Archive for 'International'

GHI’s Missing Piece in Nepal: Abortion

Posted on September 6, 2011, by Hanna Ingber, under Health, International, Politics, women.

LAMAHI, Nepal – United States President Barack Obama set up the Global Health Initiative to take a more comprehensive approach to improving health care in developing nations. In particular, his administration has given great weight to saving the lives of women and to supporting countries’ priorities in health care.

But there’s one exception: abortion.

In Nepal, that exclusion is in plain view, and many say the lack of support disregards evidence that safe abortions can save women’s lives. Nearly all experts here — with the notable exception of those employed by the U.S. government — publicly state that the best way to improve maternal health is by offering a wide range of services that includes more awareness about and access to safe abortion.

In a long-standing U.S. law, stretching back nearly 40 years, Congress has prevented any foreign aid for abortions.

The politics in Washington around the issue of funding abortion have become so heated in recent months that many global health supporters on Capitol Hill won’t even talk about family planning services because so many conservatives falsely equate it with abortion.

Anti-abortion advocates have accused Obama and his administration of using the GHI as part of a larger strategy to link abortion rights to universal access to reproductive health. An article in the New American last year by senior editor William F. Jasper argues that Secretary of State Hillary Clinton has used “‘reproductive health’ and other similar code words … in attempts to camouflage policies that promoted abortion.”

Clinton’s State Department has dismissed such claims and stressed that U.S.- funded programs through the GHI are simply trying to offer comprehensive reproductive health within the accepted health practices of the host countries, including saving a woman’s life if she suffered an unsafe abortion and working on family planning issues that adhere to the accepted health practices of the host country.

Some 7,000 miles from Washington and far from the charged debate around international aid and the question of abortion, there is a more pointed question in the villages of Nepal. That is, whether the unyielding U.S. policy against funding abortions is hurting its efforts to improve health care?

Continue reading and see the slideshow at GlobalPost.

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Political Instability Threatens Nepal’s Health Care Program

Posted on August 13, 2011, by Hanna Ingber, under Health, International, Politics.

My blog from GlobalPost’s Global Pulse:

KATHMANDU, Nepal — Healthcare providers, advocates and academics have told me during my travels in Nepal these past two weeks that one of the biggest challenges to improving the country’s healthcare system is the nation’s political instability.

Nepal is in the process of trying to draft a new constitution and create a new government in the aftermath of a 10-year armed conflict that pitted Maoist insurgents against the state. The conflict ended in 2006 when the Maoists agreed to give up their arms. Nepal’s unpopular monarchy was soon thereafter abolished.

It has been five years since the end of the civil war, but the country still has a barely functioning government. A deadline to draft a new constitution has been delayed twice since 2008, and it looks unlikely that the current deadline of August 31 will be met.

Some political analysts fear that if this deadline is again missed, there will be even more instability in the country.

“In a situation like this, people might even be happy if someone takes control, if a sort of benign dictator emerges,” Lokraj Baral, a political science professor who heads the Nepal Center for Contemporary Studies, told AFP.

The constitution is being held up due to a number of issues including a disagreement over the integration of former Maoist combatants into Nepal’s army.

Nepal’s prime minister has threatened to resign by Sunday if there is not more progress made on the peace process. Prime Minister Jhala Nath Khanal said he will step down if there is not agreement made on the new constitution and the integration of former Maoist combatants.

The political situation affects Nepal’s healthcare system in a number of ways. First, the frequent turn over of ministers creates a situation where little progress can be made because much time is devoted to convincing each new minister of a particular program or approach, Bidhan Acharya, an associate professor in the department of population studies at Tribhuvan University, told GlobalPost.

The political system also exerts great influence on the health sector as some politicians put people from their own party, whether the most qualified or not, to fill top positions.

There is a strong feeling of frustration with the government in Nepal, and critics argue that the politicians are so busy fighting among themselves they have little time to work on the nation’s development.

See the accompanying photo.

Follow Hanna’s trip to Nepal on Twitter: @Hanna_India

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Maternal Health and Rural Development in Nepal: One Woman’s Fight

Posted on August 10, 2011, by Hanna Ingber, under Health, International, women.

For GlobalPost’s Global Pulse Blog:

GHORAHI, Nepal — Asmani Chaudhary grew up dirt poor in a village in Nepal’s Terai region, which runs along the border with India. A member of a long-disadvantaged Nepali community called Tharu, Chaudhary was raised in a mud hut that housed her entire 30-member extended family.

Now, at age 37, Chaudhary walks around the office of the organization she founded with a sense of confidence and pride. She points out the framed photographs and letters hanging on her wall: one shows her with UN Secretary General Ban Ki-moon, another is a letter from U.S. Senator Chuck Schumer thanking her for her hard work.

The photographs and letter are from when the Americans for the United Nations Population Fund recognized Chaudhary as a “2008 International Honoree for the Health and Dignity of Women.” The award honored Chaudhary’s community-based efforts to improve the health and well-being of some of Nepal’s poorest women.

Chaudhary was close to spending the rest of her life as one of those women. She was born and raised on the small lane outside her office in Ghorahi in Dang district. She took me on a walk down the road this afternoon, explaining that much remains the same for these people three decades later. The villagers living there, all from the Tharu community, are still dirt poor. She pointed out the tiny, one-room mud homes with thatch roofs as kids played in the street and roosters wandered over the grass. The people of this area continue to be disadvantaged and uneducated, she said.

When Chaudhary was a child, Tharus typically only sent one of their many children to school as the rest were needed to farm and help in the house. Most families sent their son to school. But Chaudhary got lucky – her brother was too young, and her parents therefore chose her. They sent Chaudhary to the nearby government primary school and kept her four sisters and little brother home.

Chaudhary, a slender woman with long brown hair that she wears in a braid that almost reaches her waist, finished not only primary and secondary school but also went on to university. Her sisters, who stayed home farming, were illiterate. Like most uneducated Nepali women, they got married by the time they were 16 or 17 and started having children. Chaudhary did not marry until she was a few years older and waited until she was 24 to have the first of her (only) two children.

After university, Chaudhary decided she wanted to help the women of her community and formed the Rural Women Development Centre in 1993. It now has six branches and focuses on providing rural women empowerment and employment opportunities, health education and social awareness.

Chaudhary has also worked to bring attention to and treatment for women affected by uterine prolapse, a maternal health condition common in Nepal. Chaudhary visited a village where she met two women who had suffered from the condition; their uteri had shifted from its normal position and gradually extended outside of the body. The women tried to solve the problem by putting their own bangles inside their vaginas to hold their uteri in place. Chaudhary brought a team of doctors to the area to provide the women with safe medical treatment in the form of a ring pessary inserted into their vaginas.

Chaudhary says that she has seen a lot of improvements in Dang since she was a child, but a lot more needs to be done for marginalized and uneducated groups like the Tharu.

Addressing the health needs of Nepal’s disadvantaged, poor communities is now one of the primary objectives of President Obama’s Global Health Initiative in Nepal, USAID staff told me this week. Tomorrow, I will visit some of these villages in Dang district to learn more about their needs and see how GHI is addressing them.

Follow Hanna’s trip to Nepal on Twitter: @Hanna_India

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Nepali Villagers Forced to Travel Treacherous Roads to Nearest Hospital

Posted on August 10, 2011, by Hanna Ingber, under Health, International, travel, women.

My blog for The Pulitzer Center on Crisis Reporting:

The ride there was actually quite lovely. It was coming back when we realized just how harrowing doing something as basic as driving to town can be for the people of Nepal’s rural areas.

Pulitzer Center intern Anna Tomasulo and I arrived Monday night in Dolakha, a district in Nepal’s mountain region with picturesque mountains and lush green rice paddies. We set off Tuesday morning to visit a small village up in the hills. The area mostly consists of the Thami ethnic group, and the majority of those in this village marry their girls off as young as 12 or 13. We wanted to talk to one of these young women about her experience with early marriage.

Our team included a media officer from the non-governmental organization SOLID Nepal, a Kathmandu health journalist and two local community workers.

We drove as far as we could without getting stuck in the mud and then set off by foot. We only covered about 10 kilometers, but the journey took three hours given the rough terrain – and our fair share of chai stops.

As we trekked, we edged along the mountain, viewing terraced fields and small red homes in the distance. The sky looked like one large cloud, hovering above the mountains. One of our team members pointed to a school on the opposite mountain, explaining that kids in this village had to walk three hours to get to that high school.

We hiked down steep rock paths, carefully watching each step. In front of me, a villager dressed in a red sari and sandals walked down the rocks carrying a baby wrapped in a blanket on her back.

Eventually, we reached the village and found a line of women squatting in a field planting rice paddies. Our female community worker went to talk to the women and try to convince the one who married at 14 to share her story with us. We stayed on the dirt road, enjoying the crisp air and mountain scenery.

The community worker returned: the young woman is busy planting and doesn’t want to talk. If we can give her health care, great, but otherwise, she’s busy.

Thirty minutes later, after the community worker and our NGO media officer convinced the village’s health officer, who convinced the other village women, who convinced the young mother to talk – and after Anna and others from our team offered to help plant – she agreed to sit with us.

The young mother told us she had three children soon after marrying. During her third birth, her labor lasted 48 hours, and her family then decided to take her to the hospital in town. They put her on a bus, but the bus broke down.

Follow updates on the project page to learn this young woman’s story.

Meanwhile, we finished the interview and decided to head back to town. We met up with the others, who did not want to walk back because it would take four hours given the hills. We had tea and waited at the village’s one-stop shop-restaurant-home-bus stop. We waited and waited. The bus didn’t come.

The villagers decided to try to fix a massive truck that had broken down near the shop-restaurant-home-bus stop. Anna and I watched as men squatted on the ground and stuck various tools under the truck. Boys in school uniforms gathered to watch. A bad sign came when the SOLID Nepal media officer, who had no auto mechanic experience, also squatted on the ground and played with the tools.

Will they ever fix this truck, we wondered. And how will it be safe driving along the mountain’s edge back to town? We remembered the waterfalls we passed on the way here. We had watched in horror as a bus crammed full with villagers drove through the waterfall, bouncing back and forth against the rocks and water. How will this truck drive through the waterfalls? I laughed, finding the situation a bit too crazy to believe.

After two hours of waiting at the shop, the bus arrived. We jumped up with glee. Men jumped on top; we crammed inside. The bus was packed full with people, giving us barely enough room to fit.

We set off for town but quickly realized the bus was a horrible decision. We rocked back and forth as it tried to maneuver the muddy road and deep tire tracks. Anna accidentally looked down the mountain, and saw the green rice paddies and fields far below. She forced herself not to look down again. We gripped the railings above. I leaned my body towards the mountain and away from the cliff as I noticed the other passengers’ expressions. One woman in a seat miraculously slept, or at least pretended to, but another standing behind me looked as horrified as I felt. She clenched her teeth and closed her eyes with each turn. I remembered the countless news stories I had read about road accidents involving overcrowded buses in India, and I prayed this would not be one more such story.

Soon, Anna and I decided this was too much. Atul, we need to get off this bus, I said to the Kathmandu health journalist. Don’t worry, he said, we’ll be fine. No, Atul, we really need to get off this bus.

The others insisted we’d stop at the waterfall and get off there. No way were we going to drive with this bus along that waterfall. Don’t worry, the team said again and again, we’ll get off before the waterfall.

But as the waterfall approached, it became clear we weren’t getting off. It was too slippery to stop the bus.

Eventually, after what was probably 10 minutes but felt like an hour, the road improved, and we successfully convinced the driver to stop.

Our team jumped out – relieved we were still alive – and began to hike back to town. And then, it began to pour.

After a couple more hours, we made it back safely. It was a terrifying experience being on the bus, and difficult to trek in the rain. But as we hiked, one thought returned to my mind over and over: the young woman in the village did that trek nine months pregnant and after 48 hours in labor. I don’t know how she mustered the strength.

Go to the Pulitzer Center site for photos from our trip.

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Will the Elderly Bring Down India?

Posted on July 29, 2011, by Hanna Ingber, under Culture, Health, India, International.

MUMBAI, India — Maqbool Beg has been driving a rickshaw for 42 years. Now, at the age of 62, his children have grown, his beard has turned white, his teeth are red from years of chewing betel nut. And he suffers from high blood pressure. But he keeps on driving.

He needs the money. Thanks to inflation and the high cost of living in Mumbai, Beg has never been able to save. The 4,500 rupees (about $100) he earns a month make him ineligible for even a small government handout. Beg and his wife cannot rely on their sons, who earn even less working as a tailor and mechanic.

“Until I can no longer work, I will work,” he said, waiting outside a mobile health van in Bandra East, a suburb of Mumbai.

Beg is one of India’s 81 million elderly (technically, those over 60). While much of the attention on India’s population focuses on its young, the country also faces a rapidly growing elderly segment.

About half of India’s 1.2 billion people are younger than 25. India’s youth are often touted as the country’s best hope for one day surpassing China in economic growth rates.

Every year, India increases by the size of the population of Australia, and many blame nagging poverty on such stats. In some parts of India, local officials are taking extreme measures to try to curb numbers of children in families. In poor northern states like Bihar and Uttar Pradesh, an average woman still bears four children over her lifetime.

But, as with many things in India, the problem of too many children presents a contradiction.

It turns out that, overall, family planning efforts and rapid social development have resulted in lower fertility rates in most Indian states. Fertility rates have fallen from about six births per woman in the 1960s and 1970s to about 2.6 births in 2008, according to the U.N. Population Fund.

Smaller families and longer life spans have set India on a path to facing a massive population of elderly, say advocates for the aging and demographers.

Due to changes in social norms and the ongoing breakdown of joint families, much of this population of elderly will not have India’s traditional family system to support them. Furthermore, the state has not put into place adequate services for the aging, say advocates. The elderly — long deeply respected and honored in Indian culture — will be left to fend for themselves.

India’s population over 60 is expected to more than triple by 2050, and its 80-plus population is expected to quintuple, according to an article, “India’s Baby Boomers: Dividend or Disaster?” by David E. Bloom, a professor of economics and demography at Harvard University’s School of Public Health.

Activists and experts fear India is not in a position to handle so many old folks.

Continue reading at GlobalPost.

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A Hive of Productivity

Posted on July 27, 2011, by Hanna Ingber, under Business, India, International.

Nearly a billion people worldwide live in slums. Hanna Ingber Win visits Dharavi in Mumbai, one of the world’s largest slums – and a functioning economy that exports goods all over the world

Published in The Times of London July 25, 2011

From a distance, a slum’s haphazard collection of huts piled on top of one another, corrugated metal roofs and makeshift windows looks like a disaster in the making.

And yet, step inside and the picture changes dramatically. Many slums in the developing world, in particular Mumbai’s famous Dharavi, are hives of productivity and ingenuity.

Walk down one of Dharavi’s main thoroughfares or through the zigzagging lanes, and one finds snack shops, restaurants, tailors, bakeries, welders and barbers. In an area called Kumbharwada smoke billows forth from brick kilns as men sit on the floors of their adjacent homes sculpting clay pots on a wheel. In another area, a woman squats in front of a deafening chilli pepper grinder as a boy sits across the lane selling watermelon by the slice. Dharavi swarms with the activity of business.

As the world undergoes rapid urbanisation, more and more people are moving to cities to find work and then – unable to afford proper apartments or houses – creating temporary homes nearby.

As the slums grow, it is time policy makers and urban planners view them more accurately, says Aneerudha Paul, the director of the Kamla Raheja Vidyanidhi Institute of Architecture and Environmental Studies in Mumbai.

A slum such as Dharavi, one of the world’s largest, is not merely a residential area for Mumbai’s poor and downtrodden. Dharavi has a well-established, complex economy and in some ways operates like its own nation state.

Dharavi imports items such as food staples and raw materials, and it exports small-scale, labour-intensive manufacturing like the assembly work of cheap sunglasses. Its massive population – estimated between 700,000 to 1 million people – also becomes a market for goods and services produced there.

What stands out most about Dharavi’s economy is the high level of entrepreneurialism among its residents. Poor people who move into a city like Mumbai do not have the ability to fall back on the state if they cannot find a job. Instead, they must find a way to make do. They might start by selling bananas and eventually open their own shop. The area has more than 5,000 informal businesses, according to a report by the Harvard Business School.

Dharavi’s economic scale has enabled it to become both a producer and consumer of goods, according to Vinod Shetty, the director of the ACORN Foundation India. Businesses within Dharavi serve the population food, goods and even entertainment services. One afternoon, a group of young men gathered on wooden benches in a one-room theatre to watch a Tamil movie.

The nature of a slum like Dharavi also enables entrepreneurs and small businesses to operate with low costs. Many work out of their homes, keeping rent costs down. The congestion enables businesses to sell in volume plus have a constant supply of both skilled and unskilled labourers. Employers avoid the time-consuming bureaucracy involved in setting up formal businesses in India.

However, an informal economy also has drawbacks. Government services like sanitation are rare. Businesses regularly flout labour, environmental and safety regulations. Employers often do not provide safety gear, and employees have no recourse for compensation. Furthermore, informal businesses cannot get bank loans and therefore must rely on expensive moneylenders.

In countries without safety nets or enough formal jobs, slums like Dharavi have become places the poor rely on for housing, services and – most importantly – work.

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Terror returns to Mumbai

Posted on July 26, 2011, by Hanna Ingber, under India, International.

Here is a story I wrote with Andrew Buncombe on this month’s blasts in Mumbai. It was published in the Independent of London.

The spectre of terror and violence returned to India’s financial capital yesterday as three explosions were set off within a matter of minutes, killing at least 21 people and injuring more than 140. Officials described the incident as a terror attack but declined to publicly speculate as to who may have been responsible.

In the first attacks in Mumbai since November 2008, when Pakistan-based militants lay siege to parts of the city for almost three days and killing more than 160 people, the explosions were set off in crowded areas at evening rush hour. Reports suggested the blasts, described as coming from improvised explosive devices, all occurred between 6.50pm and 7.04pm.

Images from the scene of the explosions showed streets slick with blood, people suffering injuries and corpses under plastic sheets. The injured were ferried to hospitals across the city in taxis, trucks and any other available vehicles. Doctors called for blood donations and armed police cordoned off those areas struck by the blasts.

Last night, with cities across India placed on alert, the country’s Home Minister, Palaniappan Chidambaram, said in Delhi that the authorities had no information about further attacks. “I would appeal to the people of Mumbai and people all over the country to remain calm and to remain peaceful. There is no information [regarding] any other bomb or threat.”

He added that because of the timing of the blasts, “we infer that this was a co-ordinated attack by terrorists”.

Perhaps unsurprisingly, local media was already speculating that the blasts were the work of either Lashkar-e-Taiba or the Indian Mujahideen, a home-grown militant organisation that has carried out attacks elsewhere in India. Some reports said that yesterday was the birthday of Ajmal Kasab, the sole survivor of the 10 militants who carried out the 2008 attacks.

Yet the chief minister of the state of Maharashtra, Prithviraj Chavan, also refused to be drawn on the issue of who was responsible. Speaking on television, he added: “It is another attack on the heart of India, an attack on Mumbai.”

Asif Ali Zardari, Pakistan’s President, and its Prime Minister, Yousaf Raza Gillani, were among the first to condemn the blasts and offer their condolences. President Barack Obama offered American help in tracing those responsible. There was no word whether the attack would interfere with scheduled talks later this month in Delhi between the Indian and Pakistani foreign ministers.

The first of yesterday’s blasts hit at 6:50pm in Jhaveri Bazar, a jewellery market in Kalbadevi, the second at Opera House and the third in Dadar West, in central Mumbai. Police said the blast at Opera House appeared to have been the strongest and had caused the most injuries.

Mumbai has been the scene of repeated attacks. In 2006 more than 200 people were killed when explosive devices were detonated on commuter trains. After each attack, locals complain that for all their claims, police do little to improve security. Yesterday evening, people were again reeling from the realisation that the city had become struck by violence they could do nothing to prevent.

“It’s horrendous. Forget whether it’s terrorists or not. To attack unsurprising folks with an IED, I think is horrendous,” said Arun Kapur as he sat in front of his television set watching the news of the attacks in the northern neighbourhood of Bandra. His wife, Rita Kapur, added: “It’s so sad. We really feel so sad. Mumbai used to be such a safe city.”

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Three blasts rattle Mumbai

Posted on July 13, 2011, by Hanna Ingber, under India, International.

PBS NewsHour interviews me about the string of blasts that hit Mumbai during rush hour this evening.

Hanna Ingber Win, GlobalPost’s Mumbai correspondent, said she visited one apartment building in Bandra in northern Mumbai. Residents there were closely monitoring developments on their TVs, updating their Facebook statuses to let people know they were OK and answering phone calls from relatives checking in from abroad.

“There was a feeling of anger that innocent civilians have been killed and a deep feeling of sadness among most people,” she said. But people also weren’t surprised that Mumbai had been attacked again, based on what they had gone through in 2008.

Mumbai — considered India’s cultural and financial capital — is a target because in many ways it represents what India has become. “It’s a very vibrant city with migrants pouring in everyday. It’s growing and booming. There’s a real entrepreneurial sense here,” she said.

Win also noted that those she spoke to said that while they can no longer live their lives without any fear of terrorist attacks, they still would go to Mumbai’s city centers. Their mentality was “you have to live your life and you do have to go on.”

Continue reading at PBS.

And GlobalPost has a Raw Feed with my reporting from Mumbai. Watch the video here.

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Lessons from India’s Largest Slum

Posted on June 2, 2011, by Hanna Ingber, under Business, India, International.

MUMBAI, India — Barefoot children chase each other around large brick kilns billowing out smoke. In another area of Dharavi, one of Asia’s largest slums, girls in oversized dresses wander onto piles of garbage. And in a third, a boy chases a goat with a cricket bat, near an open sewer.

Developers and some political figures look at Dharavi, centrally located in the increasingly congested city of Mumbai, and see a goldmine. They want to tear down the eyesore, move the current population into high-rises with electricity, water and sanitation and turn the bulk of the area into profitable housing and commercial property.

The architect who is behind the latest redevelopment plans, Mukesh Mehta, says the new Dharavi will benefit the current population as well as India’s economy as a whole.

“If 33 percent of [the] urban population lives in slums — they may live in sub-human conditions, but still, they are a drain on the economy,” he told CNN. “Tomorrow they start becoming contributors to the economy.”

Many of Dharavi’s residents along with activists, journalists and urban planners agree that the area needs redevelopment. They welcome the idea of bringing proper infrastructure like water and sanitation to the shanties and other informal homes there.

But they also say that Dharavi is much more than merely an unhealthy, polluting, trash-strewn slum. It is a self-sustaining ecosystem that in many ways operates quite well and serves needs not being met elsewhere.

Dharavi offers important economic, development, environmental and social lessons for Mumbai and India at large.

Continue reading and watch the video at GlobalPost.

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In India, Divorce Among the Elderly Is on the Rise

Posted on June 2, 2011, by Hanna Ingber, under India, International, women.

MUMBAI, India — The profile reads like many others: Vegetarian Hindu seeks Gujarati-speaking non-smoker to be life partner. Interests include traveling and old Hindi songs.

But unlike most men on Indian remarriage sites, this bachelor is 73.

Another profile says the woman is a divorced Bohra Muslim. She’s 4′5″, a Gemini, and her “About me” section on Secondshaadi.com reads: “Fat woman. Understanding. U can be fat or slim. No problem. Have to earn lakhs [1 lakh equals $2,200].”

This candidate for love — and lakhs — is 90.

Over the past couple decades India has seen divorce become more and more common among young, urban couples. Now, even elderly couples are doing what was once considered unthinkable: saying goodbye to their spouses after decades of marriage and moving on.

Continue reading at GlobalPost.

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