Sunita Reddy

Informed consent in medical decision‐making in commercial gestational surrogacy: a mixed methods study in New Delhi, India

To investigate ethical issues in informed consent for decisions regarding embryo transfer and fetal reduction in commercial gestational surrogacy.

Rajiv Aarogyasri Community Health Insurance Scheme in Andhra Pradesh, India: a comprehensive analytic view of private public partnership model.

The Rajiv Aarogyasri Community Health Insurance (RACHI) in Andhra Pradesh (AP) has been very popular social insurance scheme with a private public partnership model to deal with the problems of catastrophic medical expenditures at tertiary level care for the poor households. A brief analysis of the RACHI scheme based on officially available data and media reports has been undertaken from a public health perspective to understand the nature and financing of partnership and the lessons it provides. The analysis of the annual budget spent on the surgeries in private hospitals compared to tertiary public hospitals shows that the current scheme is not sustainable and pose huge burden on the state exchequers. The private hospital associations in AP, further acts as pressure groups to increase the budget or threaten to withdraw services. Thus, profits are privatized and losses are socialized.

Aarogyasri Scheme in Andhra Pradesh, India: Some Critical Reflections:

Various models are being tried out under Public–Private Partnerships in health care. Community health insurance is one of the models for providing health security for the people Below Poverty Line (BPL). Various states are experimenting on community health insurance with largely state financing, private provisioning of health care, especially curative care. When the partnership is with the for-profit private/corporate sector, where the underlining principle is profit making, the core principal of partnerships of beneficence and equity is undermined. The Aarogyasri scheme started in 2007 as a political move is continuing and praised as one of the most effective ways of treating tertiary, curative, largely surgeries and therapies for BPL population and is completely sponsored by the state. This article critically analyses the procedures and the cost incurred in private and public hospitals and finds that Aarogyasri is skewed towards curative tertiary care and is a big drain on the state exchequer with questions of sustainability. Further, this kind of partnership undermines the existence of large public sector, which is underutilised. The way forward for sustainable and comprehensive health care for people of Andhra Pradesh to ensure ‘Arogyandhra’ is to promote and strengthen public sector.

Medical tourism in India: perceptions of physicians in tertiary care hospitals.

Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians’ however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical issues emerging out of that and the need for understanding the linkages between public and private sectors for a more effective intervention for an equitable medical care policy.

Mega Tourism in Andaman and Nicobar Islands: Some Concerns

Abstract Tsunami has changed lives of thousands of people in the islands of Andaman and Nicobar (A & N) Islands, India since it struck on 26.12.04. The tsunami has posed certain uncertainties in the minds of people about the kind of houses they are going to stay in, the kind of neighbourhoods going to form, the kind of livelihood they are going to indulge in. Providing livelihood to the Tsunami affected is going to be the top most agenda of the administration. The Administrators see this as an opportunity to rebuild the profile of islands, starting from the rebuilding of livelihoods to building of infrastructures, and also reviving and expanding tourism. It is being anticipated that developing tourism at a massive scale would by default generate employment. It would also rebuild the economy, especially matching its scope with the some of the well known international island tourist spots. As per the information obtained from the Information, Publicity and Tourism Department of Andaman and Nicobar Islands, IPNT, a proposal of Rs 5000 crores for developing tourism in the Andaman and Nicobar Islands is submitted to the Ministry of Tourism, Government of India for consideration. It is worthwhile to take stock of the current ecological state of the islands, socio-economic and demographic profile of the people living in these islands. Accessibility to these islands and how far these islands can take the possibilities and pressures of tourism? Whether the fragile ecosystem of the islands can sustain the pressures of the above development? Whether the environmental degradation due to the development can be balanced with the growth in economy? With the proposed pattern of development what irreparable damages will occur to the environment, impact on lives of people and their habitat, their culture and their health?

“There are many eggs in my body”: medical markets and commodified bodies in India

With breakthroughs in science and reproductive technologies, “natural” birthing has undergone change due to the “assisted” use of conceptive technologies. Bodies and their parts have become commodities, to be sold and purchased in medical markets. In the literature, there have been numerous debates on commercialization and commodification, which have addressed the biopolitical and bioethical aspects of organ, egg and sperm donations, and gestational commercial surrogacy. This paper examines the everyday experiences of surrogates and egg donors, coerced and enticed into selling their reproductive services (for familial and socio-economic reasons), which become commodities for the larger medical markets of Indias In Vitro Fertilization (IVF) industry. Based on a qualitative study of 4 IVF clinics and 28 surrogates in a state capital city of a southern state in India, this paper addresses the issue of commodification of womens bodies, where the women from lower socio-economic families are either lured or pushed to respond to the demands of reproductive markets. However, legal gestational commercial surrogacy in India, without clear laws and regulations to guide it, is a complex issue and raises many bioethical concerns. This paper limits itself to addressing the commodification of surrogates’ bodies.

Ecosystems approach to human health: a case of Konda Reddi tribes and womens health.

Abstract The health of humans, like all living organisms, is dependent on an ecosystem that sustains life. Healthy ecosystems are the sine qua non for healthy organisms. The consequences of ecosystem degradation to human health are numerous. Countries across the world have a strong inclination to continue economic growth, even at the cost of severe environmental damage. The human population is now at all-time high, and associated pressures of human activity have led to increasing degradation of the earth’s ecosystems. Ecosystems approaches strive for outcomes that involve long term economic benefit rather than short-term financial gain. Ecosystem approaches to management involves a holistic, ecological view of natural resources and the environment. They recognize that human activity and production takes place within, and not outside of, ecosystems. This paper attempts to view tribal health from the ecosystems approach with the help of a case study of a Primitive Tribal Group; Konda Reddis in Andhra Pradesh, Southern India. The paper focuses on the tribe’s adaptability to their surrounding physical environment. They have harmonious interdependent relationship. However, a change in ecosystem due to human activities, development and modernization is disturbing this harmonious relationship. As a consequence of deforestation, forest rules and exploitation by the non-tribals their survival is threatened and life is becoming more and more challenging. The emphasis is on the adaptation, livelihoods, well-being and survival strategies of the Konda Reddis in this predominantly tropical rain forest environment. It focuses on the human contexts of deforestation and its repercussions on women’s health. This paper focuses on the ethno-ecological knowledge and on local resource management. The study gives emic perspective, the local perception, and gives the indigenous people a voice.

The Asian Tsunami and Post-Disaster Aid: Critical Perspectives

The Asian Tsunami of 2004 drew worldwide attention due to the sheer scale of destruction: massive loss of lives, livelihoods, and infrastructure. It attracted unprecedented international attention, assistance, and aid. While there has been a lot written on the Asian tsunami, mostly by natural scientists, engineers, disaster management, and policy specialists, yet a sustained body of scholarly work in the social sciences on long-term Rehabilitation has not been developed. The existing perspectives from different disciplines are understandably influenced by the enormous loss of property and material devastation and the efforts to manage and mitigate disasters.

New Andamans: The Aftermath of Tsunami in the Andaman and Nicobar Islands

Lieutenant Governor (LG) Ramachandra Ganesh Kapse made a commitment to rebuild the Union Territory of Andaman and Nicobar into ‘New Andamans’ after the 2004 tsunami. He declared that INR 30 billion would be required for reconstructing and modernizing infrastructure in the islands, focusing on tourism, fisheries, and high value agriculture in the process of rehabilitation. This chapter analyzes the development plans post-tsunami, focusing on the long-term rehabilitation, livelihoods, and shelters, by the Andaman and Nicobar Administration. The top-down rehabilitation packages were not suitable to the needs and choices of the people and were thrust upon them. By providing free ration nearly for five years until they were shifted to permanent houses, there was a disjunction in establishing food security and livelihood to the people. Even though they got the ‘tsunami’ houses, although of poor quality, livelihoods of majority remained an unresolved question. The tsunami unearthed many core issues: legal-illegal status of people, encroachment of forestlands, and the whole debate on the ‘development’ plans of the islands. The chapter examines the gap between the bureaucratic norm and the emergent norm: the assessment of the officials about the success of the rehabilitation process and the fulfilment of expectations and needs of the people. The gap between the bureaucratic norm and the emergent norm was far and wide.

Surrogacy in India: Political and Commercial Framings

India stood as a ‘baby cradle’ for the world, and a preferred destination for IVF and surrogacy. Based on the empirical research in different cities in India, and secondary sources, the authors address the policy shifts and the process in which surrogacy became a debatable issue. From unregulated commercial gestational surrogacy, the policy shifted to proposing a complete ban on commercial surrogacy allowing only altruistic surrogacy for Indian couples. The law on surrogacy is still in its making and various stakeholders are advocating towards reversal of the proposed ban, as it will incur financial huge losses for the IVF clinics and surrogates. It is yet to be seen when the law will be passed and what will be the final decision, who will monitor and regulate it.