The Indian Express


Head Line: C-section in India: twice as frequent in 10 years, growth twice as fast as world’s

1) Mains Paper II: Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

Why in news:

  • A study in JAMA Network Open throws the spotlight on the rapid growth of caesarean section births in India.

 Call for monitoring:

  • The proportion of births delivered by cesarean delivery has increased especially fast during the last decade in India, reaching 17.2% in 2010 to 2016 according to the NFHS-4 survey.
  • This level is already higher than that observed in some industrialized countries in Europe such as the Netherlands or Finland.
  • The emerging situation also points to significant regional and sex disparities, with a substantial deficit of cesarean deliveries among underprivileged groups and almost 2 million excess cesarean births every year among more advanced sections of the population.
  • The need to monitor the further progression of cesarean rates is urgent,” the paper states.
  • The researchers list changes in lifestyles, commercial pressure, and cultural factors as some of the plausible explanations for the rise.
  • At the same time, they highlight the importance of making both women and medical professionals aware why C-Sec is not a commercial or lifestyle choice but a medical one.

The numbers:

  • India’s annual birth rate is 2.64 crore per year. The paper flags the growth in C-sec rate to 17.2%, which is above the World Health Organization’s recommendation.
  • In a statement in 2015, WHO said: “Since 1985, the international healthcare community has considered the ‘ideal rate’ for caesarean sections to be between 10% and 15%.
  • New studies reveal that when caesarean section rates rise towards 10% across a population, the number of maternal and newborn deaths decreases.
  • But when the rate goes above 10%, there is no evidence that mortality rates improve.”
  • If caesarean rates are below 5% in a population, WHO suggests it indicates a problem in healthcare access.
  • The new study says the current cesarean rate corresponds to an estimated 4.38 million births per year between 2010-16.
  • The change during the last decade corresponds to an annual rate of increase of 7%, almost twice the rate observed in the world, it says.
  • While China had 5.3 million cesarean births in 2008-2014, the cesarean rate is reportedly contracting.
  • In a matter of years, the study estimates, India will become home to the largest number of cesarean births.

NFHS Report:

  • NFHS-4 data show an institutional and regional skew — 40.9% of babies in private hospitals are born through C-sec as compared to 11.9% of those born in government hospitals.
  • The C-sec figures range from 87.1% of deliveries in private hospitals of urban Tripura (against 36.4% in government sector) to 25.3% of private hospitals in urban Haryana (10.7% in government).
  • In Tripura, the overall government-private gap was 73.7% to 18.1%.

 The choice:

  • Public health experts the world over agree that C-secs save lives. Yet last year, WHO released a document underscoring its concern about rising C-section rates, while there remains a section of women who do not get it when they need it.
  • “Caesarean birth is associated with short- and long-term risks that can extend many years beyond the current delivery and affect the health of the woman, the child and future pregnancies.
  • These risks are higher in women with limited access to comprehensive obstetric care.
  • Caesarean sections are also costly, and high rates of unnecessary caesarean sections can therefore pull resources away from other essential health services,” WHO said.

 Behind the growth:

  • Caesarean packages can range between Rs 9,000 (approved rate under Ayushman Bharat -PMJAY) to well over a lakh in some of the swankier hospitals.
  • C-secs under PMJAY can be reimbursed only if they happen in government hospitals or are pre-authorised by the competent authority to be carried out in a private hospital.
  • Doctors often say that a non-medical C-sec decision is taken at the behest of the mother or the family.
    There are also mothers who want their babies to be born on a particular day or a particular time, leading to a C-sec. There are others who are reluctant to go through protracted labour and want to get it over quickly.
  • According to a paper by the International Union for Scientific Study of Population: “… Unnecessary caesareans generate higher expenditure at individual and national levels and have the potential to divert human and financial resources from higher priority intervention.
  • In 2008, the cost of the global excess/unnecessary C-section delivery was estimated approximately $2.32 billion.


Head Line: Rukmini Callimachi explains: What the fall of the last ISIS village in Syria means

2) Mains Paper III: Security challenges and their management in border areas - linkages of organized crime with terrorism.

  • Role of external state and non-state actors in creating challenges to internal security.

Significance of loss of territory by ISIS:

  • ISIS has been in Iraq since the 2000s. For a long time it held no territory at all.
  • But it was a no less deadly or destructive force then. In many ways, the Caliphate period is an anomaly, an outlier if you look at the arc of the group’s history.
  • Starting in 2014, it took large swathes of territory in Iraq and Syria, and that was the time when it declared itself the Caliphate. At one time, it was literally the size of Great Britain.
  • It collected taxes from millions of people and that allowed them to become the world’s richest terrorist group.
  • It used that safe haven to make a number of innovations including learning how to manufacture their own weapons, their own rockets and mortars.
  • That made it self-sufficient. So territory was crucial to the height they reached as a terrorist organisation.
  • The loss of territory means they no longer have the ability to collect taxes, they no longer have the most visible symbol of their brand which allowed them to recruit tens of thousands of foreign fighters.

What can be reaction of ISIS:

  • In the way people seem to think about ISIS, there is this dichotomy — that ISIS is either territory, or it is an idea in people’s heads.
  • ISIS continues to exist as a physical insurgency, in Iraq and Syria.
  • It has lost its territory but it still has thousands of ISIS fighters just in Iraq and Syria. And that’s not counting their presence outside Iraq and Syria.
  • ISIS’s Khorasan province, its province in East Asia in the Philippines, ISIS’s West Africa province, are not ideas in the heads of people.
  • These are groups that are robust on the ground and there is enough evidence to suggest that there is connective tissue between the affiliates and ISIS’s core group in Iraq and Syria.
  • A claim of an attack in Afghanistan put up by ISIS’s affiliate uses the same template as a claim of attack by ISIS in Iraq or Syria.
  • That shows that ISIS is at a minimum coordinating the media output of its far-flung branches.

Where is ISIS strongest now outside of Iraq and Syria?

  • ISIS’s presence is strong and growing in Afghanistan, in the Philippines and in West Africa.
  • Anecdotally we are seeing evidence of some foreign fighters travelling to these outposts instead of Iraq and Syria, suggesting a pattern.
  • The estimates we have in Afghanistan is that they have 2,500 fighters, according to a recent United Nations report. They are present from Nangarhar to Kunar and Kabul.

Where is all the money that ISIS collected?

  • No one really knows, but some of the ISIS operatives that were caught fleeing ISIS’s last territory in Syria were carrying huge amounts of cash, like $20,000.
  • There are also reports that ISIS has invested some of its cash in local businesses.

Where is Abu Bakr al-Baghdadi, and how strong is his hold over ISIS now?

  • No one really knows where Baghdadi is but the working theory is that he is somewhere in Iraq and Syria.
  • He is the Caliph of the Islamic State, and he is the person to whom every fighter pledges his allegiance and so he remains an important symbol for the group.
  • In 2011, according to the CIA there were only around 700 ISIS fighters in Iraq. There are several multiples of that in Afghanistan today.
  • The Taliban and ISIS are groups that are at odds, and the Taliban has been fighting ISIS for some time. This is not a new development.

Case of India:

  • India is in many ways an example of countering radicalisation.
  • India has close to 200 million Muslims and less than 100 persons have travelled to join the group in Iraq and Syria.
  • Compare that to Tajikistan, a country that has a Muslim population of 9 million. And over 1,300 of them have travelled to join ISIS.
  • The low numbers clearly point to the fact that despite the difficulties, the country still seems to be doing something right.
  • It speaks to the plurality of your society that the ISIS message has not seeped down.

Rohingya issue amid loss of ISIS:

  • SIS is always pushing a narrative of Muslim victimhood, but one of the ironies is that their message has been most receptive amongst Muslims that have experienced little or no discrimination themselves.
  • Take Huzayfah, the Canadian recruit profiled in Caliphate, who explains that he and his family were treated well in Canada, and yet he decided to join the group.
  • By contrast, Muslim communities that have experienced real trauma and true discrimination have been almost immune to ISIS recruitment.
  • There are no reports of a single Rohingya Muslim that has joined ISIS and the number of Uighur Muslims from China that have joined ISIS are miniscule.

Head Line: Setting limits

3) Mains Paper III: Indian Economy and issues relating to planning, mobilization, of resources, growth, development and employment.


  • The former governor of the RBI, Raghuram Rajan, has reignited the debate on the autonomy or independence of the country’s central bank by suggesting that it was perhaps an opportune time to set statutory limits to protect the term of the governor.
  • He said that imposing checks on the government’s powers was important to secure operational independence and to put an end to constant interference by the sovereign, to achieve the broader objective of price and financial stability.
  • The former RBI chief’s remarks appear to have been framed in the context of the exit late last year of Urjit Patel, well before the end of his term, after a spat with the government, as well as his own uneasy relationship during his three-year tenure.

Need for autonomy:

  • Rajan is not alone in voicing this suggestion, some of his predecessors, too, have in the past pitched for a secure five-year term for the RBI Governor,
  • Arguing that a full service central bank — like the one India has — with a mandate not just for monetary policy but also oversight of the financial sector, besides currency management and payments and settlements, needs to be autonomous.

 The conflict between the government and central bank regarding policy measures:

  • The bank and government have differed often over how to achieve its goals-especially on interest rate management and the approach to resolving the issue of bad loans.
  • It is not unusual to see such differences globally — like in the US.
  • Where President, Donald Trump, unhappy with the US Federal Reserve’s stance on interest rates, has issued threats to the world’s most powerful central bank chairman, Jerome Powell.

 Reasons and nature of conflicts:

  • These conflicts are naturally given the shorter political horizon ofelected governments and the need for central banks to take a non-political medium-term approach to achieve price or financial stability.
  • The 2008 financial crisis further
    • Underlined the importance of macro-economic stability.
    • And that the policies for achieving it are inter-linked.
    • Signalling the importance of having a strong central bank free of political compulsions.

 Ways to ensure autonomy:

Making it accountable to parliament

  • One institutional response to ensure that and to shield the central bank from growing political assaults is to make it directly accountable to the Parliament without being dependent on funding, like the way the US Fed derives its powers from the Congress.

Ensuring accountability

  • But that statutory protection to the RBI and its chief must be accompanied by an accountability mechanism.
  • Simply put, there is merit in central bank independence — not unbridled — as there are macro-economic gains which would accrue besides boosting policy credibility.

 Way Forward:

  • Ultimately, as the first Indian governor of the RBI, CD Deshmukh, said seven decades ago, it is not the constitution of the institution that matters, but the spirit in which the partnership between the ministry of finance and the bank is worked.
  • The success of the partnership will, in the final analysis, depend on the manner in which the government asks to be served and provides opportunities accordingly.
  • It is the display of such a spirit by any government that will be critical to the future of India’s public institutions, including the RBI.


Head Line: Time is of the essence, steps must be taken to increase consumption of renewable energy

4) Mains Paper III: Infrastructure: Energy, Ports, Roads, Airports, Railways etc.

  • Conservation, environmental pollution and degradation, environmental impact assessment.


  • Today, every projection of India’s energy future draws the same broad conclusion: energy demand will move on an upward curve, indigenous supplies will fail to keep pace, energy imports will rise, and the environment will face increasing stress.
  • Today, every projection of India’s energy future draws the same broad conclusion.

Energy sector in India:

The International Energy Agency (IEA), multinationals like Exxon-Mobil, BP or Shell, the erstwhile Planning Commission, or now the NITI Aayog Conclusion is that

  • The forecast is that energy demand will move on an upward curve.
  • Indigenous supplies will fail to keep pace with this increase in demand;
  • Energy imports will rise in absolute and relative terms.
  • The environment will face increasing stress.
  • Coal will dominate, oil and gas will have significance; renewables, whilst on a rising trend, will account for a relatively inconsequential share and air pollution, depleting water tables and extreme weather conditions will presage ecological collapse.

 India’s Energy demand:

  • India will import 95 per cent of its oil requirements; 60 per cent of its gas requirements and 30 per cent of its coal requirements (despite the fact that it contains the fifth largest deposits of coal in the world).
  • India will meet its Paris commitments to reduce GHG emissions by 35 per cent in 2035 relative to 2005.
  • But, given this level of fossil fuel consumption, it will be one of the largest absolute emitters of pollutants in the world.

 The reasoning underpinning all these reports is well known:

Abundance of Coal

  • Coal is abundantly available — it is the cheapest of fuels and there are no competitive substitutes for liquids as a fuel for mobility.

High cost for renewables

  • The costs of transitioning to renewables — whether calculated in terms of the sunk costs of stranded thermal power assets or the creation of transmission and distribution infrastructure to overcome the problem of “intermittency” (the sun does not shine all the time; nor does the wind blow with regularity) are huge.

Technology and other constraints

  • There are technological (that is, storage or carbon sequestration) and regulatory (conservation norms, emissions standards) issues to overcome before clean energy can be brought to scale.

How to overcome dependence on energy imports:

  • We have to ask the counterfactual and contemplate the counterintuitive — “What institutional, economic, technological, financial and collaborative steps must be taken to flip the ratio between fossils and renewables in the energy basket of emergent India?

 Way forward:

Replacing the Current views on energy sectors

  • This lens provides a disaggregated picture and encourages a siloed approach to energy governance.
  • It does not facilitate a holistic overview of thelinkages between the different components of energy (oil, gas, coal, renewables, nuclear, hydro, bio, non-commercial);
  • Nor between fuel usage, electricity, mobility, industry, and agriculture, on the one hand, and, ecology on the other.
  • A general equilibrium macro model is required that captures such linkages and enables decision-makers to consider the systemic implications of changes in one or more of these variables.

Creating appropriate Instituions

  • We have to create the appropriate institutional structures of decision-making.
  • The current structure of multiple “energy” ministries (petroleum, coal, renewables, power, atomic) should be collapsed into one omnibus Ministry of Energy and Environment.
  • This will enable integrated decision making; it will also provide a platform for collaborative public-private and constructively “disruptive” innovation.
  • Besides, it will also bring sustainability to the fore of policy.

Legislate Environment Act

  • The government should use its newly derived mandate to legislate an “Energy and Environment Security” Act.
  • The purpose should be to engage the public in the larger debate on how to weaken if not break the current unhealthy nexus between economic growth, energy demand and environmental degradation.

It should be to elevate the objective of wreaking an energy “discontinuity” into a national priority

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