This is Part II of the Dr. Y.K. Sandhya’s exclusive conversation with LSPR. You can read Part I of the post here.

LSPR: There is a surfeit of communal narrative in some communities like Muslims who have marginally higher fertility rates that they don’t follow family planning. Although the facts show decline in fertility rates amongst muslims, the mainstream  narrative has become highly polarized. How do we navigate through the communal challenge of this narrative and what are your insights about this?

Dr. Sandhaya: In India, it is not just the muslims but poor people who have large families. As per Sachar Committee report, muslims are highly deprived economically. So this contributes to their marginally higher rate of fertility. The feeling is that two is the ideal number of children. People think that the poor people have no idea about this mainstream norm and hence with an infantilizing logic, claim that they should have no agency. There is no one who is willing to understand the perspective with which underprivileged people bear more kids. Due to resource deprivation, they are concerned about infant mortality rate.

With respect to muslims, unfortunately, the psyche of vast majority of Hindu middle class has been communalized. This majority’s minority complex or the fear in upper caste hindus is that one day Islam will have equal or more number of people in the country. This false political narrative is apparent from the whatsapp messages which go around fear-mongering about Islamization.

LSPR:  As someone who has worked on the ground with the muslim community, do you think there is any religious or cultural justification in addition to poor socio-economic status for aversion to family planning?

Dr. Sandhaya: I know that in Islam you should not use contraception and that many women don’t want it. It is also true that we have no alternative available for them even if they want to use it. Their families don’t let them use contraception. Once we went to Muzaffarnagar, the women there were telling us that the health worker never comes to their basti. So the situation is like even if I want to use contraception after outlawing cultural-patriarchal hierarchies, I cannot due to the lack of access. Ideally, if I cannot go to the system to enforce my fundamental right to good maternal health, the system has to come to me in addition to making cultural reforms. So that if I need any contraception, I can get it. It is government’s duty to make it available and tell people about its pros and cons. Privileged majority communities like this sit back and say that muslims are irresponsible but not focus on the structural otherization that plagues implementation of policy. For instance, most of the health providers are hindus primarily because they constitute and overwhelming majority in Indian population. The way in which they make the minority community feel is not welcomed and accepted. And because they don’t feel welcomed they avoid using these public health facilities. Because of this bias and uncomfortable treatment, you find if you see the data that their use of public health system is much less and they use private system because they are respected and not abused. It is the way in which they are turning them away. It is thus not their religion or culture but the failure of the system to reach out to them.

LSPR: Post-2004, there was a rejig in the Public Health policy in the country with the introduction of National Rural Health Mission and Indian Public Health Standards. The policy approach seems to have shifted towards insurance and private sector participation after NDA government came to power in 2014. What are your views about this change in perspective?

Dr. Sandhya: The funding boost and governmental impetus did help the health sector post 2004. What it did was that it put back the public health centres back on the map which got lost before that. And, it kind of strengthened the health infrastructure which was deteriorating. Thus, there was a lot of money pumped into the system which did help a lot and some of it did not. We had schemes which did not actually help for example this Janani Suraksha Yojana.  I don’t think it was one of the brilliant ideas the government had. Because it talked about building demand. You gave money and facilities to woman who did not need it. It did not have adequate number of infrastructural assistance in the primary health centres, but provided the incentive. For example, it did not provide for facilities to deal with obstetric difficulties. I still think that it did bring public healthcare back on the national agenda.

In my opinion, the NDA government is bringing privatization back. The new system is going to convert sub centers into welfare centers.

LSPR: What are your views about the whole gamut of civil society engagement and public accountability enforcement? How has the equation between policy makers and civil society transformed after this government took office and founded NITI Aayog? How is that different from erstwhile National Advisory Council- Planning Commission Framework of UPA.

Dr. Sandhya: It’s extremely important that whatever changes that have happened on the ground are reflected in government policy due to collective action. We have seen that for example Maharashtra which has a community based monitoring system, it functions better and the government has funded and it has taken a long way in Maharashtra to improve. Now the same thing if you take in UP, we don’t have a government mandated community monitoring system.

On a relative scale, I think government responsibility of the last two governments were much more and they welcomed government-civil society integration. So the erstwhile National Advisory Council in previous government allowed for direct civil society engagement with Public Policy. Planning Commission was a more comprehensive body and it had a window where you could come and make a presentation on some issue, talk about it, put your issues on agenda, deliberate and when they made policies they engaged with people and asked them before making the policy. The NITI Aayog now is no longer interested in engaging with civil society. There is no kind of consultation and while it does put out policies online and ask for comments but the policies are not really impacted. So consultation has become more of a formal thing. As civil societies work with human right culture, it has been difficult to integrate and engage with this government’s policy perspective. But one has to keep working with government and provide work which is more palpable. These are really hard times for the civil society activists but one has to keep working on the ground with marginalized and deprived communities to make a real impact. That is the only thing that can save our democracy from the ensuing poison of communal divide that is spreading in the country.

LSPR: Indeed, we have to strengthen our networks of support, solidarity and collective action. It was enlightening to speak with you, Ma’am.

Image Source: The Wire