Every parent in India carries a persistent hope that education will give their child the chance to step into a wider world of opportunities. Yet in many parts of the country, this hope rests on crumbling foundations, sometimes quite literally.
Earlier this year, at a government school in Rajasthan’s Jhalawar district, children gathered for morning prayers. Minutes later, part of the building collapsed. Seven students died. It was a brutal reminder that for millions of Indian children, the greatest barrier to learning isn’t curriculum or digital access, it is the safety of the very rooms they sit in.
Before we talk about pedagogy or 21st-century skills, we must confront the truth that school infrastructure is the foundation of education, not an afterthought.
The Unseen Architecture of Learning
India’s policy debates often orbit around big reforms — teacher training, assessments, ed-tech. But the daily reality of children in thousands of schools is defined by more basic variables: whether the ceiling fans turn, whether there is light in the room, whether the toilets function, whether the water taps work.
Infrastructure may sound prosaic, but research worldwide shows it is one of the strongest predictors of learning outcomes.
A 2024 study from Ecuador’s primary schools, a context with surprising parallels to India, found that access to simple school infrastructure such as water, sewage connections, art/music rooms, nursing facilities and computer labs consistently correlated with better student performance in both mathematics and language.
Crucially, the researchers noted that basic infrastructure often produced greater learning gains than high-profile or expensive upgrades. In rural areas especially, investments in clean water, waste collection and functional computer labs had a stronger impact than more sophisticated facilities.
The lesson is blunt but powerful that if you strengthen the basics, learning follows.
India’s Progress — And Its Uneven Geography
India has made progress. The ASER surveys show steady improvements:
These are encouraging numbers, but they still leave millions of children in schools without safe sanitation or reliable water. The gaps are most acute in parts of the Northeast and in rural pockets across several states. Electricity remains erratic in many districts and schools continue to operate in buildings older than independent India itself.
The Ecuador findings resonate uncomfortably here: small, unglamorous investments in basic infrastructure can have disproportionately large effects but they often receive the least political attention.
Funds gravitate towards visible projects like boundary walls, digital boards while sewage, ventilation and nursing rooms remain invisible priorities.
Girls, Early Childhood and the Geography of Disadvantage
For adolescent girls, infrastructure is destiny. The absence of separate toilets remains one of the top reasons for dropout once they reach puberty. Safety — of the walk to school, of the classroom structure — is another.
The consequences begin earlier than we admit. Anganwadis, where India’s youngest learners take their first steps into structured learning, often operate in rooms with damaged flooring, poor ventilation and no age-appropriate equipment. Early childhood researchers warn that the physical environment in the first five years shapes cognitive ability, socio-emotional development and school readiness. Gaps created at this stage widen over time.
Children in facilities with basic amenities and dedicated activity spaces, including art and music, performed better academically, hinting at how environmental enrichment fuels cognitive growth.
Why Finland Still Matters
Finland’s schools are not better because they have more technology or modern designs. They are better because they are built on an uncompromising commitment to safety, dignity, equity.
Clean toilets. Well-lit rooms. Ventilation. Medical support. Free meals. These do not make headlines. But they create the conditions where teachers can teach and children can learn.
India, too, needs this clarity of purpose.
A New Model of School Infrastructure Reform
India’s demographic dividend will remain rhetoric if classrooms remain unsafe, undignified or simply unfit for learning. The path forward is not mysterious:
national minimum infrastructure standards
dedicated budgets for WASH (water, sanitation, hygiene)
safe, enriched Anganwadis
reliable electricity and digital connectivity as core entitlements
functional labs, libraries and activity rooms (not just computer labs)
ongoing teacher training so infrastructure is actually used, a gap the Ecuador study pointed out clearly
We need a shift in how we think. School infrastructure is not the backdrop to education; it is part of the learning system itself.
Transforming Spaces, Restoring Dignity
Smile Foundation has been investing in precisely this quiet architecture of opportunity creating STEM labs, English and science labs, solar-powered digital classrooms, smart class installations and upgraded learning environments. These efforts show that transformation doesn’t always come from sweeping reforms; often, it starts with a working light bulb and a safe room.
From Bengaluru to Nagaland, every child deserves a classroom that affirms their dignity, sparks their curiosity and expands their sense of possibility.
India has long believed in the power of education. It is time we give our children the infrastructure to make that belief real.
The alarm rings at 4:00 AM, as it always does. Long before the sun, Sita’s kitchen glows faintly under a single bulb. The fan clicks overhead while she folds the bedsheet, ties her hair tight and packs lunch for everyone in the family, in silence, while streetlamps outside flicker and the world is still half asleep.
Sita moves through the darkness with practiced precision — the clink of steel vessels, the hiss of the stove, each sound marking another task completed in the quiet race before her own day begins. By the time the first pale thread of dawn slips into the lane, she is already at the bus stop, every step marked by the weight of chores already done, pressing silently on her shoulders.
The bus lurches in with impatient horns. She braces herself, eyes narrowing at the high step. It takes all her strength to climb aboard and then she grips the overhead bar with her right hand. Her left arm reaches back, fingers searching until they catch the trailing pallu. And she draws it forward, sliding the fabric under her elbow, and presses it firm against her waist. The pallu clings there, held by the steady weight of her arm pressed throughout the journey. The bus sways, the crowd leans, but her arm does not move.
The day gets brighter, the streets get busier and the bus packs tighter. Her left arm, pressed at her waist with the pallu, now lifts higher. The pallu drops back naturally, but her arm climbs, crossing her chest and the palm sets at her right shoulder. The crowd sways, the bus bumps and her arm stays strong protecting herself from getting hurt by bearing every push from all sides.
She feels a cool breeze at her waist, glowing, not from the latest skin care routine on social media, but from sweat gathered since 4:00 AM.
Now her phone rings. A sharp trill of a hand‑me‑down mobile phone ringtone slices through the roar of the bus. But she just holds the bar tighter, and her other arm steady across her chest. Now the phone keeps ringing, but she cannot reach it.
Her thoughts spin — could it be family? something urgent? or is it something at work again — a deadline, a warning? The phone keeps ringing, each trill digging deeper questions.
Lost in her worries, she glances around. The men travel with ease — one hand steady on the bar, the other free for their phones.
They’re laughing, they’re relaxed and smiling, and they treat the commute like a break rather than a burden.
She begins to dwell on how heavy it already feels, though the day has barely begun. Then the whistle cuts through her thoughts. Her stop is called. Time to rise, step off the bus and begin work.
And this is how millions of women begin their day — balancing safety, space and exhaustion long before work even starts. Rising before everyone, carrying responsibilities, navigating unspoken rules shaped by culture and then stepping into workplaces where they must prove their worth twice to be seen once, expected to be tireless, calm and capable all over again.
According to the National Family Health Survey (NFHS‑5), Indian women face layered, measurable disadvantages across safety, health, education and economic life that constrain their agency and well‑being. Child marriage, while slowly declining in some states, remains widespread: the NFHS‑5 indicator for women aged 20–24 shows that a substantial proportion were married before 18, with rates systematically higher in rural areas than urban ones; national averages improved slightly (from about 27% to 23% across survey rounds), but the practice persists strongly in several states and continues to limit girls’ education, health and economic prospects.
Decision‑making and control over resources still remain uneven. Although financial and digital inclusion have improved in many places (more women now hold bank accounts and own mobile phones) gaps persist in regular paid work, asset ownership and meaningful control over earnings and mobility, which together keep many women economically vulnerable and dependent.
Large shares of ever‑married women report experiences of physical or sexual violence by a husband, showing that intimate‑partner violence remains a common and persistent problem with wide public‑health and social consequences. These patterns are not isolated: they interact. Early marriage increases the risk of school dropout and economic dependence; limited mobility and workforce participation raise vulnerability to exploitation and make reporting violence harder; and weak economic autonomy reduces the range of feasible choices when facing coercion or abuse.
What the numbers whisper: The gender gap in everyday India
Child marriage remains driven by economic precarity and entrenched social norms. Nationally, nearly one in four young women aged 20–24 were married before 18, based on the NFHS‑5 indicator used by UNICEF; rural prevalence remains higher than urban, reflecting structural disadvantages and normative pressures.
In Karnataka’s Belagavi district, 42 child marriages were recorded between April 2024 and March 2025, despite prevention efforts. Local data show the highest counts among the Kuruba community, illustrating how tradition, social expectations and household vulnerability intersect at the district level.
Child marriage is linked to interrupted schooling, early pregnancy, higher maternal and neonatal risks, and constrained lifetime earnings, perpetuating intergenerational disadvantage. NFHS‑5 and UNICEF analyses consistently associate early marriage with poorer health and economic outcomes, underscoring the urgency of sustained prevention, social protection, and norm change strategies.
A positive shift is visible: Prevention efforts have multiplied and spread across regions.
In 2023–24, more than 70,000 child marriages were reportedly prevented across 265 districts in 17 states and UTs, with both panchayats and civil society playing significant roles in detection, counseling and enforcement.
Workplace harassment and career barriers
Despite increasing female participation in formal employment, women continue to encounter bias, harassment and exclusionary practices that hinder retention and career progression. The Aon Voice of Women in Corporate India 2024 survey, which engaged nearly 24,000 professional women across more than 560 companies, highlights the scale of the challenge:
42% reported experiencing bias or potential bias.
37% cited insensitive behavior.
6% reported sexual harassment.
Importantly, less than half of those affected chose to formally report incidents, underscoring persistent gaps in workplace redress and trust in grievance mechanisms.
India’s POSH Act, 2013 establishes mandatory Internal Complaints Committees, local committees and employer duties, yet implementation gaps persist. Academic and practitioner analyses identify weak awareness, compliance shortfalls and limited trust in redress mechanisms as recurring barriers, reducing the law’s effective reach and deterrence.
Virtual harassment, AI‑generated deepfakes and technology‑fueled violence
AI‑generated deepfakes are intensifying school cyberbullying: surveys and educator reports show that 40–50% of students are aware of deepfakes circulating in schools, victims are disproportionately girls who suffer severe and lasting psychological harm, and many teachers and districts lack training or clear policies to respond. A 20-year-old student from the International Institute of Information Technology (IIIT) in Naya Raipur was arrested for allegedly creating obscene images of female classmates using AI tools, said the police.
In Assam, an influencer was reportedly targeted with explicit AI‑generated content allegedly created and monetized by an ex‑partner. Media coverage in July 2025 noted her large follower base and subsequent police action, highlighting how personal violations can quickly scale into public crises. The case highlights systemic vulnerabilities, revealing how existing mechanisms struggle to keep pace with AI‑driven harms.
The growing risk environment chills women’s participation online, damages reputations, and can fuel extortion and social isolation. Current regulatory and enforcement frameworks struggle to keep pace with the speed and scale of AI‑enabled abuse, pointing to the need for clearer platform obligations, faster takedown protocols and victim‑centric remedies.
Safety concerns and harassment in everyday public life
Women’s safety in public spaces shapes mobility, access to work and education and time use. Policy guidance highlights design and planning gaps in transport, lighting, last‑mile connectivity, and reporting pathways; surveys indicate fear and harassment that rarely appear in official records. Perception data from urban India suggest many women feel unsafe and under‑report incidents, reinforcing the need for gender‑responsive urban mobility and public‑space planning.
Intersecting norms: Culture, caste, superstition and religion
Harmful practices are embedded in gendered power structures: ideas about family honor, marriage timing, and “protection” of girls combine with economic pressures like dowry costs and poverty. In Bihar, a multi‑district survey found women branded as “witches” were often aged 46–66, married or widowed, and disproportionately from lower castes; accusations frequently followed visible increases in women’s or households’ income or leadership roles, pointing to control and retaliation beyond superstition. Jharkhand reports persistent witch‑hunting, with Gumla recording high caseloads; survivors face prolonged insecurity even after convictions.
In 2020, two individuals were killed after being accused of witchcraft in Karbi Anglong, Assam. The incident was reported as mob violence, followed by police arrests. The tragedy highlights how entrenched beliefs can spiral into extreme harm when left unchecked. It highlights the urgent need for preventive community engagement, swift police intervention, and robust legal accountability to dismantle harmful practices and protect vulnerable lives.
From schemes to systems: India’s multi-pronged push for women’s safety, education, and economic power
Beti Bachao Beti Padhao: Changing the narrative from birth
Launched in 2015, Beti Bachao Beti Padhao (BBBP) targets declining child sex ratio and girls’ education through national campaigns and district-level action. Government updates report sex ratio at birth improving from 918 in 2014–15 to around 930 by 2023–24, alongside increases in girls’ secondary enrollment, attributed to sustained outreach and enforcement under BBBP.
One Stop Centre (Sakhi): Integrated support for survivors
The One Stop Centre (OSC) scheme offers co-located medical, legal, counseling, and shelter services for women facing violence, operational across hundreds of districts. Analyses note 700+ centres are functional nationwide, with documented support across domestic violence, sexual assault, trafficking and acid attack cases; however, capacity and coordination challenges persist and vary by state.
Ujjawala and Swadhar Greh: Rehabilitation and reintegration
Ujjawala focuses on trafficking prevention, rescue and rehabilitation, while Swadhar Greh provides shelter and comprehensive support for women in distress. Both schemes have been evaluated by NITI Aayog and integrated into Mission Shakti to strengthen continuity of services; official briefings describe provisions for shelter, food, medical/legal aid and vocational training across homes nationally. Independent effectiveness studies highlight variability in implementation and recommend integration and improved staffing norms.
Mahila E‑Haat and Stand Up India: Pathways to economic independence
Mahila E‑Haat, launched under Rashtriya Mahila Kosh, provides an online marketplace for women entrepreneurs and SHGs to showcase products and services, positioning technology as a bridge to markets; early releases frame it as a Digital India/Stand Up India aligned platform. Public-facing dashboards and third-party summaries cite thousands of sellers and products onboarded, though official consolidated performance metrics are limited in the public domain.
Nirbhaya Fund and Safe City projects: Building safer urban spaces
The Nirbhaya Fund supports multi‑agency interventions for women’s safety, including Safe City projects in major metros that deploy hotspot mapping, improved lighting, CCTV, panic buttons, increased patrols and dedicated help desks. As of 2025, the government reports ₹7,712.85 crore allocated with roughly 76% utilization, 14,658 women’s help desks established and cyber forensic‑cum‑training labs operating across 33 states and Union Territories. Safe City, launched in 2018 and extended through 2024, is documented by the Ministry of Home Affairs and summarized in global databases that outline its core components and city coverage.
Gendered violence across belief, labor and digital spaces
Technology has become a weapon in silencing women journalists. What begins as trolling quickly escalates into manipulated images, deepfakes and sexualized threats designed to erode credibility and drive women out of public life. UNESCO’s The Chilling project and ICFJ’s global study reveal not only the scale of this abuse but also its strategic intent: to intimidate, discredit and isolate. Their findings call for urgent accountability — from platforms that host abuse, law enforcement that must treat it as a crime and newsrooms that need to protect their reporters rather than leave them exposed.
The Sumangali system drew adolescent girls and young women—many from Dalit communities—into bonded labour through “lump‑sum” promises tied to dowry savings. Despite legal action and brand pressure, investigations and academic studies reveal that risks persist in informal supply chains, where coercion and debt bondage remain entrenched. Addressing these harms requires more than compliance: robust enforcement, worker organizing, and transparent sourcing practices are essential to dismantle exploitative recruitment and ensure dignity in labor.
During and after COVID‑19, the National Commission for Women (NCW) expanded helplines and documented a rise in complaints. Greater awareness and improved access enabled more survivors to report violence and seek support. Alongside this, state programmes and women’s collectives have played a critical role in helping survivors reintegrate economically. To capture these shifts responsibly, analysis should draw on state‑level NCRB and NCW data to illustrate broad trends, while avoiding precise percentage spikes unless directly supported by official figures.
Beyond schemes: Education, gender inclusion, and social norms
Education is the foundation of durable social change. Government schemes and protection services create vital safety nets, but lasting shifts in life trajectories come when girls complete secondary education and gain practical skills. Completing higher secondary reduces the likelihood of early marriage, early motherhood and vulnerability to exploitation, because it expands options, delays household dependence and strengthens negotiating power.
Educational empowerment must go beyond basic literacy. Effective programmes combine:
Core schooling and retention strategies;
Life skills and socio‑emotional learning that build confidence and agency;
Digital literacy so women can participate safely in online economies and civic life;
Gender sensitisation for boys and men to reshape norms about care, leadership, and consent.
When girls are taught to claim space and boys are taught empathy and equality, the cultural script that normalises control and abuse begins to change.
Education is only the start: building pathways to equity
Economic and financial inclusion
Education without economic opportunity leaves empowerment incomplete. Financial literacy, access to safe savings, affordable credit and market‑linked livelihoods turn knowledge into autonomy. Programmes that combine skill training with linkages to markets, digital payments and tailored microfinance produce stronger shifts in household decision‑making and mobility than education alone.
Accessible health services
Affordable and accessible health services reinforce families’ ability to keep girls in school and women in work. Social protection reduces immediate economic incentives for child marriage and mitigates risks that push women into exploitative labor.
Social norms and cultural change
Long‑standing gender roles, caregiving burdens and mobility restrictions blunt the returns to both schooling and work. Evidence from community studies shows that increases in education and employment translate into empowerment only when accompanied by normative change: men’s engagement in caregiving, community endorsement of girls’ education, and public messages that contest honor‑based controls.
What effective programmes do differently
Integrate schooling with life skills, digital training and vocational pathways.
Couple financial inclusion with market access and mentorship for entrepreneurs.
Invest in male‑focused gender education and community dialogue to shift household practices.
Combine legal protections with accessible, survivor‑centred services and local accountability mechanisms.
Education starts the transformation; inclusive finance, social protection and conscious efforts to change norms complete it. Together, these levers reduce vulnerability, expand choice and make equality sustainable.
Swabhiman by Smile Foundation — community‑led health, livelihoods and agency for marginalised women
Smile Foundation launched Swabhiman in 2005 as a women‑and‑girl child empowerment programme. Over two decades it has evolved from safety and awareness activities into a multi‑sector, community‑anchored model that combines reproductive and child health outreach, nutrition awareness, entrepreneurship and livelihoods support, and digital and financial literacy training. Smile Foundation’s public materials report a wide geographic footprint — over 400 active projects across roughly 25 states — and an annual reach of approximately 1.5 million beneficiaries across Smile’s combined programmes, including a substantial share of women and adolescent girls.
Core approaches:
Community mobilisation and peer models: Swabhiman trains local “change agents” — peer educators, community health volunteers and women leaders — to drive sustained behaviour change and referral linkages to public services.
Health and nutrition outreach: The programme runs health camps, antenatal/postnatal follow‑ups, immunisation drives and nutrition awareness sessions to strengthen maternal‑child health outcomes at the community level.
Livelihoods and entrepreneurship: Swabhiman provides vocational training, enterprise development support and market linkages, promoting women‑led micro‑enterprises and self‑help group (SHG) participation. Programme materials cite cohorts of women trained and multiple small enterprises incubated through these interventions.
Digital and financial inclusion: Digital literacy, mobile money, and basic financial training are embedded to increase women’s access to markets and formal financial services.
Convergence with public systems and CSR partners: Smile Foundation partners with government bodies, CSR funders and private partners to scale services and strengthen referral systems.
The next morning, Sita wakes again at 4 a.m. The air is cool, the tap water colder. The house is quiet except for the soft hum of the ceiling fan and the ticking of her alarm clock.
But this morning feels different when she’s commuting. A new poster catches her eye — a government campaign on women’s safety with helpline numbers bold and visible. A poster from Smile Foundation’s Swabhiman hangs beside it, announcing a free health camp for women in her area. She remembers hearing about them from her neighbour — women who visited those camps said they learned how to manage nutrition, menstrual hygiene and even small savings.
During the tea break, she notices a few men standing unusually still around a phone. They’re reading how a group of school students exploited AI to produce inappropriate images of their female peers. One of them mutters, “This is terrifying.” Another sighs, “If this feels this awful to read, I can’t imagine how a woman must feel. This isn’t okay”. They head back to their desks, to the same familiar room, but it no longer feels the same. The usual conversations that objectified women taper off. Words are picked more thoughtfully. And when someone cracks an inappropriate joke, it’s met with an immediate stop.
Upon returning home, she lies down, the ceiling fan hums again, steady and familiar. The world hasn’t changed overnight, but it is changing through policies that protect, initiatives that empower and ordinary people who decide that respect and safety are not privileges, but rights.
Tomorrow at 4:00 AM, she’ll wake up again. But now, somewhere between the streetlight and the sunrise, she knows she is part of something larger, a country slowly learning to stand up for its women.
Each of these people become a thread in the larger fabric of change. They remind us that empowerment isn’t just policy or programmes; it’s a daily act of humanity that multiplies.
You can be that person — by speaking up when it’s uncomfortable, showing up when it matters, donating when you can and helping make the world a place where every woman, from the pre-dawn bus stop to the late-night return home, walks without fear and lives with dignity.
Every small act builds into something vast and unstoppable.
Be that quiet revolution.
Be her reason to believe again.
As Mother Teresa said,
“Not all of us can do great things. But we can do small things with great love.”
Controlling the Numbers of Newborn Mortality in India
In a small maternity ward in rural India, a young mother cradles her newborn with a mixture of awe and fear. Her baby’s heartbeat, fragile and insistent, is reminds one of both possibility and risk. Across the country, thousands of parents wake up to this same fragile hope. But whether that hope survives the first year of life often depends not on parental devotion, but on where the child is born.
India has made undeniable progress in reducing infant deaths. Kerala now records just 5 deaths per 1,000 live births, one of the lowest rates in the country. Nationally, infant mortality has dropped to 25 per 1,000—the lowest in India’s history, and a milestone that should not be understated. It is a sign that improvement is possible, that lives can indeed be saved. But it is also a reminder of how deeply unequal survival remains across the subcontinent. For all the headlines about progress, the truth behind the numbers is that far too many children still die from causes that should, by now, be consigned to history.
A Mirror of Inequality
Infant mortality is not evenly distributed across India’s vast landscape. It mirrors the country’s most stubborn inequities—geographical, economic, social. The emotional toll is immeasurable: the mother who watches her child slip away because the nearest clinic lacks oxygen; the father who cannot afford transport to a district hospital; the family that buries a newborn because the local health worker never arrived.
In rural communities, these tragedies often unfold amid isolation, shame, and entrenched cultural expectations. Women are frequently blamed—quietly, pointedly—for their child’s death, accused of neglect or misfortune. Such reactions only deepen the trauma, adding emotional injury to physical loss. But the real causes lie elsewhere: in the lack of nutrition for expectant mothers, inadequate antenatal care, unsafe birthing environments, and the absence of timely medical support. Infant mortality, perhaps more than any other health indicator, reveals the geography of opportunity, and of neglect.
Why Newborns Die: The Preventable Causes
Across India, nearly half of all deaths among children under five occur within the first 28 days—the neonatal period. The causes are well understood. Complications of preterm birth. Birth asphyxia. Infections like sepsis and pneumonia. These are not mysterious ailments; they are predictable, largely preventable conditions that require functioning health systems, supportive nutrition programmes and skilled care during childbirth.
For infants aged one to twelve months, the threats shift slightly: diarrhoea, malaria, malnutrition. Congenital disorders also claim lives throughout the first year. But the underlying story remains the same: too many children are born into circumstances that drastically limit their chances of surviving into toddlerhood.
Poor maternal health plays an outsize role. Anaemia, still stubbornly prevalent among Indian women, weakens both mother and child. Malnutrition during pregnancy increases the risk of low birth weight and premature delivery. These vulnerabilities cascade, making newborns susceptible to infections and complications that stronger, healthier infants might withstand.
Hidden Costs: Social, Emotional, Economic
The death of an infant reverberates far beyond the family’s grief. Siblings grow up under the shadow of loss. Communities lose trust in health systems that they perceive as indifferent or unreliable. Overstretched hospitals must redirect scarce resources toward emergency interventions that could have been prevented.
On a national scale, these losses translate into diminished human capital. Every infant death represents a future foreclosed—a worker never trained, a student never enrolled, a life never lived. Economic progress is, at its core, the story of human potential. When infants die, that potential is erased before it can even begin.
When Culture Undermines Care
India’s cultural landscape is rich and diverse, but certain traditional practices continue to undermine newborn health. Essential Newborn Care (ENC)—the gold standard for safe infant care—recommends keeping babies warm, avoiding early bathing, ensuring hygienic cord care and breastfeeding within the first hour. Yet in many communities, babies are bathed immediately after birth, exposing them to hypothermia. Herbal substances are placed on the umbilical cord, inviting infection. Colostrum, the thick, antibody-rich first milk that protects infants from disease, is sometimes discarded due to misconceptions about impurity.
Gender norms deepen these risks. In many regions, the birth of a girl can bring disappointment, even resentment. This bias manifests in tragic ways: daughters receive less nourishing food, are taken to health clinics later than boys, or are simply neglected. The recent case in Rajasthan’s Sikar district, where a father allegedly killed his infant twin daughters, serves as a grim reminder that cultural attitudes remain deadly. Addressing these realities requires more than medical interventions; it requires confronting the social beliefs that shape daily decisions about newborn care.
Strengthening Mothers, Strengthening Newborns
The wellbeing of a newborn is inseparable from the wellbeing of the mother. A healthy pregnancy sets the stage for a healthy start to life, but that requires access to antenatal care, nutritious food and safe delivery services.
Government initiatives like the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) and SUMAN have expanded access to antenatal check-ups and improved conditions for childbirth. Investments in midwife training, essential delivery kits and well-equipped birth centres are crucial steps toward ensuring dignified deliveries. But coverage remains uneven, and too many rural communities still rely on under-resourced facilities or unskilled birth attendants.
Mobile medical units, simple vans staffed with nurses and doctors, offer a lifeline in remote areas, stitching together the vast distances that often separate families from healthcare. When functioning well, they bring antenatal check-ups, vaccinations, counselling and emergency support directly to rural hamlets that are otherwise cut off.
Empowering adolescent girls is equally critical. Ensuring their nutritional health, providing menstrual hygiene resources and offering reproductive health education strengthens future mothers long before pregnancy begins.
The Cultural and Policy Gap
Despite ongoing efforts, the gap between policy goals and lived reality is often wide. Many frontline health workers shoulder impossible caseloads. Clinics in remote districts may have electricity only intermittently. Ambulances, when they arrive at all, may come too late. Public health messages often fail to penetrate local belief systems. India’s successes, like Kerala’s low mortality rate, demonstrate what is possible when governance, healthcare and public awareness align. But replicating those successes nationwide requires sustained political will, well-funded health systems and deep engagement with women and communities who navigate these risks daily.
Why This Moment Matters
India stands at a demographic crossroads. Its aspirations, to become a major global economy, to harness its youth bulge, to strengthen its workforce, will falter if it cannot secure the survival of its youngest citizens. Infant mortality is not merely a health statistic; it is a measure of whether a nation is honouring its most fundamental obligation: to protect life at its most vulnerable.
The sobering truth is that many infant deaths are not inevitable tragedies but preventable outcomes. They reveal where systems have failed, where knowledge has not reached, where nutrition is inadequate and where women lack autonomy over their own health.
A Future Worth Building
Among the civil society organisations confronting these challenges, Smile Foundation stands out for its sustained work in maternal and child health. Through programmes like Swabhiman and Smile on Wheels, the foundation delivers essential healthcare to underserved communities, promotes institutional deliveries, supports maternal nutrition and raises awareness about breastfeeding and newborn care. By bringing health services directly into communities through mobile clinics, trained volunteers and behaviour change initiatives, it helps ensure that more children survive the precarious first months of life.
These models demonstrate what is possible when systems meet people where they are, when services take into account cultural contexts, and when mothers are treated not as passive recipients but as central partners in their health journey.
The Promise in Every Heartbeat
A newborn’s first cry is not just a biological reflex; it is a declaration of possibility. Every tiny heartbeat holds the promise of a future, an education, a livelihood, a life lived fully. For India to secure that promise, it must transform not only its health systems, but also its social structures, cultural norms and political priorities.
When we care for mothers, educate girls, strengthen health systems and confront harmful practices, we do more than reduce mortality. We affirm a simple but profound belief: every child deserves the chance to grow, to thrive and to shape the future of the nation.
That future begins in the first year of life. And its protection is one of the most urgent responsibilities we have.
Every year, millions of Indian families face a wrenching choice: say “yes” to a promising education that could lift a child out of poverty, or say “no” because the fee is simply unaffordable. An Indian student’s educational journey often hinges on the family’s ability to absorb sudden financial shocks.
The Barriers to Studies
For low-income households, even modest fee hikes, transport expenses or the cost of digital devices can push education beyond reach. This financial fragility becomes most visible at the secondary and post-secondary levels, where the cost of continuing education rises sharply. In the absence of timely financial support, many students are forced to rely on high-risk loans or informal credit, exposing families to long-term debt cycles that can be difficult to escape.When formal loans are out of reach or too slow, desperate households sometimes turn to dangerous alternatives.
This belief forms the core of the Scholarships@Smile initiative, which has already supported more than 100,000 students across 22 states, many of them first-generation learners.
The Gaps Remain: Supply vs Need
Despite government and bank efforts (including new collateral-free education loan products and model loan schemes intended to increase access), there remain large gaps in coverage, timeliness and appropriateness of financial aid for the poorest households. Government schemes are evolving — for example, new schemes seek to extend collateral-free loans to meritorious students — but getting funds to the right students at the right time still depends on outreach, awareness and administrative simplicity. That’s where scholarships and NGO partnerships step in as swift, targeted solutions.
Borrowing is Growing, but so are the Risks
Education lending in India has expanded rapidly with education portfolios of NBFCs and banks having ballooned in recent years. As of mid-2024, the outstanding education loans of banks were reported at roughly ₹1,23,066 crore, a sign of both opportunity and mounting household exposure to debt. For many families that can’t meet bank criteria (collateral, guarantors, credit history), borrowing options narrow and the danger of predatory lenders rises.
Why Loan Sharks is an Education Problem
When legitimate channels fail, informal and often illegal lenders, AKA loan sharks, step in. These lenders charge crippling rates, demand brutal recovery methods and create cycles of debt that push vulnerable families deeper into crisis. For students, this translates into stress, interrupted study and sometimes forced withdrawal from college. The best safeguard isn’t only better regulation of lending but reducing the need to borrow in the first place by expanding grants and scholarships that are safe and predictable.
Research and field experience show scholarships are far more than money on a ledger. When combined with mentoring and community support, scholarships meaningfully reduce dropout rates and improve learning outcomes and completion. Smile Foundation’s scholarship initiatives including the Scholarships@Smile portfolio already support well over 100,000 students, demonstrating the immediate leverage that targeted financial aid gives to vulnerable learners.
Creating a Pathway for Equity
Girls and first-generation learners, in particular, benefit significantly from scholarships because they are disproportionately affected by social pressures, early marriage risks, and competing household responsibilities. Access to predictable financial aid, combined with academic support and mentorship, creates conditions that allow them to stay in school, pursue technical and professional education and transition successfully into the workforce.
As India pushes toward becoming a knowledge-driven economy, the demand for skilled workers in STEM, healthcare, technical and digital industries continues to rise. Yet, without adequate scholarship coverage, the country risks losing a large pool of capable students simply because they cannot afford elementary and higher education. Expanding scholarships, both in scale and in scope, is therefore not just a welfare measure but a strategic investment in national growth and gender equity. Larger, more accessible, and more inclusive scholarship systems can prevent vulnerable families from turning to predatory lending and ensure that the promise of education remains a path to progress, not a source of financial hazard.
Girls, in particular, benefit from a layered model that combines school-level scholarships for Grades 8 to 12 with opportunities for vocational education in fields such as IT, design, management, finance and pharmacy, as well as full engineering scholarships that cover all four years of B.Tech or B.E. degrees. Smile’s Girls-in-STEM initiatives further strengthen this ecosystem by providing laptops, digital learning tools, internship pathways and structured mentorship, ensuring that talented young women can enter technical fields with confidence and continuity. Through campaigns like She Can Fly, the Foundation adds life-skills training, mental well-being sessions, counselling, guidance and employability coaching so that girls are supported not only academically but are also somewhat protected from the social pressures, financial shocks and household barriers that so often push them out of school.
In a nutshell, scholarships need to become more than a financial intervention, it must aim to shield against vulnerability and a long-term investment in gender equity and national progress.
Why Smile Foundation focuses on Scholarships
If India hopes to reduce harmful borrowing and unlock the full potential of its young population, scholarship programmes need a structural rethink. The first step is making them bigger, not only in number but also in the actual value of each award. Scholarships must move beyond partial support and be large enough to realistically cover tuition fees, learning essentials and academic enablers such as books, internet access and transportation. Financial gaps — often small in absolute terms — are the very barriers that push students toward loans or force them to abandon their education altogether.
They must also become faster. Delayed or unpredictable disbursal often defeats the purpose of financial aid, as students may drop out, take on high-interest debt, or miss admission deadlines while waiting for funds. A streamlined, technology-supported process that delivers aid at the beginning of the academic cycle can prevent these avoidable disruptions.
Scholarships need to be smarter as well. Data-driven targeting based on income levels, geography, gender, caste and first-generation status can ensure that the most vulnerable students are prioritised rather than those who are already relatively secure. This approach strengthens equity and ensures that limited resources produce maximum social impact.
Equally important is making scholarships richer in support. Financial aid alone cannot compensate for a lack of guidance, exposure or digital access. Pairing funding with mentorship, career counselling, skill-building opportunities and modern learning tools creates a more holistic ecosystem in which students can thrive rather than merely cope.
Finally, scholarships must become sustainable. Long-term impact requires models that blend public investment, CSR partnerships, philanthropic capital, and community participation. A multi-stakeholder approach ensures that scholarship programmes do not disappear after a single grant cycle but remain resilient and predictable for years to come.
In essence, “bigger and better” scholarships are those that expand their financial reach, accelerate support, intelligently target need, enrich student development and endure across academic journeys, transforming education from a fragile aspiration into a stable, achievable reality.
Smile Foundation’s model already follows many of these principles — providing financial aid as part of holistic support packages that address the reasons students leave school, not just the costs.
A Practical Pathway: How Donors and Partners can help Scale Scholarships
Corporate partners (CSR): Fund scholarship cohorts tied to outcome metrics like retention and pass rates.
Foundations & trusts: Seed large endowments dedicated to regional scholarship hubs.
Individual donors: Monthly micro-scholarships (between 500 and 2000) create predictable support that keeps one student in school.
Policymakers: Simplify registration and disbursal frameworks for NGOs to partner with government scholarship databases.
Banks & Fintechs: Co-create early-warning funds that convert pending loans into scholarships for high-risk students.
Let Scholarships mean Promise and Protection
In the tug-of-war between opportunity and risk, scholarships are a practical way to tip the balance toward a stable future. They prevent families from turning to dangerous credit, protect students from the stress and violence of predatory lending and promise a different life through education. Smile Foundation’s reach — touching more than a million lives every year — proves that well-designed support works. But to protect every child who deserves a chance, scholarships must grow bigger, faster and smarter. Join us in making that happen.
Effective health communication is crucial for making any healthcare system effective for the public. It is all about how authorities and governance utilise all their tools for the strategic dissemination of information, which ultimately enables individuals and communities to make informed decisions about their health, foster behavioural change and strengthen the trust between citizens and institutions.
Much like its diverse population — with 1.4 billion people, India’s health challenges also remain diverse. Hence, the need for transparent, inclusive and context-specific communication in India cannot be stressed enough. Many diseases, such as infectious diseases, maternal mortality, non-communicable illnesses, malnutrition and more, are not just biomedical but deeply rooted in information gaps, stigma and behavioural barriers. In this regard, effective public health communication becomes key to translating policy into practice, transforming awareness into action, and ensuring that health interventions reach the last mile and save lives.
Lessons from Covid emergence
The Covid-19 pandemic became a prime example, revealing the cracks and pitfalls in India’s health communication. While government interventions, campaigns and digital platforms helped spread awareness and break through many myths, the rampant misinformation and lack of access to credible information, exacerbated by the growing digital divide, exposed the existence of information-based structural inequalities. If anything, the pandemic has underscored the need to reimagine communication as an integral component of public health care.
Evolution of Public Health Communication
Over the past few decades, India’s public health communication has undergone a significant transition from broad, top-down campaigns to more participatory and digitally mediated strategies.
In the early years, large-scale initiatives such as the national family-planning programme leveraged simple visual symbols and mass-media outreach to popularise contraceptive use across rural India. Then, with the launch of the National Health Mission in 2005, health-information campaigns moved beyond mere awareness-building to behaviour-change communication (BCC) and community-engagement models, recognising that effective messaging depends on local context and active citizen participation.
Then, with the launch of the National Health Policy in 2017, the health-related communication infrastructure shifted further, emphasising preventive and promotive health-care calling actions across sectors.
Over time, the advent of digital technology, social media messaging, and local-language media has further diversified the channels of health communication. For example, the Ministry’s Information, Education & Communication (IEC) division regularly issues print and outdoor campaigns for interventions such as breastfeeding weeks, dengue awareness and other public health themes across regional languages. Taken together, these developments reflect a trajectory: from centralised broadcast-style messaging to multi-channel, community-based and increasingly digital, inclusive frameworks.
What is the Role of Health Communication?
In current times, public health communication has become integral to building effective health systems, because it is a vital bridge linking policy and services with individual and community behaviour. This helps promote health literacy and fosters trust and participation.
Underpins disease prevention and control
By conveying timely information about symptoms, risks, and protective actions, health communication enables people to adopt preventive behaviours. For example, during the COVID‑19 pandemic, researchers found that inadequate health communication and low health literacy hampered the response of an estimated 36% adults globally, as they exhibited only basic or below-basic health literacy, underscoring the need for clear messages.
Management of NCDs
Secondly, public health communication plays a crucial role in managing non-communicable diseases (NCDs). Studies emphasise that improving nutrition literacy is central to tackling under-nutrition, micronutrient deficiencies and rising NCDs.This shows that communication isn’t just about acute threats, but also about long-term behavioural change, encouraging a balanced diet, physical activity, screening and adherence.
Health system, trust and accountability
Thirdly, effective public health communication helps to build trust and accountability within a national health framework. According to one review, effective health promotion “provides relevant information and adequate motivation to impact attitudes and behaviours in individuals or groups” and links epidemiological data with social-science insights to facilitate community engagement. In India, where socio-cultural, linguistic and geographic diversity is vast, tailoring messages to local contexts enhances reach and uptake. For example, research shows that using infographics in regional languages improves comprehension among audiences with diverse literacy levels.
Guidance during a crisis outbreak
Looking back on the COVID-19 pandemic, it becomes clear how communication serves as a crucial tool in crisis management. During health emergencies, mass media and digital platforms become key platforms for rapidly disseminating guidance, guidelines and shaping community norms, all of which help counter misinformation. A systematic review of Indian health communicators found that social media played a key role in promoting protective behaviours and enabling transparent communication, although misinformation remains a significant barrier.
Challenges in India’s Health Communication
India’s public health communication faces significant challenges due to deep socio-cultural, linguistic and technological divides, as well as the country’s low health literacy rate. According to several studies, a considerable portion of the population struggles to comprehend even basic health information, thereby increasing their vulnerability to misinformation. With this, health-related misinformation, primarily through social media platforms, becomes a double challenge. For instance, a recent report found rampant misinformation about cancer, reproductive health, vaccines and lifestyle diseases, with many people turning to unproven natural remedies or ignoring medical advice.
Another challenge is the digital divide and low digital literacy, with nearly 60% of rural Indians lacking access to regular and stable internet, thereby limiting their access to reliable digital health services. Even when digital platforms exist, many health tools are not designed for low-literacy or resource-constrained settings, and a skills gap often exists among frontline health workers in using these tools effectively.
On top of this, cultural and linguistic heterogeneity further complicates communication. For instance, tribal communities may not relate to messages delivered in standard or regional languages because they prefer their dialects and their traditional practices often shape how they interpret health advice. Ultimately, trust deficits and fragmented communication channels hinder effective public health outreach. Fact-checking and credible health journalism are under-resourced, while regulatory oversight for online health content remains weak. All of these challenges together make it difficult to deliver accurate, timely and culturally resonant public-health messages across India’s diverse landscape.
Way Forward for India’s Health Communication
Strengthening India’s public health communication requires a shift from ad-hoc awareness campaigns to a systematic, evidence-driven communication ecosystem aligned with national health planning. First, India must invest in health literacy as a public good by integrating it into school curricula, community programmes and frontline worker training so that citizens can better interpret health information, recognise misinformation and make informed decisions.
Second, communication strategies must be localised and inclusive, using regional languages, culturally relevant narratives and community-led platforms to ensure that messages resonate with diverse populations. This includes co-creating content with ASHA workers, panchayats, youth groups and local media.
Third, India needs a stronger digital public health infrastructure that bridges the digital divide through low-data, multilingual tools, audio-visual formats and accessible interfaces. Collaboration with fact-checkers, media platforms and technology partners is essential for combating misinformation swiftly and transparently.
Fourth, public institutions must enhance inter-ministerial coordination to ensure that health messages across ministries (health, education, WCD, sanitation) are consistent and mutually reinforcing.
Finally, communication must be backed by continuous research, behavioural insights and data monitoring to track message reach, impact, and community feedback.
Smile Foundation & Health Communication
Smile Foundation’s work demonstrates how civil society can play a transformative role in strengthening India’s public health communication landscape. By grounding its programmes in community participation, child health, maternal care and school-based awareness campaigns, the organisation bridges critical gaps between policy intent and people’s everyday realities.
Smile Foundation’s Mobile Health Units, Swabhiman initiatives and school health programmes rely on trusted front-line educators and local volunteers who communicate health messages in culturally appropriate, simplified and accessible formats. This model significantly improves health-seeking behaviour among underserved populations.
One of its notable contributions is integrating health communication with social determinants, including nutrition, sanitation, education and gender empowerment. Compounding this, Smile Foundation’s partnerships with government agencies, medical institutions and corporate CSR programmes further amplify the reach and credibility of its messages. Its work underscores the larger lesson for India: meaningful health communication must originate within communities, adapt to their contexts and empower them to take charge of their own well-being.
A healthy looking mother and her infant out and about
India has long measured maternal health in clinical terms — haemoglobin counts, institutional delivery rates, antenatal check-ups, nutritional supplements. But buried beneath these familiar metrics is another crisis, quieter and harder to quantify: the mental health of mothers. It is a crisis that rarely makes it into government dashboards or political speeches, but it is one that shapes both the health of women and the futures of the children they bring into the world.
In conversations with frontline workers across rural Rajasthan, urban Maharashtra and tea estates in Assam, one pattern repeats itself: women who are overwhelmed, anxious, depressed — but almost entirely unseen by the system. A young mother in Jaipur, cradling her newborn, quietly admits she hasn’t slept in days and sometimes feels frightened of being alone with her baby. A tribal woman in Odisha says the hardest part of pregnancy is “thinking too much,” but she never told the ASHA worker because “everyone has problems.” A migrant worker in Mumbai breaks down because she is still grieving the loss of her first child, even as she prepares to deliver her second.
These women are not outliers. They are the face of a public health challenge that remains largely invisible: one in five women in India experiences mental health difficulties during pregnancy or postpartum, according to emerging evidence. Yet mental health is still treated as a secondary concern — an optional extra in a system that is already overburdened.
The emotional weight of pregnancy
Pregnancy is often portrayed culturally as a time of joy, anticipation, and celebration. But for many women, especially those living in poverty, navigating unstable relationships, or lacking support, it is also a period of profound vulnerability.
Antenatal depression and anxiety do not occur in isolation. They are shaped by the social conditions surrounding women: food insecurity, domestic violence, long working hours, inadequate housing and the sheer physical labour involved in surviving day to day. For millions, pregnancy unfolds against the backdrop of smoky kitchens, demanding jobs and constant financial precarity.
When a woman is expected to cook for a family of eight over a chulha, or carry bricks on a construction site through her third trimester, it is unsurprising that her mental resilience begins to fray. Yet the system is rarely designed to recognise this emotional toll. The assumption is simple and outdated: if a woman is physically healthy, she must be well.
The silence around mental healthcare in maternal health
In a country where conversations around mental health still carry stigma, maternal mental health occupies an even more silenced corner. Many women do not have the vocabulary to describe what they are feeling. Words like “stress,” “worry,” and “tension” are used as catch-alls that mask more serious symptoms.
Family members often misinterpret mood changes as weakness or ingratitude. A woman who expresses sadness after childbirth is told she is “overthinking,” while one who feels anxious is encouraged to “be strong for the baby.” Depression becomes reframed as a lack of discipline or devotion. This cultural framing traps women in isolation.
Healthcare workers, too, are rarely trained to recognise perinatal mental health concerns. In overburdened clinics, the priority is blood pressure, weight and foetal growth. Mental health, if addressed at all, is reduced to the occasional question: “Do you feel fine?” Most women simply nod.
The consequences ripple across generations
Maternal mental health is not merely a private emotional matter — it has profound implications for public health. Research globally and increasingly in India shows that untreated maternal depression can affect foetal growth, increase the risk of preterm birth and influence early childhood development.
After childbirth, maternal mental health continues to be a powerful predictor of infant outcomes. A mother who is depressed may struggle with breastfeeding, bonding and maintaining consistent infant care. Children born to mothers with untreated depression are more likely to experience developmental delays, lower school readiness and behavioural challenges.
Mental health during pregnancy and postpartum is therefore not a separate silo; it is deeply interwoven with the long-term health, education and social mobility of the next generation. The wellbeing of women is the wellbeing of children — the chain is unbreakable.
A gap between policy and reality
India has made impressive strides in maternal health over the last two decades. Institutional deliveries have risen sharply. Maternal mortality has fallen. But mental health still lies outside the purview of most national programmes.
While the National Mental Health Programme acknowledges perinatal conditions, frontline implementation remains weak. In many states, mental-health positions remain vacant. Primary care physicians rarely receive systematic training on identifying perinatal depression. Screening tools exist, but they are seldom used.
Even where guidelines emphasise women’s mental wellbeing, their execution is hobbled by lack of resources, limited digital record-keeping and competing priorities. A single ASHA worker covering hundreds of households may not have the time or training to probe mental health concerns.
The gap is not due to lack of evidence, but lack of urgency.
What better maternal healthcare could look like
A maternal health system that genuinely integrates mental health would not be radically expensive or administratively complex. It would require three shifts: recognition, training, and community support.
First, recognition: Healthcare providers must be encouraged to see mental health as a core part of antenatal and postnatal care, not a luxury. A simple screening question asked earnestly can change the trajectory of a woman’s care.
Second, training: ASHA workers, ANMs, and primary care physicians are the backbone of India’s maternal health system. Equipping them to detect red flags — persistent sadness, withdrawal, fear or loss of appetite — could dramatically improve early intervention.
Third, community support: Women who are supported by families, neighbours and social networks are more resilient. Programmes that work with husbands, mothers-in-law and community leaders to recognise emotional distress can help shift the culture that normalises women’s suffering.
Examples from states such as Telangana — where pilot initiatives have trained primary care providers in perinatal mental health — offer a glimpse of what a strengthened system can achieve.
The emotional burden of care
What often goes unspoken is the emotional labour women are expected to perform immediately after childbirth — hosting visitors, cooking, cleaning, caring for older children — at a time when their bodies and minds are still recovering. The expectation that women must cope without complaint adds to their distress.
Postpartum depression is not a sign of failure. It is a sign of the impossible burdens mothers face.
A call to take women seriously
Maternal mental health deserves mainstream attention not because it is a “soft” issue, but because it is a foundational one. Women cannot be expected to carry the weight of pregnancy, labour, childcare and household responsibilities while also navigating emotional pain in silence.
If India wants to ensure healthy mothers and thriving children, it must start by taking seriously something it has long ignored: the inner lives of women.
Mental health is not a footnote to maternal healthcare. It is the hinge on which the wellbeing of families — and future generations — turns.
A future where women feel seen
Imagine a maternal healthcare system where a woman can say, “I’m struggling,” and know she will be heard. Where her emotional health is checked as routinely as her blood pressure. Where support doesn’t depend on luck or geography, but on a system that values her dignity and humanity.
Integrating mental health into maternal healthcare is a recognition that women are whole people, not vessels for childbirth. It acknowledges that the path to healthier families begins by caring for the minds of mothers.
India has transformed maternal health before. It can do so again — this time, by ensuring that women’s emotional wellbeing is not the missing piece.
Where hope is beginning to take shape
Across the country, small but meaningful attempts are already showing what is possible. Organisations working at the community level are creating shifts — often long before policies catch up.
Smile Foundation, for instance, has begun integrating mental health conversations into its maternal and child healthcare programmes. Our community health workers, trusted faces in some of the most underserved neighbourhoods, are being trained to recognise early signs of distress, counsel women and link them to care. In places where women rarely speak about what they feel, these conversations are offering a lifeline.
It is not a grand reform. It is not loudly advertised. But it is changing something essential: women no longer feel invisible.
And that is the starting point for any real transformation.
If India can scale efforts like these — pairing clinical care with emotional support and giving women the space to be honest about their struggles — maternal health will look very different in the years ahead. Healthier mothers, stronger families and children who begin life with the stability and security they deserve.
Maternal mental health is not a side note. It is the story. And the sooner we treat it that way, the more hopeful the future becomes.
On the streets of urban India, the warning signs often go unnoticed. A middle-aged security guard at a gated colony in Noida feels exhausted but shrugs it off as “long hours.” A domestic worker in Mumbai dismisses her dizzy spells as dehydration. A rickshaw driver in Patna ignores a persistent wound that refuses to heal. These are not just stories of hardship — they are symptoms of a growing health crisis sweeping silently across India’s poorest neighbourhoods: type 2 diabetes.
As we mark World Diabetes Day, the numbers are staggering. India now has more than 101 million people living with diabetes, the second-highest in the world after China. And yet, what is often missing from this conversation is the geography and inequality of this burden. The disease no longer belongs only to the affluent or elderly. It is now hitting the poor, the young and those least equipped to manage it — making it one of the most pressing yet under-recognised public health challenges in the country.
A Lifestyle Disease No Longer Limited to Lifestyle
Type 2 diabetes, once known as a “lifestyle disease,” is increasingly fuelled by urbanisation, poor nutrition and unequal access to care. As cities grow and rural populations migrate for work, food systems and daily routines shift in deeply unhealthy ways. Home-cooked meals give way to processed snacks. Long days of physical work are replaced by sedentary labour with erratic schedules. Sugary tea, cheap fried foods and white rice become staple sources of energy. And regular health check-ups remain an unaffordable luxury.
In these conditions, the body rebels — gradually, but with consequences that last a lifetime.
The latest National Family Health Survey (NFHS-5) data confirms that the prevalence of high blood sugar has increased across all socio-economic groups, including the lowest wealth quintiles. And yet awareness, treatment and control remain alarmingly low. A Lancet Global Health report recently noted that only 50% of people with diabetes in India are even aware they have the condition, and fewer than 10% achieve adequate control.
Cost of the Unseen
Diabetes is often described as a “silent” disease because its symptoms can remain unnoticed for years. But its impact is far from silent. It slowly corrodes health systems and family savings. Unchecked, it leads to complications: kidney failure, heart attacks, strokes, blindness, foot amputations. For those already struggling with precarious jobs and incomes, the costs are catastrophic — not only medically, but socially and financially.
Ironically, the places where diabetes is rising fastest — low-income urban neighbourhoods — are the least served by India’s overstretched public health infrastructure. There may be a Primary Health Centre a few kilometres away, but the wait times are long, the diagnostics limited and awareness about chronic illness low. In urban slums and peri-urban settlements, there is often no system to catch diabetes early or monitor its progression. The result is that millions fall through the cracks, diagnosed only when it’s too late.
Gendered and Generational
The burden of diabetes is also deeply gendered. Women, particularly in poor households, tend to prioritise the health of others — husbands, children, elders — above their own. Symptoms are ignored. Medical appointments are postponed. In some families, a woman’s diabetes is not even acknowledged until it affects her ability to cook or work.
There is also growing evidence that children and adolescents in urban poor families are not immune. Rising obesity and poor diet have led to a small but growing number of early-onset diabetes cases in Indian teens — many of whom have little understanding of what the condition entails or how to manage it. In the absence of school-based screening or community awareness, these numbers will likely rise.
Community-level Solutions are the Missing Link
If India’s diabetes crisis is to be tackled, the response must extend beyond hospitals and metros. It must reach the frontlines: neighbourhoods, schools, workplaces, homes. And that means equipping communities themselves to become part of the solution.
Community health workers — ASHAs, ANMs, trained volunteers — have long been central to maternal and child health in India. But in recent years, they have also been instrumental in bringing chronic disease education, blood sugar screening and follow-up support into low-resource settings. Across states, pilot programmes are showing that non-communicable diseases (NCDs) like diabetes can be addressed effectively at the grassroots — if the model is proactive, trusted and continuous.
This is where several NGOs and health initiatives have stepped in to fill the gap — particularly in urban poor settlements where the government’s reach remains inconsistent.
From Awareness to Action: A Grassroots Response
In the cluttered alleyways of East Delhi or the narrow lanes of Old Agra, teams of health educators now go door-to-door, explaining the signs of diabetes in plain language: “thirst that won’t go away,” “wounds that don’t heal,” “getting tired without reason.” In small schoolrooms and community halls, group sessions explain the role of food, exercise and regular blood sugar checks. Local women are trained as peer educators. Free screening camps identify early cases and refer them for follow-up.
In one community session in a peri-urban cluster near Gurugram, a woman in her fifties stood up after her sugar was checked and simply said: “I never knew this was a disease. I thought I was just aging.” That realisation — quiet but life-changing — is what these sessions aim to achieve.
Crucially, these efforts don’t end with diagnosis. Follow-up is the differentiator. Community health workers check in regularly, reinforce behaviour change and help patients navigate government schemes. Some programmes even provide support for basic medicines and nutritional guidance, ensuring that the first step — awareness — leads to sustained care.
How Smile Foundation is Stepping In
Over the past few years, one such effort has grown in reach and impact. Smile Foundation, known for its mobile health programmes and community development work, has made diabetes prevention and care a key part of its urban health strategy.
Through its Smile on Wheels mobile health initiative and urban outreach efforts, the Foundation is running diabetes screening and awareness sessions in underserved parts of Delhi, Agra and other cities. Their model blends health education with on-site blood sugar testing, medical counselling and free distribution of basic medicines when needed.
In low-income settlements where most residents have never had a preventive health check-up, Smile Foundation’s teams are often the first to explain the concept of diabetes in a relatable way. From using pictorial aids to explain dietary swaps to demonstrating how to walk daily for heart health, the approach is local, empathetic and patient.
Their community health workers — many of whom are women from the neighbourhoods themselves — also serve as long-term guides. They help families understand how to manage diabetes with limited resources: how to cook with less oil, how to reduce sugar without giving up flavour and how to keep moving even in tight spaces.
In schools, Smile Foundation’s team is beginning to work on preventive education as well, explaining the links between sugar, snacks and long-term health. As awareness rises, so too does the demand for more regular check-ups and access to medicines — a positive sign that prevention is beginning to take root.
The Way Forward
India’s National Health Mission has recognised non-communicable diseases like diabetes as a rising priority. Yet, bridging the urban poor health gap requires more than policy. It needs more mobile clinics, more community workers and stronger partnerships with NGOs and corporates who are already in the field.
As Smile Foundation’s work shows, change does not always need grand declarations. Sometimes, it begins with a health educator sitting beside a woman on a charpai, explaining that what she thought was age might be something treatable. Sometimes it’s a glucometer at a street corner that reveals what a hospital never reached. And sometimes, it’s a mobile van that brings care — and clarity — right to someone’s doorstep.
As India races toward urbanisation, we must ensure that healthcare — especially for chronic diseases like diabetes — keeps pace. Because no one should lose a foot, a livelihood or a life simply because they didn’t know what was wrong.
This article was first published on Oct 10, 2025 in Hindustan Times
Recently I came across a 15-year-old relative logging on to YouTube to revise linear equations before his exam. Within minutes, his screen floods with unrelated suggestions: Videos on quick wealth, viral pranks, and breaking celebrity news. An hour later, he had not solved a single math problem. He feels restless, guilty, and inexplicably drained. His story captures the dilemma of a generation caught between access and excess, empowered by information yet overwhelmed by it.
Artificial Intelligence (AI) was designed to simplify life, to curate and organise the world’s knowledge. Yet, in practice, it has multiplied distraction. Algorithms built to personalise our experience now amplify noise, turning the “information superhighway” into a labyrinth of endless recommendations, alerts, and notifications. Human cognition, evolved for depth and context, is struggling to survive in an ecosystem optimised for velocity and volume.
Researchers at the University of California, San Diego estimate that the average person now consumes nearly 34 gigabytes of information per day, roughly equivalent to watching five full-length films. With AI-driven content recommendation and multitasking culture, that number is almost certainly higher today. The result is a mind perpetually alert, yet increasingly unable to sustain focus.
UNESCO’s Global Education Monitoring Report 2023 warns that while technology enhances access, it is also reshaping how young people learn, shortening attention spans and eroding reflective capacity. Its State of Education Report for India 2024 finds that nearly half of adolescent experience fatigue, eye strain, or disrupted sleep linked to prolonged screen exposure. Across Organisation for Economic Co-operation and Development (OECD) nations, 96% of 15-year-olds now have access to a computer or tablet at home, and 98% own a smartphone, meaning the digital environment envelops almost every waking hour. In nearly all participating countries, over half the population of teenagers spend more than 30 hours a week on devices for work and leisure combined. The consequence is cognitive fragmentation at a scale humanity has never before experienced.
The impact of this constant mental churn extends far beyond distraction. Each day, people make hundreds of micro-decisions, which notification to check first, which news to trust, which message to reply to. Over time, this cognitive clutter erodes focus and emotional stability. Decision fatigue has become a quiet epidemic of its own.
The World Health Organization recorded a 25% global increase in anxiety and depression in 2020, much of it linked to the social and digital disruptions of the pandemic. The online world that once promised connection became a conveyor belt of crisis — exposing users to rolling waves of bad news, misinformation, and fear. Among adolescents, WHO’s European data show that problematic social media use rose from seven percent in 2018 to 11% in 2022, strongly associated with disturbed sleep and higher stress. UNICEF’s Childhood in a Digital World report adds that while connectivity brings opportunity, unmoderated exposure, to harmful content, online harassment, and social comparison, can intensify loneliness and anxiety.
Adults, too, are trapped in the same loop. AI-based productivity tools were meant to save time; instead, they have expanded the workday. Microsoft’s Work Trend Index 2022 found that employees now spend significantly more time in virtual meetings and receive 42% more messages after hours than before the pandemic. The OECD’s How’s Life in the Digital Age underscores how unbroken connectivity erodes recovery time, the mental space essential for creativity, empathy, and rest. Productivity has become perpetual motion, with little pause for restoration.
The way forward is not to reject technology but to redefine our relationship with it. AI, like any tool, reflects human design. The danger lies not in its existence but in our uncritical surrender to its rhythm. Managing mental wellness in the AI era requires a balance between cognitive stimulation and emotional stillness: between knowing more and absorbing less.
UNESCO and the OECD have both urged countries to integrate digital wellbeing into education and policy. UNESCO’s media and information literacy framework calls for teaching individuals how algorithms influence what they see, and how to consciously moderate digital consumption. The OECD recommends “safety by design” platforms that embed reflection and rest rather than optimise only for engagement.
There is another dimension often overlooked in conversations about overload: inequality. While some of us drown in data, others remain digitally stranded. UNICEF and the International Telecommunication Union estimate that two-thirds of the world’s school-age children, about 1.3 billion, lack internet access at home. In low-income countries, fewer than one in twenty have household connectivity, compared to nearly nine in ten in high-income nations. The digital divide thus creates a paradoxical landscape: One half battling the mental health consequences of overexposure, the other deprived of the very tools needed to learn and connect.
The challenge of the 21st century, then, is not merely to ensure access to information but to safeguard the ability to process it wisely. Attention must be treated as a finite resource: Guarded, replenished, and respected. Silence, once incidental, must now be deliberate. Walks without phones, meals without screens, and conversations uninterrupted by notifications are no longer luxuries but essentials for mental recovery.
In a world where engagement is currency, and distraction is design, the simplest act of resistance may be to pause. Between one scroll and the next lies the possibility of reclaiming clarity: a small, personal rebellion against an age that has mistaken connectivity for consciousness.
India faces an acute oral health equity crisis. Studies show that untreated dental disease is rampant – roughly 85–90% of adults and 60–80% of children in India suffer from cavities – yet most dental professionals work in cities, leaving rural and slum communities vastly underserved. Poor oral health contributes to chronic pain, stigma and lost productivity. In India’s high-tobacco context, the problem is especially dire: WHO data report that India accounts for about 37% of global oral cavity cancers (and 42% of deaths) due largely to tobacco use.
Compounding this, only a minority of Indians practice good preventive habits (under half brush twice daily) and many delay care until pain becomes unbearable. As a leading review observes, “untreated oral health conditions often worsen over time, necessitating professional intervention at advanced stages,” which both raises costs and causes people to lose workdays. In short, India’s rural and poor populations often live within sight of clinics but out of reach of routine dental care – a stark gap in a country pushing for Universal Health Coverage.
Smile’s Dental Project with Haleon
Mobile health units are one way to bridge this gap. By taking care to people’s doorsteps, these vans overcome distance, cost and awareness barriers. Smile Foundation’s Smile on Wheels Mobile Oral Healthcare Unit – funded by Haleon (maker of Sensodyne) – is an innovative example. Launched in late 2022 by GSK (now Haleon) CSR, four fully equipped dental vans now crisscross Delhi-NCR (serving Delhi, Gurugram and Noida) and even Agra, carrying dentists and equipment directly into slums and villages. Each van is staffed by a dentist, technician and coordinator, and offers a comprehensive package of care: free dental check-ups, fillings and basic treatments, free medicines and referrals, lab tests (when needed) and even oral cancer screening.
Importantly, the vans also double as classrooms – the teams run health education sessions, teach brushing techniques, and distribute toothbrushes, and they operate a School Oral Health Programme. Once a week they visit nearby government schools to give awareness talks on oral hygiene followed by free check-ups and fluoride treatments for children. In this way the dental project blends treatment and prevention, coupling curative services with a steady campaign of education and outreach.
The impact has been impressive. In its first year the four vans aimed to reach 72,000 beneficiaries; by the latest report they had served tens of thousands. In 2023–24 alone about 48,000 people received dental care and education from the vans(for perspective, a year earlier the programme had reached 34,000 people across 50 villages). These numbers are growing. Altogether, since launch the Smile on Wheels initiative has now touched well over 175,000 lives with free check-ups, medicines, oral-cancer screening and school camps – a scale few grass-roots dental programmes can match.
For many families, the van is literally a lifeline. Patients who once endured tooth pain silently now get treatment. As Smile Foundation co-founder Santanu Mishra says: “
This pilot project is a step towards addressing dental healthcare in India… We are hoping to bridge the gaps in dental healthcare delivery and provide quality services at the grassroots to ensure oral healthcare for all.”
Frontline dentists on the vans report dramatic results. A Smile on Wheels practitioner notes that in one day’s camp the team might find dozens of untreated cavities, gum disease or precancerous lesions and immediately provide care or referrals. “We see mothers relieved that their child’s cavity is filled on the spot, and elders grateful that someone finally screened them for oral cancer,” says Dr Kumar* of Smile on Wheels.* (Official data bears this out: one field study found that among high-risk waste workers, 33% screened positive for potentially malignant oral lesions – far above the population average).
By catching problems early, the mobile units can often treat decay with a simple filling or extraction, instead of allowing it to turn into painful abscesses. They also identify and refer advanced cases; Smile Foundation has set up links so patients with, say, oral pre-cancer (leukoplakia) can get follow-up at hospitals. In short, each visit combines curative care (fillings, cleanings, oral medicine) with preventive action (education, fluoride applications, cessation counselling for tobacco users) to maximize impact.
The public health insight here is clear: expanding dental care requires both innovation and community engagement. In India’s slum communities, people often skip dental care due to cost or lost wages. The Smile on Wheels vans mitigate these by being free and local, even giving out medicines on-site. They also leverage the trust of schools and community workers to deliver messages on diet and hygiene. A regular IEC (Information, Education and Communication) campaign is key; clinics can treat only one patient at a time, but education (group talks, brochures, posters) multiplies effect. Early feedback shows healthier habits creeping in – for example, after a van visit many schoolchildren report brushing twice a day and avoiding sweets. In data terms, the Smile Foundation reports that 75–80% of their beneficiaries are women and children – a sign that mobile clinics are reaching those most often side-lined from care.
Behind this success of the dental project is strong support from Haleon. Sensodyne-maker Haleon (spun off from GSK) underwrites the mobile clinics as part of its CSR commitment to everyday health for everyone. Head of CSR Shanu Saksena explains:
“There’s a synergic relationship between oral health and overall wellness… Taking actions to support communities to be healthy is reinforcing our commitment that better everyday health should be within reach for everyone.”
In practice, this means Haleon funds van operation, supplies equipment and part-funds medications. The public-private partnership model is instructive: corporate support lets an NGO scale quickly, while the NGO’s outreach expertise ensures the investment reaches those in need. Smile on Wheels shows how brand-driven health campaigns (like those by Sensodyne/Haleon) can dovetail with social objectives, bolstering national health goals like Ayushman Bharat and the Sustainable Development Goal of universal health.
What More Needs to be Done for Dental Projects?
Despite these gains, the need remains vast. Hundreds of millions in India still lack basic dental screening or advice. Mobile clinics can’t cover everyone, so the model should inspire wider action. As more healthcare providers deploy telemedicine, portable X-ray units, or AI-based screening tools (as Smile Foundation is piloting), the hope is to multiply outreach. The experience in Delhi, Gurugram, Agra and beyond underscores that accessibility is half the battle. When children smile again after a free filling, or a laborer learns that tobacco might have caused her mouth ulcer, it proves that combining treatment with education truly changes lives.
In the end, the Smile on Wheels initiative is about more than clean teeth – it’s about equity and dignity. By bringing dental care into the streets and schools of India, it is literally meeting patients where they are.
With Haleon’s backing and the Smile Foundation’s grassroots work, mobile dentistry is not just a stopgap – it’s driving India toward healthier, more confident smiles across all communities through this very impactful dental project.
Menstrual health is a critical yet often neglected aspect of adolescent wellbeing. In India, it remains shrouded in silence and stigma. A Dasra report notes that 70% of mothers consider menstruation “dirty,” and girls miss about 20% of the school year each month due to periods. Such taboos force girls to hide their needs: some skip classes or sit isolated during their cycles. Breaking these stereotypes requires more than just supplying pads—it demands open education and dialogue at every level.
School Health Programmes: From Awareness to Action
In classrooms and community centres, teachers and health workers are equipping girls with facts about menstruation. School sessions often include demonstrations on proper pad use and disposal, with experts answering questions about hygiene and myths. Government schemes like Odisha’s Rashtriya Kishor Swasthya Karyakram (RKSK) and local “Khushi” initiatives distribute subsidized napkins and train Accredited Social Health Activists (ASHAs) to educate girls on menstrual care. This means that even in remote villages, girls are learning to treat periods as a normal part of life. By combining free products with instruction, these programmes teach girls how to change pads regularly, dispose of them safely, and maintain cleanliness during menstruation.
Community Outreach and Family Support
Beyond schools, community workshops and peer groups bring health awareness to rural and urban neighbourhoods alike. Many programmes invite not only girls but also their mothers and even local men to join discussions on menstruation. Involving the whole community helps dismantle silence: experts emphasize that educating everyone – including boys – about periods builds empathy and breaks down prejudice. In village centres, ASHAs and school health coordinators are taking pads and information door-to-door. These outreach sessions emphasize hygiene (handwashing, clean cloth or pad use), nutrition and respectful care. Gradually, girls report feeling more confident asking questions and seeking support from family and teachers.
Period Practices: Proper Hygiene and Safe Disposal
Practical aspects of menstrual care are a key focus of awareness drives. For example, a cohort study in rural Odisha found that nearly half of girls simply discarded used pads in the open. Recent programmes therefore teach responsible disposal methods: wrapping used pads in paper and burying them or using designated incinerators where possible. Girls are cautioned that flushing pads or burning plastic-backed napkins is unsafe and environmentally harmful. Instead, many schools now provide disposal bins and facilitators encourage girls to ask for incinerators or pits. Learning these hygiene practices not only keeps girls healthy (reducing infections) but also helps them advocate for proper facilities at home and school.
Nutrition and Anaemia Screening
Awareness sessions make the important link between diet and menstrual health. Heavy flow and growing bodies can deplete iron, so girls are taught to eat iron-rich foods like greens, lentils, nuts and eggs, especially during their periods. This is crucial in India: nearly 60% of adolescent girls were found to be anaemic in recent surveys. Workshops often include haemoglobin screening; girls with low scores receive supplements and nutrition counselling on the spot. By integrating weekly iron-and-folic-acid (WIFAS) tablets into school health programmes, organisers help girls build strength and prevent fatigue and dizziness related to anaemia. Nutrition education in the context of menstruation also empowers girls to talk to their families about diet and to seek medical advice if needed.
Voices from the Field regarding Period Practices
“Before this session, I felt ashamed even to mention my period,” says Meena, a 15-year-old girl from a Tamil Nadu village. “Now I know how to use a sanitary pad and how to throw it away properly. I feel stronger and not afraid.”
“I always wondered if I was doing it right,” shares Aarti, 14, from a Mumbai suburb. “The workshop taught us how to track our cycle and eat the right foods. I’m not embarrassed to ask questions now – even to the doctor.”
These girls’ words reflect a common experience: education brings confidence. After attending a health-awareness session, they have practical knowledge and self-assurance that they lacked before.
Building a Supportive Future
India’s government and civil society are taking note. For instance, the National Health Mission now trains ASHAs to distribute subsidized pads and organise school discussions on menstrual hygiene. NGOs like the Smile Foundation are also stepping up: Smile regularly hold sessions in Virudhunagar, Tamil Nadu, reaching over hundreds of schoolgirls with health talks, pad kits and anaemia screenings. Such community-led programmes are demonstrating how far we’ve come in normalising menstruation.
The path ahead should include expanding these efforts and improving infrastructure. Every school needs private toilets with water, waste bins or incinerators and a curriculum that openly addresses puberty and menstrual health. By continuing to spread awareness in culturally sensitive ways and to screen for anaemia, we can ensure no girl’s education or wellbeing is derailed by natural biology. In doing so, India will not only break the period taboo but also empower a generation of young women with the knowledge and confidence to manage their health.
In the villages of Uttar Pradesh, conversations around menstruation have often remained cloaked in silence — spoken about in hushed tones, if at all. For many adolescent girls, their first period arrives not with preparation, but with confusion, fear and shame. Cultural taboos continue to restrict open dialogue, leaving girls with limited understanding of how to manage their health and hygiene safely.
In response, Smile Foundation recently conducted a community-based session in Baraich that brought women and adolescent girls together for a candid, informative discussion on menstrual health. Held in an environment of trust and cultural sensitivity, the session helped participants unpack both the practical and emotional aspects of menstruation. Health educators explained how to use and dispose of sanitary pads properly, discussed safe hygiene habits and addressed common questions that are rarely voiced in public.
But the conversation went beyond hygiene. Facilitators emphasised how nutrition, hydration, light exercise and emotional well-being all contribute to healthy menstrual cycles. Girls were encouraged to see menstruation not as a burden, but as a natural biological process — one they have the right to understand and manage with dignity. The session also focused on dispelling myths and involving families in the conversation, promoting openness that can eventually ripple through entire communities.
By bringing accurate information and empathetic guidance directly to where it’s needed most, initiatives like these are helping to transform attitudes, strengthen confidence, and ensure that no girl feels alone or ashamed about her own body.
