India: Too Many Women Dying in Childbirth - Human Rights Watch

Despite National Commitment, Many Unable to Access Services

October 7, 2009

Relatives mourn the loss of Kiran Yadav, who died after giving birth. Gopalpur, Uttar Pradesh.

© 2009 Susan Meiselas/Magnum

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• In Silence: Maternal Mortality in India

Unless India actually counts all the women who die because of childbirth, it won’t be able to prevent those thousands of unnecessary deaths. Accountability might seem like an abstract concept, but for Indian women it’s a matter of life and death.

Aruna Kashyap, South Asia Researcher in the Women's Rights Division

(Lucknow, India) - Tens of thousands of Indian women and girls are dying during pregnancy, in childbirth, and in the weeks after giving birth, despite government programs guaranteeing free obstetric health care, Human Rights Watch said in a report released today.

The 150-page report "No Tally of the Anguish: Accountability in Maternal Health Care in India" documents repeated failures both in providing health care to pregnant women in Uttar Pradesh state in northern India and in taking steps to identify and address gaps in care. Uttar Pradesh has one of the highest maternal mortality ratios in India, but government surveys show it is not alone in struggling with these problems, including a failure even to record how many women are dying.

"Unless India actually counts all the women who die because of childbirth, it won't be able to prevent those thousands of unnecessary deaths," said Aruna Kashyap. "Accountability might seem like an abstract concept, but for Indian women it's a matter of life and death."

The report cites numerous examples of cases in which breakdowns in the system ended tragically. Kavita K., for example, developed post-partum complications, but the local community health center was unable to treat her, according to her father, Suraj S., who said the family then tried to take her to government hospitals in three different towns.

"From Wednesday to Sunday - for five days - we took her from one hospital to another," he told Human Rights Watch. "No one wanted to admit her. In Lucknow, they admitted her and started treatment. They treated her for about an hour, and then she died."

India created a flagship program, the National Rural Health Mission, in 2005 to improve rural health, with a specific focus on maternal health. The program promises "concrete service guarantees," including free care before and during childbirth, in-patient hospital services, comprehensive emergency obstetric care, referral in case of complications, and postnatal care. But the system is not working as it should in many cases, Human Rights Watch research showed.

The report identified critical shortcomings in the tools used to monitor the health care system and identify recurring flaws in programs and practice. While accountability measures, such as monitoring how and why women die or are injured, or how many pregnant women with complications can use the government's emergency obstetric facilities, may seem dry or abstract, they are critical to intervening in time to make a difference and to saving the lives of women.

The major gaps in the system identified by Human Rights Watch are:

• The failure to gather the necessary information at the district level about where, when, and why deaths and injuries are occurring and whether women with pregnancy complications in practice get access to emergency obstetric care; and
• The absence of accessible grievance and redress mechanisms, including emergency response systems.

"India has recognized that thousands and thousands of its women are dying unnecessarily, and it could be leading the world in reversing that deadly pattern," said Kashyap. "But for all India's good intentions, the system still leaves many women at risk of death or injury."

The research for the report was conducted between November 2008 and August 2009, and included field research and interviews with victims, families, medical experts, officials and human rights activists in Uttar Pradesh and elsewhere in India. Researchers reviewed government surveys and reports by local and international nongovernmental organizations.

The investigations in Uttar Pradesh also show that while health authorities are upgrading public health facilities, they still have a long way to go. The majority of public health facilities have yet to provide basic and comprehensive emergency obstetric care. Many have a health worker trained in midwifery but who can do little to save the life of a pregnant woman unless supported by a functioning health system, including an adequate supply of drugs, emergency care, and referral systems for complications.

The reality is far different from what is guaranteed to women on paper. Niraja N., a health worker who routinely accompanies pregnant women to health facilities so they can give birth told Human Rights Watch:

"Nothing is free for anyone. What happens when we take a woman for delivery to the hospital is that she will have to pay for her cord to be cut ... for medicines, some more money for the cleaning. The staff nurse will also ask for money. They do not ask the family directly ... We have to take it from the family and give it to them [staff nurses] ... And those of us [ASHAs] who don't listen to the staff nurse or if we threaten to complain, they make a note of us. They remember our faces and then the next time we go they don't treat our [delivery] cases well. They will look at us and say ‘referral' even if it is a normal case."

In part, this happens because many women are unaware of their entitlements under health care programs and have no way to make sure that their complaints and concerns about the treatment meted out to them at health facilities or by health workers are heard and addressed.

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Letter From New Delhi: India Loses Patience With the Super-Rich - washingtonpost.com

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By Emily Wax
Washington Post Foreign Service
Tuesday, October 6, 2009

NEW DELHI -- In this developing nation, government officials have long enjoyed first-class air tickets, overnight stays at five-star hotels, and vast entourages of servants and security, in what is known here as "V-VIPism."

But with the global economy in peril and India in the middle of its worst drought in years, such displays of wealth have begun to anger the public, especially after the Indian media reported that Foreign Minister S.M. Krishna and his deputy, Shashi Tharoor, had been holed up for more than three months in two of the capital's most opulent five-star hotels while their pricey bungalows were being built.

The men said they were paying for the hotel stays out of their own pockets. But television pundits wondered how public servants could afford suites that can cost anywhere from $250 to more than $2,000 a night.

While the extravagance is not all that notable for India, the fact that it's become such a hot issue is. Many Indians say an "austerity drive" announced by the ruling party would never have even surfaced 10 years ago. There is more hope for genuine social mobility in India then ever before and more willingness to question those at the top who are seen as living lavishly on the public dime.

The two Foreign Ministry officials recently moved out of the hotels and into modest guesthouses. But that's when penny-pinching became political.

Suddenly, leaders of all ages and political parties began flying economy class, taking the train, eating roti rolls and lentils at roadside truck stops, and wearing khadi -- Mohandas Gandhi-esque homespun cottons, which are a symbol of commitment to the common man in Indian politics. All this was done with the cameras rolling, of course.

Pranab Mukherjee, the finance minister, flew economy class from Delhi to Kolkata. "It was quite enjoyable," Pranab told a scrum of TV reporters.

Soon after the hotel exposé, Sonia Gandhi, leader of the ruling Congress party, announced the austerity drive and flew economy class. She had also previously asked ministers to contribute 20 percent of their salaries toward drought relief.

Rahul Gandhi, the party's heir apparent and Sonia Gandhi's son, made front-page news when he took the train.

More recently, Rahul Gandhi made headlines when he visited a poor rural area and slept outside on a rope cot known as a charpai, refusing even a mosquito net. He then bathed at a hand pump, ate local vegetables and hung out with low-caste farmers.

But there is a question of just how sincere these efforts really are. Tharoor, minister of state for external affairs, went on Twitter and wrote that he would travel "cattle class out of solidarity to all our holy cows." He was chastised by leaders of the Congress party, who were reelected this year on a platform to lift hundreds of millions of Indians out of abject poverty.

Tharoor, a well-dressed man with a head of thick, shiny black hair, is popular in India and was well respected abroad when he was a U.N. undersecretary general. His defenders said that his comments were clearly a joke and that most Indians themselves aspire to fly first class.

The tabloid newspaper Mail Today ran a front-page story describing "sheepish Tharoor going to various offices through the day, to apparently apologize for his remarks. All in a country where less than one percent of the population travels by air."

Even as the politicians appear to be adopting more austere ways, they also know that deep beneath the feelings of young Indians and their aspirations to the middle class is an even stronger current of respect for the wealthy. In a nation built on centuries of caste-driven roles, the tolerance of those born to a higher position is strong.

"Rarely are the rich questioned," said Brahma Chellaney, a security expert with the New Delhi-based Center for Policy Research. "Egalitarianism is not from this part of the world. This is starting to change."

The Scottish-born William Dalrymple, who lives in India and is the author of several best-selling books on Indian history, weighed in on the hubbub: "In London you might expect the traffic to be held up for the queen or the prime minister, but that's it -- in Delhi, traffic will be held up for the minister of fertilizer distribution. All this makes for a greater contrast and culture of irritation between the haves and have-nots as compared to anywhere else I have lived," he wrote in the business newspaper Mint.

Government V-VIPs are known to shut down rush-hour traffic whizzing by with sirens blaring and red-and-blue lights flashing atop their official white sedans, complete with curtains to keep child beggars from peering into the car windows. They have separate lines at airports and are often ushered into luxury hotels with a phalanx of armed guards.

India is often described as the best place in the world to be rich and the worst place to be poor. It's not just V-VIPs who enjoy a life of privilege. Even most middle-class Indians have a staff of servants, including maids, cooks, laundry men, nannies, drivers and what are known as "peons," or fetchers of lunch.

Amit Gupta, 34, a manager of a food company, said it is up to elected officials to lead the change. Only if they do, he said, will modern Indians truly be able to move up the economic ladder.

"It's become our national reality show. But if our politicians go on TV and eat street food, we all know that they'll never be seen there again once this attention is over," Gupta said. "It makes good television, though."

Special correspondent Ayesha Manocha contributed to this report.

Childbirth at the Global Crossroads - The American Prospect

The auto-rickshaw driver honks his way through the dusty chaos of Anand, Gujarat, India, swerving around motorbikes, grunting trucks, and ancient large-wheeled bullock-carts packed with bags of fodder. Both sides of the street are lined with plastic trash and small piles of garbage on which untethered cows feed. The driver turns off the pavement onto a narrow, pitted dirt road, slows to circumvent a pair of black and white spotted goats, and stops outside a dusty courtyard. To one side stands a modest white building with a sign that reads, in English and Gujarati, "Akanksha Clinic." Two dozen dainty Indian women's sandals, toes pointed forward, are lined along the front porch. For it is with bare feet that one enters a clinic housing what may be the world's largest group of gestational surrogates -- women who rent their wombs to incubate the fertilized eggs from clients from around the globe. Since India declared commercial surrogacy legal in 2002, some 350 assisted reproductive technology (ART) clinics have opened their doors. Surrogacy is now a burgeoning part of India's medical tourism industry, which is slated to add $2 billion to the nation's gross domestic product by 2012. Advertisements describe India as a "global doctor" offering First World skill at Third World prices, short waits, privacy, and -- important in the case of surrogacy -- absence of red tape. To encourage this lucrative trend, the Indian government gives tax breaks to private hospitals treating overseas patients and lowers import duties on medical supplies. In his 2007 book, Supercapitalism, Robert B. Reich argues that while industrial and clerical jobs could be outsourced to cheaper labor pools abroad, service jobs would stay in America. But Reich didn't count on First World clients flying to the global South to find low-cost retirement care or reproductive services. The Akanksha clinic is just one point on an ever-widening two-lane global highway that connects poor nations in the Southern Hemisphere to rich nations in the Northern Hemisphere, and poorer countries of Eastern Europe to richer ones in the West. A Filipina nanny heads north to care for an American child. A Sri Lankan maid cleans a house in Singapore. A Ukrainian nurse's aide carries lunch trays in a Swedish hospital. Marx's iconic male, stationary industrial worker has been replaced by a new icon: the female, mobile service worker. We have grown used to the idea of a migrant worker caring for our children and even to the idea of hopping an overseas flight for surgery. As global service work grows increasingly personal, surrogacy is the latest expression of this trend. Nowadays, a wealthy person can purchase it all -- the egg, the sperm, and time in the womb. "A childless couple gains a child. A poor woman earns money. What could be the problem?" asks Dr. Nayna Patel, Akanksha's founder and director. But despite Patel's view of commercial surrogacy as a straightforward equation, it's far more complicated for both the surrogates and the genetic parents. Like nannies or nurses, surrogates perform "emotional labor" to suppress feelings that could interfere with doing their job. Parents must decide how close they are willing (or able) to get to the woman who will give birth to their child. As science and global capitalism gallop forward, they kick up difficult questions about emotional attachment. What, if anything, is too sacred to sell? *** I follow a kindly embryologist, Harsha Bhadarka, to an upstairs office of the clinic to talk with two surrogates whom I will call Geeta and Saroj. (Aditya Ghosh, a journalist with the Hindustan Times, has kindly offered to join me.) The room is small, and the two surrogate mothers enter the room nodding shyly. Both live on the second floor of the clinic, but most of its 24 residents live in one of two hostels for the duration of their pregnancy. The women are brought nutritious food on tin trays, injected with iron (a common deficiency), and supervised away from prying in-laws, curious older children, and lonely husbands with whom they are allowed no visits home or sex. Geeta, a 22-year-old, light-skinned, green-eyed beauty, is the mother of three daughters, one of whom is sitting quietly and wide-eyed on her lap. To be accepted as a surrogate, Akanksha requires a woman to be a healthy, married mother. As one doctor explains, "If she has children of her own, she'll be less tempted to attach herself to the baby." "How did you decide to become a surrogate?" I ask. "It was my husband's idea," Geeta replies. "He makes pav bhaji [a vegetable dish] during the day and serves food in the evening [at a street-side fast-food shop]. He heard about surrogacy from a customer at his shop, a Muslim like us. The man told my husband, 'It's a good thing to do,' and then I came to madam [Dr. Patel] and offered to try. We can't live on my husband's earnings, and we had no hope of educating our daughters." Geeta says she has only briefly met the parents whose genes her baby carries. "They're from far away. I don't know where," she says. "They're Caucasian, so the baby will come out white." The money she has been promised, including a monthly stipend to cover vitamins and medications, is wired to a bank account that Patel has opened in Geeta's name. "I keep myself from getting too attached," she says. "Whenever I start to think about the baby inside me, I turn my attention to my own daughter. Here she is." She bounces the child on her lap. "That way, I manage." Seated next to Geeta is Saroj, a heavy-set, dark woman with intense, curious eyes, and, after a while, an easy smile. Like other Hindu surrogates at Akanksha, she wears sindoor (a red powder applied to the part in her hair) and mangalsutra (a necklace with a gold pendant), both symbols of marriage. She is, she tells us, the mother of three children and the wife of a vegetable street vendor. She gave birth to a surrogate child a year and three months ago and is waiting to see if a second implantation has taken. The genetic parents are from Bangalore, India. (It is estimated that half the clients seeking surrogacy from Indian ART clinics are Indian and the other half, foreign. Of the foreign clients, roughly half are American.) Saroj, too, knows almost nothing about her clients. "They came, saw me, and left," she says. Given her husband's wages, 1,260 rupees (or $25) a month, Saroj turned to surrogacy so she could move to a rain-proof house and feed her family well. Yet she faced the dilemma of all rural surrogates: being suspected of adultery -- a cause for shunning or worse. I ask the women whether the money they earn has improved their social standing. For the first time the two women laugh out loud and talk to each other excitedly. "My father-in-law is dead, and my mother-in-law lives separately from us, and at first I hid it from her," Saroj says. "But when she found out, she said she felt blessed to have a daughter-in-law like me because I've given more money to the family than her son could. But some friends ask me why I am putting myself through all this. I tell them, 'It's my own choice.'" Since Dr. Patel began offering surrogacy services in 2004, 232 surrogates have given birth at Akanksha. A 2007 study of 42 Akanksha surrogates found that nearly half described themselves as housewives and the rest were a mix of domestic, service, and manual laborers. Hindu, Muslim, and Christian, most had seventh- to 12th-grade educations, six were illiterate, and one -- who turned to surrogacy to pay for a small son's heart surgery -- had a bachelor's degree. Each surrogate negotiates a different sum: One surrogate carrying twins for an Indian couple discovered she was being paid less (about $3,600) than a surrogate in the next bed who was carrying one baby for an American couple for about $5,600. Observers fear that a lack of regulation could spark a price war for surrogacy -- Thailand underselling India, Cambodia underselling Thailand, and so on -- with countries slowly undercutting fees and legal protections for surrogates along the way. It could happen. Right now international surrogacy is a highly complex legal patchwork. Surrogacy is banned in China and much of Europe. It is legal but regulated in New Zealand and Great Britain. Only 17 of the United States have laws on the books; it is legal in Florida and banned in New York. In India, commercial surrogacy is legal but unregulated, although a 135-page regulatory law, long in the works, will be sent to Parliament later this year. Even if the law is passed, however, some argue it would do little to improve life for women such as Geeta and Saroj. For example, it specifies that the doctor, not the surrogate, has the right to decide on any "fetal reduction" (an abortion). Moreover, most Indian federal laws are considered "advisory" to powerful state governments, and courts -- where a failure to enforce such laws might be challenged -- are backlogged for years, often decades. Dr. B.N. Chakravarty, the Calcutta-based chair of the surrogacy law drafting committee, says that the growth of the industry is "inevitable," but it needs regulating. Even if the law were written to protect surrogates and then actually enforced, it would do nothing to address the crushing poverty that often presses Indian women to "choose" surrogacy in the first place. For N.B. Sarojini, director of the Delhi-based Sama Resource Group for Women and Health, a nonprofit feminist research institute, the problem is one of distorted priorities. "The ART clinics are posing themselves as the answer to an illusory 'crisis' of infertility," she says. "Two decades back, a couple might consider themselves 'infertile' after trying for five years to conceive. Then it moved to four years. Now couples rush to ARTs after one or two. Why not put the cultural spotlight on alternatives? Why not urge childless women to adopt orphans? And what, after all, is wrong with remaining childless?" But Dr. Patel, a striking woman in an emerald green sari and with black hair flowing down her back, sees for-profit surrogacy as a "win-win" for the clinic, the surrogate, and the genetic parents. She also sees no problem with running the clinic like a business, seeking to increase inventory, safeguard quality, and improve efficiency. That means producing more babies, monitoring surrogates' diet and sexual contact, and assuring a smooth, emotion-free exchange of baby for money. (For every dollar that goes to the surrogates, observers estimate, three go to the clinic.) In Akanksha's hostel, women sleep on cots, nine to a room, for nine months. Their young children sleep with them; older children do not stay in the hostel. The women exercise inside the hostel, rarely leaving it and then only with permission. Patel also advises surrogates to limit contact with clients. Staying detached from the genetic parents, she says, helps surrogate mothers give up their babies and get on with their lives -- and maybe with the next surrogacy. This ideal of the de-personalized pregnancy is eerily reminiscent of Aldous Huxley's 1932 dystopian novel Brave New World, in which babies are emotionlessly mass-produced in the Central London Hatchery. Patel's business may seem coldly efficient, but it also has a touch of Mother Teresa. Akanksha residents are offered daily English classes and weekly lessons in computer use. Patel arranges for film screenings and gives out school backpacks and pencil boxes to surrogates' children. She hopes to attract donations from grateful clients to help pay children's school fees as well. "For me this is a mission," Patel says. In light of appalling government neglect of a population totally untouched by India's recent economic boom, this charity sounds wonderful. But is it wonderful enough to cancel out concerns about the factory? *** After leaving Anand, I head to Dr. Nandita Palshetkar's office in Mumbai. With Alifiya Khan, another journalist from the Hindustan Times, I meet with Leela, a lively 28-year-old who gave birth to a baby for Indian clients about six months ago. Like Geeta and Saroj, Leela had been desperate for money, but her experience of pregnancy was utterly different. On the day I meet her, she is dressed in a pink sari, hair drawn back from her olive-skinned face into a long black braid. She leans forward, smiling broadly, eager to talk about her baby, his genetic parents, and her feelings about being a surrogate mother. At age 20, Leela married a fellow worker at a Mumbai-based company canteen. "I didn't know he was alcoholic until after we married," she says. "My husband ran up a $7,000 debt with the moneylender who sent agents to pressure him to repay it. ... We couldn't stop the moneylender from hounding us. I decided to act. I heard from my sister-in-law that I could get money for donating my eggs, and I did that twice. When I came back to do it a third time, madam [Dr. Palshetkar] told me I could earn more as a surrogate." Was she able to pay off the debt? Leela lowers her head: "Half of it." She ate better food during her paid pregnancy than during her other pregnancies and delivered the baby in a better hospital than the one where she delivered her own children. Unlike others I spoke with, Leela openly bonded with her baby. "I am the baby's real mother," she says. "I carried him. I felt him kick. I prayed for him. At seven months I held a celebration for him. I saw his legs and hands on the sonogram. I suffered the pain of birth." The baby's genetic parents, Indians from a nearby affluent suburb, kindly reached out to Leela. The genetic mother "sees me as her little sister, and I see her as my big sister," Leela says. "They check in with me every month, even now, and call me the baby's 'auntie.' They asked if I wanted to see the baby. I said 'yes' and they brought him to my house, but I was disappointed to see he was long and fair, not like me. Still, to this day, I feel I have three children." A friendship of sorts arose between the two mothers, although Leela's doctor, like Patel, discouraged it. "I deleted their phone number from my list because madam told me it's not a good thing to keep contact for long," she says. In a November 2008 New York Times Magazine article titled "Her Body, My Baby," American journalist Alex Kuczynski describes searching through profiles of available surrogates. "None were living in poverty," she writes. Cathy, the woman she eventually chose to carry her son, was a college-educated substitute teacher, a gifted pianist, and fellow fan of Barack Obama. They shared a land, a language, a level of education, a political bent -- coming together to create a baby didn't seem like such a giant leap. But when the surrogate and genetic mother come from different corners of the globe -- when one is an Indian woman who bails monsoon rains from her mud-floor hut and the other is an American woman who drives an SUV and vacations at ski resorts -- the gap is more like a chasm. And as one childless American friend (rendered infertile through a defective Dalkon Shield intrauterine device) told me, "If I had hired a surrogate, I'm not sure how close I'd want to be to her. How open can you keep your heart when it's broken? Sometimes it's better not to touch unhealed wounds." A code of detachment seems almost necessary to circumvent the divide. But detachment isn't so easy in practice. Even if you can separate the genetic parents from the surrogate, you cannot separate the surrogate from her womb. One surrogate mother told the sociologist Amrita Pande, "It's my blood, even if it's their genes." Psychologists tell us that a baby in utero recognizes the sound of its mother's voice. Surrogates I spoke with seemed to be struggling to detach. One said, "I try to think of my womb as a carrier." Another said, "I try not to think about it." Is the bond between mother and child fixed by nature or is it a culturally inspired fantasy we yearn to be true? I asked Dr. Chakravarty if he thought that some children born of surrogacy would one day fly to India in search of their "womb mothers." (The proposed regulation requires parents to reveal to an inquiring child the fact of surrogacy, though not the identity of the surrogate.) "Yes," he said. But chances are such an 18-year-old would not find her womb mother. Instead, she might come to realize she had been made a whole person by uniting parts drawn from tragically unequal worlds. In a larger sense, so are we all. Person to person, family to family, the First World is linked to the Third World through the food we eat, the clothes we wear, and the care we receive. That Filipina nanny who cares for an American child leaves her own children in the care of her mother and another nanny. In turn, that nanny leaves her younger children in the care of an eldest daughter. First World genetic parents pay a Third World woman to carry their embryo. The surrogate's husband cares for their older children. The worlds of rich and poor are invisibly bound through chains of care. Before we leave the Akanksha clinic in Anand, the gentle embryologist, Bhadarka, remains across the table from Aditya and me after Geeta and Saroj have left the room. I ask Bhadarka if the clinic offers psychological counseling to the surrogates. "We explain the scientific process," she answers, "and they already know what they're getting into." Then she moves her hands across the table and adds softly, "In the end, a mother is a mother, isn't that true? In the birthing room there is the surrogate, the doctor, the nurse, the nurse's aide, and often the genetic mother. Sometimes we all cry." *** Special thanks to Aditya Ghosh and Alifiya Khan.
Arlie Hochschild's most recent books are The Commercialization of Intimate Life and (co-edited with Barbara Ehrenreich) Global Woman: Nannies, Maids and Sex Workers in the New Economy.

Questions on Executions Mount in India - NYTimes.com

Image by kalyan3 via Flickr

By LYDIA POLGREEN

AHMEDABAD, India — The tableau was as improbable as it was grisly. The bullet-riddled bodies of four Muslims lay neatly lined up in the middle of a road. One of the dead cradled a machine gun. Bomb-making chemicals and a suitcase full of cash sat in the trunk of their car. Intelligence reports had identified the four as terrorism suspects.

It was a tidy crime scene with a story to match: four Islamic extremists who planned to assassinate the powerful chief minister of India’s richest state stopped cold by a fearless band of policemen early on the morning of June 15, 2004. The officers were hailed as heroes.

But the story was too good to be true, according to a recently released magistrate’s report. The supposed militants included a 19-year-old college student, a woman named Ishrat Jehan, who had no evident links to terrorist groups, the magistrate wrote.

The forensic evidence showed that the four had not died in a shootout but were shot at point-blank range, much earlier than the police had said. None of the four had actually fired a gun. They had been killed, the magistrate declared, in cold blood.

The sensational case has fed a heated national debate about the longstanding Indian police practice of killing suspects. Known euphemistically as “encounter killings,” such extrajudicial executions have been a tolerated and even celebrated method of dealing swiftly with crime in a country with a notoriously slow and sometimes corrupt judiciary. An officer in such cases invariably “encounters” a suspect and kills him, supposedly in self-defense.

In cities like Mumbai, which was for decades gripped by violent organized crime syndicates, officers who killed notorious gangland figures were often seen as dark folk heroes, selflessly carrying out the messy business of meting out justice. These officers, known as encounter specialists, became celebrities, even boasting about the number of gangsters they had killed.

But Indians have become increasingly wary of police officers crusading as judge, jury and executioner. Since 2006, 346 people have been killed in what seem to have been extrajudicial police killings, according to the National Human Rights Commission.

In many of these killings, investigations have found, the motive was not vigilante justice. The police often staged such killings for personal gain: bumping off a rival of a powerful politician in the hopes of a big promotion; killing a crime boss at the behest of one of his rivals; settling scores between businessmen.

Here in the state of Gujarat, the grim practice took on an even more sinister form. According to court documents, lawyers, human rights activists and the families of the victims, police officers seeking the favor of Gujarat’s chief minister, Narendra Modi, began killing small-time Muslim criminals and framing them as big-time terrorists bent on mass murder. No evidence has been offered to show that Mr. Modi encouraged such killings.

Riots in Gujarat killed more than 1,000 people, most of them Muslims, in the aftermath of an attack on a train carrying Hindu pilgrims that killed 59 people in 2002. Mr. Modi, a prominent member of the Hindu nationalist party, the Bharatiya Janata Party, has long been accused of fueling the anti-Muslim violence with inflammatory remarks.

Tensions between Hindus and Muslims here are high. The officers who carried out the killings hoped to win promotions and other favors from lawmakers, according to court documents and human rights workers here.

In Gujarat, the team of officers suspected of carrying out these killings usually chose their victims carefully. In all five cases pending in the courts so far, the main targets had shady pasts confirmed by an arrest or conviction, usually for a petty crime. Most were Muslims.

But in the killing of Ms. Jehan that formula went awry. She hardly fit the usual profile of encounter victims. She was a full-time college student who also worked to provide for her widowed mother and six siblings.

According to her family, she was on a trip with her employer to help him set up his marketing business. On June 15, she was shot, according to the police, along with her accomplices as they tried to evade capture.

But the Gujarat magistrate’s report shredded that claim. The food in the victims’ stomachs proved that they had been killed much earlier, the report said. Their wounds were consistent with point-blank shootings. Their hands showed no trace of gunpowder residue. The police had planted weapons on the victims and staged the crime scene.

Gujarat government officials dispute the magistrate’s report, and Gujarat’s High Court has stopped the authorities from arresting the officers it named as the court conducts an inquiry.

Jay Narayan Vyas, a spokesman for the state government, said that the four people killed had been identified by the central government as terrorism suspects. A government intelligence report said that the four were possible terrorism suspects, but the central government has said that these were merely suspicions and could not justify the killings. Mr. Vyas said that the magistrate had overstepped his authority. He dismissed the findings as “false propaganda” from political opponents who wished to discredit Gujarat’s leaders.

Lawyers had known for years that something strange was happening in the Gujarat police force and that the killings of terrorism suspects were dubious, said Mukul Sinha, a lawyer for the relatives of several victims. But hardly anyone thought the killers would be brought to justice.

Then in 2005, the brother of one victim — a small-time bandit named Sohrabuddin Sheikh — sent a letter to India’s Supreme Court demanding an inquiry into the death of Mr. Sheikh, who had been killed by the police and branded a terrorist and who, like the four killed in June 2004, had been accused of planning to kill the chief minister of Gujarat.

Under Indian law any citizen can petition the country’s highest court directly, and the Supreme Court demanded an investigation. In 2007, Gujarat’s government acknowledged that the killing did not happen as the police had claimed and that the police had also killed Mr. Sheikh’s wife to cover up the crime.

The revelation opened the floodgates. “People realized that something can be done, that it is not impossible to get justice in Gujarat,” Mr. Sinha said.

After the officers who made up the elite squad that had carried out these encounters were arrested in the death of Mr. Sheikh, the killings stopped.

“All of a sudden the terrorists have stopped coming to kill Modi,” Mr. Sinha said.

But families of the victims are still waiting for justice.

Ms. Jehan’s mother, Shamima Kausar, said that the charge that her daughter was a terrorist was ludicrous. “She was just a college girl,” she said, tears welling in her eyes. “She was my right hand. I am lost without her.”

Hari Kumar contributed reporting.

India Weighing Limits on Greenhouse Gas Emissions - washingtonpost.com

Proposed Legislation Signals Shift, Aims at Bolstering Image

By Rama Lakshmi
Washington Post Foreign Service
Thursday, September 24, 2009

NEW DELHI -- Trying to burnish its international reputation as it prepares for a major climate conference, India is considering adoption of curbs on carbon emissions that it has long resisted.

India had thus far rejected emission cuts, declaring that they would compromise the populous nation's economic growth, even as developed countries criticized its intransigence. But under a proposed national law, India may set limits on greenhouse gas emissions over the coming decade, focusing on energy efficiency, new building codes, clean energy and fuel economy standards.

India's leadership hopes that by acting on its own, rather than responding to what are likely to be tough demands from other countries during the December climate conference in Copenhagen, the measures will garner more domestic support.

"We have to take up bold new responsibilities that we have evaded so far," Jairam Ramesh, India's environment minister, said at a recent trade conference. "But if we want durable political consensus, then it has to be rooted in domestic legislation and not in an international agreement."

The cuts would be a national goal; they would be neither an internationally binding commitment nor open to international verification. Still, Ramesh said he hoped that the measures would portray India as a "positive player" in climate talks.

India's emerging economic might and global ambitions are nudging Prime Minister Manmohan Singh, an Oxford-educated economist, to be more mindful of the nation's image. His aides say he wants India to engage with the world in a way that befits its aspiration to be a permanent member of the U.N. Security Council and have greater say in the running of the International Monetary Fund and the World Bank.

"India does not want to be the global bad boy in international negotiations. We don't want to be blamed as the stumbling block anymore," said Tarun Das, head of the Confederation of Indian Industry, who works closely with the Indian government. "I believe the mandate from the prime minister is 'Deal, don't break,' whether it is international trade or climate change negotiations. He believes that India should not be locked up in the old-world fears any longer. What is there to be afraid of?"

The new resolve was visible last month when the Indian government convened a meeting of key trade officials from 30 countries to restart global talks that broke down in July 2008 over the issues of farm subsidies and import tariffs. Many Western nations blamed India for the collapse of the negotiations, upsetting Singh.

"He did not want India to become the lightning rod for international criticism," said Sanjaya Baru, a former spokesman for the prime minister.

Coal meets about 60 percent of India's power needs, and the country is ranked fifth in the production of greenhouse gas emissions. India, which has more than 1 billion people and a rapidly expanding economy, has argued that its per-capita emissions are a tenth of those in the United States and that the bigger polluters should cut first.

"The prime minister feels the arguments that worked two years ago may not work anymore," said an aide to Singh, speaking on the condition of anonymity because he was not authorized to discuss the matter publicly. "We will not barter away our national interest, but we can afford to make marginal adjustments."

Singh's new confidence that he will win political support among Indians comes from the majorities his party won in recent elections, freeing his government of its five-year-old dependence on Communist allies who refused international concessions.

India took its first step toward more cooperation on carbon emissions two months ago, at the Major Economies Forum in Italy, when it signed on to a declaration to cap the average global temperature at 2 degrees above preindustrialization levels.

But India also has long said that richer nations must assist poorer ones with the cost of mitigating climate change. Not expecting any financial assistance to be offered at the Copenhagen summit, the New Delhi government is not prepared to have its new efforts at reducing emissions overseen by other countries.

"The goals we set will not be open to international verification, because there does not seem to be any money on the table for us at Copenhagen," said Ajay Mathur, director general of India's Bureau of Energy Efficiency. "But Copenhagen need not fail. We can still go for the low-hanging fruit by agreeing on joint development of new technologies. That builds goodwill between nations."

The Hindu - Farmers’ suicides must end, says Kalavati

Image by Getty Images via Daylife

Women in Jalka village in Yavatmal district have been going to Kalavati Bandurkar, ever since Rahul Gandhi’s famous visit to her house last year. They are in need of help; of houses; and of some respite from distress.

It is the plight of these women and that of the countless more hit by the agrarian crisis which Kalavati will project when she contests this Assembly election from Wani. The alliance of Sharad Joshi’s Shetkari Sanghatana and Vidarbha Jan Andolan’s Kishore Tiwari announced her candidature on Saturday.

“I am not standing for elections to enter politics; I am putting forth the issue. Farm suicides should end. Women should get help. That’s what I will say; nothing else. Women from the village come to me and tell me their problems. They say, ‘your needs have been met, what about us?’,” Kalavati told The Hindu, amidst a flurry of phone calls and media interviews.

In spotlight

Mr. Tiwari said fielding Kalavati may not bring victory, but it would put the agrarian crisis in the spotlight.

Over one lakh women have lost their debt-ridden husbands to the farm crisis. Kalavati is one of them. Her husband committed suicide in 2005, leaving her to pay off a huge debt and run a large family of four daughters, two sons and grandchildren.

“She [Kalavati] lost her husband at 50, but there are women in their 20s whose lives have been ruined after their husbands committed suicide. They should be rehabilitated. Suicides must end. When I asked her if she would contest, she said let’s fight,” Mr. Tiwari said.

Price rise devastating

A farm labourer, Kalavati underscored the key issues plaguing agriculture, like the right price for cotton and jowar. “When we take our produce to the market it’s cheap. When it reaches the dealer, the price goes up. How? It’s the middlemen who do it.” Then, the steep rise in prices of tur and sugar had been devastating.

Kalavati has had to tackle a barrage of questions on going against Rahul Gandhi and the Congress. “I am not against Rahul Gandhi. I am not against the government. I am satisfied [with the help I got],” she said.

With the help she received at Rahul’s behest, Kalavati built a home. “The government announces houses, but the panchayats and the middleman don’t give them to you,” she said.

Kalavati’s cup of woes is far from empty. Jealousy and resentment against her abound in her remote village, making her fear for the well-being of her children.

“I won’t go anywhere to campaign. Maybe once or twice in the car. But, I have to be back home by 6 p.m. What if someone murders my children?

“People in the village are maligning me. Let them talk. I am talking for the farmers,” she says.

VOA - Pakistan Restricts Leader of Group Accused in Mumbai Terror Attack

Image by Gauravonomics via Flickr

Pakistani police are restricting the movements of an Islamist militant group leader accused by India of masterminding last year's Mumbai attack.

Police said Monday they stopped Hafiz Muhammad Saeed, the founder of the militant group Lashkar-e-Taiba, as he was leaving his home for Eid al-Fitr celebrations marking the end of a month-long fast for Muslims. Police said authorities gave verbal orders to keep Saeed in his house.

On Saturday, Pakistan acknowledged for the first time that the militant Islamic leader is under investigation in connection with last year's Mumbai terrorist attacks.

India accuses the hardline Pakistani cleric and his outlawed group of masterminding last November's carnage that left 166 people dead.

This confinement is the second time authorities have restricted Saeed's movements. Saeed was placed under house arrest in December after a U.N. committee put him on a list of people accused of supporting al-Qaida.

A Pakistani court released him in June because of insufficient evidence.

Federal Interior Minister Rehman Malik said Sunday that Pakistan has concluded its own investigation into the Mumbai attacks using what he described as "sketchy" information provided by India. Malik said the evidence and other relevant material have been presented to the court, which will indict seven other suspects later this week.

He said Saeed will be arrested only if authorities can provide solid evidence against him.

India has been pressing Pakistan to prosecute or hand over militants accused of planning the Mumbai attacks, before the two rival nuclear powers resume peace talks.

The foreign ministers of the two countries are expected to meet on the sidelines of the upcoming United Nations General Assembly in New York.

Indian Weavers Shun Health Plan - WSJ.com

By VIBHUTI AGARWAL

PANIPAT, India -- Amir Jahan can spin thick, white thread into magnificent cloth, but the 46-year-old weaver has been unable to unravel her health plan to pay for stomach surgery.

Under a health-insurance program introduced a few years ago, the Indian government has provided health-insurance coverage for the country's hand-loom weavers, a group of 6.5 million workers, 60% of them female, who are mostly illiterate and invariably poor. Yet holding an insurance card hasn't helped Ms. Jahan, who says the coverage only pays for minor ailments and not for major problems, such as the removal of a stomach tumor.

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Vibhuti Agarwal/The Wall Street Journal

Amir Jahan spins thick white thread into magnificent cloth. She puts in 12 hours of work every day to earn about $15 a month.

"The health care is all a sham," Ms. Jahan says angrily. "I was refused treatment on grounds of huge expense. I won't ever go to be humiliated again."

Ms. Jahan's health-care issues represent the problems that come with trying to provide insurance to India's poor. Access to quality care remains a distant dream for many in this country of 1.1 billion.

Last year, the Indian government launched the National Health Insurance Program on promised health coverage of $700 per person for families earning less than $100 a year.

Holders of health cards have to register in their home states to access benefits, thereby precluding a large population of migrant laborers. Those who can get past the complex state-identification and qualification process often can't cope with hospital bureaucracies.

One of the biggest problems: Getting the impoverished weavers to pay $1 for the card that provides free access to health care for one year. Many weavers feel the investment in the card is a waste of valuable household income.

Other plans aimed at farmers, construction workers and other low-income groups have been dogged by problems.

In India, the hand-loom industry is the second-largest segment in the economy, after agriculture. The Handloom Weavers Health Insurance Program was backed by a private insurance company, ICICI Lombard General Insurance Company Ltd., a joint venture of India's ICICI Bank Ltd. and Fairfax Financial Holdings Ltd. of Canada.

An initial payment of $1 entitles a family of four to coverage totaling 15,000 rupees, or about $300 -- but no more than $150 of that can be for any one family member. Beneficiaries receive coverage at designated hospitals and clinics, or are reimbursed for treatment at centers not on the list -- after upfront payments that can be difficult for weavers to afford.

According to insurance-company officials, the program has been implemented in 26 states across India, and covers 1.9 million weaver families. In the Lalahar Memorial Prem Private Hospital, here in Panipat, nearly 70 weavers line up each day for health services under the plan.

Many weavers work six days a week in factories, under poor conditions and with few benefits. Others, like Ms. Jahan, work from home, making clothing, rugs and other woven items for a variety of companies.

Ms. Jahan started working at the age of eight. Today, she says she works 12 hours, seven days a week, to earn about $15 a month. That isn't enough to support her seven kids, and the insurance card can only cover four family members.

Ms. Jahan's stomach surgery was $200, but she was told she could only use $150 from the card because of the spending cap for each family member. The remaining $50 had to be paid from her own pocket. She continues to work with the untreated stomach tumor.

The ICICI doesn't deny treatment to any individual, but "the weavers think it is an ATM card and want to get it cashed to the maximum limit," said ICICI manager Milan Maheshwari, based in New Delhi. "The government has fixed a cap, so that the benefits … can be extended to the entire family."

One of the program's goals was to cut out government intermediaries. In a past program, the Indian government was running a health package for the weavers that involved complicated payment procedures that deterred many participants, according to B.K. Sinha, development commissioner of hand-looms at the Ministry of Textiles in New Delhi.

The new program has won support among those who have been able to get long-neglected medical problems addressed. Working 12 hours a day on the loom from her dimly lit house, Janmati, who uses one name, suffered from blurred vision before she had eye surgery for $80 through the health card.

"Initially the hospital authorities hesitated, but finally agreed," says Janmati. "Thanks to the card, I got my vision back."

But broad participation hasn't panned out. The government acknowledged that only 40% of weavers are covered under the health program.

Insufficient funds -- 1.2 billion rupees ($25 million) preclude covering more, even if the weavers are willing. Nevertheless, "We intend to cover every handloom weaver in the country in the next two years," Mr. Sinha says.

On a simmering afternoon in Panipat, outside India's capital of New Delhi, a group of irate weavers surrounded an insurance agent to complain about the health-insurance scheme.

Mohammad Ali, 25, said he was denied treatment at one of the private hospitals in Panipat and ended up paying from his own pocket. Another man, Mohammad Irshad, grumbled that he couldn't get his wife covered under the same card because he couldn't provide proper identification for her. "Getting the insurance card is tedious," he says.

Write to Vibhuti Agarwal at vibhuti.agarwal@wsj.com

Drought Puts Focus on a Side of India Left Out of Progress - NYTimes.com

Image via Wikipedia

By JIM YARDLEY

PIPRI VILLAGE, India — Two very different recent scenes from India: At a power breakfast in New Delhi for many of the country’s corporate leaders and top economic officials, Finance Minister Pranab Mukherjee declared that India had “weathered the storm” of the global economic crisis and was witnessing “green shoots” in industry and services that signaled a return to more rapid growth by next year.

Hundreds of miles away in this farming village in Andhra Pradesh, in the south, weeds were the only green shoots sprouting in the black soil that belongs to the widow Chandli Bai. Her field went 12 weeks without rain during India’s annual monsoon season before showers finally arrived on Aug. 23, splattering down too late onto the dry dirt. Her summer crop of lentils was stillborn in the ground.

“We eat once a day,” said Mrs. Bai, 65, explaining how she and her family had survived the lack of rain.

For the past year, as the economic crisis convulsed much of the world, India wobbled but never tumbled over. And now that the world is starting to pull itself out of the mire, India seems poised to resume its rapid economic expansion. Government officials are projecting that growth will reach or surpass 6 percent this year and approach 8 percent next year, almost the pace that established India as an emerging global economic power second only to China.

But the cautious optimism about the broader economy has been tempered by a historic summertime drought that has underscored the stubborn fact that many people are largely untouched by the country’s progress. India’s new economy may be based on software, services and high technology, but hundreds of millions of Indians still look to the sky for their livelihoods; more than half the country’s 1.1 billion people depend on agriculture for a living even though agriculture represents only about 17 percent of the total economy.

No one thinks India is facing the type of famines that struck it decades ago; government grain stocks can replenish any shortfalls. But the drought has focused attention, again, on the problems facing Indian agriculture as the population continues to expand at the same time that water resources come under greater pressure.

During the 1960s, India introduced a “green revolution” that sharply improved grain output. Now, many analysts are calling for a second green revolution to address the complicated problems presented by global warming, rapidly diminishing groundwater supplies and stagnant incomes for farmers.

“A lot of us have gotten carried away and forgotten these problems exist,” said Bharat Ramaswami, an economist at the Indian Statistical Institute. “We need to think a little more about how this economic growth could better filter down to the poor.”

Last spring, Prime Minister Manmohan Singh and his Congress Party won a resounding victory in national elections by promising to address this inequality, but the government has yet to announce major programs.

One problem now, as opposed to in the 1960s, is that there are no obvious technological breakthroughs to radically change the status quo. During the green revolution, India introduced high-yield seeds and fertilizers and expanded irrigation.

Today, the challenge is more nuanced, involving a nationwide coordination effort to improve irrigation, better capture rainwater and conserve groundwater while lifting production — the type of complicated management task that critics say is rarely the strong suit of the Indian bureaucracy.

Every summer, India awaits the monsoon. Some years bring too much rain and catastrophic flooding; others bring too little rain. This summer, rainfall is down 25 percent, and roughly half of the rural districts were declared drought zones. As production has fallen, prices have risen for staples like rice.

To the eye, the drought can be deceptive. In Pipri Village, as in other areas, greenery is evident, even as nearly every field without irrigation is stunted.

In recent days, rains have returned to Pipri and some other areas, but not in time to save the summer, or kharif, crop. Located three hours from the high-tech center of Hyderabad, Pipri is one of thousands of Indian villages decimated by the drought.

On a recent afternoon, Mrs. Bai, the widow, stood at the edge of her ragged seven acres, her toes caked in dirt as she motioned to the remains of the pyre used to cremate her husband four months ago. The family had borrowed 80,000 rupees, or about $1,640, to treat his kidney disease; the failed crop left them without money to pay off the debt. Only one of her seven children reached 10th grade, and none can find work off the land.

“I may die before I can repay that loan,” she said.

This cycle of debt is a persistent problem, often blamed for periodic spates of farmer suicides, while the high illiteracy rate in the countryside makes it hard for farmers to switch to jobs in India’s services sector.

Before the national elections, the Congress Party announced a plan to forgive certain farm loans. Many farmers can also take part in a government employment program that guarantees 100 days of manual labor for roughly $2 a day.

But the drought has brought renewed pressure. An hour from Pipri Village, farmers recently clamored around a dilapidated branch of the government’s Syndicate Bank. One man came because of the false rumor that farmers were receiving a 1,500-rupee stipend (about $30). Others came looking for loans. “We need the loans to plant the other crops,” one farmer said. “They keep saying to come back next week.”

Before the drought, rural India was helping to buttress the national economy during the global downturn as rural consumption helped drive consumer spending. But parts of that demand were driven by backdated pay increases for millions of government workers. Now the government is subsidizing seeds and diesel fuel to help farmers through the drought, even as some economists worry that subsidies will worsen the federal deficit.

Too often, many analysts say, the government’s response involves such short-term fixes rather than efforts to tackle the structural problems in the rural economy. A study by the International Food Policy Research Institute noted that India spent $25 billion in 2008 on fertilizer subsidies, but only $5 billion on agricultural investment — even though investment yields 10 times more returns.

India, analysts say, must learn to produce more food with less water, even while lifting rural education levels so that farmers can shift to the higher paying jobs at the heart of India’s economic rise.

“We can manage the drought,” said T. Nanda Kumar, secretary of the Ministry of Agriculture. “We have managed earlier droughts. But we need to move some people out of agriculture. I don’t think that a 17 percent share of G.D.P. and a 50 percent share of employment are viable in the long run.”

Hari Kumar contributed reporting.

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Kashmiris oppose Pakistan’s Northern Areas package - Dawn

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ISLAMABAD: Kashmiri politicians opposed a Pakistani plan on Monday they say is aimed at integrating the strategic but disputed Northern Areas into Pakistan, arguing it will undermine their case for independence from India.

The Northern Areas of Gilgit and Baltistan were bundled in with Kashmir and demarcated as disputed territory under UN resolutions passed after Pakistan and India fought the first of their three wars in 1948.

Bordering China on one side and the mainly Buddhist Indian region of Ladakh on the other, Pakistan's sparsely populated Northern Areas are known to mountaineers as the home of many of the world's highest peaks.

Pakistan and India fought a brief but intense border conflict in the Kargil sector of this region in 1999.

Although Pakistan has held the northern territories since the first war with India, their status was hitherto undefined as Pakistan had not wanted to compromise its case in the broader dispute over Kashmir.

On Saturday, Prime Minister Yousuf Raza Gilani unveiled a reform package that would result in these areas having their own governor and chief minister.

The areas have also been renamed as Gilgit-Baltistan.

Amanullah Khan, leader of the pro-independence Jammu and Kashmir Liberation Front, rejected the package, saying it appeared to be aimed at merging the disputed areas into Pakistan.

‘We strongly condemn this package. It will harm the interests of Pakistan as well as Kashmiris,’ he told Reuters.

‘It looks like they are integrating these areas into Pakistan as done by India.’

‘Suspicious, unacceptable’

Sardar Attique Ahmed Khan, a pro-Pakistan politician and a former prime minister of Pakistani-administered Kashmir, also expressed reservations about the package.

‘We support internal autonomy for these areas...but such moves to unilaterally alter the status of these areas and gradually give them the status of a province are suspicious and unacceptable,’ he said.

The roughly 1.5 million people of Gilgit and Baltistan largely oppose integration into Kashmir and demand the territory be merged into Pakistan and declared a separate province.

Officials in the past had stonewalled on this demand because it would have diluted Pakistan's demand for implementation of a UN-mandated plebiscite to allow the people of Kashmir to determine their own future.

Pakistani-administered Kashmir, known as Azad Kashmir, enjoys some sort of self-rule with its own government, parliament and flag, but the Northern Areas are directly ruled by Islamabad.

India holds about 45 per cent of Kashmir and Pakistan more than a third. China controls the remainder.

Analysts say the reform package appears to be aimed at striking a balance between giving some sort of internal autonomy to the Northern Areas without undermining Pakistan's position on the Kashmir dispute.

‘They have met the demands of people of the Northern Areas on a limited scale,’ said Hasan Askari Rizvi, a political analyst.

‘It's a mid-way house. They will give them some concessions and then will wait and see what happens to the Kashmir issue.’

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India's Afghan Aid Irks Pakistan

With $1.2 Billion in Pledged Aid, New Delhi Hopes to Help Build a Country That Is 'Stable, Democratic, Multiethnic'

By PETER WONACOTT

KABUL -- After shunning Afghanistan during the Taliban regime, India has become a major donor and new friend to the country's democratic government -- even if its growing presence here riles archrival Pakistan.

From wells and toilets to power plants and satellite transmitters, India is seeding Afghanistan with a vast array of projects. The $1.2 billion in pledged assistance includes projects both vital to Afghanistan's economy, such as a completed road link to Iran's border, and symbolic of its democratic aspirations, such as the construction of a new parliament building in Kabul. The Indian government is also paying to bring scores of bureaucrats to India, as it cultivates a new generation of Afghan officialdom.

India's aid has elevated it to Afghanistan's top tier of donors. In terms of pledged donations through 2013, India now ranks fifth behind the U.S., U.K., Japan and Canada, according to the Afghanistan government. Pakistan doesn't rank in the top 10.

Afghanistan is now the second-largest recipient of Indian aid after Bhutan. "We are here for the same reason the U.S. and others are here -- to see a stable, democratic, multiethnic Afghanistan," Indian Ambassador to Afghanistan Jayant Prasad said in an interview.

Such a future for Afghanistan is hardly assured, as the run-up to Thursday's presidential election shows. On Tuesday, a pair of mortar shells hit near the presidential palace in Kabul while Taliban insurgents attacked polling stations across the country, as part of wave of violence aimed at preventing people from casting ballots in the election.

Despite backing the Taliban in the past, Pakistan doesn't want to see an anarchic Afghanistan, say Pakistani security analysts.

"Pakistan is doing nothing to thwart the elections in Afghanistan and everything to help Afghanistan stabilize and have a truly representative government," says Gen. Jehangir Karamat, Pakistan's former ambassador to the U.S. and a retired army chief.

Yet India's largess has stirred concern in Pakistan, a country situated between Afghanistan and India that has seen its influence in Afghanistan wane following the collapse of the Taliban regime. At the heart of the tensions is the shared fear that Afghanistan could be used by one to destabilize the other.

"We recognize that Afghanistan needs development assistance from every possible source to address the daunting challenges it is facing. We have no issue with that," says Pakistani foreign-ministry spokesman Abdul Basit. "What Pakistan is looking for is strict adherence to the principle of noninterference."

The two countries have sparred repeatedly about each other's activities in Afghanistan. Indian officials say their Pakistani counterparts have claimed that there are more than the official four Indian consulates in Afghanistan, and that they support an extensive Indian spy network. For years, Pakistan refused to allow overland shipment of fortified wheat biscuits from India to feed two million Afghan schoolchildren. India instead had to ship the biscuits through Iran, driving up costs for the program.

The World Food Program, which administers the shipments, said the Pakistan government gave its approval for overland shipment in 2008 -- six years after the first delivery from India. "Why did it take six years ... is something that WFP cannot answer," a spokesman for the aid organization said. "However, we are indeed thankful to the government of Pakistan for allowing transit for the fortified biscuits."

Mr. Basit, the foreign-ministry spokesman, didn't respond to a question about the Indian food assistance.

India's aid has extended well beyond physical infrastructure to the training of accountants and economists. For a nation devastated by decades of war, these soft skills fill a hole, says Noorullah Delawari, Afghanistan's former central-bank governor and now head of Afghanistan Investment Support Agency, an organization that promotes private enterprise. "The country shut down for 20 years," he said. "We stopped producing educated people to run our businesses and government offices."

Some believe there is room for cooperation between India and Pakistan in Afghanistan since both countries share an abiding interest in its stability. "The opportunity is there," says Gen. Karamat, "if we can get out of the straitjacket of the past."

—Matthew Rosenberg contributed to this article.

Write to Peter Wonacott at peter.wonacott@wsj.com