In Bangalore, India, a Cuddle With Your Baby Requires a Bribe
The New York Times
BANGALORE, India - Just as the painful ordeal of childbirth finally ended and Nesam Velankanni waited for a nurse to lay her squalling newborn on her chest, the maternity hospital's ritual of extortion began.
Nesam Velankanni had to pay to see her daughter, Arokya, at her birth 16 months ago in Bangalore, India. She has an older daughter, Ruby, 6.
At the Austin Town Maternity Home in Bangalore, it is common for nurses to demand bribes to bring newborns to their mothers.
Before she even glimpsed her baby, she said, a nurse whisked the infant away and an attendant demanded a bribe. If you want to see your child, families are told, the price is $12 for a boy and $7 for a girl, a lot of money for slum dwellers scraping by on a dollar a day. The practice is common here in the city, surveys confirm.
Mrs. Velankanni was penniless, and her mother-in-law had to pawn gold earrings that had been a precious marriage gift so she could give the money to the attendant, or ayah. Mrs. Velankanni, a migrant to Bangalore who had been unprepared for the demand, wept in frustration.
"The ayah told my mother-in-law to pay up fast because the night duty doctor was leaving at 8 a.m. and wanted a share," she recalled.
The grand thefts of rulers may be more infamous, but the bitter experience of petty corruption, less apparent but no less invidious, is an everyday trial for millions of poor people across Asia, Africa and Latin America. Increasingly, it is being recognized as a major obstacle to economic development, robbing the impoverished of already measly incomes and corroding the public services they desperately need.
The bribes vary from place to place and in the services affected, but stretch from cradle to grave, according to surveys and anticorruption investigators. People pay to give birth, and to collect their loved ones' bodies from mortuaries, and for everything in between: garbage collection, clean water, medicines, admission to public schools. Even policemen double as shakedown artists.
Such petty bribery acts as a hidden regressive tax, according to research financed by the World Bank Institute, the bank's educational and research arm. In Zambia, for example, poor people paid 17 percent of their incomes in bribes for medical care, while the middle class paid only 3 percent. The comparable figures for Paraguay were 7 percent for the poor and only 1 percent for the middle class.
"The poor not only are paying much more of their incomes to get the same medical services as the middle and richer classes, but they are also discouraged from seeking basic medical care because they can't afford it," said Daniel Kaufmann, director of global programs at the institute.
When low-level officials pick the pockets of the poor, it is also often a reliable indicator of greater corruption higher up the bureaucratic and political hierarchy.
Here in Bangalore, a city of 6.5 million known for its booming high-technology industry, pleasant climate and good private schools, local health managers commonly pay bribes to senior bureaucrats or elected officials to get good jobs, say investigators, civic leaders and senior civil servants. The health professionals then exact payments from subordinates and patients, emulating their bosses.
"Most of the district health officers have to pay bribes to get promotions and postings, and they in turn collect bribes from their staff and patients," said Hanumappa Sudarshan, the vigilance director for health and education in Karnataka State's anticorruption agency. "It's a vicious cycle."
Mr. Sudarshan's boss, Nanjegowda Venkatachala, a retired Indian Supreme Court justice who heads the agency, put it even more bluntly: "The greed of politicians is ruining the country. There's nothing to mince in this regard."
No matter where the corruption starts, it moves down through the ranks and finally to the poor, for whom it is an inescapable burden.
Though Bangalore has made progress in fighting corruption, it persists in the hospitals. In the narrow lanes of the slums and working-class neighborhoods around the 30-bed Austin Town maternity hospital, families with babies and toddlers described their personal experiences of bribery.
Shobha Rani, the doctor in charge, emphatically disputed such accounts in an interview earlier this year. "I've not come across even one patient who's come here and said I've been charged for anything," she said. "So many times, I've spoken to patients without the knowledge of my staff. I say: 'Tell me the truth. What did you face?' They always give me a good report."
But people who have used the hospital tell a different story. Nagaratna Hanumanthu, 23, and her husband, Hanumanthu, 28, a sugar-cane-juice vendor with a single name, lost their first baby to a raging fever just two days after he was born. Their anxieties were high last November when their daughter was born at Austin Town.
The moment the baby emerged, the nurses took her away and demanded $7, the parents said. But Mr. Hanumanthu, a tall, imposing man, said he pretended he knew important people and threatened to complain. The nurses backed down, he said.
But then his fears grew that the staff might hurt the baby. "We had already lost one child, and we were worried we would lose this child, too," he said.
Mr. Hanumanthu, who earns about $1 a day, turned to his mother, who makes $11 a month sweeping floors and washing dishes. She gave him money for the bribe.
As he described his ordeal, his glowering presence seemed to fill a dark, cramped room of their home in the slums, where his wife rocked the sleeping baby, Sujata, in a cradle.
It was far from the first bribe he had paid, he said, and certainly not the last.
Every month, he said, he must pay off city workers who threaten to confiscate his pushcart. He has no choice, he said. How else would he make a living? Last summer, he saw what happened to a vendor who refused to move when the city workers told him to. They overturned the man's cart, cracking the motor. He was out of work for three months.
"I've studied up to 10th grade and passed," he said bitterly. "I try to earn a decent living, but because of all the demands, I'm tempted to rob and steal to make money fast. I'm fed up with life."
A growing number of surveys of poor households, commissioned by nonprofit groups like the Public Affairs Center here in India, are documenting the problems of corruption and poor public services, arming advocates who are fighting corruption with useful information and providing voters with data that helps them hold elected officials accountable.
The center pioneered the use of consumer surveys here in Bangalore to measure the extent and effects of bribery and to give citizens a collective, credible voice about their experience of public services. The approach was the brainstorm of Samuel Paul, who formerly led one of India's premier business schools.
During the past decade, the center has released report cards that that have generated splashy coverage in local newspapers. "There was power in the information," Mr. Paul said.
The idea has been widely copied. Today report cards are used in Ethiopia, Uganda and Zanzibar, in Ukraine, Bangladesh, the Philippines and Vietnam.
Bangalore's success in fighting corruption, under the leadership of a reform-minded government that took office in 1999, has enhanced the appeal of report cards. The center's latest survey, done in 2003, found that bribery had fallen sharply since 1999 and satisfaction with public services had risen, though bribes persisted at shockingly high levels in maternity hospitals.
One necessary step was removing bureaucratic middlemen. Bangalore substantially reduced corruption in property tax assessments by setting simple rules so citizens could estimate their own property values, cutting out inspectors who had demanded payoffs. Property tax collections rose sharply.
Cleaning up the city's 30 maternity homes, which mainly serve the poor, has proved tougher, however.
A 1999 survey by the center found that 9 of 10 families whose relatives gave birth in the hospitals reported paying a bribe, usually to see the baby. The average amount paid has since dropped to $7 from about $16. But 8 in 10 women still reported paying bribes in 2003 - to have their baby delivered, to see the child after birth, to get their newborn immunized or to obtain medicines that were supposed to be free.
K. Jairaj, who became city commissioner in 1999, said he was appalled when Mr. Paul handed him the original maternity hospital findings six years ago. "It was the trigger to move the politicians and bureaucrats forward," he said.
At the center's urging, the city set up boards of volunteers to monitor hospitals. It also posted citizens' charters in maternity hospitals stating that bribery was prohibited and listing phone numbers for complaints. But the boards were often toothless, and many patients already knew bribes were illegal.
The city's current commissioner, Karuppiah Jothiramalingam, who took office last year with a new government, said he would retrain hospital workers and punish those who solicited bribes. He added, "This type of action can only be taken on specific complaints."
But the ingrained habits of bribery persist in part because the poor, powerless in so many aspects of their lives, are afraid to object. They worry that their newborns will get bad medical care from angry health workers. They dread retribution when they return for subsequent births.
Shireen Taj, a car mechanic's wife, had her first baby at Austin Town on Jan. 21. The family said they paid the going rate - $12 - to see the boy.
Razia Begum, Mrs. Taj's mother, said that even when Shireen was born at Austin Town 18 years ago, the family paid a bribe to see her, though the price then was the same for boys and girls. "Now boys cost more, girls less," she said, describing the devaluing of females in a society where the male child is often more desired. Sometimes the very poorest people are charged less, she and others said.
"It's a practice there," she said. "My older daughter also paid. So I brought money." The nurses and attendants are the ones who ask for the money, while the doctor is never present, families say.
As Razia Begum spoke, an elderly neighbor came to the door. "If you write about it," she said to a reporter, "they will chase us out of the hospital. Where will we go?"
Several women who had just given birth and their families, interviewed on an open ward at the hospital and shortly after the mothers were discharged, also said they had been asked to pay bribes.
Margaret, a 50-year-old grandmother who uses only one name, said she paid to see her 19-year-old daughter's baby the day he was born, Feb. 16. She earns only $10 a month as a maid and said that she was determined to pay no more than $7 - and that she did not.
"Though I felt bad and a little angry, a private hospital would have cost at least 2,500 rupees," or about $60, she said. The bribe was still costly but, by the calculus of poverty, a relative bargain.