Shorenstein APARC Fellow Thomas Fingar, FSI Senior Fellow Siegfried Hecker, and CISAC Senior Fellow Scott Sagan are part of a group of 80 national security experts included in a Massive Open Online Course (MOOC) focused on the prospects for peace and security in South Asia.

The MOOC, titled Nuclear South Asia: A Guide to India, Pakistan, and the Bomb, is an inaugural course in a series produced by the Stimson Center in Washington, D.C. It is free to enroll and can be taken anytime and at any pace from a digital device.

Learn more about the MOOC.

Since the 1960s, India’s groundwater irrigation has increased dramatically, playing an important role in its economy and people’s lives — supporting livelihoods of over 26 crore farmers and agricultural labourers who grow over a third of India’s foodgrains. These benefits, however, have come at the cost of increased pressure on groundwater reserves. 

India is the world’s largest user of groundwater and, since the 1980s, its groundwater levels have been dropping. The severity of the problem is particularly acute in the northwest, where levels have plunged from 8m below ground to 16m, so that water needs to be pumped from even greater depths. Worse yet, much of this is non-renewable since recharge rates are less than extraction rates and replenishing this resource can take thousands of years. 

This won’t last 

Using up such “fossil” groundwater is unsustainable. Moreover, the future of monsoon rainfall remains uncertain; while some climate models predict an increase, others forecast a weakening monsoon, although changes in monsoon variability are already underway and will continue into the future. Historical records show the number of dry spells and the intensity of wet spells have risen over the past 50 years. As climate change alters the monsoon, the large stresses on India’s groundwater resources may increase.

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Protecting freedom of expression is essential to vibrant democracies and to meet the needs of people now and into the future, Indian historian Ramachandra Guha said at a Stanford event seeking to draw people together for policy-relevant discussions about India’s growth following 25 years of reforms.

Guha’s remarks were part of a colloquium titled “Eight Threats to Freedom of Expression in India,” and one in a series, co-hosted by the Shorenstein Asia-Pacific Research Center (APARC) and Center for South Asia.

The colloquia, which continue this spring, are motivated by an opportunity to garner reflections and expertise from Kathleen Stephens, the William J. Perry Fellow in the Freeman Spogli Institute, who served as chargé d'affaires at the U.S. Embassy New Delhi in 2014.

“As I was preparing to go to India, I read Ram’s extraordinary book India after Gandhi, which provided much-needed historical, cultural and political context,” Stephens said. “When I visited Bangalore, we met and instantly clicked as we talked about U.S.-India relations. It’s a pleasure to welcome him back to Stanford.”

Guha, a renowned author and scholar, has written numerous critically acclaimed books about India’s history and culture as well as social ecology, and is a frequent commentary contributor to publications such as The Telegraph and Hindustan Times. In 2000, Guha was a visiting professor at Stanford, where he taught courses on the politics and culture of South Asia and cross-cultural perspectives on the global environmental debate.

India is often referred to as the world’s largest democracy for its population size of 1.3 billion and system of governance since partition and independence in 1947. Guha said that, while India is “solidly and certifiably democratic,” there are serious flaws, including growing threats to freedom of expression of Indian artists, filmmakers and writers.

Indian society, Guha said, has become too sensitive to criticism, wherein “somebody will take objection” to any message. This kind of environment has encouraged newspaper editors to self-censor, for example, and led public figures to, at times, neglect to protect artists, filmmakers and writers.

In total, Guha detailed eight threats to freedom of expression in contemporary India: 1) archaic colonial laws affecting the first amendment, 2) imperfections in the judicial system, 3) rising importance of identity politics, 4) complicity of the police force, 5) pusillanimity of politicians, 6) dependence of media on government-sponsored advertisements, 7) dependence of media on commercially-sponsored advertisements and 8) ideologically–driven writers.

Would an absence of those threats imply freedom of expression? Responding to the question from the audience, Guha lamented that the answer wasn’t simple. His task was to offer a diagnosis of the challenges, he said, and not provide instruction on how to solve them, but in general, focused efforts bear change.

“Building democracies is about quiet persistent work,” Guha said of next steps in the process to extinguish threats to freedom of expression. “I think quiet persistent work in repairing our institutions, modernizing our laws and improving civil society institutions can still mitigate some of the threats.”

Guha expressed optimism about India’s civil society, noting an expansion in the supply of non-governmental organizations working on social issues and private philanthropists funding projects in that sector. But he tempered: “we could do more.”

Stephens ended the event by thanking Guha for leading the discussion, and referenced America’s first president George Washington, who at the end of his term in office, called upon citizens to be “‘anxious, jealous guardians of our democracy.’”

“And, I see that today in Ram and in the many people here – very jealous, anxious and passionate guardians of our democracy – who we can learn a lot from,” she said.

Listen to an audio recording of the colloquium.

India is a focus of colloquia at the Shorenstein Asia-Pacific Research Center during the next few months. A seminar series entitled “A New India? The Impact of 25 Years of Reform” will explore the country’s economic growth and efforts to revitalize its foreign relations.

The colloquia, co-sponsored by Stanford’s Center for South Asia, will include lectures from scholars, policymakers and other thought leaders on India’s democratic system and society, and provide a forum to discuss how the country can overcome obstacles to long-term prosperity.

Kathleen Stephens, the William J. Perry Fellow at Shorenstein APARC and former U.S. ambassador to the Republic of Korea, has organized and will moderate the colloquia. She served as the chargé d'affaires at the U.S. Embassy in New Delhi in 2014.

Stephens said, “Now is the right time and Stanford is the right place for a renewed focus on India, its daunting challenges and its extraordinary potential. This series will consider the strategic bet U.S. policymakers have made on India's rise, and India's own aspirations to play a bigger global role, particularly in Asia.

“In this series and beyond, we want to knit together the expertise and resources at Stanford and in Silicon Valley with policy leaders from India and elsewhere to expand our understanding of India in all its contemporary complexity and importance.”

From 1999 to 2013, Shorenstein APARC had a prolific initiative that supported scholarly work related to South Asia. The center envisions the colloquia will be some of many activities about the region going forward.

A listing of the seminars and related multimedia can be accessed here; more information will be added as it becomes available.

An Indian businessman approached Stanford Medicine in 2005 with an outlandish proposition: Help us build an ambulance system across the sprawling South Asia nation, which is home to 10 percent of the world’s traffic deaths.

S.V. Mahadevan, MD, an associate professor of emergency medicine at Stanford Medicine, was skeptical the nonprofit GVK EMRI (Emergency Management and Research Institute) could truly pull it off.

They only had 14 ambulances in the world’s second most populous nation.

Today the system has expanded to a fleet of nearly 10,000 ambulances, manned by some 20,000 medical professionals who ply the roads in cities and rural villages to provide access to emergency care to 750 million people — three-quarters of India’s population — according to a story in Stanford Medicine magazine last year.

“It’s hard to fathom what this system has done in 10 years,” said Mahadevan, founder of Stanford Emergency Medicine International, which has provided medical expertise to GVK EMRI over the last decade, helping to train the EMTs who now belong to the largest ambulance service in the developing world.

“It could be regarded as one of the most important advances in global medicine in the world today," he said.

Yet up until now there has been no analytical research on the impact of the ambulance service. Though EMRI says its 911-like service has saved more than 1.4 million lives in its first decade, there has been no published research to back up that claim.

Now, research by Stanford Health Policy scholars published in the October edition of the health policy journal, Health Affairs, indicates EMRI’s system has had a significant impact on saving the lives of newborns and infants, one of the most challenging health dilemmas plaguing India today.

Focusing on the first two states served by GVK EMRI — with a combined population of 145 million — their results show that the organization’s services have reduced infant and neonatal mortality rates by at least 2 percent in high-mortality areas of the western state of Gujarat. There were similar effects statewide in the southeastern state of Andhra Pradesh.

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“With our modern medical knowledge, childbirth should not be so risky and newborns should not be dying at such high rates,” said Babiarz.

India has 28 maternal neonatal or infant deaths per 1,000 live births, according to the World Bank, making it one of the highest in the world. The global average is 19.2 deaths per 1,000 births; the rate drops to 4 in North America.

“These issues are particularly compelling to me as a mother,” Babiarz said. “It's wonderful to find a model that has found some success in connecting mothers and their infants with high-quality and timely emergency care when it is most needed.”

The authors used electronic service records from GVK EMRI, matched to population-representative surveys from the International Institute for Population Sciences, and their own survey that they conducted in Gujarat in 2010 through the Collaboration for Health System Improvement and Impact Evaluation in India. The combined surveys include information on over 16,000 live births.

The public-private nonprofit provides its services free of charge and most of its beneficiaries are the poorest of the poor. Each state contributes to the ambulance system, as does the federal government. It also depends on private philanthropy among some of India’s wealthiest industrialists.

The School of Medicine in 2007 signed a formal agreement to develop an educational curriculum and train the initial group of 180 skilled paramedics and instructors. Over the years, the Stanford instructors have learned to tailor the curriculum to local needs.

About one-third of the toll-free calls to 108 — an auspicious number in India — are from women in labor. Deliveries have traditionally been done at home, particularly in rural villages, where women often die of complications. So the Stanford team has since designed a special obstetrics curriculum and helped create the country’s first protocols for obstetric care.

Grant Miller, an associate professor of medicine, core faculty member at Stanford Health Policy and senior author of the study, has worked on many health policy projects in India over the years. The results aren’t always hopeful.

“I’ve conducted a number of evaluations of large-scale health programs in India, and there are disappointingly few programs and policies that we’ve found to be effective,” said Miller, who is also director of the Stanford Center for International Development and a senior fellow at the Stanford Institute for Economic Policy Research and the Freeman Spogli Institute for International Studies. “So it’s exciting to find one that may have worked quite well.”

Miller and his fellow authors note, however, that further research on emergency medical services in other Indian states and by other providers is still needed.

“We need to do a lot more work — but these results suggest that something important has happened,” he said. “With the release of more population-representative data from more states, we’re eager to expand our analysis to the rest of the country.”

Stanford Medicine’s Center for Innovation in Global Health also supported the authors’ research in India.

Ruthann Richter, director of media relations for the medical school's Office of Communication & Public Affairs, contributed to this story.