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Indian Pediatrics 2003; 40:1127-1129 

Indian Academy of Pediatrics and Child Abuse and Neglect and Child Labour (CANCL)

The magnitude and complexities of the problems facing the child population in our country are well known to pediatricians. There is an enormous burden of disease and disability that defies control. Many preventable conditions and deficiency disorders remain widely prevalent. Adverse socioeconomic conditions, poverty, illiteracy and ignorance contribute very significantly to illness and in addition create gigantic problems of exploitation and abuse of children. A burgeoning population may be an aggravating factor, if not the root cause, for most of these. Twenty five million babies are born every year. They need proper perinatal care, nutrition, immunizations, stimulation and attention to early development, which is presently available to only a minority.

Pediatricians, like most other doctors, have been mostly concerned with treatment of the sick child and preventive work. IAP’s contribution in the fields of oral rehydration therapy, promotion of breast feeding, and immunization (particularly polio eradication) is well recognized and widely acclaimed. With advances in medicine and medical technology, IAP formed subspecialty chapters, which enabled us to keep pace with increasing knowledge and translating it into excellence in curative services. Over the years, as our numbers increased, IAP put more emphasis on various other factors that adversely affect child welfare. In 1996 at its annual conference at Mangalore, IAP adopted "comprehensive child care" as its motto. Thereafter a Child Abuse and Neglect and Child Labour (CANCL) Group was established. The Group has chapters in several States and quite a few members are actively involved in CANCL related activities.

Problems of Child Abuse and Neglect and Child Labour (CANCL)

The problems of child abuse and neglect and exploitation of children in its various forms are mind boggling. Whereas some information and data are available on child labour, the extent of engagement of children in non-organized sectors (eating places, vehicle repairs, domestics, small shops, etc.) and street children, ragpickers etc. can only be guessed. Crimes against children including sexual abuse, and trafficking in children appear to be on the increase.

Some facts about child labour in India are worthy of note. Our country has the largest number of child labourers in the world, more than 1.04 crore in 1991 census.

• Every 7th child is economically active, working for himself or family.

• Many of the children begin work by the age of 4.

• Child labourers toil, at an average, for 12 hours a day.

• Child labour contributes to 20% of GDP.

• Half of the child labourers are in Andhra, Madhya Pradesh, Maharashtra and Chhatisgarh.

• 90% of child labourers are in rural areas.

Whose Responsibility is the Child?

Ideally, and perhaps compulsorily, the parents and the immediate family must assume total responsibility for the care of their children. Every child birth should be a planned event. No child should be born as a bye product or a side effect. Indeed, one could argue that ‘not to be born’ should be a fundamental right of the unborn! Once, however, a child arrives in this unjust world he/she deserves the best possible care. Poverty, parental illiteracy and ignorance preclude even basic care in many cases and services freely provided by the Government are not availed of. Optimal nutrition, protection from preventable diseases, a stimulating environment and appropriate education are the essential demands of children and must be met with.

Who Cares for Children?

It is a sad fact of life that except for their parents, nobody cares for children. The society mostly exploits and abuses them. Politicians make pious declarations and use children as exhibits for ceremonial occasions. Various Governmental Child Welfare Schemes and ritualistic pretences to child care appear to have made only a marginal impact. Pediatricians are trained to care for children and readily empathize with them, but have been overwhelmed with the treatment of the large numbers of sick children.

Child’s Rights and Justice

The child’s rights have been defined. Impressive International declarations and lofty agreements have been made. These mostly remain on paper. The rights have to be fought for and obtained, which obviously children cannot do. Who will fight for children’s rights? It is time that all those working for various aspects of child welfare get together and speak up for children. There are acts and laws to protect children, but little infra-structure for their enforcement. Working of children in hazardous occupations is prohibited, but goes on nevertheless.

Persuasion and Accountability

In the absence of adequate parental concern and care, could an element of persuasion be introduced? For example, can it not be made mandatory for the parents to have their children appropriately vaccinated, particularly when such services are freely available? Similarly, the proximate community could be made responsible and accountable for complete vaccine protection of all children in their domain. The village panchayat, Block development and District officials could be made to ensure that children receive basic health services.

Primary Education

Free primary school education for every child has been proposed as a fundamental right. Yet 15% children never go to school and of every 100 who begin 1st class only 52 reach the 5th class. We should propose that primary education be made compulsory and totally free. IAP may adopt "every child in school" as one of its mottos. The necessary inputs, schools, teachers, books, study material and mid-day meals must be provided by the Governments. They must understand that an educated and healthy society will contribute to all round development of the country whereas illiterate and unhealthy masses will constitute a national burden. Once a child is in school, he must stay there and the family should not be allowed to withdraw him and put to work. Obviously parental education and their understanding of the benefits of literacy are necessary to achieve that since education does not bring immediate monetary gains.

Role of Pediatricians and IAP

Pediatricians are the natural spokespersons and advocates for children. The sheer numbers of sick children and a shortage of pediatricians have hitherto prevented them from playing their designated role towards comprehensive child care. With the firm establishment of IAP CANCL Group, we need to increasingly tackle various factors that impede child development and welfare. There are several pediatricians working in different parts of the country in CANCL related issues. Whereas advocacy and creation of awareness are our chief concerns, pediatricians can individually and in groups provide health care to ‘underprivileged’ children. The magnitude of the problems must not lead to frustration and disappointment, which is likely to happen if one works in isolation.

I appeal to all IAP members and other pediatricians to become members of the IAP CANCL Group. While individually one may not be able to spare much time towards CANCL work, the united membership of about 15,000 pediatricians would constitute a very sizable force and could have a major influence on governmental policies and decision-making bodies.

Joining Hands and Cooperation

CANCL groups should interact with Governmental agencies and NGOs and others involved in child welfare activities. We need networking and joining hands to strive for a common goal. There is a plethora of NGOs, small and large, working in various aspects of CANCL in different parts of the country. These mostly work as individual groups and try to maintain their separate identity. Perhaps pediatricians could be a coordinating and cohesive influence. We must work in concert and harmony. There is no limit to what can be achieved provided it does not matter who gets the credit. Perseverance and fortitude eventually succeed.

CANCL Movement

Pediatricians should spearhead the movement to create social consciousness to obtain equity and justice for children. Physical abuse of children in homes, schools and society at large is still a way of life in our country. No matter where children are, they must be treated in a humane and kind manner. The IAP CANCL groups and various other agencies should come together and put pressure on the Governments to institute effective measures to provide healthcare and education and protection to all children. Appeal to reason and debate can lead to legal safeguards for children. However, to bring about major changes in social and cultural attitudes and shifts in inveterate values, we need to move the hearts.

R.N. Srivastava
Advisor, IAP CANCL Group,
487, Mandakini Enclave, Alaknanda,
New Delhi 110 019,
E-mail: rns2@vsnl.com.




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