How NEET deprived Tamil Nadu’s marginalised medical-aspirants and drove them to suicide

A protest against the National Eligibility cum Entrance Test for medical colleges in Chennai, on 13 September. The previous day, three medical aspirants had taken their own lives out of fear of the exam. One of them, M Jothisri Durga, wrote in a seven-page suicide note, “I am sorry, I am tired.” ARUN SANKAR/AFP/ Getty Images
21 September, 2020

Widespread protests broke out across Tamil Nadu on 13 and 17 September, led by students’ organisations and Dalit outfits, in the cities of Madurai, Karur, Thanjavur, Thiruvarur, Pudukottai, Kanyakumari, Virudhunagar, Veeloor and Chennai. The protests were in opposition to the National Eligibility cum Entrance Test, or NEET, an exam for admission into India’s medical and dental courses, which was held on 13 September. Since its introduction in 2017, Tamil Nadu’s students, civil-society groups and political parties have all condemned the NEET, arguing that it disproportionately disadvantages students from marginalised communities. Every year since then, the NEET has led to numerous deaths by suicide of medical aspirants from the state. The latest set of protests came in the wake of three student suicides on the day before the exam.

The last time M Jothisri Durga’s parents saw her, at 1 am on the intervening night between 12 and 13 September, the 19-year-old was still preparing for the NEET. She had spent the entirety of the previous year preparing for it. Murugasundaram, Jothisri’s father and a sub-inspector of police in Madurai, said that he and his wife knew that a lot was weighing on their daughter’s mind, but that was only expected with the exam right around the corner. “She seemed normal on Friday night, had dinner and went to her room,” Murugasundaram said. “In the morning, our room was locked from outside. With great struggle we managed to come out only to find our daughter hanging in the hall.”

In a moving voice note that she left behind, the 19-year-old said that she was scared that she might fail the examination although she had studied well. “If I couldn’t get a seat, everyone will be disappointed,” Jothisri said. “I am sorry Appa. I am sorry Amma. Appa, please take care of your health as you are a heart patient. Do not worry about me. Amma, Appa please don’t blame yourself. It is not your fault. It is solely my decision. Amma, I am going to miss you. Amma, I am sorry.” She could be heard sobbing. In a seven-page suicide note, she wrote, “I studied well … I got 590+ marks in the last mock test. But, Appa I am afraid of this exam.” A quote from her note came to be repeated widely during the protests that followed, “I am sorry, I am tired.”

The exam was initially scheduled to take place on 3 May this year, before the COVID-19 pandemic led to it being postponed indefinitely. Amid calls from students across the country to postpone the exam, including petitions before the Supreme Court that were ultimately dismissed, the NEET was held on 13 September. The NEET exam has led to at least 18 suicides among young, Bahujan medical aspirants in Tamil Nadu since 2017, five in this year alone.

Until 2017, Tamil Nadu, which has among the highest number of medical aspirants in the country, determined admissions to medical colleges on the basis of twelfth-standard board-exam marks alone. Due to the wide accessibility and comparatively good quality of government schools in the state, medical education became increasingly representative of marginalised Dalit, Adivasi and Bahujan communities. However, the introduction of the NEET, which is largely based on the syllabus followed by the Central Board of Secondary Education, made this entrance process incredibly hard for the state’s marginalised communities.

The exam inspires immense fear among its aspirants, and the results from the past three years indicate that it has disproportionately excluded members of marginalised groups. Its syllabus often requires rigorous coaching in private centres, in order to adapt to the new CBSE-based syllabus, which is inaccessible in rural areas and completely unaffordable for the poor. This has deprived many first-generation learners, particularly from marginalised communities, of medical seats they would have got under the previous system.

“The NEET exam, more than other exams, really builds this guilt in students,” Ezhilan Naganathan, a physician and anti-caste activist working on improving marginalised caste representation in medical education, told us. “When you are 17 or 18 and three whole years of your life are spent in writing this exam again and again, with your parents spending inordinate amounts of money for the preparation, it really feels like you have lost a majority of your life.”

Naganathan continued, “That’s an age where you can see your own forward-class friends do well and get ahead in life, but you instead are breaking yourself to even pass this exam.” He added, “Even worse, in most Bahujan communities, you know that somebody just like ten years ago was able to get into medicine, their uncles, their older friends, all equally brilliant made it into medical colleges easily under Tamil Nadu’s old system. But now with NEET instead of seeing the entire system as rigged against them, it is easy to see this as a personal failure and to see yourself as a burden on your parents.”

These complexities of parental relationships underlies the three suicides on the night preceding NEET. Jothisri studied in a government-aided school, in Aruppakkottai town in Virudhunagar district, and scored 518 marks out of 600 in her tenth standard. Murugasundaram told the New Indian Express that Jothisri finished her primary education in Tamil and then made the challenging switch to an English medium. In 2019, she could only afford a 40-day crash course for NEET and failed the exam. She was not ready to give up on her medical seat. To support Jothisri, her parents sought transfers from their jobs to relocate and help her prepare. Murugasundaram, a guard in Delhi’s Tihar Jail, transferred to Madurai so that coaching classes would be more accessible for his daughter. However, all coaching classes drew to a close in March in light of the COVID-19 pandemic.

In the interview with the New Indian Express, Murugasundaram said that Jothisri and many like her from government schools were at a complete disadvantage when it came to NEET. “Which government school teacher is aware of the syllabus or questions asked in NEET?” he asked. “Do they have the resources to prepare a student for the exam?” He emphasised that “NEET is not a normal entrance examination just because of the anxiety and pressure surrounding it.” Murugasundaram continued, “Nothing is as before and it never will be. These memories will haunt us throughout our lives and we are at a loss on how to navigate through it.”

Such struggles by families to prepare their children for the exam echoed throughout the state. M Adithya, a 20-year-old resident of Senthil Nagar village of Dharmapuri district, was among the three students who took their own lives on the night before the exam. Adithya had been a bright student scoring highly in his tenth and twelfth board exam, though studying in a state board school put him at a significant disadvantage for the NEET. He had written the exam twice previously, in 2018 and 2019, but failed. After he failed the exam in 2019, Manivannan, his father, a tractor mechanic belonging to the Vanniyar community, classified as a Most Backwards Caste in Tamil Nadu, paid to have him go for private coaching in Bengaluru.

On 12 September, Manivannan and his wife, M Jayachitra, were reportedly in Salem, around seventy kilometres away from Senthil Nagar, for some personal work. Adithya’s exam centre for the next day was also in Salem, and his parents visited the centre before returning home. At around 6 pm that day, when Manivannan and Jayachitra returned, they found Adithya hanging from the fan in their house.

Manivannan and Jayachitra initially refused to take custody of Adithya’s body, protesting that they would not do unless the government cancelled the NEET exam. But they were reportedly persuaded to do so by local police officials. But Adithya’s death triggered protests broke out outside the Dharmapuri Government Medical College and Hospital, and in Senthil Nagar demanding that the NEET exam be permanently cancelled, or for Tamil Nadu’s exemption from it. Adithya was Manivannan and Jayachitra’s only son and had he passed the exam; he would be the first doctor from his village.

Like Adithya, M Mothilal, a 20-year-old from Kumaramangalam village in Namakkal district, had also written the NEET exam twice previously. He had been more fortunate with his education, studying in an English-medium private school in his own village. He did well in his twelfth standard exam, scoring 1081 marks out of 1200. Murugesan, Mothilal’s father and the sole breadwinner of the family, ran a small electrical shop. He came from a middle-class background and Mothilal’s family ensured that he, too, attended NEET coaching classes. On the night of 12 September, Murugesan and his wife called out to their son. When he did not respond for a while, they broke open his door. Mothilal, their eldest son, had taken his own life.

After the post-mortem the next morning, his body was handed over to his parents. The police, however, tried to keep the death under wraps. “We are yet to confirm whether the boy committed suicide due to NEET exam fear,” S Sakthi Ganeshan, Namakkal’s superintendent of police, told us. “The exact details will be known only after the police investigation.” As on 20 September, the police did not provide any update on the investigation.

These three suicides form part of a far longer history of medical aspirants from Dalit and other Bahujan communities taking their own lives, which began with the introduction of the NEET in 2017. The most emblematic case of this, that led to widespread protests across Tamil Nadu, was the death by suicide of Shanmugam Anitha, a 17-year-old from Ariyalur district’s Kuzhumur village, in September 2017.

Anitha’s mother had died when she was young and her father was a daily-wage labourer. Despite living in abject poverty, lacking even a toilet in their house, she passed her twelfth standard as a state topper, scoring 1176 marks out of 1200. With such high marks, she would have easily crossed the cut-off required to get a seat in a Tamil Nadu medical college before the NEET was introduced.

She came from a Dalit community, and would have been the first doctor from her village and the first graduate in her family. However, in the NEET exam, based on a syllabus she was completely unfamiliar with, she scored only 86 marks out of 700. NEET also introduced a percentile system to judge students, and Anitha fell in the 12.33 percentile. The percentile cut-off for the Scheduled Caste reserved category was set at 14.9.

Since the first proposals of NEET, consecutive Tamil Nadu governments under both the Dravida Munnetra Kazhagam and the All India Anna Dravida Munnetra Kazhagam, have opposed the exam. The parties pointed out that it would disadvantage rural students and all those who studied in the state board. When the central government introduced the new admission process, in 2017, the Tamil Nadu government challenged the exam in court. Anitha, too, impleaded herself in the case. But the challenge failed before the Supreme Court, prompting the state government to order a separate merit list for state-board students, reserving 85 percent of seats in the state’s government medical colleges for them. On 14 July that year, this order was struck down by the Madras high court.

On 14 August, the Tamil Nadu government submitted a draft ordinance to RK Mitra, who was then the joint secretary in the union home ministry, exempting Tamil Nadu’s state-board students from taking the NEET exam for a year. The ordinance proposed assigning medical seats based on twelfth-standard marks. This was done in accordance with a statement by Nirmala Sitharaman, then the union minister of commerce and industry, issued on the previous day. Sitharaman had said that the centre would accept the exemption for one year if the state passed such an ordinance.

But the central government reversed its stance when a constitutional challenge to the ordinance was pending before the Supreme Court. KK Venugopal, the attorney general, had first cleared the ordinance when it was referred to him for his legal opinion. But Venugopal reportedly changed his opinion when the ordinance was sent back to him by the health ministry, and informed the ministry officials that the ordinance would not stand legal scrutiny. On 22 August, the Supreme Court ordered the Tamil Nadu government to begin medical admissions in government medical colleges purely on the basis of NEET marks.

The senior advocate Nalini Chidambaram, whose husband P Chidambaram was a union minister in 2012 when NEET was first proposed, had represented CBSE in the case. She told the News Minute, “NEET has to be a basis for admission for now.” She added, “Tamil Nadu government has nothing else to argue if there is no ordinance. Any further appeal against NEET can only be done to God.” On 1 September, nine days after the Supreme Court’s order ruled out any possibility of Anitha getting a medical seat, she took her own life.

Anitha’s story of academic brilliance, and the undoing of her struggle because of the NEET, continues to resonate in the state, which witnessed suicides every year since then. S Pradeepa, a Dalit teenager from Peruvallur village, in Villupuram district, had a shining academic record despite growing up in abject poverty. She topped her class in tenth standard, scoring 490 marks out of 500, and scored 1125 marks out of 1200 in her twelfth-standard exam. Pradeepa, whose father was an agricultural labourer, could afford a private school in her eleventh and twelfth standard only because she was offered a full scholarship. In 2017, she cleared the NEET, but could get only a naturopathy seat, and discontinued the course because she could not pay the exorbitant fees. She hoped to sit for it again and get an MBBS seat in a government medical college. But the nearest government coaching centre was more than seventy kilometres from her home. On 4 June 2018, the day she learnt that she had failed the exam, Pradeepa took her own life. That year, another NEET aspirant, K Subashri from Tiruchirapalli district, also died by suicide following the results. 

In 2019, three suicides occurred within two days of the NEET results. M Monisha, an 18-year-old from Konnimedu Kuppam village in Villupuram district, took her own life after failing the exam for the second time. She came from an impoverished fishing community and her family was unable to afford NEET coaching. Two other young women, S Rithushree from Vellingadu village in Tiruppur district and N Vaishya from Pattukottai town in Thanjavur district, also took their lives in the following two days after failing the exam. Both Rithushree and Vaishya had scored more than 90 percent in their twelfth standard exams. Vaishya set herself alight, a form of protest than has been commonly used in Tamil Nadu when fighting against a central government decision that is seen as unjust. This was seen during the 1965 anti-Hindi agitation, the 2017 protests against the bull-taming sport Jallikattu, and the 2013 protests seeking an investigation into war-crimes and genocide in Sri Lanka.

This year, Tamil Nadu had witnessed multiple deaths by suicide even before the three aspirants who ended their lives on the day before the exam. R Subashri, a 19-year-old NEET aspirant from Coimbatore had attempted the exam previously but only scored 451 marks, which made her ineligible for a general medicine course. On 19 August, two days after the Supreme Court ruled that the exam would take place as scheduled on 13 September, Subashri took her own life. On 9 September, V Vignesh, a 19-year-old NEET aspirant, died by suicide. Vignesh was from rural Ariyalur district too, not far from Anitha’s village. He was from the Vanniyar community, classified under the Most Backward Classes category in Tamil Nadu. Vignesh had attempted the exam twice and failed both times. After his death, his parents told the media that exam stress and the fear of failing a third time had driven him to suicide.

The NEET admission data establishes without doubt that the exam places students from marginalised backgrounds, first-generation learners and state-board educated students at a significant disadvantage. In November 2019, the Madras High Court heard a petition demanding proper counselling procedures for seats in Tamil Nadu’s medical colleges. According to data submitted to the court by the Tamil Nadu government, only 2.1 percent of those admitted to all medical colleges in 2019 passed the NEET without enrolling in private-coaching centres. For only government medical colleges, this number fell even lower to a mere 1.55 percent. The data also noted that only 1,040 students cleared NEET on their first attempt, while 2,042 students took two or more attempts to clear the exam. The government also submitted to the court that private coaching institutes charge anywhere between Rs 2.5 lakh and Rs 5 lakh for a single year of coaching, an amount that is unaffordable to poor Tamils, particularly those from marginalised communities.

The high court bench of justices N Kirubakaran and P Velmurugan observed that NEET had disadvantaged poor students and treated “unequals as equals.” The court asked the central government to consider cancelling the exam, but that did not come to pass.

In addition to disadvantaging students as a result of its syllabus, the NEET also excludes aspirants from marginalised backgrounds by not fully providing reservations for aspirants from Other Backwards Classes. The exam was introduced to allow students from one state to study in other states. To this end, the NEET mandates that state and private medical colleges must surrender 15 percent of their seats for an all-India quota for undergraduate courses and 50 percent for postgraduate courses. However, the exam did not reservation to OBC students within this all-India quote. According to data collected by the All India Federation of Other Backward Classes Employees’ Welfare Association—a federation of nearly forty OBC organisations that seeks to promote the interests of its communities—candidates from the Other Backward Classes have been denied reservations under the all-India quota both in undergraduate and postgraduate seats.

In May this year, the OBCEWA wrote to the National Commission of Backward Classes claiming that not a single OBC candidate had got into any medical college within the all-India quota since 2017. The DMK, on 29 May, made a similar plea to the Supreme Court, demanding that 50 percent of the all-India quota must be from the backward classes as Tamil Nadu assured them 50-percent reservation. In July, the Congress president Sonia Gandhi wrote to the prime minister, Narendra Modi, arguing that the lack of reservations within the NEET had deprived nearly 11,000 OBC students of the opportunity to study medicine.

Ezhilan, the physician and education activist, was key in filing a range of RTIs and conducting surveys that showed the inherent caste, class and language biases in the NEET. “From the data we collected through the RTIs, we found that before 2017, over 90 percent of students who got into government medical colleges were from government schools, government-aided schools or small, private schools following the state syllabus,” Ezhilan said. “This really was a revolution—you had people from even the most marginalised, the most cut-off areas becoming medical professionals. This sort of social-justice and democracy is not visible in any other state.”

He continued, “The success stories in our communities were many, and they inspired a generation of students who thought this was achievable if they concentrated on the state syllabus.” Ezhilan added that Tamil Nadu had also increased the number of government colleges after introducing a policy to establish a fully provisioned government medical college in every single district. “The state currently has 24 or 25 government medical colleges with a seat strength of 3,600,” he said. “Our RTIs also found that 600 students that joined medical colleges in 2016 were from Tamil-medium schools. This is why Tamil Nadu is more affected by NEET than other states—this was one state where for more than a decade the best medical education in the country was accessible to even the poorest and the most downtrodden.”

Kavin Malar, a senior journalist and anti-caste activist, emphasised that the suicides were a “failure of the system.” Malar added, “The system, the ruling governments have failed our children. Is it not against the Constitution? The right to education is violated blatantly when the children from less privileged communities are denied opportunities to pursue the education they want, due to such exams.”

Malar further asked, “How can people claim that NEET will bring in equality when the truth is even for attending coaching classes parents have to spend in lakhs? It’s not possible for majority of the families from underprivileged sections.” She explained that without coaching, and with parents who themselves are not well-educated enough to point out other opportunities and avenues, children are bound to try for NEET alone and be completely unprepared for it. “A 17-year-old is left to prepare for an all-India level exam by herself, and people expect them to compete with children from upper sections of the society with enough money to send them for coaching,” Malar told us. “They even might have doctors or professionals in the family to guide them. How can these two children be considered on the same scale?”

Tamil Nadu’s education system has not just produced doctors from marginalised sections, but has also been able to produce a large number of doctors willing to work in rural areas or charge small amounts for their services. “When people come into medical education spending lakhs of money from the elitist society, they don’t like to serve in government institutions or in villages,” Malar said. “We have had five-rupee and ten-rupee doctors here in Tamil Nadu,” she said, referring to doctors in the state who won a lot of public admiration for charging very low fees. “Tamil Nadu, before NEET, has produced the best doctors in the country. Such doctors are now serving in government hospitals and saving thousands of people during the pandemic. If through NEET we shut the door for underprivileged youngsters, few years from now we will end up facing a severe shortage of doctors in government hospitals and villages, which will cause serious damage to our social infrastructure.”

Ezhilan, himself a government medical-college graduate, said that Tamil Nadu’s prioritisation of producing doctors from marginalised backgrounds is what led to the state’s medical-success story. “If you look at medical students in Tamil Nadu, after their MBBS, nearly 50 percent opt to work in government rural service,” he said. “This also gives them a higher chance of getting into a postgraduate course in Tamil Nadu and keeps our PHCs”—primary health centres—“well-staffed. Nearly every one of the student suicides, if you listen to what they wrote or what they spoke, the one thing they assert is that they want to study medicine to work in their own impoverished communities.”

According to Ezhilan, these policies led Tamil Nadu to maintain among the lowest infant mortality and maternal mortality rates in the country. “A vast majority of doctors from marginalised communities join government service. The Tamil Nadu health service has nearly eighteen or nineteen thousand doctors. Tamil Nadu has a doctor for every 253 people, much higher than every other state, better than WHO guidelines and easily comparable to the developed Scandinavian countries. It is this proud medical revolution that they destroy when they introduce policies like NEET that murder our children.”