]
Coerced abortions are especially common among women enslaved in sex trafficking.[4,5] But it is also common within...
Show MoreIt is a humble request if you could kindly specify the names of villages and areas that you surveyed, as it would be of immense help and guidance.
Thank you
A very informative and well-round study that gives a somewhat comprehensive explantation (as a pioneer study) on how scientists from different fields interact with policymakers during the COVID19-pandemic. It gives a good explanation of how difficult the “sandwich position” seems to be when you have to work in a field requiring interdisciplinary competencies.
Show MoreSome critique points might include the fact that one of the interviewed scientists mentioned, that wearing a mask was not effective (P4, the Netherlands on page 5). Given the view from a very European perspective, a view over to the Asian neighbours would have or could have clarified this point. (1)
The European point is another thing that needs to be taken into consideration. Although the authors mentioned that the result might not apply to other parts of the world, it is crucial to mention that this issue needs to be addressed if we talk about a better interdisciplinary workforce globally during a pandemic.
Moreover, could a quantitative approach would have led to different results? Maybe the purview or range among scientists would have been more applicable with a fitting survey so that more scientists in related fields and positions could have been reached.
Fears and reservations about anonymity could be eradicated by this study design over a potentially large(r) study population.
However, I would like to thank you for this paper and hope that broader research on the field could bring...
Vaccines are our only promising key to minimizing the spread of the virus and returning to a normal life. Lockdowns and quarantines have a negative impact on people’s mental health and social lives. Vaccine passports can allow us to participate in certain activities such as traveling without having to go through extreme channels such as quarantining for weeks when you travel into or outside of a country. This can helps us transition back to life before COVID-19 while minimizing the fears of spreading the virus globally.
Dear Authors, very interesting and convincing study. It is known that smallpox and polio have no human reservoirs (only infecting Humans) making the vaccine strategy very efficient. However, what about the animal reservoirs of covid-19 ? If such animal reservoirs of covid-19 exists it (highly likely, and proposed as the initial step of the pandemy: infection of an human from an animal carrying covid-19 in Wuhan...) will make the eradication of the virus impossible, except if you vaccinate those animals also or kill them simply...Did you take into account animal reservoirs in your study (the big difference with smallpox and polio used as exemple). Regards. M Maresca
In the BMJ Global Health article, “Is the cure really worse than the disease? The health impacts of lockdowns during COVID-19“, Meyerowitz-Katz et al. (1) seek to assess the impact of lockdowns on population health. However, any comprehensive evaluation of the impacts of lockdown may benefit from including the broader effects that such restrictions may have on health due to environmental changes - particularly in regard to air pollution and greenhouse gas (GHG) emissions and the flow-on effects these have on human health due to climate change.
As described by the authors, lockdowns are associated with broad detriments to human health and are generally undesirable. However, there is now considerable evidence that lockdowns result in noticeable decreases in air pollution. The 6th IPCC Assessment Report deems with high confidence that air quality improved as a result of COVID-19 lockdowns (2). When global lockdowns reached their most widespread point in April 2020, global CO2 emissions decreased by 17% (3), while global NOx emissions decreased by 30% (4), representing reductions in both long-lived and short-lived climate forcers.
Unfortunately, though these variations are measurable, the effect of such fluctuations on climate change are likely to be negligible (4) and transitory in nature (5, 6). Despite the popular perception that “nature is healing” as a result of lockdowns, the effects are unlikely to mitigate climate change on their own.
Yet even so...
Show MoreSince long, the debate on meritocracy has been in the academic circle which originated from academicians, researchers, professionals and students belonging to ‘lower and/or backward’ castes. However, not much attention was paid to such discussions by the privileged and elite majorly because of their vested interests associated with it or due to the fact that we considered this caste as an uneducated, uncivilized and voiceless community unless they are educated and speak for themselves their voice become a part of the politicization of caste system.
This uncomfortable point is time and again raised by many on several instances like suicide of Rohith Vemula (Leonard, 2019: 52), hurling abuses by Prof Seema Singh to the marginalized caste students in IIT Kg (Datta, 2021), etc. however, meritocracy becomes a topic of intense discussion when a globally recognized political philosopher Michael Sandel put them into words and problematizing the way the elites think.
Once again, the lateral entry in UPSC was criticised at various fronts ranging from students’ protests to policy researchers. The connection of meritocracy with public policy and public health is due to technocracies and the policy decisions which were not so fruitful in the recent past. However, this was the same danger which dissenters were warning the world. That reminds us of Avengers Endgame when Tony Stark said to Steve Rogers that we are Avengers and not “pre-vengers”.
Similarly, scien...
Show MoreAn additional factor of importance in the perception of a gender imbalance is the consequence of an age difference between partners (e.g. groom and bride) and the growth rate of the respective society. If, for example, there was a constant age difference of 5 years between (older) men and (younger) woman, and around 2% of annual population growth, leading to an increase of 10% in the number of births over each 5 years, that in its effect would just counterbalance a 10:9 sex imbalance (around 47.5% women to 52.5% men). In a shrinking society with a similar preference for younger women, the two effects would add and the imbalance in birth rates would feel even worse for men.
The imbalance would ultimately affect the “market power” of the respective genders in partnerships and/or the “marriage market”. If women actually prefer a partner of similar age, and woman of one cohort can start to pursue that preference due to the “oversupply” of men, this would further enhance the marriage squeeze for men, as even more of the older bachelors would be left out while the women turn to the younger competitors of the older men. Certainly, in the advent of such transition, some men will overlook that effect and thus be left out unmarried once the patterns have changed.
A gradual increase of the age of marriage may also trigger or enhance that effect: Young women (or their parents, to the extent they are participating in the choice of their daughters partner or life partner)...
Show MoreThe authors report a reduction in transmission in households regularly disinfecting with chlorine or ethanol based agents, but what is being disinfected is quite vague. Does this include household that, for example, only use bleach in the bathroom? Was this limited to household disinfecting ALL non-porous contacted surfaces? Did this include the use of bleach on laundry? If the authors could clarify what cleaning practices this actually encompasses, that would be appreciated.
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