SOCIAL ISSUES

1. LONELINESS: A PUBLIC HEALTH CONCERN

Context:

• Recently, World Health Organisation (WHO) declared a pressing, albeit underappreciated, global health threat ‘loneliness’ in its report.

What is loneliness?

• Definition – It is largely understood to be “the unpleasant experience that occurs when a person’s network of social relations is deficient in some important way, either quantitatively or qualitatively,” and is computed as an experience other than ‘social isolation.

Vulnerable population

• World Health Organisation (WHO) – At least 10% of adolescents, and 25% of older people are lonely.
• The Global State of Social Connections– At least 25% of 4.5 billion people felt ‘lonely’ or ‘very lonely’ in 2023.
• Spread – WHO clarified in 2023 that loneliness impact the health and well-being of all age groups across the world.
• Reason for higher levels – Wars, climate change and social inequality have only accelerated this ‘silent’ threat.
• Impact of Covid pandemic – It have calcified loneliness as a feature of daily life, with implications on people’s long-term mental and physical health, longevity and well-being.
• Measure - The WHO has established a Commission on Social Connection (2024–2026) with the intent of addressing loneliness from a public health lens.
• It will propose a global agenda on social connection and work to develop solutions targeting loneliness as a medical and social condition.

What is India’s status in Loneliness?

Loneliness in India

• 2004 NSSO study – About 49.1 lakh people (12.3 lakh men and 36.8 lakh women) were living alone and suffered from loneliness.
• In 2012, self-reported loneliness was found to be 17.3% and 9.5% in urban and rural adolescents, respectively.
• Loneliness among younger people – The Centre for the Study of Developing Societies (CSDS) in 2017 studied 6,000 people aged 15-34 years across 19 States.
• 12% of India’s youth reported feeling depressed often, and about 8% frequently felt lonely.
• Loneliness among the elderly – The Longitudinal Ageing Study in India (LASI) in 2017-18 surveyed 72,000 people from 35 States and Union Territories.
• 20.5% of adults aged 45 years and above reported moderate loneliness, and 13.3% were severely lonely.
• Gender vulnerability – The odds of loneliness were higher among females as compared to males.
• A taboo in our society – There is lack of acknowledgment of mental health issues as people see poor mental health as a “collective problem” that reflects badly on the family, even impairing one’s marriage eligibility.
• Why loneliness as a public health concern in India?
• A fertiliser of other diseases – It can thus inflame India’s rising communicable and non-communicable disease burden.
• The 2017 LASI found that loneliness also increased the odds of major depressive disorder and insomnia symptoms.
• Emerging dementia epidemic - Mental health disorders like depression, anxiety disorders, bipolar disorder have risen steadily over the last few years.

What are the reasons for India’s loneliness epidemic?

• Social inequity – People belonging to marginalised communities go through loneliness intensely.
• Socioeconomic challenges – High poverty, income inequality, low education, high dependency ratio is making people depressed.
• Higher dependence on monsoon – There is rising farmer suicides due to the burden of seasonal droughts.
• Rapid urbanisation and changing family structure – The suicides of daily wage or migrant workers is more due to their disintegration at their village home as well as the lack of any family structure in the urban setting.
• Reduced social cohesion and support – Changing lifestyles erode kinship ties and interpersonal relationships.
• Slum rehabilitation issues - The 2022 study in Mumbai reported that slum rehabilitation dwellers loneliness was partly due to random allocation of flats.
• It hampered their collective identity, weakened their social support network, and significantly led to loneliness.
• Attachment to Social media – Social media has uniformly been linked to rising loneliness.
• Impact of COVID-19 pandemic – Loneliness among young people is on the rise.
• Chronic illnesses – It exacerbate loneliness among people.
• Institutional deficiencies – According to a 2023 report by a Standing Committee on Health and Family Welfare, India lags with inadequate staff, medical infrastructure and budgetary allocation.

What has to be done?

• Change perspectives – Treat loneliness as a conditions itself rather than considering as a symptom or state of mind.
• Tailored treatments – Treat loneliness as a distinct social and medical condition to develop targeted interventions specific to people’s cultural context.
• Capacity building – Investing in mental healthcare facilities, training doctors and setting up health provisions in AIIMS.
• India has launched suicide and mental health help lines.
• Scale up digital infrastructure – Develop and improve digital mental health programming infrastructure.
• Efficient diagnosis and treatment – Find the root cause of loneliness and suggest physical exercise and spending time socially.
• Develop healthcare dedicated to addressing loneliness.
• Promote community intervention – Address deficits in communities by building safe spaces like community facilities, effecting anti-discrimination and equality laws, and tackling the causes and consequences of poverty.
• Conduct national-level survey – It should be conducted in local languages, and questions modified to match people’s cultural context as almost 60% of India which lives offline remains beyond the purview of research paradigms.

2. PM JANMAN SCHEME

Context:

• Recently, India has launched the PM Janjati Adivasi Nyaya Maha Abhiyan a campaign for the tribals.

What is PM-JANMAM scheme?

• Launch- On Janjatiya Gaurav Diwas (Birth anniversary of Birsa Munda) in Jharkhand.
• Objective- To provide essential amenities such as road and telecom connectivity, electricity, secure housing, clean drinking water, sanitation, and improved access to education, health, nutrition, and sustainable livelihood opportunities.
• Awareness generation- The government will showcase and spread awareness of various government schemes made for the tribals.
• Coordinating role- The scheme will be implemented by 9 ministries with Ministry of Tribal Affairs playing the key role.
• Beneficiary- Government has identified 75 tribal communities and primitive tribes with a population of lakhs who reside in more than 22 thousand villages in the country.
• Focus- 11 critical interventions for Particularly Vulnerable Tribal Groups (PVTG).
• Ayush Wellness Centres- It will be set up by the Ministry of AYUSH and AYUSH facilities will be extended to PVTG habitations through mobile medical units.
• Skill enhancement- Ministry of Skill Development and Entrepreneurship will facilitate skill and vocational training in PVTG habitations, multipurpose centres and hostels according to suitable skills of these communities.

What are the challenges in implementation of the scheme?

• Data inaccuracy-There is lack of current data on PVTGs, as no census since 1951 has accounted for them separately.
• Lack of transparency- The current project is going ahead with the baseline surveys but the results are not made public.
• Lack of accountability- The scheme involves multiple ministries, this may lead to issue of overlapping or conflicting mandate, gaps in service delivery etc.,
• Loss of ecological diversity- Some of the interventions such as road construction may affect the availability and quality of natural resources.
• Loss of cultural heritage- The scheme provides education, health, skill development etc., this may result in loss of their intellectual and cultural heritage, and reduce their resilience and adaptability.
• Lack of autonomy- Mobile connectivity, Anganwadi centres and Bandhan Vikas Kendra may bring the PVTGs under the purview of state and market forces and compromise their sovereignty and rights.

What lies ahead?

• National Advisory Council (NAC) 2013 report on the state of PVTGs had recommended that the Ministry of Tribal Affairs should design and conduct a Census specifically for the PVTG communities.
• The Census should not just enumerate but also find out the status of education, health, and housing.

About PVTG

3. SURROGACY LAW

Context:

• Recently, the Delhi High Court has questioned the association of marital status with eligibility for surrogacy under the Surrogacy (Regulation) Act 2021.
• The petitioner challenged Section 2(1)(s) of the Surrogacy Act, which limits the right to avail surrogacy to Indian widows or female divorcees between the ages of 35 and 45.
• The petitioner's plea also challenges the regulation that compels a single woman (widow or divorcee) to utilize her own eggs for surrogacy. Due to her age, using her own gametes is medically inadvisable, and she seeks a donor for female gametes.

What is Surrogacy?

About:

• Surrogacy is an arrangement in which a woman (the surrogate) agrees to carry and give birth to a child on behalf of another person or couple (the intended parent/s).
• A surrogate, sometimes also called a gestational carrier, is a woman who conceives, carries and gives birth to a child for another person or couple (intended parent/s).

Altruistic Surrogacy:

• It involves no monetary compensation to the surrogate mother other than the medical expenses and insurance coverage during the pregnancy.

Commercial Surrogacy:

• It includes surrogacy or its related procedures undertaken for a monetary benefit or reward (in cash or kind) exceeding the basic medical expenses and insurance coverage.

What is the Surrogacy (Regulation) Act, 2021?

Provisions:

• Under the Surrogacy (Regulation) Act, 2021, a woman who is a widow or a divorcee between the age of 35 to 45 years or a couple, defined as a legally married woman and man, can avail of surrogacy if they have a medical condition necessitating this option.
• The intended couple shall be a legally married Indian man and woman, the man shall be between the ages of 26-55 years and the woman shall be between the ages of 25-50 years, and shall not have any previous biological, adopted, or surrogate child.
• It also bans commercial surrogacy, which is punishable with a jail term of 10 years and a fine of up to Rs 10 lakhs.
• The law allows only altruistic surrogacy where no money exchanges hands and where a surrogate mother is genetically related to those seeking a child.

Challenges:

• Exploitation of the Surrogate and the Child: The banning of commercial surrogacy moves from the rights-based approach to a needs-based approach, thus removing the women’s autonomy to make their own reproductive decisions and right to parenthood. One could argue that the state must stop the exploitation of poor women under surrogacy and protect the child’s right to be born. However, the current Act fails to balance these two interests.
• Reinforces Patriarchal Norms: The Act reinforces traditional patriarchal norms of our society that attributes no economic value to women’s work and, directly affecting the fundamental rights of the women to reproduce under Article 21 of the constitution.
• Emotional Complications: In altruistic surrogacy, a friend or relative as a surrogate mother may lead to emotional complications not only for the intending parents but also for the surrogate child as there is great deal of risking the relationship in the course of surrogacy period and post birth.
• Altruistic surrogacy also limits the option of the intending couple in choosing a surrogate mother as very limited relatives will be ready to undergo the process.
• No Third-Party Involvement: In an altruistic surrogacy, there is no third-party involvement. A third-party involvement ensures that the intended couple will bear and support the medical and other miscellaneous expenses during the surrogacy process.
• Overall, a third party helps both the intended couple and the surrogate mother navigate through the complex process, which may not be possible in the case of altruistic surrogacy.

Some Exclusion from Availing Surrogacy Services:

• There is exclusion of unmarried women, single men, live-in partners, and same-sex couples from availing surrogacy services.
• This amounts to discrimination based on marital status, gender, and sexual orientation, and denies them the right to form a family of their choice.

What are the Recent Changes Made by the Supreme Court?

• A government notification in March 2023 amended the law, banning the use of donor gametes.
• It said “intending couples” must use their own gametes for surrogacy.
• The petition was filed in the Supreme Court challenging the amendment as a violation of a woman’s right to parenthood.
• The Court interpreted the requirement for the child to be "genetically related" as being related to the husband.
• The Court emphasized that the law permitting gestational surrogacy is "woman-centric," meaning that the decision to have a surrogate child is based on the woman's inability to become a mother due to her medical or congenital condition.
• The Court clarified that when Rule 14(a) of the Surrogacy Rules Applies, which lists medical or congenital conditions that allow a woman to opt for Gestational Surrogacy, the child must be related to the intended couple, especially the husband.
• Gestational surrogacy is a process where one person, who did not provide the egg used in conception, carries a fetus through pregnancy and gives birth to a baby for another person or couple.
• The Supreme Court stayed the operation of Rule 7 of the Surrogacy (Regulation) Act, 2021, to allow the woman suffering from the Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome —a rare congenital disorder that affects the female reproductive system — to undergo surrogacy using a donor egg.
• Rule 7 of the Surrogacy Act bans use of donor eggs for the procedure.