India’s coastline is now estimated to be about 11,100 km, and this includes many pristine beaches. In 2019, the government selected 13 beaches for Blue Flag certification from the Foundation for Environment Education, a Denmark-based NGO. This certification is incumbent on 33 criteria broadly under the categories of environmental education and information, bathing water quality, environment management and conservation, and safety and services.

But this pursuit had led to violation of coastal regulations, some of which are later legitimised through post-facto orders, and to alienation of local communities from public beaches, disrupting their livelihood, we found. Experts warn that these activities are leading to irreversible changes to the sensitive systems.

Elsewhere, four in 10 children are now in private schools, up from about a third seven years ago. Experts say this is largely driven by parental perception of quality of education, and the demand for English-medium instruction. But the shift has not been uniform.

The grey area in blue-flag beaches

After residents approached the National Green Tribunal against illegal constructions in Puducherry’s Eden beach, the panchayat people who had set up temporary stalls. For 58-year-old Anbukarasi and others who earned their living selling food or trinkets on the beach, this has meant loss of livelihood and mounting debt.

Developing beaches to get them the Blue Flag certification has been one of the government’s key eco-tourism initiatives. Between February and July 2026, we visited three beaches—Eden in Puducherry, Kappad in Kerala and Padubidri in Karnataka—to understand the aftermath of the Blue Flag certification that 13 Indian beaches received.

In March 2026, the Puducherry Coastal Zone Management Authority issued a directive to remove unauthorised construction at Eden Beach, including on sand dunes. It ordered removal of the tile work laid down for opening a restaurant and removing unauthorised buildings on sand dunes and restoration of the area. In July, we found that the walls of the restaurant collapsed from erosion while the tile work remained.

At Padubidri, a green, forested patch along the Kamini river was cleared for a parking lot and treatment plants—reclaiming part of the riverbank in the process.

In Kappad, the infrastructure has corroded and requires constant funds for maintenance. “None of the lights work, the metal structure propping up the solar panels corroded and fell. Those are now lying in a corner as scrap metal,” 64-year-old Nasar Kappad said, adding how none of the permanent infrastructure was made to last.

Both beaches now charge an entry fee, effectively limiting access to local communities. At Kappad, a small stretch outside the certified zone remains free—kept that way, residents say, because children fought to keep their playground.

Shreya Raman writes on the cost of the project.

Why parents prefer private schools

Private-school enrolment increased by about 3 million in the past year, while government schools—where 48% of children are enrolled—saw their numbers decline by about 2.7 million, according to the Unified District Information System for Education (UDISE+).

The number of government schools also declined by 78,500 over this period to reach 1.01 million in 2025-26, with the largest decline (more than 51,000) seen in 2019-20. The private sector, in contrast, saw a net increase of about 15,000 schools, adding up to about 342,000 schools in 2025-26, UDISE+ data show.

Choosing a private school also comes at a higher cost. Average annual education-related expenditure was Rs 28,693 per student in private schools, compared with Rs 2,863 in government schools, as ISignal reported in April 2026.

Bihar and West Bengal have higher government school enrolment, but the trends are different: Bihar's private-school share rose from 10.2% in 2018-19 to 14.8% in 2025-26, while West Bengal's fell from 11.4% to 6.3%.

Parents are increasingly choosing private schools at lower levels: 71% students in pre-primary or kindergarten and 40% in primary (grades I to V) were in private schools. In contrast, about 10% of students at the primary level were in government schools.

Among students from marginalised caste groups, enrolment is higher in government schools compared to private institutions.

English medium instruction is also driving the shift to private schools: In government schools, English-medium institutions accounted for 6.4% of schools and 8.3% of enrolment in 2024-25.

Read Vijay Jadhav’s analysis here.

Wish you a happy Independence Day. We’ll be back next week with more.

Stubble burning—the practice of burning the residue left in the soil after the harvesting of paddy and wheat, before sowing of the next crop begins—releases carbon dioxide and unburnt smoke particles into the air, adding particulate matter pollutants thinner than human hair.

Depending on the location of these fires, wind speed and direction, besides local weather conditions, this contributes to air pollution in places far from the source. Farm fires also impact the soil health and fertility, kill microflora and other organisms in the soil, we explained in December 2022.

Private-owned carbon farming projects, as we noted last week, are enlisting farmers to shift away from this practice and encourage the use of superseeder machines to mix residue back into the soil, offering subsidies on machine rentals upfront. This has also improved soil fertility and yield. But if the climate is unfavourable, farmers say, they have to opt for the faster and more economical method to dispose of this stubble by burning it since there is a short window available to prepare for sowing of the next crop.

For direct-seeded rice, on the other hand, most farmers saw a yield drop. Large landholders say this is offset by reduced spending on labour, but small and marginal farmers are seeing an income drop, which could affect continued adherence to the method.

Elsewhere, we look at dangerous humid heat, which is no longer confined to the hottest months in several Indian cities.

Why farmers need to see the money in carbon farming

Subeg Singh (27) from Saraiyan Kaysthan village in Parsendi block in Sitapur district began using a Rs 2.5-lakh worth superseeder machine even before he enlisted in a carbon farming project. The soil quality for his 30 acres’ land improved and wheat production rose by 2.5 quintals per acre, he told us. For others, the developer is offering an upfront subsidy to offset rental costs of the superseeder.

But another initiative—shifting away from flooded transplanting to paddy to direct-seeded rice, which is aimed at reducing methane emissions—has led to an initial yield drop, farmers told us. For Singh, who did see a small production drop the first year, it still made sense to continue as the overall cost was less, considering his large landholding.

Singh was promised a subsidy of Rs 1,750 an acre for giving up residue burning. In 2025, without explanation he could accept, it dropped to Rs 700. Soil samples are collected every year to measure carbon gains—but farmers say they never see the reports. “They collect samples every year, but there is no word on the reports,” Singh said.

The companies promise 55-70% of eventual carbon credit revenue to farmers—but none can say how much that will actually amount to, since it depends on credit volumes and market prices that remain uncertain.

On the other hand, partners on the ground—farmer producer organisations, mill cooperatives, etc—who are tasked with intensive work such as enlisting farmers, collecting documents, collecting soil samples and helping with monitoring—are often left without answers, potentially affecting the trust built over years.

Experts argue that the long-term success of carbon farming depends not only on reducing emissions but also on creating an ecosystem of training, transparency, technical support and economic incentives that enables farmers to continue these practices. Aishwarya Tripathi writes in the second and concluding part of this series

Humid heat is becoming harder to escape

Tirunelveli, Chennai, Tiruchirapalli and Vijayawada now experience more than 250 days of dangerous humid heat every year. That is more than eight months.

The finding comes from Climate Central, which defines dangerous humid heat as days when the maximum wet-bulb temperature reaches 25°C or more. Wet-bulb temperature combines heat and humidity.

Our survival depends on our bodies staying at a consistent temperature, as we explained in August 2017. Normally, our core temperature—from the top of the head to mid-chest, encompassing the brain, lungs and chest—is regulated at 37°C, and our skin at 35°C. Sweating helps us shed excess heat—sweat beads cool the skin, and evaporation of sweat gets rid of heat, restoring the equilibrium.

This process of thermoregulation occurs efficiently only when ambient air is favourable for us. Air can hold a limited quantity of water until it saturates. In dry air without much water content, sweat evaporates quickly, causing cooling. In humid air that has much moisture already, sweat does not evaporate as easily, leading to overheating of the body.

India recorded an average of 141 dangerous humid-heat days a year between 2016 and 2025. Of these, 49 days were attributable to climate change.

In India, heat policy gets split across environment, labour, and health ministries, “and nobody is really coordinating across those”, Vidhya Venugopal, a professor of occupational and environmental health in Chennai, says, adding that India needs heat and humidity rules with real teeth, real-time monitoring, protection schemes for informal workers, and enforcement that means something. Tanvi Deshpande writes.

That’s all for this week. We’ll be back soon, with more.

India does not have a single national estimate of how many people die because of heatwaves.

For 2024, the National Crime Records Bureau recorded 1,832 deaths from heat or sunstroke. The National Centre for Disease Control counted 161 confirmed heatstroke deaths, while the India Meteorological Department recorded 389 heatwave deaths.

The differences begin with what each agency counts. The NCRB relies on police records of deaths attributed to forces of nature. The NCDC’s National Heat-Related Illness and Death Surveillance system collects reports from health facilities. The IMD compiles information from state disaster management authorities and media reports.

Even within these systems, suspected cases do not necessarily become confirmed deaths. Between March 2023 and July 2024, Madhya Pradesh recorded 12,765 suspected heatstroke cases but only 18 deaths. A person who dies after heat worsens a heart, kidney or respiratory condition may have that illness recorded as the cause, with no mention of heat.

Experts say recording has to move beyond hospitals, and systems have to be set up to ensure cases are not missed.

Elsewhere, Uttar Pradesh farmers enrolled in private carbon-farming projects say they are in the dark about how carbon credits were generated from their fields, when the credits might be sold or how much money they could receive.

Why India Needs To Record Heatwave Mortality Better

On May 25, six-year-old Hasnain died in Madhya Pradesh’s Chhatarpur. His family believes he died due to the extreme heat. Health officials say it may have been food poisoning.

Heatwaves are among the deadliest climate disasters, but their toll is unusually difficult to see. A cyclone can destroy houses and a flood can sweep away settlements. Heat often kills by aggravating an existing illness, leaving no single visible sign that establishes it as the cause.

Official figures can exclude people who never reach a hospital. This is particularly important for outdoor workers, people living alone and residents of rural areas with limited access to healthcare. Even when a patient is treated, doctors may record cardiac arrest, kidney failure or another immediate medical condition rather than the heat exposure that precipitated it.

Public-health researchers use “excess mortality” to estimate this wider burden: they compare the number of deaths with the number that would ordinarily be expected. To do this properly, India would need daily, local mortality data from civil registration systems, hospitals, crematoria and burial grounds, matched against temperature and humidity data.

Such estimates would help identify where deaths are rising, which populations are most vulnerable and whether measures under heat action plans are reducing mortality. Shivam Bhardwaj writes.

The Communication Gap That’s Plaguing Private Carbon Farming

In August 2022, climate-technology company Boomitra held an online meeting for farmers and partner organisations in northern India. Its project documents say 487 people attended and include a feedback form bearing the name and signature of Jung Bahadur, a farmer in Hardoi.

Bahadur does not remember attending the meeting. The handwritten form says he learnt about the importance of carbon for farmers and the benefits of organic farming. But Bahadur, who studied until Class VIII, said he could not have written the responses attributed to him. He signed his own palm to compare the signature with the one on the document.

Bahadur is among farmers listed in documents for projects that aim to generate carbon credits by changing agricultural practices. Farmers may be asked to stop burning crop residue, reduce tillage, alter fertiliser use or shift to direct-seeded rice. The resulting reduction or removal of emissions can be converted into credits and sold to companies seeking to offset their own emissions.

But among 15 farmers we spoke to in five villages in Hardoi, only two recalled people visiting to discuss crop-residue management. Several did not know that they had been included in a carbon project.

The companies say they work through local partners such as farmer producer organisations, which help identify and communicate with farmers. Boomitra said it verifies farmers’ telephone numbers and provides access to its application, though adoption varies.

The potential sums are difficult for farmers—or outsiders—to calculate. Carbon-credit generation differs by farm and depends on baseline conditions, soil, implementation and verification. The selling price is generally not public. Varaha promises farmers 70% of net revenue after specified costs, while Boomitra says farmers receive 55% of total revenue. But without knowing the sale price and deductions, farmers cannot independently determine whether they have received the promised share.

We analysed hundreds of pages of project records and traced the companies, field partners and farmer networks behind two large projects in Uttar Pradesh. Aishwarya Tripathi writes in the first of a two-part series.

That’s all for this week. We’ll be back soon, with more.

India’s 775 fast-track special courts—398 of them set up exclusively for cases under the POCSO Act—have disposed of 366,124 cases since 2019. By April 2026, they still had 249,000 pending.

That’s the backdrop against which Prime Minister Narendra Modi announced fast-track courts for paper-leak cases this week, three days after police baton-charged and tear-gassed students marching from Delhi’s Jantar Mantar to Parliament.

“How does this mechanism partially, marginally or even peripherally address the concern which has brought the youth of this country out on the streets?” asked lawyer Vrinda Grover, who called the move a gimmick.

Elsewhere, we report on a Kerala village where sea erosion has swallowed hundreds of homes—and where India’s search for rare-earth minerals for its clean-energy transition could deepen the damage.

Last week, I spoke to a public health physician about how Lakshadweep, an archipelago where the sea often decides whether help can even arrive, became the first part of India declared free of tuberculosis.

Why fast-track courts keep failing to be fast

Students protests are continuing in several cities across the country, seeking accountability for paper leaks in critical competitive exams such as the National Eligibility cum Entrance Test for undergraduate medical admissions. On Thursday, the Prime Minister announced fast-track courts to “ensure swift and stringent punishment for those involved in paper leaks”.

Fast-track courts are not new to India. A 2019 centrally sponsored scheme provided for setting up fast-track special courts (FTSCs), including exclusive courts to deal with cases under the Protection of Children from Sexual Offences (POCSO) Act.

But even these courts see pendencies and delays. A 2022 study of 486 POCSO courts by the Vidhi Centre for Legal Policy found that they took an average of 510 days to dispose of a case. In 2020, Delhi had the highest average case length at 1,284 days or about 42 months. This is six months shy of the time taken to complete a graduate degree.

Scheme guidelines require each fast-track court to have one judicial officer and seven support staff, with no court allowed to double up as an existing one. In practice, several courts have simply been redesignated, carrying the burden of two dockets at once.

Further, paper leak cases will require rigorous and meticulous investigation involving both digital and physical evidence, said Grover. “The conversation we don't have is, how competent, skilled, relevant is the investigation that is done.”

“Merely having a faster judicial track is not enough to expedite the resolution of cases,” Valay Singh, lead at India Justice Report, told me. “What is equally important is the presence of a dedicated unit of investigative agencies to serve these courts.”

Singh cited the 2025 report to point out that there is a nearly 50% vacancy in posts of scientific officers in forensic labs, nationally. “In police, separation on investigative and law and order wings remains to be implemented on the ground, therefore, investigations remain poor and slow,” he explained. Read my report here.

Between the dark sands and the blue seas

Saina Banu spent years saving from her work processing prawns for export. By 2025, she'd saved Rs 45,000—enough to build a barrier of sandbags around her home in Kerala's Thottappally. Last August, the sea took her house of 35 years.

Her village, along Kerala's Alappuzha coast, sits atop rich deposits of rare-earth-bearing sands, now central to the magnets that power EVs, wind turbines and defence equipment.

Mining here dates to the 1960s, and residents, fish workers’ unions and environmentalists say decades of extraction have stripped the coast of its natural defences. At least 746 houses have collapsed to erosion across five panchayats, local groups estimate. A government scheme compensates families with Rs 10 lakh per lost home. “What are you going to get with Rs 10 lakh?” Saina Banu asked. “You can’t even buy land with it, forget a house.”

This is also affecting livelihoods: Farmer Satheseeran once harvested two paddy crops a year on his land in Kuttanad. Today, rising salinity has pushed him partly toward fish farming, as saltwater intrudes further into fields that used to sustain his family. On the other hand, fishers say years of mineral sand mining have changed the seabed, reduced catch and made livelihoods more uncertain.

As India builds rare-earth corridors in four states to cut its 85-90% dependence on Chinese imports, mining projects remain exempt from public hearings—a rule meant to expedite approvals but one that risks the opposite, researchers say, as stalled projects and land conflicts multiply along India’s coasts.

Read Anuj Behal’s story here.

How an archipelago beat TB

Lakshadweep, India’s smallest Union Territory, was declared TB-free in 2021—the country’s first such success. Getting there meant running a national health programme across ten inhabited islands two to five hours apart by sea, with one island a 16-hour ship journey from headquarters. Rough seas can cut movement for nearly five months of the year.

I spoke to Rakesh P.S., public health physician, researcher, and health systems specialist who worked on the programme, about what it took. His answer: decentralised diagnosis and treatment, trained local teams, and repeating the unglamorous basics—house-to-house screening, quick sputum testing—year after year.

“Perhaps it is the health system that is hard to reach,” he said, questioning why planners default to calling remote communities the problem. He also credited panchayats, trusted ASHAs and women’s relative autonomy in Lakshadweep’s matrilineal culture for reaching people that routine coverage numbers missed.

“To an outsider peering through a diving mask, the underwater world looked impossibly peaceful. Or perhaps I was not sensitive enough to understand their conflicts, fears, and insecurities,” Rakesh wrote in his just-published book, Echoes from the Atoll.

To me, these two lines serve as a metaphor for the challenges faced in the archipelago’s journey to TB-free status. Rakesh describes how officials from the mainland had a disconnect with the implementation teams on the islands.

Read the interview here.

That’s all for this week. We’ll be back soon, with more.

It was 2011. The national conversation was centred around accountability, but apart from some numbers that were routinely quoted, the narrative—for the large part—remained abstract, sans the information and context that can help provide the basis for action.

That is when IndiaSpend was born, with a clear and simple aim: using data to tell stories about India. Fifteen years later, we are one of the most widely cited publications in India and abroad.

We counted things that weren’t being counted. We put numbers where there were only opinions. And for 15 years, that work—slow, rigorous, often thankless—quietly shaped how India’s best journalists, policymakers, and citizens understood the country they lived in. We are proud of every word of it.

We’ve held power to account irrespective of dispensations, focusing on the foundational issues of the country—healthcare, education, gender, the environment and climate change, and livelihoods. We continue to believe when these basics are addressed effectively and consistently, India will have a baseline of opportunity and growth for every citizen.

Fifteen years later, the landscape is changing faster than ever. The internet is noisier than it has ever been, information moves faster, spreads wider, and gets harder to trust with every passing year. People are beginning to get their information from AI models prone to error, hallucination and sycophancy. All of this makes our job more important than ever.

In that environment, a name that said “we count India’s spending” started to feel like a description of a tool instead of a statement of purpose. We were doing so much more than counting. And the people who needed us most—younger, more online, navigating an information landscape we couldn’t have imagined when we launched—didn’t always know we existed.

We needed a name that announced what we stand for before anyone clicked a single link.

Why ISignal

We are now ISignal, because when you strip away the noise, all that survives is a precise, purposeful signal. It is the facts that dispel the rumours, and the data that inform the discourse.

We have spent 15 years doing that. The team hasn’t changed, nor have the standards or the commitment to verification.

What changes is the name. And with it, the scope of what we’re building.

ISignal is IndiaSpend with a broader mandate. We are investing in AI-powered tools that help readers navigate information in real time. We are building products for a generation that consumes news on their phones, in thirty-second bursts, between other things—and still deserves to be told the truth with clarity.

What doesn’t change

Our mission remains the same. As a small newsroom, we are not the first on the scene, nor are we the loudest voice. We are the most reliable. Everything that made IndiaSpend worth reading is still here.

We work with the same journalists who spend months reporting, writing and fact-checking to bring India’s stories to your screens. Our editors will continue to hold the standards, ever more important in these times. We bring to you facts, presented clearly and without agenda.

If anything, that matters more now than it did in 2011.

ISignal exists to cut through.

A note to our readers

If you have been with us since the beginning, thank you. You have been part of something genuinely unusual—a newsroom that believed rigour was a competitive advantage, and that the truth, told carefully, could find an audience.

If you are new here: welcome. You picked a good moment to arrive.

ISignal. India’s signal.

— The ISignal team, formerly IndiaSpend

More than a quarter of Indian men and women are overweight or obese. This is in a country where, as we reported last week, every third Indian child is still underweight. How can this happen together? The answer lies largely in what India eats.

First, India’s diets are cereal-heavy. And as households’ expenditure on cereals has fallen since the turn of the century—partly aided by food security entitlements—that money has not shifted to more nutritious food groups. At the same time, spending on beverages and processed foods has doubled. This also coincides with a 40-fold rise in retail sales of ultra-processed foods.

Second, in the West, lower socio-economic groups are more likely to be obese—a function of lower awareness and access to nutritious food. But in South Asia, as incomes rise, more sedentary jobs and diets high in carbohydrates, edible oils, sweeteners and animal-source foods increase, we had reported in 2019 based on a study published in the journal Nutrients.

“South Asia’s education systems are in effect passive bystanders to the unfolding of a hugely significant nutrition and health crisis; they must do more to inform, educate and promote improved dietary choices, physical activity and healthy behaviours,” said the study.

Elsewhere, as India proposes to set up mega textile parks in challenge mode, we look at the state of existing parks.

The Rise & Rise Of India’s Obesity

A full decade ago, Prime Minister Narendra Modi first raised concerns about India’s rising obesity. After that, he’s mentioned obesity at least 18 times, appealing to his fellow citizens to eat better, calling on sportspersons and teachers to raise awareness, and repeatedly asking Indians to cut down on oil consumption.

Since then, India’s prevalence of overweight or obese—where the body mass index (BMI) is above 25 or 30, respectively—has increased by about 10 percentage points in both men and women.

The prevalence is rising across every category in India: rural and urban India, men and women, young and old.

Research shows that the increase is being driven by poor dietary diversity, high consumption of ultra-processed foods, and sedentary lifestyles. Improving diversity in food will help both with undernutrition or malnutrition and obesity or overweight.

Women are carrying a higher share of the burden. “Many women consume the least protein in the household while going through life stages such as pregnancy, where the risk of gestational diabetes increases, and menopause, where declining estrogen levels accelerate muscle loss,” Mrudul Deshpande, a Pune-based functional medicine physician specialising in metabolic health and nutrition, explained.

And that is no surprise. In many Indian households, the men eat first, the children next, and the women last. In 2017, we had reported on an intervention in Rajasthan which got families to eat together, and led to improved nutritional intake for women and children.

Vijay Jadhav analyses data from five rounds of the National Family Health Survey.

Textile Parks Half Empty

Two decades ago, India launched the Scheme for Integrated Textile Parks. Industrial parks aim to cluster manufacturing firms, in the process, helping them to generate efficiencies by accessing common infrastructure.

A 2023 Comptroller & Auditor General (CAG) of India audit found delays of one to more than 10 years in completion of the parks, cancellations of 43% of the sanctioned parks, and generation of 30% of the envisaged employment and 50% of the envisaged investments from the functional units.

The CAG asked why “without ensuring successful completion of the parks sanctioned during the 10th Plan period by March 2007 as envisaged in the Scheme guidelines, the Ministry proceeded with sanctioning more parks in the 11th and 12th Plan periods”.

Experts point to the same recurring problems—parks built far from cities where workers and investors don’t want to go, weak marketing efforts, and a lack of anchor investors willing to commit early.

It is not just textile parks that see delays. Of 4,257 industrial parks mapped on the India Industrial Land Bank as of earlier this week spanning 681,000 hectares, 134,000 hectares are still available. Yet, new industrial parks continue to be announced.

India has proposed a new round of mega textile parks—five years after announcing seven of them within a three-year timeline. Most are still under construction. Textiles employ 45 million Indians, the country’s second-largest employer, and contribute 2.3% of GDP.

Read Charu Bahri’s story here.

That’s all for this week. We’ll be back soon, with more.

Every three years or so, the National Family Health Survey gives us a detailed snapshot of health across India—based on interviews with hundreds of thousands of households.

The sixth round released this year covers over 680,000 households that form a representative sample of the national picture, and includes four schedules:

• the household schedule, with information such as access to electricity, drinking water, insurance coverage, etc.;

• the woman’s schedule, which includes indicators on marriage, fertility, contraception, child immunisation, and domestic violence etc.;

• the man’s schedule, which covers information such health issues, nutrition, sexual behaviour and attitudes towards gender role; and

• the biomarker schedule, which includes measurements of length/height and weigh, blood pressure and random glucose levels.

Earlier rounds also included data such as infant and early childhood mortality, but even without these indicators, the latest survey conducted during 2023-24 provides a wide picture of population health and healthcare trends. This week, we parsed NFHS data to understand the state of children’s health and delivery care.

First, the good news: Indian children are now taller than before, with data showing a decline in stunting rates. Stunting is an important proxy for overall cognitive and physical development, and studies have shown that stunted children face a lifetime of lost opportunities in education and work.

Elsewhere, births by Caesarean section have increased to 17% in public facilities, which indicates an improvement in emergency obstetric care.

But, children continue to have lower weights, and more than half the deliveries in private hospitals across India are through C-sections, we found.

Why Every Third Indian Child Is Still Underweight

Indian children are growing taller. Stunting fell from 35.5% to 29.3% between the two survey rounds. But nearly two in five children are still wasted (low weight for height), and a third remain underweight.

Some of the improvement in stunting traces back to better maternal care: antenatal visits rose from 59% to 65%, and immunisation coverage climbed from 77% to 83%. Early breastfeeding also improved sharply, up from 41.8% to 50.1%.

But exclusive breastfeeding for infants under six months actually fell, from 64% to 56%. And only 15% of children aged 6–23 months get what the survey calls an “adequate die”.

“Weight is such an important thing,” said Veena Shatrugna, former deputy director of the National Institute of Nutrition (NIN) and advisor to Jan Swasthya Abhiyan (JSA). “If children are growing taller but not putting on weight proportionately, then underweight and wasting remain concerns.”

Nutrition experts have long argued that dietary diversity depends not only on awareness and feeding practices, but also on whether families can regularly afford foods such as milk, pulses, fruits, vegetables and animal-source foods. “How can you improve dietary variety without improving incomes?” asks Shatrugna.

Overall, food accounts for about 46% of monthly spending, data from the Household Consumption Expenditure Survey show. But while the share of cereals fell from 22% at the turn of the century to about 5% in 2022-23, other food groups have not seen increased spending.

Prachi Salve reports on the gap between height gains and weight stagnation, and why India needs to move from food security to nutrition security.

Why C-Section Deliveries Are Rising in India

More than a quarter of Indian births now happen via C-section, up from 21.5% in 2019-21. The WHO recommends Robson classification, a checklist of 10 obstetric parameters, to determine the need for a C-section. These include factors such as the history of a pregnancy and gestational age.

Some of the increase is good news, considering that the profile of pregnant women has changed significantly over the past two decades. Women are having children later in life, fertility treatments such as IVF have become more common, and conditions such as obesity, diabetes, hypertension and other pregnancy-related complications are increasing. In this context, higher rates show improved access to emergency obstetric care.

But a 2015 WHO statement says C-section rates above 10% do not reduce maternal or newborn mortality at the population level. In public hospitals, the rate sits close to the WHO’s recommended threshold, at 17%. In private hospitals, it is 54%. “What we are seeing now is that three out of every five Caesarean sections in India’s private sector are medically unnecessary,” says Abhay Shukla of Jan Swasthya Abhiyan.

A normal delivery can take twelve hours of monitoring; a C-section is scheduled and quick. And the costs fall on families—private delivery costs 17 times more than public care, and states with high C-section rates also have among the highest delivery costs, data show.

Financial incentives may further explain the increase. Dileep Mavalankar, former director of the Indian Institute of Public Health, Gandhinagar, argued that payment systems often reward C-sections more than normal deliveries, creating incentives that favour surgery. Referring to earlier experiments in Gujarat, he noted that when private hospitals were paid a fixed amount regardless of whether a woman delivered vaginally or by C-section, surgical delivery rates remained comparatively low.

Read Prachi Salve’s analysis here.

Have a good weekend.

About 9,000 people arrested before the Covid-19 pandemic remained in Indian prisons at the end of 2024, with their trials still pending. Another 20,000 people had spent between three and five years in custody waiting for their trial.

Overall, India’s 1,333 prisons held over half a million inmates. Of these, 371,000 were under trial. Only eight other countries have a higher proportion of prisoners in pre-trial detention.

This week, we looked at the state of Indian prisons using latest data from the National Crime Records Bureau.

Undertrial prisoners are typically young, with low levels of education, and a majority are from marginalised communities. The reason for this profile, we had reported over the years, is indiscriminate arrests, limited access to legal assistance and difficulties in meeting bail conditions.

Elsewhere, Mumbai’s Kanjurmarg landfill made it to the list of 25 sites with the highest emissions of methane across the world. We explain how the trouble begins with a lack of waste segregation at source.

Who are India’s undertrial prisoners?

India’s prisons held 511,000 people at the end of 2024—13% above capacity. In addition, about 1.5 million undertrials were released on bail that year, indicating the constant overcrowding in jails.

Nearly three in four were undertrials: people in custody whose cases are still pending investigation or trial. Their share has risen from 66% in 2005 to 73%.

Two in three undertrial prisoners belong to Scheduled Caste, Scheduled Tribe or Other Backward Classes communities. Another 26% are Muslim, Sikh or Christian.

Nearly half are under 30. About 63% did not complete secondary school.

“When young undertrials are from poor socio-economic and educational backgrounds, their life chances get reduced,” Vijay Raghavan, professor at TISS’s Centre for Criminology and Justice, told us earlier. “Longer periods of imprisonment can affect their health including mental health.”

A provision under the Bharatiya Nagarik Suraksha Sanhita allows first-time offenders to seek bail after serving a third of the maximum potential sentence. In 2024, 968 undertrials were identified for release under these provisions, and 627 were released.

Vijay Jadhav reports.

How Mumbai’s garbage is contributing to global warming

Mumbai’s Kanjurmarg landfill—which receives most of the city’s waste—ranked 12th in a global list of 25 sites with the highest methane emissions from the waste sector. Methane’s warming impact is 28 times more potent than carbon dioxide. It is responsible for about a quarter of global warming. India ranks sixth among the world’s largest methane emitters.

Last year, the landfill in suburban Mumbai emitted 4.9 tonnes of methane per hour, on average. This is roughly equivalent to the warming impact of one million SUVs. For context, greater Mumbai has a total of 1.5 million cars.

The trouble begins before waste reaches the landfill. Mumbai generates around 6,300 tonnes of solid waste a day, of which 72% is food waste. Wet and dry waste are rarely separated at source, meaning biodegradable material that should be composted or processed ends up decomposing in landfills and releasing methane.

“The law clearly states municipal bodies will not collect mixed waste but segregation is neither being done nor is being enforced,” said activist Rishi Agarwal, who has worked on Mumbai’s waste crisis for over 30 years. Residents near Kanjurmarg continue to report foul odour, mosquito infestation and health hazards. The Bombay High Court has threatened to order the facility’s closure if urgent steps are not taken.

Read Tanvi Deshpande’s story here.

Have a good weekend.

India has nearly tripled health insurance coverage over the past seven years. Sixty percent of households now have at least one person covered under some form of health insurance. Yet, the average household spends more out of pocket on medical care than before.

This is because insurance in India is built almost entirely around hospitalisation, and usually does not cover outpatient care, medicines, or the transport and lodging costs that mount when a family must travel for treatment.

For the millions managing chronic disease—diabetes, kidney failure, cancer—who require continuous care between hospital stays, insurance changes little. Nearly half of India’s health expenditure is still borne directly by families, up from 45.1% the previous year. Among BRICS members, only Egypt has a higher share of out-of-pocket expenditure than India.

Elsewhere, we explore what government data show about who migrates for informal work, how far they travel, and why.

Why health insurance isn’t cutting India’s medical bills

Even the poorest Indian households spend an average of Rs 25,000 per hospitalisation—an amount that can exceed a family’s monthly income and push them into debt, asset sales, or reduced spending on food and education. Nearly three in five rural hospitalisations happen in private hospitals, where average costs can reach Rs 55,000 per stay, against about Rs 6,900 in government hospitals.

“Publicly funded insurance schemes are largely targeted at below-poverty-line populations. When they go to hospitals, they are told certain treatments or medicines are excluded, and they end up paying from their own pockets,” says Ravi Duggal, a Mumbai-based public health researcher.

PMJAY, the government’s flagship scheme, has authorised nearly 109 million hospital admissions since 2018. But “the scheme encourages people to seek care in the private sector, where costs are much higher. Care that is supposed to be “cashless” often ends up involving substantial out-of-pocket payments,” says Indranil Mukhopadhyay of the Jindal School of Government and Public Policy.

In rural India, kidney failure is the costliest ailment, averaging Rs 1.2 lakh per hospitalisation in private hospitals. Cancer follows at Rs 87,339. In urban areas, cancer overtakes all else at Rs 1.47 lakh in private hospitals—against Rs 21,802 in public facilities.

Non-medical costs compound the problem. Transport, lodging for attendants, and food can be a sustained drain for families managing long-term illness. “Unlike hospitalisation, which may be a one-time event occurring once every few years, chronic illnesses require continuous spending on daily medicines, regular doctor consultations, and periodic tests,” says Mukhopadhyay.

Prachi Salve reports.

‘Among Informal Workers, The Less Educated Travel The Farthest’

India’s migrant workers are an amorphous group, scattered across several states, moving for a variety of push and pull factors. To understand the profile of the average migrant, researchers at Azim Premji University looked at the eShram portal, a government registry of over 300 million unorganised sector workers.

I spoke with Tamoghna Halder, a co-author of the State of Working India 2026 report, to understand their findings. Halder teaches economics at the University and has a PhD from the University of California, Davis.

Informal workers are increasingly young and have relatively higher levels of education, reflecting a direct consequence of two decades of expanding educational enrolment across India, Halder told me.

But education shapes how far they travel. Less educated workers from eastern states travel the farthest, dominating destination districts across large parts of the country. More educated informal migrants stay closer to home, likely treating informal work as transitional while searching for formal opportunities nearby.

Halder identified three distinct migration channels: distress-driven dispersal from Uttar Pradesh and Bihar; a combination of economic pressure and historically rooted corridors for migrants from Jharkhand and West Bengal; and spatial containment near Assam and Madhya Pradesh, despite similar poverty levels.

Underlying all of it is a demographic rebalancing. Ageing, richer states are absorbing surplus labour from younger, poorer ones.

Read the full interview here.

That’s all for this week. We’ll be back next week with more stories.

A single factory in Faridabad making automobile components saw 76 workers sustain life-altering injuries between 2018 and 2025, according to a new report released yesterday. This was despite repeatedly being flagged to the government and the auto brands that source material from it.

This one factory represents what’s wrong with the automobile supply chain sector, where workers suffer injuries—many of them ‘crush injuries’ losing two fingers, on average—working on faulty machines, often without formal training, for long hours beyond government stipulations. Two in three injured workers said their factory had been audited in the previous year, but 82% said auditors never spoke to them.

Many of these injuries never make it to government records, and workers face an uphill battle in accessing entitlements. About a fifth of workers and sixth of helpers who were injured said they did not receive a minimum wage. Only 5% received an appointment letter, about half do not receive salary slips, and most of those who do receive them report errors such as underreporting of working hours and lower wages for overtime.

And that’s just a part of the story. These data are based on workers assisted at SII’s Manesar, Faridabad and Gurugram centres in Haryana, and Mohan Nagar and Chakan in Maharashtra.

“SII posits that given its limited outreach nationally, many more thousands of workers continue to be injured in the automotive sector every year across the country,” the report states.

For our other story this week, we look at crime records for the year 2024 to understand the decline in domestic violence cases.

Preventable accidents in India’s factories

In 2025, the Safe in India Foundation assisted 2,514 injured factory workers across India—the highest in a decade. More than two-thirds were in the auto supply chain, working in factories that supply to India’s largest automobile brands.

Most workers who were injured were migrants, young, without formal training, putting in over 60 hours a week. Two in five knew their machines were malfunctioning and many had reported it to their supervisors. They were ignored.

Further, 93% of injuries involved power press machines—used to cut and shape metal—with no safety sensors. “Where sensors do exist, they’re often removed so the machine runs faster, and when workers raise the alarm, they’re ignored,” says Siddharth Raina of SII. “For a factory, the sensor is a small cost; for the worker, the cost is permanent—on average, two fingers lost.”

In Haryana, the Directorate General Factory Advice Service and Labour Institutes recorded 40 non-fatal factory injuries in 2023. That same year, SII assisted 1,041 injured workers in the state.

“Both government and buyer inspectors are essentially not reaching these factories, and when they do, they don’t talk to the workers,” says Dhanraj Balakrishna of SII.

Vijay Jadhav reports.

What declining domestic violence numbers conceal

Ganga (name changed), 31, starts her day at 6 a.m. She cooks and packs food for her children, drops them at school, and leaves for work. After nine hours, she comes home and cooks dinner. Most nights, her husband beats her. “I don’t think approaching the legal system will solve this,” she says.

Cases under “cruelty by husband or relatives” account for 27% of all crimes against women in India, according to the National Crime Records Bureau’s 2024 report. That year, India recorded, on average, 50 cases of crime against women every hour, down 10% from the previous year.

But legal experts say fewer complaints do not mean fewer incidents. “Cases are not reported or escalated, and intervention is not sought till the beating becomes life-threatening,” says Vibhuti Patel, social researcher and activist who has taught at TISS Mumbai. Even when women do come forward, most cases are dismissed as “family affairs” at the complaint stage, before an FIR is registered.

Attitudes help explain the persistence. A 2025 survey across 29 countries found 52% of Indian respondents agreed a wife should always obey her husband. Globally, Gen-Z men hold more traditional views on gender roles than older cohorts.

The National Family Health Survey 2023-24 found that 22% of ever-married women aged 18-49 had experienced spousal physical or sexual violence, down from 29% in 2019-21. Only 14% of women who face such violence ever sought help to stop it.

The legal system, Ganga says, offers little. Her one aspiration: to move out with her husband and children and live as a nuclear family. “I just want to be independent, my children to be educated well, and I want my husband to show some change.”

Saumya Tewari reports on what the numbers conceal and the distance that remains between law and lived experience.

Last week, we looked at India’s fertiliser scenario, and the potential ramifications of a shortage from supply chain disruptions due to the war in West Asia. This week, we turn to edible oils, prices of which are already high as Food Price Watch, our tracker of what a healthy diet costs in India, has been showing for weeks.

Since 2025, Prime Minister Narendra Modi has appealed to his fellow citizens to reduce the consumption of edible oils by 10%, first for health reasons, and last month, with the added objective to conserve crucial foreign exchange reserves.

But household surveys suggest that the average Indian is consuming just about the recommended amount of oil. The other part of the consumption story is industrial—think soaps and cosmetics, biofuels, lubricants & greases, paints & coatings.

India meets only 44% of its demand for edible oil. In 2024, the government launched the National Mission on Edible Oils, to increase oilseeds production 79% by the end of the decade. But that is not as simple as it sounds, we report.

Elsewhere, we analysed national crime data released recently for the year 2024, and found that cases of crime against children are at a decadal high, chargesheeting rate is low, and pendency in courts persists.

The impending oil crisis in your kitchen

Packaged sunflower oil prices across India are up 15% year-on-year, mustard oil up 12%, palm and soya up 9% each. India farms 15-20% of the world’s oilseed acreage but produces just 6-7% of its vegetable oil. It then imports $20 billion worth a year to make up the gap.

The government launched a mission two years ago to boost domestic oilseed production by nearly 80% by 2031, but experts say the numbers don’t add up without solving deeper problems: inputs don’t reach small farmers, procurement centres are absent in remote areas, and prices fell below MSP in 2023 with no government intervention.

As a result, farmers tend to allocate better land, irrigation, and inputs to cereals and cash crops, and “oilseeds are often cultivated in residual moisture conditions, on relatively poor soils and in less-favoured production regions,” explained Ravi Mathur, director of the ICAR-Indian Institute of Oilseeds Research. Consequently, India’s productivity is lower than other countries.

With price volatility and inadequate post-harvest infrastructure leading to distress sales and losses of up to 10% for oilseeds, beyond support prices, instituting ways to add value to farm produce can play a key role in incentivising farmers to adopt these crops.

Charu Bahri reports on what it will actually take to close India’s edible oil gap.

In 6 Charts: Crime Against Children In India

In 2024, India recorded, on average, one case of crime against children every three minutes. Most cases were related to ‘kidnapping and abduction’ or under the Prevention of Children from Sexual Offences (POCSO) Act.

India’s National Crime Records Bureau collates data on crime, accidental deaths and suicides from all states and Union territories. The latest data, for 2024, were released last month. Our analysis for the last decade shows some patterns that persist.

Chargesheeting rate is falling:

Each year over the last decade, police have filed chargesheets in about half the cases registered during the year.

In 2024, the police disposed of 181,446 cases of which 111,426 ended in chargesheets against the accused, a rate of 61.4%. This was the lowest rate in the last decade.

Pendency in courts is rising:

Nine in 10 cases up for trial remained pending at the end of the year. Overall, cases pending before courts have risen from 165,853 in 2015 to 644,887 in 2024, nearly three-fold increase in a decade.

A caveat when working with crime data is that a rise in cases does not necessarily mean a rise in crime. It could be due to multiple factors including more reporting and easier registration.

Read Vijay Jadhav’s analysis here.

That’s all for this week. We’ll be back next week with more stories.

Indians are eagerly awaiting the arrival of the monsoon. This summer has been deadly, quite literally for hundreds of people, and several parts of the country continue to reel under heatwave conditions. In this context, the India Meteorological Department (IMD) has released an updated forecast for the monsoon, and it is not good news.

The IMD projects that India will see a below-normal to deficient monsoon, with rainfall totals estimated to be 90% of the long-period average with a 4% margin of error. But even this hides spatial variations. Some regions may see much lower rainfall, and—as our experience over the past few years has increasingly shown—the season could see long dry spells accompanied by a few days of extreme rainfall events.

And, that’s not all. An intense El Niño could further derail the monsoons, and lead to increased temperatures in parts of the country. In an economy that is beginning to see the impact of the war in West Asia, this could lead to further distress—more than half of India’s area under cultivation is rain-fed. In an interview, we explain what this means for India, and how we can prepare for it.

Further, in the face of fertiliser shortages due to the war, we examine what a shift to natural farming can look like, and where policy is falling short.

Bleak monsoon

Changing climate has made monsoons increasingly erratic. In some years, overall rainfall for India as a whole has been stable, but wide variations have come to be the new normal. Many parts receive a large chunk of annual rainfall over a fortnight, a phenomenon that disrupts crops, tests urban drainage systems and resilience, and does little to recharge depleting groundwater levels.

This year, the complication of what is being called a ‘Super El Niño’ or ‘El Niño Godzilla’ imperils the monsoon. El Niño is a powerful atmospheric-ocean phenomenon. The National Oceanic and Atmospheric Administration describes the phenomenon as follows:

This causes wide disruptions—from increased rainfall and flooding in regions such as South America, East Africa, and the southern United States; to drought conditions in eastern and northern Australia, Indonesia, southern Africa, and parts of South Asia due to suppressed monsoon activity.

The war in West Asia is expected to further hit fertiliser supply. Combine that with a weak monsoon and increased fuel prices, and it is a perfect storm for India’s agriculture, and consequently, food production and prices.

But models are notoriously bad at predicting the amplitudes very well, explained Raghu Murtugudde, an earth systems scientist, Emeritus Professor at the University of Maryland, and visiting faculty at the Kotak School for Sustainability at Indian Institute of Technology (IIT), Kanpur.

In an interview, Tanvi Deshpande spoke with Murtugudde on what the science says so far about this year’s El Niño and what steps India could take to better prepare for its impacts. Read the full interview here.

‘Policy Changes, Not Prayers’

In his Independence Day speech in 2019, Prime Minister Narendra Modi called on farmers to reduce the use of chemical fertilisers by 10-25%. He repeated this appeal six years later, again from the ramparts of the Red Fort on Independence Day. Most recently, earlier this month, he called for a 25-50% reduction in fertiliser use.

But appeals without accompanying policy moves achieve precious little, experts say. During this time, India’s fertiliser consumption as a whole has risen 15%. Reducing the use of chemical fertilisers in soil that is habituated to their use causes a significant drop in yield. And if farmers are not protected from the yield drop, their already fragile incomes can dwindle further, leading to widespread distress.

A Union government-sponsored scheme launched in November 2024 to promote natural farming has so far covered 880,000 hectares, which is less than 1% of India’s cultivated land.

“To scale natural farming, we need policy changes, not prayers,” Avinash Kishore, senior research fellow in the Development Strategies and Governance Unit, International Food Policy Research Institute (IFPRI), told IndiaSpend.

If in 2010 a farmer had to sell 27 kg of rice at the prevailing minimum support price to buy 50 kg of urea; today a farmer could buy it for only 12 kg of rice, pointed out Kishore. “At such low prices, it simply doesn’t make economic sense for farmers to use urea judiciously or consider the alternative, natural farming, which involves much more hard work.”

The government should promote small scale rural enterprises to manufacture the inputs needed for natural farming, make alternative nutrient solutions at scale, and provide subsidies at least on par with chemical fertiliser to cover their costs and losses when they first make the switch, says G.V. Ramanjaneyulu, executive director, Centre for Sustainable Agriculture.

The Indian Council of Agricultural Research has identified potential domains for a transition to natural farming—balancing sustainability and national food security—to cover 25.8% of India’s net cultivated area. But scaling up from 1% area is impossible without policy change, Charu Bahri reports.

That’s all for this week. We’ll be back in your inbox next week with more stories.

The India Meteorological Department has forecast heatwave to severe heatwave conditions in 17 states and Union territories until May 27.

Temperatures are breaking records in several cities, including minimum temperatures—which is particularly dangerous because, as we reported in May 2023, bodies need cooler nights to recover from the heat of the day, and when minimum temperatures remain high, we are stuck in persistent thermal stress.

Heatwave advisories ask people to stay indoors, but in informal settlements and affordable housing complexes, poor ventilation leads to trapped heat inside the home, making it intolerable. For patients with chronic illness, it adds to the stress, exacerbating their condition.

Our story this week looks at people with conditions such as diabetes, hypertension, cardiac issues, and disabilities to understand how extreme heat is affecting their health, livelihood and lives.

Meanwhile, the LPG crisis is forcing women to return to the chulha or traditional cookstoves. Cooking gas cylinders are in short supply, and are selling for a premium on the black market. Working on a chulha in this heat can become dangerous very quickly.

Elsewhere, India’s road accident victims struggle to access legal compensation, due to a lack of awareness, long delays, and complicated procedures.

Living with chronic disease in the summer

Vidya (name changed) can no longer work outside home. Her leg has a persistent wound from a burn injury, and her sugar levels remain high. Every summer, she says, “I feel this fear. My heart starts palpitating sometimes. What problems are waiting for me in these months?”

For Radha (name changed), who lost the function of her legs after spinal surgery four years ago, the summer means something worse: mostly confined to her bed in Guntur’s Sarada colony, with a single fan and corrugated iron roof overhead, she cannot cool herself, bathe, or do the most basic things without her 10- and 11-year-old children’s help.

And for Krishna (name changed), who had heart valve surgery three years ago and can no longer work, the heat inside his house brings a specific dread. “I feel tense during the heat inside,” he said. “Like something adverse will happen.”

Everyday life is already a struggle for people like them, living in informal settlements with poor ventilation, roofs that trap heat, and limited access to cooling methods. But summers make it worse.

Research shows that heat stress raises blood sugar, can trigger sudden drops in blood pressure, damages kidneys, and strains the heart—risks that multiply for those with comorbidities in poorly ventilated homes. Frontline doctors often don’t recognise exhaustion or weakness as heat-related illness, prescribing painkillers that further harm the kidneys, experts say.

And it is bound to get worse. About 57% of Indian districts, home to 76% of the population, are at high to very high heat risk. Hemanth Chandu and Pavani Pendyala report from Vijayawada and Guntur.

Back to the chulha

The West Asia war has choked India’s LPG supply—India imports 60% of its liquefied petroleum gas—and cylinder prices have nearly doubled. A commercial 19-kg cylinder that cost Rs 1,768 in March now costs Rs 3,071, and on the black market, gas is selling for Rs 350-400 per kilogram. Delhi’s poorest women have gone back to wood and coal.

Parveena Khatun, 45, who runs a tea stall in Munirka, built a brick stove when supplies ran out in March. On a day when Delhi hit 43°C, the smoke and heat left her dizzy enough that she had to sit under a tree and wash herself with cold water. Her hands have burn marks—she had never cooked on a chulha before.

“If I buy Rs 100 worth of gas for Rs 400,” she said, “I would have to raise the price of a cup of tea from Rs 10 to Rs 40. Who would buy it?”

Each time a woman cooks over a chulha in this heat, her body is fighting two battles: trying to cool down while breathing harmful smoke. “It is a killer combination,” said Vidhya Venugopal, professor of occupational and environmental health. “This is far more dangerous than either problem alone and can quickly lead to exhaustion, dizziness, and breathing difficulties.”

A 2022 estimate places deaths from household air pollution at 1.65 million a year in India. Research published last month found that air pollution becomes significantly more dangerous as temperatures rise. For Reena Kumari in Vasant Vihar, who has no gas connection and two small children who cry from the smoke, the choice is stark: the chulha or starvation. Shivam Bhardwaj reports.

The compensation dead-end

India recorded 480,583 road accidents in 2023, resulting in 172,890 deaths. Two-thirds of those killed were aged between 18 and 45—the prime working years. For poor families, the financial burden can quickly compound.

Shoba Kshirsagar, a 55-year-old waste-picker in Pune, became her family’s sole earner overnight when her son was hit by a dumper truck. The family spent Rs 2.75 lakh out of pocket. She has filed for third-party insurance, but the case is ongoing. She has moved her family into a smaller place to survive.

Laws exist: mandatory third-party insurance, a Motor Vehicle Accident Fund, cashless treatment in the golden hour after a crash. In practice, 70% of low-income victims are unaware these mechanisms exist. Only 205 claims were filed against 25,000 eligible hit-and-run crashes in 2022-23. The average compensation timeline is 3.6 years—often stretching to 8-10 years. Meanwhile, Rs 80,455 crore in pending claims sit in courts across the country.

For Mitali (name changed), a professional in Gurugram whose scooter was struck by a car on the wrong side of the road, pursuing compensation required physical court appearances she couldn’t manage for months, a lawyer charging 30% contingency fees, and a case that still hasn’t concluded. “The key issue is not just the amount, but access,” said Ranjit Gadgil of Parisar. “By the time compensation arrives, families may already have taken on debt at high interest rates.” Prachi Salve reports.

Have a good weekend.

Hospital waiting rooms are depressing, and depending on where you are, can get intolerable. And in the hours of waiting for updates from doctors outside an ICU, you tend to read the advisories and informational material pasted in the room.

This week, I spent some time in the waiting room outside an ICU in Hyderabad, where we lost a friend’s father. There was a six-foot standee advocating organ donation, with text in English and Telugu, and illustrations showing which organs could be donated. But when the time came, and we asked if the hospital could connect us for further process, no one around knew what to do.

At IndiaSpend, we have written about such gaps several times before—between a noble, well-intentioned policy or idea and lax implementation. This week too, we have two stories that look at such gaps.

The first is a recommendation by the 16th Finance Commission to include heatwaves in the list of disasters, so that states can unlock critical financing. But definitional issues persist, and without resolving them, the most vulnerable may never see benefits.

And the other is a story on how medical boards set up to review cases of abortion are turning into final arbiters of rights.

The fine print in disaster relief

India’s disaster management laws currently recognise 13 types of natural disasters, providing access to emergency funds for states reeling under the impacts.

Over the years, experts and state governments have called for heatwaves to be included in this list, but this has not yet happened. The Finance Commission has, for the first time, made this recommendation, but the government is yet to accept it. If and when it is accepted, definitional problems could cut off access to funds for the most vulnerable.

Take the case of drought: Declaration of a drought in a state, assessing its extent, damage and issuing compensation to those affected often becomes a problem and many who suffered losses are not recognised.

A heatwave is declared by the India Meteorological Department, but extreme heat can affect the health of vulnerable populations even below the heatwave threshold. In such scenarios, states will not be able to access disaster relief funds to provide compensation or support.

“So far, lightning and heatwave are local disasters and the number of casualties are low, so the states don’t need large-scale resources such as the NDRF,” said Krishna Vatsa, member and head of the department at the National Disaster Management Authority. “But when it comes to mitigation, which are the long-term measures where we need to set up early warning systems, improve awareness, the resources required may be larger… Besides, it could help in the implementation of heat action plans.”

As India is expected to see more heatwave days and warmer nights in several parts of the country, Tanvi Deshpande explains what it will take to provide access to critical funds.

How medical boards control access to abortion

On April 24, the Supreme Court allowed a 15-year-old in her third trimester to terminate her pregnancy. A medical board pushed back citing rights of the unborn child, a concept not recognised in Indian law. The Supreme Court stood firm, but the minor gave birth to a baby boy on May 2.

India’s 2021 amendment to the Medical Termination of Pregnancy (MTP) Act expanded access to safe abortion by increasing the gestational limit from 20 to 24 weeks for special categories of women, including rape survivors, minors, and women with disabilities, and also mandated the establishment of state-level medical boards to evaluate complex cases.

Nikhil Datar, a Mumbai-based obstetrician and gynaecologist, had challenged the original 1971 MTP Act, the 2021 amendment and the rules in the Supreme Court. Datar said the “shoddy drafting” of the abortion law itself is “problematic” and that the creation of medical boards not only violates fundamental rights but is also “another layer of paternalism whereby the law wants doctors to also be the legal gate keepers besides being medical advisors”.

“A woman’s right over her own body is absolute, subject to only one condition that she cannot cause harm to her own body,” senior advocate Colin Gonsalves said. “If there is no harm caused, she has an absolute right to decide on an abortion and nobody, not the government, not the medical board, nobody can actually overwrite that decision of a woman.”

A 2025 report, which studied 1,114 cases in the Supreme Court and the high courts between 2019 and 2024, revealed that permission to abort a pregnancy was denied in 11% cases. Of these, courts relied on the medical board opinion in 81.5% cases. Ritika Jain reports.

Have a good weekend!

Elections to the legislative assembly in Assam, Kerala, Puducherry, Tamil Nadu and West Bengal have concluded, with counting scheduled for Monday, May 4. Campaigns in all regions were intense, but there was little focus on climate and its impact on the health and livelihoods.

Ahead of the second phase of voting in West Bengal, we looked at Purulia district on the western edge of the state. Erratic rainfall, soil erosion and lack of irrigation makes agriculture unviable for most in the region. In addition, for years now, work under the world’s largest rural jobs programme was unavailable.

While people have historically migrated for work from Purulia, changing climate is driving up distress in the region. Left behind are the elderly, women and children, who pay a heavy social price while the men toil away in faraway lands.

Elsewhere, we look at Delhi’s gig workers and the impact of heat on their health and earnings.

The Long Road to Survival

Pijush Bauri earns Rs 14,000 waterproofing roofs in Surat. But he was forced to return home to West Bengal’s Purulia as the LPG crisis unfolded. Now back at home, he has no income.

Pasupati Majhi works in construction in faraway Goa. He dreads the uncomfortable and expensive 40-hour train journeys back home to Purulia in West Bengal. “Nobody really knows how precarious our lives are,” he says.

For 33-year-old Kanika Mahato, most days are lonely without her husband, who works in Jharkhand’s Bokaro sorting and loading metal. She dreads the possibility of a health emergency for her children.

Purulia is drought-prone, and receives 60% of its annual rainfall in a fortnight. Agriculture is rainfed, and poor fertility and lack of irrigation facilities means nearly half the area under cultivation is under a single crop.

“Migration becomes a survival strategy,” Umi Daniel, director, migration and education at the non-profit Aide et Action International, says, but “does not really give them better opportunities—they do manual labour and are paid less wages,” says Daniel.

From Purulia’s Hura, Manbajar and Puncha blocks, Ritwika Mitra documents the livelihood crisis and the social cost of distress migration

The Algorithm Doesn’t Take a Heat Break

The National Disaster Management Authority has a standing advisory to protect gig workers from the impacts of heat, which among other things calls on platforms to not mandate work during the peak afternoons.

But gig workers, at the mercy of algorithms they do not fully understand, are incentivised to stay logged in during this peak time, and accept all orders. Lunchtime is a critical part of the platforms’ service, and therefore, incentivising workers makes business sense. Staying logged in is technically voluntary, but workers say that without the incentive amounts, their incomes are not enough to make ends meet in the metros they cater to.

But without critical amenities such as rest or cooling areas, UV-protective clothing, and provision of drinking water and ORS, workers face intense heat stress every shift, putting their health and life at stake. “When we climb three to five floors in apartment complexes, we get dizzy. In many buildings, they do not even allow us to use the elevator,” says Ankit Soni from Bihar’s Siwan district.

“It is not possible to take a two- or three-hour break during a heatwave under company policy. If I take a break, I won’t earn enough,” says Rinku Kumar (name changed), a Zomato delivery agent.

“For workers who depend on daily income with no wage security, heat safety cannot work unless income loss is addressed directly,” says Vidhya Venugopal, professor of occupational and environmental health at the Sri Ramachandra Institute of Higher Education and Research.

As several parts of India are seeing high temperatures, Shivam Bhardwaj reports on the worker heat stress subsidising India’s delivery economy. (Explore this interactive quiz to navigate through a gig worker’s day).

That’s all for this week. We’ll be back next week with more stories.

Meet Rudrani Chhetri, a transgender woman and project director of the Garima Greh (shelter home) in Delhi run by Mitr Trust. We have been following Chhetri’s work for years now.

In 2023, she recounted how her friend Rupali, who needed dialysis, could not get blood from anyone from her community because of a HIV/AIDS-era blood donation ban. Rupali died in 2017.

The following year, she spoke about the difficulties the shelter home faces: delayed funds, borrowed credit, staff working without salaries, and—in one instance—police harassment: In July 2022, the police took a transgender man housed at the shelter home with them at the request of his family. When other residents went to the police station to enquire, they were assaulted by the police, she had told us.

Even before a new amendment to the transgender protection law, there were significant gaps in implementation, and a lack of awareness about rights. “Although there are chapters addressing discrimination, denial of education, and healthcare, there is no recourse for individuals when these rights are violated,” Chhetri had told us. But now, self-identification and support are both at risk, as we explained this week.

Elsewhere, as schools begin to shut for the annual summer vacation, we look at the patterns on spending on school education.

From Rights to Red Tape

The Transgender Persons (Protection of Rights) Amendment Act, passed in March, has left shelter homes like Chhetri’s in an information black hole. Residents who had started to settle are quietly leaving. “We are stuck in uncertainty,” she told us.

For instance, the Ayushman Bharat transgender health plan—which had promised Rs 5 lakh in health insurance for surgeries and hormone therapy—had not even completed hospital empanelments when the law changed the definition of who qualifies. “You made the plan yourself, after understanding the definition of gender,” Chhetri says. “Now you’re saying that whatever you had learned was wrong.”

The amendment does several things at once: It removes trans-man, trans-woman and gender-queer from the legal definition—retroactively, as if they were never included.

It makes legal recognition contingent on a medical board’s recommendation followed by district magistrate approval, replacing the right to self-identification that the Supreme Court affirmed in 2014.

It introduces provisions criminalising anyone who “compels” a person to adopt a transgender identity—a clause that guru mas in traditional trans households now fear could be used against them for sheltering young people who come to them.

The rationale for the amendment, the government said, was the misuse of benefits meant for transgender persons. But even before this amendment was enacted, getting an ID card was difficult. Only 33,000 identity cards have been issued so far—7% of the estimated population. Between 2021 and 2024, just 11% of allocated welfare funds were spent.

“How can the government or a medical board affirm or reject my identity?” Ayaan, 24, a transman, asks.

Divya Tiwari reports on what the change means for community members, shelter homes and healthcare providers.

The Cost of Schooling

The Right To Education Act provides for free and compulsory elementary education (grades I to VIII) to each and every child. But that does not mean children are studying for free. A government survey of 52,085 households shows that parents are increasingly spending on coaching and private school. Even those whose children are studying in government schools spoke of associated costs such as books and stationery, transport and uniforms.

On top of tuition, nearly four in ten secondary students are enrolled in private coaching, with spending rising almost fourfold between primary and higher secondary level. Private school fees average ten times government school fees.

“Entry to higher education is now almost totally driven by entrance examinations,” says Kishore Darak, a senior educationist, “and the coaching industry is the gatekeeper.”

Taken together, families with school-going children spend between 5% and 10% of their monthly expenditure on education and related costs, our analysis shows. And marginalised communities spend a higher percentage of their incomes for a shot at the same opportunities. Vijay Jadhav reports in six charts.

We’ll be back next week with more stories.

I am writing from sweltering Kuala Lumpur, Malaysia, where 30 journalists from across South and Southeast Asia convened for a workshop on heat and its impact on human health.

As my colleague Tanvi Deshpande reported last week, extreme heat particularly affects the most marginalised groups and communities. Construction workers and farmers are acutely impacted, as are street vendors, factory workers, gig and platform workers, and home-based workers.

For many of them, missing even a few hours of work means lost incomes in the face of increasing expenditure and, with the onset of the summer vacation, more caregiving duties, especially for women who bear a disproportionate burden.

And this is just the beginning. All predictions show that several parts of India are set to see high temperatures, more heatwave days and normal to below normal rainfall this monsoon. Over the next few weeks, we will continue to tell the stories of how vulnerable populations are coping with extreme heat.

Meanwhile, we saw a heated parliamentary debate on an amendment to increase the number of seats in the Lok Sabha to 850. Several parties that lead state governments have opposed the move, citing a potential decrease in the proportion of seats. The motion was defeated as it failed to garner the two-thirds majority necessary for constitutional amendments.

This move was meant, the government says, to fast-track the implementation of a law to provide 33% reservation for women in the parliament and legislative assemblies. This week, we examine the current state of women’s representation at different levels of government and the barriers that women face in moving up the ranks.

Elsewhere, we look at the worsening urban crisis and how the wealthy are seeking oases in the middle of cities—gated communities, integrated townships and other exclusive enclaves. As a result, they withdraw from civic participation, leaving the rest to deal with failing city infrastructure.

From Village Councils to Parliament

More than 1.5 million women hold elected positions in Panchayati Raj Institutions, with representation exceeding 50% in many states. This is largely due to a 1992 amendment to the Constitution reserving a third of seats for women in rural and urban local bodies. In 18 states, women now occupy more than half of all PRI seats. Only the Union territories of Dadra and Nagar Haveli and Ladakh have less than 33% representation of women in these grassroots institutions.

But even in these institutions, women routinely face gender prejudice, financial constraints, discrimination and physical threat, as we reported over the years.

And the path up to the higher levels of government is rocky. Even states with higher representation of women in PRIs see fewer women MLAs. In Himachal Pradesh, for instance, women account for 50% of PRI representatives, but only one of 68 members in the state’s legislative assembly is a woman.

In Lok Sabha, women’s representation has increased from 22 of 489 members (5.5%) in 1957, to 75 of 544 members (13.79%) in 2024. Vijay Jadhav explains in five charts.

Inside the Gates: India’s Urban Inequality Crisis

Indian cities are crumbling. The Economic Survey for 2025-26 calls them “sites of daily strain: long commutes, uneven services and shared spaces that often fall short of collective expectations”. This state of affairs and growing aspirations are driving India’s urban affluent to gated communities to experience a more organised version of their city.

Advertisements for upcoming or exclusive communities promise landscaped open spaces, play areas, gyms, club houses, sports centres, all of which are supposed to be part of city development plans, but aren’t. Two in five households in India’s top 50 cities today opt to live in a gated complex, up from one in three households five years ago, according to a new report from Redseer Strategy Consultants on the rise of gated communities in India.

But their exit leaves urban local bodies less accountable to the less privileged who lack the means to question service delivery lapses.

“When a city’s most resourceful residents disengage, it can create conditions where the needs of the less affluent are more easily deprioritised and over time, the city’s sense of shared responsibility can quietly narrow,” said Amit Kapoor, chair, Institute for Competitiveness.

City governance reform needs the empowerment of urban local bodies to implement the functions they have been constitutionally entrusted with, higher funding for service delivery, citizen participation and greater accountability, Charu Bahri writes.

Have a good weekend.

Parts of coastal and southern India are bracing for a heat wave, or hot and humid conditions next week. The India Meteorological Department has forecast more heatwave days and warmer nights this summer in several parts of the country.

The most vulnerable are often overlooked in mitigation and planning. Particularly affected are India’s informal workers who have no paid leave, no air-conditioned workplaces, and no financial buffer, leaving them with little room to navigate health impacts and income loss.

This week, we look at the impact of heat stress on two specific groups of workers: street vendors, already living at the margins in the face of vending-free zones and limited access to social security, and garment workers who work in cramped spaces with little ventilation, often in workshops covered with heat-trapping asbestos roofs.

India is projected to lose about 5.8% of working hours in 2030, up from 4.3% in 1995. Given its large population, the country is expected to lose 34 million full time jobs in 2030 as a result of heat stress—with agriculture and construction, the sectors with the highest number of workers, expected to be most affected.

Elsewhere, India’s Green Credit Programme—which aims to encourage voluntary plantations on degraded lands—is mired with implementation gaps, with internal documents suggesting evictions, possible violations of the Forest Rights Act, procedural lapses, selection of unsuitable sites and delays.

No Shade, No Water, No Protection

Shobha Devi is a flower seller in Mumbai’s Santacruz area. She does not have a fixed station—she just stands in the busy market areas holding flowers and gajras (flower strings) for sale.

“This heat is nothing. May is the worst,” said Devi, who carries water and food from home. Sometimes, she brings her four-year-old son along. “Kya karoon? (what should I do)” asked Devi, when asked if the toddler can be protected from the heat.

There is a municipal toilet nearby. She lives in Virar, an hour away by local train, and cannot return home during the peak heat hours.

A study by Women in Informal Employment: Globalizing and Organising (WIEGO), of more than 400 street vendors in Delhi-NCR, showed that 70% of vendors lacked access to toilets, clean water and shade, and that access worsened during the heat period. Nine in 10 vendors reported no access to free, clean water while working.

Nearly every respondent (96%) reported seeing fewer customers, and 90% said they reduced their working hours due to extreme heat. Borrowing nearly doubled, with women taking on more debt than men.

Another study, conducted by Heat Watch and Tata Institute of Social Sciences, surveyed 115 garment workers in Tamil Nadu and Delhi, and found that in the last 12 months, 87% workers reported facing heat-related issues such as headaches, dizziness, weakness and muscle cramps.

Nearly two in five workers reported that the toilets are often unclean, 73% reported they do not have running water, 78.3% workers reported that it is difficult to get permission to use the toilets. Women are particularly affected, with a vast majority reporting urinary tract and menstrual health issues.

To mitigate these impacts, experts are calling for urgent reforms, including the classification of heat-related illnesses under the Employees’ State Insurance Act, the implementation of parametric insurance for informal workers, and the deployment of industrial hygienists to enforce workplace temperature standards. Tanvi Deshpande reports.

What’s Ailing India’s Green Credits

India’s Green Credit Programme, launched in 2023 as a market-based climate solution, has been positioned as a tool to incentivise environmental action. However, internal documents suggest it is coming at the cost of local lives and livelihoods. In Assam, plantations have been carried out on lands from which villagers were evicted, while in Gujarat, land claimed by tribal communities has been fenced off, raising concerns over rights and access.

While the scheme hoped to enrol individuals and private sector industries, until now, it has attracted investments from only state-run oil, coal and power companies. Seventeen public sector units—including, Indian Oil Corporation and other petrochemical corporations, Coal India Limited and its subsidiaries, National Thermal Power Plant Corporation—have bought green credits.

Since its launch, eco-restoration has begun in 225 sites across 12 states covering about 48 square kilometre of “degraded land”, government data show.

Documents obtained under the Right to Information Act—inspection reports for 169 sites across 10 states spread over 35 sq km involving Rs 117 crore worth of green credits—highlight implementation gaps, including a “mismatch” between species listed in cost estimates and those actually raised in nurseries. Several identified sites were also found to have dense canopy cover, unsuitable for plantations, and involved activities adjacent to approved areas.

Experts argue that, as a potential replacement for compensatory afforestation (CA), which mandates companies to offset forest diversion by bringing non-forest land under plantation, the GCP departs from its original intent by promoting plantations on “degraded” forest land. It also lacks safeguards to ensure that such forest parcels, many of which are used by tribal and forest-dwelling communities, are not taken up for plantations before their rights are recognised under the Forest Rights Act. Sukriti Vats reports.

That’s all for this week. Until then, stay hydrated.

Let me take you back to early 2021, a few months before the horrors of the second Covid-19 wave, when much of the world was waiting for approval and/or widespread availability of vaccines.

Clinical trials were being conducted widely, but there were problems: Many lacked rigour, some trial participants said they did not understand that they were taking part in a trial, some agreed assuming that it was a vaccination drive, still others said they were offered Rs 750 as payment. “I needed the money,” one participant had told us.

Fast forward to today, and the Union government wants to “create a network of over 1000 accredited India Clinical Trials sites”. This is under the newly announced Biopharma SHAKTI, aimed at building an “ecosystem for domestic production of biologics and biosimilars”, and developing India as a global Biopharma manufacturing hub.

But low patient awareness is still a concern, as are participant recruitment, trial finances and ethics committee membership and operations, our reporting found. Filling these gaps is critical to ensure that patient’s rights are upheld.

Elsewhere, with shrinking habitats and narrowing migration corridors, human-elephant conflict has become frequently, often with deadly consequences. We follow a group of volunteers who spend days and nights tracking elephant movements, and help prevent encounters.

From ‘Guinea Pig’ to ‘Aware Patient’

Over the last 13 years, India’s clinical trial framework has been significantly strengthened. New rules include provisions for compensation to trial participants, and recording consent on video, especially among vulnerable populations. These, and mandatory registration of ethics committees with the central licensing authority were to improve safeguards for patients.

That is on paper.

Studies show that anywhere between 60% and 75% of the population is insufficiently informed.

“Many patients who participate in clinical trials in India aren’t aware that they could suffer an adverse drug reaction, contrary to getting better, nor are they aware of their rights in such an eventuality,” explains Amulya Nidhi of the Swasthya Adhikar Manch, a not-for-profit working in the clinical trials space.

A Supreme Court-recommended apex committee to approve new trials has never met. And there are issues with trial finances and ethics committee membership and operations. At Ahmedabad’s Sheth VS General Hospital, for instance, a probe found financial irregularities across 58 trials involving over 500 patients: 15 doctors had diverted Rs 1.87 crore to personal accounts over four years.

As 1,000 new accredited trial sites come online, Poonam Bagai, founder and chairman, CanKids…KidsCan, which also hosts the Pediatric Cancer Research Institute (pCRI), an initiative focused on patient-centred paediatric oncology research, pointed out that the government will need to strengthen monitoring. “Oversight should be risk-based and enabling, ensuring ethical standards without discouraging responsible research.”

Read Charu Bahri’s story.

Tracking Elephants In The Dark

One morning in 2023, Manwari Bareth and her husband left their village in Chhattisgarh to collect mahua seeds—oil from the seeds can bring a family Rs 6,000 in a month. They heard a sound in the forest. Her husband said it must be a falling twig. It wasn't.

"Around 9 a.m., they found his body. His chest and shoulder crushed, his body was in a twisted position," Bareth said.

His was one of 135 human deaths recorded in the Dharamjaigarh forest division of Raigarh district between 2000 and 2023. In the same period, 33 elephants died there from electrocution by the fences farmers use to protect their crops.

This is what human-elephant conflict looks like on the ground: a shrinking forest, farmers desperate to protect harvests, elephants with nowhere left to go, and communities caught in between.

Six volunteers—paid Rs 10,000 a month, with no insurance—spend days and nights tracking elephant herds. "If you think of this work as a source of livelihood, it is impossible,” says 40-year-old Javed Sheikh, a member of the Hathi Mitra Dal.

When not tracking elephants, Sheikh and his team visit villages and spread awareness, discouraging villagers from using electrical fencing, and informing them about changes in elephant movement patterns.

Farmers whose livelihoods depend on their harvests can become frustrated when herds damage fields overnight. “If crops are damaged, people become angry. We have to face that too,” he adds.

The Hathi Mitra Dal is a state government initiative started in 2018, and works with forest officials to track herds and alert villages. But as forests fragment and elephants lose corridors, the volunteers are managing a crisis that structural investment has not kept pace with, Stephin Thomas reports.

Have a good weekend!

For the first time in four decades, young Indian men are withdrawing from education. Graduate earnings are stagnating. Half of new jobs are in agriculture. And India expects its demographic dividend to peak before 2030.

A new report from Azim Premji University traces 40 years of youth employment and education data, and the picture it draws is more complicated than the headline growth numbers suggest. The economy is expanding. The jobs it’s creating aren’t what a young, educated workforce needs.

Elsewhere, a different kind of target missed: India recorded 185 TB cases per 100,000 people in 2025—more than four times its own elimination goal.

Young, Educated, Waiting

Half of the 83 million jobs added between 2022 and 2024 were in agriculture, a sector that contributes least to output and earnings, according to a new report released earlier this month. The demographic dividend India hopes to cash in before 2030 depends on a labour market that isn’t ready.

I spoke with Rosa Abraham of Azim Premji University, lead author of the State of Working India 2026 report, about what four decades of data reveal.

Abraham pointed to three surprising trends: the gender pay-gap narrowing not from a surge in women's income but from declining men's earnings; young men withdrawing from education for the first time in four decades; and a heartening shift of SC and ST workers away from traditional occupations into modern industries.

Abraham is an associate professor of economics at the University, and heads its Centre for Sustainable Employment. In this interview, she explains why earnings are stagnating, who waits longest for salaried work, and what AI might do to entry-level jobs next. Read the interview.

The Long Road To TB Elimination

When Rajendra Nayak, a driver in Odisha, developed a persistent cough and started losing weight, he did what most patients do—he went to a health facility. Three tests came back negative for tuberculosis (TB). Those around him assumed his drinking was to blame. He was ready to give up on seeking care.

It took a community volunteer and one more test—a molecular one this time—to find the TB that sputum microscopy had missed. Nayak's experience is not an exception. Experts say half of all patient losses in India's TB care system happen at this very first step.

India’s TB elimination target for 2025 was 44 cases per 100,000 population. But that year, India had 185 cases per 100,000, more than four times the target.

Increased notifications are not necessarily a result of higher incidence, but could be attributed to India’s active casefinding. The problem lies in the gap between intent and execution.

Smear microscopy, which misses half of all TB cases, accounted for three in four tests in 2023, the latest year for which such data are available. Molecular testing remains unevenly available. Experts describe a testing pathway "designed for leakages"—patients referred across multiple facilities, returning for results, referred again.

Further, nearly 40-50% of microbiologically confirmed TB cases show no typical symptoms, meaning symptom-based screening alone cannot find them.

Clinicians and researchers say the answer lies in reaching patients earlier, through active community screening. The government’s updated strategy says this too. The distance between strategy and practice is where patients disappear. Prachi Salve takes stock.

That’s all for this week. Have a good weekend!