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Good health and well-being: Goal 3 of the SDGs



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1. Abstract

With the Covid-19 pandemic bringing the worldwide health infrastructure to its knees, now seems to be a good time to revisit the health goals we as a civilization should vow to protect. Keeping this in mind, the topic picked up for this paper is Goal 3 of the Sustainable Development Goals by the UN. Being such a wide topic, we have decided to dive deeper into two of those targets in this paper

Goal A: Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol

Goal B: Ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.

2. Introduction

Branching from the Millennium Development Goals (MDGs) which placed focus on reducing child mortality, improving maternal health, and tackling HIV/AIDS, tuberculosis, malaria, and other diseases, Goal 3 of the 2030 agenda addresses all major health priorities, including reproductive, maternal, and child health; communicable, non-communicable and environmental diseases; universal health coverage; and access to safe, effective, quality and affordable medicines and vaccines. The occurrence of disease impacts the overall well-being of an individual, burdens family, and public resources, weakens societies.

Goal 3 aims to address the various emerging health issues of the ever-changing world.

The Goal has 13 targets to measure healthy lives and promote well-being for all. The targets taken up in this paper are :

Goal A Intro: Target 3.5


The overwhelming effects of substance abuse on individuals, families and societies demand effective mechanisms of deterrence. While there is consensus about the importance of prevention, there is a lack of agreement over the best way to achieve it.


Prevention is understood as any activity designed to avoid substance abuse and reduce its health and social consequences. This broad term can include actions aimed to reduce supply (based on the principle that the decreased availability of substances reduces the opportunities for abuse and dependence) and actions aimed to reduce demand (including health promotion and disease prevention).

Goal B Intro: Target 3.7

Universal access to sexual and reproductive health-care services promotes health and well-being; saves hundreds of thousands of women’s and girls’ lives every year (with tens of

millions of babies born healthy); access to voluntary family planning supporting individuals and couples to make informed choices about if, when and how many children to have, with wider social and economic impact; and places the poorest, most marginalized and excluded women and girls at the forefront in exercising their human rights.

Sexual health and well being is recognised as an indivisible aspect of human rights, with its roots in the right to health. The term ‘well being’ confirms that its domain is not limited to disease prevention and treatment, but includes aspects relating to autonomy and pleasure with reference to sexuality.


3. Ecosystem Analysis

Goal A: Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol

a. Stakeholders

- State and central government- for implementing policies for regulating sale and consumption of alcohol and drugs

- People addicted to the consumption of alcohol and drugs

- People in the business of liquor

b. Infrastructure

- De-addiction centre

- A main institution or agency, as appropriate, to be responsible for following up national policies, strategies and plans;

- Administrative and deterrence systems for infringements on marketing restrictions c. Information


- Education and public awareness programmes among all levels of society about the full range of alcohol-related harm experienced in the country and the need for, and existence of, effective preventive measures.

- Awareness of harm to others and among vulnerable groups caused by drinking

- Well-executed mass media campaigns targeted at specific situations, such as holiday seasons, or audiences such as young people.


d. Indian Ecosystem

- According to WHO, total per capita (15+) alcohol consumption (in litres of pure alcohol) in India was 5.61 (for both sexes), 9.06 (for males) and 1.8 (for females) in 2019.

- The 12-month prevalence of AUDs (Alcohol Use Disorder) in India in the year 2010 was 2.6% and that of alcohol dependence was 2.1%

- The health care system in the country suffers from inadequate funding


 

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Goal B:

i. Duration :

- The duration for our analysis is the last 15 years when National Family Health Survey (NFHS) 3 was launched in 2005 to 2021 when NFHS5 was released.

ii. Metrics/Indicators:

- Contraceptive Prevalence Rate


- Adolescent fertility


- Availability of sex education


- Total unmet need


- Maternal Mortality Rate


- Sexually Transmitted Infections iii. Analysis

- High unwanted fertility

  1. As per the National Family Health Survey 5 - 2019, nearly 10% pregnancies are either unwanted or mistimed.

  2. Total wanted fertility rate in urban areas is 1.6 and in rural areas 2.6, while total fertility rate is 2.06 in urban areas and 2.98 in rural areas

- High maternal mortality

India’s maternal mortality ratio is unacceptably high at 113 per 100,000 live births

- Sexually Transmitted Infections/Reproductive Tract Infections

In a nation-wide community-based study, prevalence was nearly 6% in the 15-50 years age group.

- Contraceptive Prevalence rate

Overall Contraceptive Prevalence Rate (CPR) has increased substantially in most

States/UTs and it is the highest in HP and WB (74%). Use of modern methods of

contraception has also increased in almost all States/UTs.

- Unmet needs of family planning

Unmet needs of family planning have witnessed a declining trend in most of the Phase-

1 States/UTs. The unmet need for spacing which remained a major issue in India in the

past has come down to less than 10 per cent in all the States except Meghalaya and

Mizoram. - Total Fertility Rate

​​The Total Fertility Rates (TFR) has further declined since NFHS-4 in almost all the

Phase-1 States and UTs. The replacement level of fertility (2.1) has been achieved in 19

out of the 22 States/UTs and only 3 states viz. Manipur (2.2), Meghalaya (2.9) and Bihar

(3.0) have TFR above replacement levels now.


4. Root Cause



5. Policy Framework


Goal A



India is sandwiched between the two largest Opium producing regions of the world that is the Golden triangle on one side and the Golden crescent on the other.

The golden crescent area includes Pakistan, Afghanistan and Iran. The golden triangle area comprises Thailand, Myanmar, Vietnam and Laos.

a. According to WHO, total per capita (15+) alcohol consumption (in litres of pure alcohol) in India was 5.61 (for both sexes), 9.06 (for males) and 1.8 (for females) in 2019.

b. The 12-month prevalence of AUDs (Alcohol Use Disorder) in India in the year 2010 was 2.6% and that of alcohol dependence was 2.1%



c.The health care system in the country suffers from inadequate funding

d. Poor investment in health infrastructure and human resource, Poor Accessibility & Accountability of health services especially for poor, weak regulatory systems for drugs and medical practice. Under-utilization of Technological and digital advancement in Government, Poor capacity in Public health management, Poor Public, Private Partnership in complementing health services and sub-optimal use of traditional systems of Medicines are the key challenges faced by the public health system of the country.


Magnitude of Substance Abuse in India 2019 report

  1. 72 lakhs people need treatment for using Cannabis

  2. 11 lakhs people need treatment for using sedatives

  3. 60 lakhs people need treatment for using Opioids.

  4. It was estimated there are around 16 crore alcohol consumers in the 10-75 years age group in India.

  5. 5.7 crore people needed treatment for using alcohol.


Policy: Central Sector Scheme of Assistance for Prevention of Alcoholism and Substance (Drugs) Abuse for Social Defence Services.

  1. It constituted the Narco-Coordination Centre (NCORD) in November, 2016 and revived the scheme of “Financial Assistance to States for Narcotics Control”.

  2. Narcotics Control Bureau has been provided funds for developing a new software i.e. Seizure Information Management System (SIMS) which will create a complete online database of drug offences and offenders.

  3. The government has constituted a fund called “National Fund for Control of Drug Abuse” to meet the expenditure incurred in connection with combating illicit traffic in Narcotic Drugs; rehabilitating addicts, and educating the public against drug abuse, etc.

  4. The government is also conducting a National Drug Abuse Survey to measure trends of drug abuse in India through the Ministry of Social Justice & Empowerment with the help of National Drug Dependence Treatment Centre of AIIMS.

  5. 'Project Sunrise' was launched by the Ministry of Health and Family Welfare in 2016, to tackle the rising HIV prevalence in north-eastern states in India, especially among people injecting drugs.

The Narcotic Drugs and Psychotropic Substances Act, (NDPS) 1985: It prohibits a person from producing, possessing, selling, purchasing, transporting, storing, and/or consuming any narcotic drug or psychotropic substance.

  1. The NDPS Act has since been amended thrice – in 1988, 2001 and 2014.

  2. The Act extends to the whole of India and it applies also to all Indian citizens outside India and to all persons on ships and aircraft registered in India.

Government has also announced the launch of the ‘Nasha Mukt Bharat’, or Drug-Free India Campaign which focuses on community outreach programs.



Goal B

a. International Policy framework


Reproductive rights are enshrined in the United Nations (UN) human rights treaties and in the consensus conference documents to which India is a party, and are protected by the Constitution of India. These treaties and documents point to the obligations of the State to respect, protect, promote, and fulfill rights related to reproductive health, with particular attention to vulnerable and marginalised population groups, without any discrimination


The first formulation of reproductive rights as human rights is found in the International Conference on Human Rights, which was held in Tehran in 1968 to further the principles and aims of the Universal Declaration of Human Rights (UDHR). India was part of the preparatory committee and participated in the conference.


Although human rights were described in earlier conventions, reproductive rights were first described in 1994 in the International Conference on Population and Development’s (ICPD) Programme of Action in Cairo.


In the Millenium Development Goals of 2000, the emphasis was on attaining lower infant mortality rates (IMR) and maternal mortality rates / ratios (MMR), and did not take into account the need for sexual health rights. The Sustainable Development Goals of 2015 have several implications for reproductive health and rights.


The Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) has expressed concern about the absence of a comprehensive anti-discrimination law in India, which addresses all aspects of direct, indirect, and intersectional discrimination against women. Article 12 directs States Parties to “ensure to women appropriate services in connection with pregnancy, confinement and the postnatal period, granting free services where necessary, as well as adequate nutrition during pregnancy and lactation.”


Article 10(h) of CEDAW emphasises the importance of guaranteeing access to educational information that ensures the health and well-being of families, including information on family planning, for the elimination of discrimination against women in the field of education, while Article 16(e) obliges the state parties to ensure that women have access to information and education that enables them to exercise their right to decide freely and responsibly on the number and spacing of children, so as to eliminate discrimination against women in matters relating to marriage and family relations.


b. Judgements in Indian Laws


While the right to health (or reproductive rights) is not expressly recognised as a fundamental right in the Constitution of India, several Supreme Court decisions have interpreted the right to health and the right to timely and adequate medical treatment as integral to the right to life.


  • In Parmanand Katara v Union of India,231 which was a public interest litigation (PIL) pertaining to the provision of emergency medical treatment to injured victims of motor accidents, the Supreme Court held that Article 21 obligates the State to preserve life, and doctors at government hospitals are duty bound to extend medical assistance for preserving life. No law, procedure, or State action can void or impede this obligation of medical professionals.

  • In Paschim Banga Khet Samity v State of West Bengal, 232 it was held that the State is obligated to provide adequate medical facilities, and denial of timely medical intervention to a person in need of such treatment by a government hospital is a violation of Article 21. (pg-76)

  • The Supreme Court in Suchita Srivastava and Another v Chandigarh Administration 233 stated that reproductive autonomy is a dimension of personal liberty as guaranteed under Article 21


10. Benchmarking

Goal A :

  1. In 2019, alcohol consumption in the world, measured in litres of pure alcohol per person of 15 years of age or older, was 5.8 litres, which is a 5% relative decrease from 6.1 litres in 2010.

  2. The prevalence of AUDs (Alcohol Use Disorder) is highest in Europe (7.5%) and the lowest among eastern Mediterranean regions, which includes Afghanistan, Bahrain and Egypt.

  3. In various countries around the world there is a strict regulation on advertising of alcohol. Eg- Lithuania - No online advertising allowed at all, Norway - A complete ban on all alcohol advertising since 1975, enforceable by law, UK - Advertising should not encourage excessive drinking

  4. Various countries have very strict Legal blood alcohol concentration (%BAC) limits around the world. Some countries even have zero tolerance limits like Czech Republic, Egypt, the Russian Federation, etc.


Goal B :

- EU a) facilitating the participation of a wide spectrum of governmental and nongovernmental partners, including civil society and the private sector, in the formulation of national policies on sexual and reproductive health and rights b) reaching agreement between relevant governmental and nongovernmental partners, including civil society and the private sector, on the distribution of roles and responsibilities 15 with respect to the effective and equitable delivery of sexual and reproductive health services c) establishing, as needed, formal arrangements with nongovernmental organizations and private sector entities to achieve equitable accessibility of services d) setting up a national committee or similar coordination and oversight mechanism tasked with monitoring and evaluating the implementation of the national action plan and making adjustments, as and when required.


- Role Health ministry plays a) evaluating achievements and impact, as well as facilitating and impeding influences, and applying lessons learned from implementing current or completed sexual and reproductive health policies and programmes b) conducting a situation analysis, using both qualitative and quantitative methodologies, of the present sexual and reproductive health and rights1 situation, including the needs and expectations of current and prospective clients with special attention to vulnerable and disadvantaged groups c) convening consultations of all relevant stakeholders, including educational institutions and the school sector, to review the draft plan, set priorities among the actions proposed, agree on distribution of roles and responsibilities, identify key targets and indicators, and establish financial and human resource requirements d) formalizing arrangements with partners responsible for implementing tasks within the overall plan e) agreeing on sex- and age-disaggregated indicators that are acceptable, feasible and practical for monitoring national action plans f) strengthening and upgrading information systems necessary for monitoring progress made towards achieving agreed targets, including the reduction of inequities g) establishing adequate mechanisms and processes to ensure proper governance, transparency and accountability h) setting up an oversight committee or similar body tasked with monitoring implementation of the national action plan and making adjustments as and when required i) promoting the national plan among high-level government officials and parliamentarians and international and national stakeholders. - The role of the WHO Regional Office for Europe a) strengthening collaboration and coherence among relevant United Nations agencies at national and regional levels; b) providing technical assistance for evaluating the implementation of the current or completed plan of action on sexual and reproductive health and conducting a situation analysis of present needs;

c) assisting with the development of a suitable monitoring framework; d) supporting countries in harmonized and standardized collection and analysis of core indicators and the preparation of progress reports; e) disseminating evidence-based guidelines and tools and assisting countries with their national adaptation; f) facilitating the exchange of country experiences to highlight barriers and promote best practices; g) cooperating closely with partners, including bilateral donor and development agencies and initiatives, funds and foundations, civil society, technical institutions and networks, the commercial and non-commercial private sectors, and partnership networks established in support of national action plans;

Domestic

  • Among the States, Kerala and Himachal Pradesh are the front runners with an SDG India Index score of 69. Among the UTs, Chandigarh is a front-runner with a score of 68

  • On the other hand states like Assam, Bihar and UP have featured badly in the index as their score was below 49.


Goal A :

  • Gujarat has banned its citizens from consuming liquor since 1961

  • In Bihar, there is complete prohibition of alcohol use since 4 April 2016

  • Manipur is now popularly called 'Wettest Dry State' since the government has lifted the ban on alcohol in some districts in 2002 after imposing a complete ban in 1991.

  • The major reason states experience fluctuation on the alcohol prohibition at the policy level is that it generates nearly 15% to 20% of their revenue from alcohol taxation, contributing a significant amount to the state treasury.

  • In states like Gujarat, where complete prohibition is in force, the rich have continued access to alcoholic beverages and the lower class and poor people resort to illegal brewing of alcohol with increase in deaths because of methanol poisoning.

  • More and more Children are taking to alcohol and the highest percentage of children who are addicted to alcohol are in Punjab followed by West Bengal and UP.

Goal B :





6. Recommendations

Root Cause 1 : Education and lack of awareness

- Teacher training on Comprehensive Sexuality Education needs to focus on not just imparting information but also capacitate teachers on the content, the importance of the subject matter and tactical ways to navigate cultural resistance to these topics.


- Early intervention services can be provided in a variety of settings (e.g., school clinics, primary care offices, mental health clinics) to people who have problematic use or mild substance use disorders. These services are usually provided when an individual presents for another medical condition or social service need and is not seeking treatment for a substance use disorder. The goals of early intervention are to reduce the harms associated with substance misuse, to reduce risk behaviors before they lead to injury, to improve health and social function, and to prevent progression to a disorder and subsequent need for specialty substances use disorder services. Early intervention consists of providing information about substance use risks, normal or safe levels of use, and strategies to quit or cut down on use and use-related risk behaviors, and facilitating patient initiation and engagement in treatment when needed. Early intervention services may be considered the bridge between prevention and treatment services. For individuals with more serious substance misuse, intervention in these settings can serve as a mechanism to engage them into treatment.


- Medical textbooks that include information on trans bodies, with guidelines for SRHR in consonance with international guidelines must be formulated. - Make available age appropriate comprehensive sexuality education, including accessible and understandable health information, as part of standard school curriculum, as well as outside of formal school setting, without parental consent and regardless of marital status, to all population groups.

Root Cause 2 : Inadequate implementation of existing laws

- Implement the HIV/ AIDS Bill and ensure non-discrimination and equal participation in all spheres of life for persons living with HIV. Central and state governments should ensure they provide free of cost Antiretroviral Therapy (ART) to all PLHIV.


Root Cause 3 : Amendment to existing laws


- Decriminalise sex work by amending the ITPA to categorically distinguish and separate sex work from trafficking. - POCSO should be amended to remove the clause on mandatory reporting in order to provide professional privilege of confidentiality to teachers, service providers and counselors. This is especially important for adolescents whose sexuality and sexual health needs should be handled with empathy and dignity, not shunned punitively. - Clarify that sexual violence within matrimonial home will be covered under section 498A IPC, and remove Exception 2 of Section 375 to criminalise marital rape.


- Decriminalize adultery by amending or repealing Sec. 497 of the Indian Penal Code.


- Repeal the provisions enabling restitution of conjugal rights in the Hindu Marriage Act (section 9), the Special Marriage Act (section 22), the Parsi Marriage and Divorce Act (section 36), and the Indian Divorce Act (sections 32 and 33).


- The permitted age for drinking alcohol varies from state to state. And even the consumption and purchasing age of alcohol are different in the states. This difference, in purchasing and consumption of alcohol, creates confusion and results in difficulty in implementation of the law of consumption age of alcohol. Hence there needs to be a centralised mechanism to regulate the age of drinking and consumption.

7. Major barriers

Cultural Barriers

Women’s normalisation of symptoms, or fear/ embarrassment as barriers to treatment, point to deeper-rooted sociocultural ideas around gynaecological morbidity. Women may believe that reproductive health problems, such as vaginal discharge or pain, are simply “women’s fate” and therefore not a condition for which they should seek medical help

Political Barriers


Majority of the recommendations involve amendments to religious laws, the due process of which is going to involve the arduous task of generating consensus among the respective communities.


Barriers due to lack of infrastructure

The continuing underfunding of the public health system and the mushrooming of unregulated private sector facilities has contributed to the rising household expenditure on health care. Similarly, the shortage of trained medical personnel is another factor that hampers the functioning of the public health system in India.


If you are interested in applying to GGI's Impact Fellowship, you can access our application link here. Meet The Thought Leaders


Shatakshi Sharma has been a management consultant with BCG and is Co- Founder of Global Governance Initiative with national facilitation of award- Economic Times The Most Promising Women Leader Award, 2021 and Linkedin Top Voice, 2021.

Prior to graduate school at ISB, she was Strategic Advisor with the Government of India where she drove good governance initiatives. She was also felicitated with a National Young Achiever Award for Nation Building. She is a part time blogger on her famous series-MBA in 2 minutes.


Naman Shrivastava is the Co-Founder of Global Governance Initiative. He has previously worked as a Strategy Consultant in the Government of India and is working at the United Nations - Office of Internal Oversight Services. Naman is also a recipient of the prestigious Harry Ratliffe Memorial Prize - awarded by the Fletcher Alumni of Color Executive Board. He has been part of speaking engagements at International forums such as the World Economic Forum, UN South-South Cooperation etc. His experience has been at the intersection of Management Consulting, Political Consulting, and Social entrepreneurship.


Pratham Mehta is an undergraduate from IIT Delhi. He is correctly employed with Boston Consulting Group as a part of India consulting team. He has also interned in Bobble.ai, Snapdeal and Deloitte giving him a plethora of experience in the corporate world. He also started his own venture in service industry. Pratham is an avid dancer and finance enthusiast when not at work.




Meet The Authors (GGI Fellows)


Aakruti Desai is currently a postgraduate student at Royal Melbourne Institute of Technology (RMIT). She has an undergraduate degree in Journalism and Communication from Manipal Academy of Higher Education (MAHE). Previously, she worked with Teach for India, Pune, for two years. She has taught 78 underprivileged students literacy and social studies. Her expertise lies in brand solutions with proven skills in editing, primary and secondary data researching, devising creative strategies, and project management. With a degree in Master of Advertising and impact at the core of everything I do, she hopes to be an agent of social change and build a career in impact and policy consulting.

Gunraj Singh is an undergraduate from BITS Pilani in Computer Science. He has worked with Amazon as a software developer in the pricing and ads organization for 2 years. When not at work Gunraj enjoys playing tennis, reading and theatre.




Manasi Gupta is an engineer from Vellore Institute of Technology, Vellore. She is a social entrepreneur and the founder of Huesofthemind, a national award-winning platform to advocate mental health. Manasi is a public speaker and a published author. She has worked with multiple ed-tech startups and social impact ventures. She believes in the power of empathy, consistency and courage.



Pranay Chenreddy is a BITS pilani graduate with majors in Electronics and Mathematics. He is currently employed with Jio Platforms as a Data Scientist. He has a wide range of interests ranging from International affairs, Machine learning, Polity to Entrepreneurship. His hobbies include playing chess, solving puzzles and travelling.


Shreyus is a management consultant working at Avalon consulting. He has worked on various projects such as Market entry strategy, growth strategy, performance improvement, Change Management amongst others. Prior to this, he worked as a Strategy Manager at Grow Indigo Pvt Ltd. He has completed his PG from IRMA. Prior to IRMA, he has worked with PWC as a consultant. He has completed his undergrad from VIT Vellore in electronics and communication


If you are interested in applying to GGI's Impact Fellowship, you can access our application link here.

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