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: [email protected].
