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The World india from A1
inserted into the women’s wombs. “The women come to us and
say, ‘Even if I die, at least I won’t face the stigma of being barren,’ ” said Anurag Bishnoi, the center’s lead IVF specialist. “These wom- en are like soldiers:, They are on the front lines for their family, their country. They may die, but their family and country will live.” Many fertility experts say per- forming IVF on women older than 45 can be dangerous for the mother, a stress on her heart and blood pressure. Many must have their uteruses removed immedi- ately after birth, because they are weaker and rupture, doctors said. The baby is also more likely to be born premature and to face health problems. The average life expectancy in India is 63, accord- ing to World Bank data. “We are talking about bringing another human being into the world,” said Sonia Verma, a doc- tor at Indraprastha Apollo Hospi- tal, one of the country’s leading centers, which discourages the procedure after age 55. “What happens when the parents die? We shouldn’t only worry about what the patient wants. We could get a prepubescent girl pregnant with the same technology. Should we also do that?” More than 40 years ago, Roh-
tash gave birth to five daughters and one son. But seven years ago, her son died in a car accident. Now she wants to try again for a male heir, a powerful cultural preference in India that many population experts say contrib- utes to women having babies un- til a son is born. “The risk for a son and a bal- anced family is my destiny,” she said. “I consider this place to be God.” Many other older Indian wom- en agree. In another case at the Hisar center, Bhateri Devi, 66, in May became the world’s oldest woman to give birth to triplets. She was unable to bear children throughout her married life. Fertility experts here say India is facing a unique problem be- cause there is so much pressure for women to have children and the technology is relatively af- fordable.
One IVF attempt at this clinic costs about $2,500, while in the United States it can run up to
R
KLMNO
FRIDAY, AUGUST 13, 2010 In India, desire to have children outweighs age risk
Unrestricted growth
India is the second-most- populous country in the world next to China, but with few efforts to control its popula- tion, it is growing more than twice as fast.
POPULATION GROWTH RATE 1.5%
0.0 0.5 1.0
2000 ’01 ’02 SOURCE: CIA World Factbook
United States, where upper-mid- dle-class couples often spend time developing their careers and wait until their late 30s and early 40s to have children. “The need of the hour is reg-
ulating these clinics,” said Pai, who worked on a new law that calls for no age limit for IVF. The United States has no age limit for the procedure, but doctors advise against IVF after 45 and can re- fuse in situations in which it is considered too risky. “There’s an argument that says
EMILY WAX/THE WASHINGTON POST
Rajo Devi Lohan, 72 — who gave birth to a daughter, Naveen, 18 months ago after seeking fertility treatment in India — is thought to be one of the oldest mothers in the world.
$15,000. Although the fees in In- dia are high for middle-class fam- ilies earning a typical $15,000 to $20,000 a year, they are often able to get money from relatives or a bank loan. Rohtash’s family of farmers did both. India is expected to surpass the
United States and China in the number of IVF cycles, said Hrish- ikesh Pai, one of the country’s leading IVF experts and vice
president of the 900-member In- dian Society of Assisted Repro- duction.
About 150,000 cycles were per- formed in the United States last year and about 80,000 in China, Pai said. No data were collected for India because many new clin- ics are not reporting numbers, but some experts think the num- ber could reach 600,000 in the next three years, Pai said. Many
doctors will try up to four rounds of IVF. India has more than 550 regis- tered IVF centers, according to Pai’s studies, and he estimates that one new clinic is opening ev- ery 15 days. There are two main client cat-
egories. About 20 percent are old- er and want to shed the stigma of being unable to conceive. Others are similar to many profiles in the
that if a man of 70 years and can have a child, why can’t a woman of 70 have a child,” said Pai, who works in Mumbai at several fer- tility clinics. “But what we need in India, because of our cultural pressures, is a policy to advise against it. It’s not safe.” At the Hisar clinic, hundreds of worried-looking couples — rang- ing from those in their 20s to sen- ior citizens — clutched scans and medical forms. M.R. Bishnoi sat in his medical
office under a poster of the Hip- pocratic oath and photographs of happy babies. “Better late than never,” said Bishnoi, who works with his son, Gyanwati Bishnoi. “Reproduc- tion is a civil right — nobody can bar you from bearing a child. We are not violating any laws of the land. Is it a home without chil- dren? In India, there is no woman who doesn’t want a child. With- out taking a risk, no one would
More tasks put Coast Guard ‘at the breaking point’ coast guard from A1
spected rigs for worker safety. It also set standards for companies that clean up spills, and has coor- dinated the joint response to the spill in the gulf.
Some analysts said the spill highlights the need to rethink Coast Guard priorities. In the past 35 years, Congress has handed the agency at least 27 new respon- sibilities, according to a tally by Rep. James L. Oberstar (D- Minn.), chairman of the House Transportation and Infrastruc- ture Committee. “They just don’t have enough personnel to carry out all those missions,” said Oberstar, who fa- vors severing the Coast Guard from the Homeland Security De- partment. “That’s just not pos- sible.”
Coast Guard officials said they did not have budget figures to compare how much is spent on oil-related programs now and be- fore Sept. 11, 2001. Even current budget numbers for these pro- grams are unclear because spend- ing falls into two categories that encompass many other activities, including fighting invasive spe- cies and oversight of recreational boating. Marine environmental protection was allotted 2 percent of this year’s operating expenses, marine safety 8 percent. The Coast Guard said that be- fore 2001, the agency was orga- nized differently. A private study in 2003 by one Coast Guard offi- cer calculated that, before the at- tacks, marine environmental pro- grams accounted for 11 percent of operating funds and marine safe- ty accounted for 14 percent. Congressional staffers said the lack of reliable figures has com- plicated their efforts to ensure that vital programs are not ne- glected. Juggling diverse missions is far from the only challenge the Coast Guard faces. Its maritime fleet is aging, and a long-delayed fleet- modernization plan has suffered design flaws and cost overruns; it is now under Justice Department scrutiny. The White House has recommended budget cuts. And the Coast Guard’s marine-safety programs have suffered a drain as personnel sought higher-profile assignments.
Senior Coast Guard officials
Te Coast Guard’s many missions Te U.S. Coast Guard has taken on many new missions over the years, many of them related to homeland security. In fiscal 2008, the hours logged by Coast Guard aircraſt and vessels to protect the environment accounted for less than one-half of 1 percent of total mission hours.
Percentage of total hours by statutory mission areas Homeland security
Ports, waterways, coastal security Aids-to-navigation
Living marine resources Illegal drug interdiction
Undocumented migrant interdiction Search and rescue Marine safety
Defense readiness Ice operations
Other law enforcement Marine environmental protection SOURCE: Homeland Security Department
said the agency’s many missions make it stronger because ships patrolling for terrorists might happen across drug smugglers or an oil slick. They said that crews develop complementary skills and that combining missions saves money.
Coast Guard officials point out
that until April, oil spills had de- creased dramatically. They said mission statistics do not reflect the division of labor at sea, where crews are ready for whatever comes their way. “The Coast Guard takes its role as an environmental-response agency seriously,” said Capt. An- thony Lloyd, chief of the Office of Incident Management and Pre- paredness. But even some defenders of the Coast Guard fear that it is edging toward crisis. “It’s basically at the breaking
point,” former commander Ste- phen Flynn said.
Community policing
Federal regulation of offshore drilling grew over the years into a patchwork. The MMS leased off- shore drilling rights to private
1.61 1.11 0.46%
NOTE: Figures for Marine Environmental Protection might not represent all activities that contribute to environmen- tal protection, including work done by personnel operating from shore, such as when they investigate coastal spills.
THE WASHINGTON POST
companies, approved emergency response plans and inspected drilling equipment. The Coast Guard ensured the seaworthiness of mobile drilling units. Today, Coast Guard inspectors
examine navigational equipment, lifesaving apparatus and fire pro- tection systems, and look after day-to-day worker safety. The agency also oversees containment of oil and major spill cleanup. The most rigorous Coast Guard
inspections occur on U.S.-flagged oil rigs; they last for days. Rigs registered in other countries, such as the Marshall Islands- flagged Deepwater Horizon, get a six-hour review. A three-person Coast Guard team last visited Deepwater Horizon in July 2009, found no major deficiencies and issued a two-year compliance cer- tificate.
When inspectors show up, they
often spot-check paperwork pro- duced by private companies, which the Coast Guard refers to as “stakeholders.” “It’s more of a community po- licing kind of approach: get to know the neighbors, help an old lady cross the street,” said Flynn,
10.23 10.09
8.27 6.16 5.75 Non-homeland security 27.71%
14.37 14.24
the former Coast Guard com- mander, who heads the Center for National Policy, a Washington think tank. “You build a level of collaboration, rather than an ‘us- vs.-them’ kind of approach.” Two months before the gulf blowout, the Obama administra- tion proposed a 3 percent cut in Coast Guard funding and active- duty personnel. The plan would slash 1,100 military personnel and decommission the National Strike Force Coordination Center, which manages oil-spill response. “Not a good idea,” Oberstar said. Coast Guard officials have long acknowledged strained resourc- es, especially with ships and air- craft. In February, Adm. Thad Allen, then Coast Guard commandant, said in a speech that the Coast Guard operates one of the world’s oldest fleets, with high-endur- ance cutters averaging 41 years of age, compared to 14 for the U.S. Navy. “No amount of maintenance can outpace the ravages of age,” Allen said, describing the sputter- ing performance of cutters as- signed to Haiti relief work. “The condition of our fleet continues to deteriorate, putting our crews at risk, jeopardizing our ability to do the job.”
During the initial gulf re- sponse, Coast Guard logs show that three aircraft and one cutter suffered mechanical problems that delayed or scuttled their mis- sions, according to a study by the Center for Public Integrity.
Alarming stories In 2007, at Allen’s request, Vice
Admiral James C. Card inter- viewed 170 civilian mariners and Coast Guard personnel about ma- rine safety operations. He found consensus that programs were deteriorating. The biggest concern, Card wrote in his report, “was that the Coast Guard no longer consid- ered Marine Safety an important mission.” The Coast Guard had become a “fundamentally different” organi- zation, Card was told. New edi- tions of the official “U.S. Coast Guard Strategy,” a 54-page manu- al, contained a single page dis- cussing marine safety, agency personnel said. Many experienced inspectors
have left the service or have trans- ferred to more “career-enhanc- ing” assignments, leaving behind a significant number who are seen as unqualified, the report said. In one service division, ma- rine inspectors spent only about 40 percent of their time on in- spections. “Every Marine Safety profes- sional I talked to in the Coast Guard, both at Headquarters and in the field, said they didn’t have enough people to do the job,” Card wrote. “Some stories were alarming.” Officers feared that choosing to work in marine safety for the long term could damage their careers because senior officials were un- supportive. The report did not ad- dress environmental-response programs, but said many people interviewed expressed similar concerns about those programs losing “experience, resources, knowledge and focus.” The report’s findings were underscored this year at a hear- ing on the Deepwater Horizon blowout. Lt. Commander Michael Odom, head of the team that in- spected the rig in July 2009, testi- fied that Coast Guard regulations are outdated. “The pace of the technology
has definitely outrun the current regulations,” Odom testified. In fact, qualifications for in-
spectors assigned to mobile off- shore drilling units, such as Deep- water, have not been updated since 2007. Although offshore in- spectors are supposed to receive annual specialized training, that has occurred sporadically, officers testified in May. Even with train- ing, they said, it takes a year for an inspector to comprehend the technologically complex rigs. Others in the field fear that an overemphasis on homeland secu- rity could actually make the Unit- ed States less safe, by drawing funding and attention away from other programs “Spending so little on this just
makes no sense,” Flynn said. “I can’t come up with any terrorism scenario, short of perhaps a nu- clear weapon launched near a city, that could produce nearly as much destruction as we’re seeing with this man-made disaster in the Gulf of Mexico.”
stephensj@washpost.com flahertym@washpost.com
’03 ’04 ’05 ’06 ’07 ’08 ’09 ’10 THE WASHINGTON POST
accomplish anything in this world.”
On a recent afternoon, he of- fered evidence that his pro- cedures are safe by introducing Rajo Devi Lohan, 72, who gave birth to a daughter, Naveen, 18 months ago. Lohan is thought to be one of the oldest mothers in the world. But Lohan has several health problems. Her husband, Bala- ram, is a farmer who always wanted a child. He even married a second wife but was unable to impregnate her. He asked Lohan to try IVF af- ter he read about the clinic in a Hindi newspaper. A relative do- nated an egg. His sperm was used. Lohan said she worked through her pregnancy, milking cows, making chapatti bread and cleaning the house. After Naveen was born, she
was even able to breast-feed. Bishnoi said his clinic bought life insurance for Lohan and her hus- band so their daughter will re- ceive money when they die. “They are old parents,” Bishnoi said, watching as Naveen played on her mother’s lap, yanking at her dress. “They won’t live for that much longer anyway. But now they have done a noble thing.”
waxe@washpost.com
Special correspondent Ayesha Manocha contributed to this report.
BP to pay record fine in Texas explosion
by Sam Hananel
Oil giant BP has agreed to pay a record $50.6 million fine for safe- ty violations at a Texas oil refin- ery where a 2005 explosion killed 15 workers.
Although the fine pales in com- parison with the billions of dol- lars BP has committed to pay for damages caused by the oil spill at its well in the Gulf of Mexico, it is the largest penalty in the history of the federal Occupational Safe- ty and Health Administration. Under the agreement, BP will
also invest $500 million between now and 2016 to upgrade safety conditions for workers at the re- finery in Texas City, about 40 miles southeast of Houston. “The size of the penalty rightly
reflects BP’s disregard for work- place safety and shows that we will enforce the law so workers can return home safe at the end of their day,” Labor Secretary Hil- da L. Solis said. Scott Dean, a BP spokesman, disputed the assertion that the company has a disregard for safe working conditions. He said OSHA and BP “have agreed to put our differences aside and move forward collaboratively” to en- hance workplace safety at the re- finery.
OSHA officials have blamed
the explosion in Texas City on a piece of equipment that over- filled with highly flammable liq- uid hydrocarbons. Alarms and gauges that were supposed to warn of the overfill did not work properly. Also Thursday, BP said officials were conducting tests to deter- mine whether further work is needed to seal the well in the gulf. A final decision was expected
Friday on whether to drill a relief well to allow for a “bottom kill” procedure, in which mud and ce- ment are pumped from deep underground to seal the well per- manently.
— Associated Press India
WORLD POPULATION 2010
India
Rest of world
4 billion 58.8% 17.2% 19.5% 4.5% United States China 1.2 billion China 1.3 billion
United States
310 million
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