States' choices set up national health experiment

WASHINGTON (AP) — President Barack Obama's health care overhaul is unfolding as a national experiment with American consumers as the guinea pigs: Who will do a better job getting uninsured people covered, the states or the feds?

The nation is about evenly split between states that decided by Friday's deadline they want a say in running new insurance markets and states that are defaulting to federal control because they don't want to participate in "Obamacare." That choice was left to state governments under the law: Establish the market or Washington will.

With some exceptions, states led by Democrats opted to set up their own markets, called exchanges, and Republican-led states declined.

Only months from the official launch, exchanges are supposed to make the mind-boggling task of buying health insurance more like shopping on Amazon.com or Travelocity. Millions of people who don't have employer coverage will flock to the new markets. Middle-class consumers will be able to buy private insurance, with government help to pay the premiums in most cases. Low-income people will be steered to safety net programs like Medicaid.

"It's an experiment between the feds and the states, and among the states themselves," said Robert Krughoff, president of Consumers' Checkbook, a nonprofit ratings group that has devised an online tool used by many federal workers to pick their health plans. Krughoff is skeptical that either the feds or the states have solved the technological challenge of making the purchase of health insurance as easy as selecting a travel-and-hotel package.

Whether or not the bugs get worked out, consumers will be able to start signing up Oct. 1 for coverage that takes effect Jan. 1. That's also when two other major provisions of the law kick in: the mandate that almost all Americans carry health insurance, and the rule that says insurers can no longer turn away people in poor health.

Barring last-minute switches that may not be revealed until next week, 23 states plus Washington, D.C., have opted to run their own markets or partner with the Obama administration to do so.

Twenty-six states are defaulting to the feds. But in several of those, Republican governors are trying to carve out some kind of role by negotiating with federal Health and Human Services Secretary Kathleen Sebelius. Utah's status is unclear. It received initial federal approval to run its own market, but appears to be reconsidering.

"It's healthy for the states to have various choices," said Ben Nelson, CEO of the National Association of Insurance Commissioners. "And there's no barrier to taking somebody else's ideas and making them work in your situation." A former U.S. senator from Nebraska, Nelson was one of several conservative Democrats who provided crucial votes to pass the overhaul.

States setting up their own exchanges are already taking different paths. Some will operate their markets much like major employers run their health plans, as "active purchasers" offering a limited choice of insurance carriers to drive better bargains. Others will open their markets to all insurers that meet basic standards, and let consumers decide.

Obama's Affordable Care Act remains politically divisive, but state insurance exchanges enjoy broad public support. Setting up a new market was central to former Republican presidential candidate Mitt Romney's health care overhaul as governor of Massachusetts. There, it's known as the Health Connector.

A recent AP poll found that Americans prefer to have states run the new markets by 63 percent to 32 percent. Among conservatives the margin was nearly 4-1 in favor of state control. But with some exceptions, including Idaho, Nevada and New Mexico, Republican-led states are maintaining a hands-off posture, meaning the federal government will step in.

"There is a sense of irony that it's the more conservative states" yielding to federal control, said Sandy Praeger, the Republican insurance commissioner in Kansas, a state declining to run its own exchange. First, she said, the law's opponents "put their money on the Supreme Court, then on the election. Now that it's a reality, we may see some movement."

They're not budging in Austin. "Texas is not interested in being a subcontractor to Obamacare," said Lucy Nashed, spokeswoman for Gov. Rick Perry, who remains opposed to mandates in the law.

In Kansas, Praeger supported a state-run exchange, but lost the political struggle to Gov. Sam Brownback. She says Kansans will be closely watching what happens in neighboring Colorado, where the state will run the market. She doubts that consumers in her state would relish dealing with a call center on the other side of the country. The federal exchange may have some local window-dressing but it's expected to function as a national program.

Christine Ferguson, director of the Rhode Island Health Benefits Exchange, says she expects to see a big shift to state control in the next few years. "Many of the states have just run out of time for a variety of reasons," said Ferguson. "I'd be surprised if in the longer run every state didn't want to have its own approach."

In some ways, the federal government has a head start on the states. It already operates the Medicare Plan Finder for health insurance and prescription plans that serve seniors, and the Federal Employees Health Benefits Program. Both have many of the features of the new insurance markets.

Administration officials are keeping mum about what the new federal exchange will look like, except that it will open on time and people in all 50 states will have the coverage they're entitled to by law.

Joel Ario, who oversaw planning for the health exchanges in the Obama administration, says "there's a rich dialogue going on" as to what the online shopping experience should look like. "To create a website like Amazon is a very complicated exercise," said Ario, now a consultant with Manatt Health Solutions.

He thinks consumers should be able to get one dollar figure for each plan that totals up all their expected costs for the year, including premiums, deductibles and copayments. Otherwise, scrolling through pages of insurance jargon online will be a sure turn-off.

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Carnival Cruise Ship Hit With First Lawsuit

The first lawsuit against Carnival Cruise Lines has been filed and it is expected to be the beginning of a wave of lawsuits against the ship's owners.

Cassie Terry, 25, of Brazoria County, Texas, filed a lawsuit today in Miami federal court, calling the disabled Triumph cruise ship "a floating hell."

"Plaintiff was forced to endure unbearable and horrendous odors on the filthy and disabled vessel, and wade through human feces in order to reach food lines where the wait was counted in hours, only to receive rations of spoiled food," according to the lawsuit, obtained by ABCNews.com. "Plaintiff was forced to subsist for days in a floating toilet, a floating Petri dish, a floating hell."

Click Here for Photos of the Stranded Ship at Sea

The filing also said that during the "horrifying and excruciating tow back to the United States," the ship tilted several times "causing human waste to spill out of non-functioning toilets, flood across the vessel's floors and halls, and drip down the vessel's walls."

Terry's attorney Brent Allison told ABCNews.com that Terry knew she wanted to sue before she even got off the boat. When she was able to reach her husband, she told her husband and he contacted the attorneys.

Allison said Terry is thankful to be home with her husband, but is not feeling well and is going to a doctor.

Carnival's Triumph Passengers: 'We Were Homeless' Watch Video

Girl Disembarks Cruise Ship, Kisses the Ground Watch Video

Carnival Cruise Ship Passengers Line Up for Food Watch Video

"She's nauseated and actually has a fever," Allison said.

Terry is suing for breach of maritime contract, negligence, negligent misrepresentation and fraud as a result of the "unseaworthy, unsafe, unsanitary, and generally despicable conditions" on the crippled cruise ship.

"Plaintiff feared for her life and safety, under constant threat of contracting serious illness by the raw sewage filling the vessel, and suffering actual or some bodily injury," the lawsuit says.

Despite having their feet back on solid ground and making their way home, many passengers from the cruise ship are still fuming over their five days of squalor on the stricken ship and the cruise ship company is likely to be hit with a wave of lawsuits.

"I think people are going to file suits and rightly so," maritime trial attorney John Hickey told ABCNews.com. "I think, frankly, that the conduct of Carnival has been outrageous from the get-go."

Hickey, a Miami-based attorney, said his firm has already received "quite a few" inquiries from passengers who just got off the ship early this morning.

"What you have here is a) negligence on the part of Carnival and b) you have them, the passengers, being exposed to the risk of actual physical injury," Hickey said.

The attorney said that whether passengers can recover monetary compensation will depend on maritime law and the 15-pages of legal "gobbledygook," as Hickey described it, that passengers signed before boarding, but "nobody really agrees to."

One of the ticket conditions is that class action lawsuits are not allowed, but Hickey said there is a possibility that could be voided when all the conditions of the situation are taken into account.

One of the passengers already thinking about legal action is Tammy Hilley, a mother of two, who was on a girl's getaway with her two friends when a fire in the ship's engine room disabled the vessel's propulsion system and knocked out most of its power.

"I think that's a direction that our families will talk about, consider and see what's right for us," Hilley told "Good Morning America" when asked if she would be seeking legal action.

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Key U.S. general backs keeping Afghan forces at peak strength

WASHINGTON (Reuters) - The U.S. general nominated to oversee a vast region that includes Afghanistan on Thursday backed keeping Afghan forces at a peak strength of 352,000, contrary to current plans to shrink them after NATO declares the war over next year.

General Lloyd Austin, nominated to lead the U.S. military's Central Command, said at his Senate confirmation hearing that a more robust Afghan force, while more costly, would "hedge against any Taliban mischief" following America's longest war.

"Keeping the larger-size force would certainly reassure the Afghans, it would also reassure our NATO allies that we remain committed," Austin said.

The comments came two days after President Barack Obama announced in his State of the Union address that 34,000 U.S. troops - roughly half of the current U.S. force in Afghanistan - would be withdrawn by early 2014.

Obama reassured Americans that the costly, unpopular war was coming to an end, but he left unanswered bigger questions about America's exit strategy, including how many U.S. troops would stay in the country beyond 2014 to help train and advise the Afghans and to battle remnants of al Qaeda.

Obama also did not discuss the future size of the Afghan forces, although a White House fact sheet sent out after his address noted they would remain at 352,000 until "at least" early 2015.

Austin warned the Taliban would be waiting to test them.

"You could reasonably expect that an enemy that's been that determined, that agile, will very soon after we transition begin to try to test the Afghan security forces," Austin said.

Under current plans, the United States and its NATO allies will help build up the Afghan armed forces to 352,000 personnel, a number they are approaching, but the size of the force - which the allies will continue to fund - will be trimmed to 230,000 after 2015.

ECHOES OF IRAQ

The hearing frequently moved away from questions about the Afghan war and other current events to questions about Austin's past role as commander in Iraq, when a failure to strike an immunity deal for U.S. troops led to their total withdrawal in 2011.

Obama administration officials have warned that failure to strike an immunity deal with Afghanistan would also result in a pullout, but Afghan President Hamid Karzai and U.S. officials have expressed confidence a deal can be reached.

Republicans, who have criticized Obama's drawdown strategy in Afghanistan, noted that the president would have left a much smaller force in Iraq than Austin recommended, even if a deal had been struck.

Senator John McCain of Arizona lamented the lack of a U.S. presence in Iraq.

Pressed by Republicans, Austin acknowledged that the situation in Iraq was trending in a "problematic" direction, and agreed that a continued U.S. role would have helped bolster Iraqi forces.

When it came to Afghanistan, Senator Lindsay Graham of South Carolina warned Austin that if Obama sought an insufficient force for the post-2014 mission, he would refuse to vote for funding the war effort.

"It can be as low as 9 or 10,000, that I will stand with them," Graham said.

"If they overrule the commanders and create a force that cannot in my view be successful, I cannot in good conscience vote to continue this operation."

Graham said he would vote for Austin's confirmation once Austin spoke with the former commander of the Afghan mission, General John Allen, about his recommendations to Obama and reported back to the committee about his opinion.

(Reporting by Phil Stewart; Editing by David Brunnstrom)

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S. Korea leader says only regime fall will change North

SEOUL: North Korea can never be made to abandon its nuclear weapons programme, South Korean President Lee Myung-Bak said Friday, arguing that only regime collapse could remove the threat from Pyongyang.

As the UN Security Council continues to debate how to punish the North for its latest nuclear test, the outgoing president suggested the best way forward was to try to foment unrest among the North Korean people.

"It has become impossible to have North Korea give up its nuclear weapons through dialogue and negotiations", Lee told a meeting of senior dignitaries including former government ministers and religious leaders.

"We cannot hope the North will part with its nuclear programmes until its regime changes or collapses", he said.

"We can help change the North Korean people, if not the North Korean regime itself."

Lee is set to leave office in 10 days at the end of a five-year term marked by an almost complete breakdown in contacts between Seoul and Pyongyang.

Lee had always promised to take a harder line than his predecessors, making continued aid to the impoverished North conditional on progress in talks on its nuclear programme.

His successor, president-elect Park Geun-Hye, campaigned on a policy of greater engagement with Pyongyang, but Tuesday's nuclear test will almost certainly see that policy shelved for months, if not longer.

-AFP/fl

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Omar Abdullah defends curfew in Valley

SRINAGAR: Jammu and Kashmir chief minister Omar Abdullah has defended imposition of curfew in the Valley saying restrictions would not have been needed if no one tried to create trouble after the hanging of Parliament attack convict Afzal Guru.

"Even these restrictions would not have been necessary if we didn't have amongst us those determined to create trouble out of this situation," Omar wrote on Twitter.

Curfew was reimposed across Kashmir Valley last night as a precautionary measure to foil the plans of separatist groups to hold a rally in memory of Guru at Eidgah graveyard.

The restrictions are strictly being imposed and there were apprehensions that people will not be allowed to offer Friday congregational prayers.

Omar, however, clarified that there are no restrictions on offering prayers at local mosques.

"There will be no restriction on people offering Friday prayers in their local Mosques," the chief minister said.

Curfew was imposed across the Valley on Saturday following the hanging of Guru in Tihar Jail in Delhi and relaxed in phased on Thursday and Friday but restrictions were re-imposed last night.

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Study: Fish in drug-tainted water suffer reaction

BOSTON (AP) — What happens to fish that swim in waters tainted by traces of drugs that people take? When it's an anti-anxiety drug, they become hyper, anti-social and aggressive, a study found. They even get the munchies.

It may sound funny, but it could threaten the fish population and upset the delicate dynamics of the marine environment, scientists say.

The findings, published online Thursday in the journal Science, add to the mounting evidence that minuscule amounts of medicines in rivers and streams can alter the biology and behavior of fish and other marine animals.

"I think people are starting to understand that pharmaceuticals are environmental contaminants," said Dana Kolpin, a researcher for the U.S. Geological Survey who is familiar with the study.

Calling their results alarming, the Swedish researchers who did the study suspect the little drugged fish could become easier targets for bigger fish because they are more likely to venture alone into unfamiliar places.

"We know that in a predator-prey relation, increased boldness and activity combined with decreased sociality ... means you're going to be somebody's lunch quite soon," said Gregory Moller, a toxicologist at the University of Idaho and Washington State University. "It removes the natural balance."

Researchers around the world have been taking a close look at the effects of pharmaceuticals in extremely low concentrations, measured in parts per billion. Such drugs have turned up in waterways in Europe, the U.S. and elsewhere over the past decade.

They come mostly from humans and farm animals; the drugs pass through their bodies in unmetabolized form. These drug traces are then piped to water treatment plants, which are not designed to remove them from the cleaned water that flows back into streams and rivers.

The Associated Press first reported in 2008 that the drinking water of at least 51 million Americans carries low concentrations of many common drugs. The findings were based on questionnaires sent to water utilities, which reported the presence of antibiotics, sedatives, sex hormones and other drugs.

The news reports led to congressional hearings and legislation, more water testing and more public disclosure. To this day, though, there are no mandatory U.S. limits on pharmaceuticals in waterways.

The research team at Sweden's Umea University used minute concentrations of 2 parts per billion of the anti-anxiety drug oxazepam, similar to concentrations found in real waters. The drug belongs to a widely used class of medicines known as benzodiazepines that includes Valium and Librium.

The team put young wild European perch into an aquarium, exposed them to these highly diluted drugs and then carefully measured feeding, schooling, movement and hiding behavior. They found that drug-exposed fish moved more, fed more aggressively, hid less and tended to school less than unexposed fish. On average, the drugged fish were more than twice as active as the others, researcher Micael Jonsson said. The effects were more pronounced at higher drug concentrations.

"Our first thought is, this is like a person diagnosed with ADHD," said Jonsson, referring to attention deficit-hyperactivity disorder. "They become asocial and more active than they should be."

Tomas Brodin, another member of the research team, called the drug's environmental impact a global problem. "We find these concentrations or close to them all over the world, and it's quite possible or even probable that these behavioral effects are taking place as we speak," he said Thursday in Boston at the annual meeting of the American Association for the Advancement of Science.

Most previous research on trace drugs and marine life has focused on biological changes, such as male fish that take on female characteristics. However, a 2009 study found that tiny concentrations of antidepressants made fathead minnows more vulnerable to predators.

It is not clear exactly how long-term drug exposure, beyond the seven days in this study, would affect real fish in real rivers and streams. The Swedish researchers argue that the drug-induced changes could jeopardize populations of this sport and commercial fish, which lives in both fresh and brackish water.

Water toxins specialist Anne McElroy of Stony Brook University in New York agreed: "These lower chronic exposures that may alter things like animals' mating behavior or its ability to catch food or its ability to avoid being eaten — over time, that could really affect a population."

Another possibility, the researchers said, is that more aggressive feeding by the perch on zooplankton could reduce the numbers of these tiny creatures. Since zooplankton feed on algae, a drop in their numbers could allow algae to grow unchecked. That, in turn, could choke other marine life.

The Swedish team said it is highly unlikely people would be harmed by eating such drug-exposed fish. Jonsson said a person would have to eat 4 tons of perch to consume the equivalent of a single pill.

Researchers said more work is needed to develop better ways of removing drugs from water at treatment plants. They also said unused drugs should be brought to take-back programs where they exist, instead of being flushed down the toilet. And they called on pharmaceutical companies to work on "greener" drugs that degrade more easily.

Sandoz, one of three companies approved to sell oxazepam in the U.S., "shares society's desire to protect the environment and takes steps to minimize the environmental impact of its products over their life cycle," spokeswoman Julie Masow said in an emailed statement. She provided no details.

___

Online:

Overview of the drug: http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682050.html

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Nightmare Ends: Passengers Leave Disabled Ship

After five days without power in the Gulf of Mexico, the Carnival Triumph cruise ship carrying more than 4,000 people arrived in Mobile, Ala., to greet a cheering crowd of friends and family members waiting to embrace their loved ones.

Passengers began to disembark the damaged ship around 10:15 p.m. CT Thursday and continued into the overnight hours. Other waiting passengers lined the decks of the ship, waving, and whistling to those on shore. "Happy V-Day" read a homemade sign made for the Valentine's Day arrival and another, more starkly: "The ship's afloat, so is the sewage."

Some still aboard chanted, "Let me off, let me off!" and "Sweet Home Alabama."

The Carnival Triumph departed Galveston, Texas, last Thursday and lost power Sunday after a fire in the engine room disabled the vessel's propulsion system and knocked out most of its power.

After power went out, passengers texted ABC News that sewage was seeping down the walls from burst plumbing pipes, carpets were wet with urine, and food was in short supply. Reports surfaced of elderly passengers running out of critical heart medicine and others on board squabbling over scarce food.

Click Here for Photos of the Stranded Ship at Sea

Passengers said many of the cabins became intolerable with the smell of raw sewage. They were forced to create makeshift beds out of lounge chairs on the ship's deck.

AP Photo/John David Mercer

Girl Disembarks Cruise Ship, Kisses the Ground Watch Video

Carnival CEO Gerry Cahill: 'I Want to Apologize' Watch Video

Carnival Cruise Ship Passengers Line Up for Food Watch Video

"We kind of camped out by our lifeboat. We would have nightmares about Titanic basically happening," passenger Kendall Jenkins told ABC News Radio after disembarking from the ship.

"I am just so blessed to be back home," she added.

Jenkins was one of many passengers that were photographed kissing the ground when they exited the ship.

WATCH: Carnival CEO Gerry Cahill Apologizes to Passengers

Approximately 100 buses were waiting to take passengers on the next stage of their journey. Passengers have the option to take a bus ride to New Orleans or Galveston, Texas, where the ill-fated ship's voyage began. From there, passengers will take flights home, which Carnival said they would pay for.

Inside the buses, Carnival handed out bags of food that included French fries, chicken nuggets, honey mustard barbecue sauce and apples.

Deborah Knight, 56, decided to stay in Mobile after the arduous journey was over rather than board a bus for a long ride. Her husband Seth drove in from Houston and they checked in at a downtown Mobile hotel.

"I want a hot shower and a daggum Whataburger," said Knight.

She said she was afraid to eat the food on board and had gotten sick while on the ship.

Cruise Ship Newlyweds Won't Be Spending Honeymoon on a Boat

For 24-year-old Brittany Ferguson of Texas, not knowing how long passengers had to endure their time aboard was the worst part.

"I'm feeling awesome just to see land and buildings," Ferguson said, who was in a white robe given to her aboard. "The scariest part was just not knowing when we'd get back," she told The Associated Press.

Carnival president and CEO Gerry Cahill praised the ship's crew and told reporters that he was headed on board to apologize directly to its passengers shortly before the Carnival Triumph arrived in Mobile.

"I know the conditions on board were very poor," Cahill said Thursday night. "I know it was very difficult, and I want to apologize again for subjecting our guests for that. ... Clearly, we failed in this particular case."

Luckily no one was hurt in the fire they triggered the power outage, but many passengers aboard the 900 foot colossus said they smelled smoke and were living in fear.

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South Korea unveils missile it says can hit North's leaders

SEOUL (Reuters) - South Korea unveiled a cruise missile on Thursday that it said can hit the office of North Korea's leaders, trying to address concerns that it is technologically behind its unpredictable rival which this week conducted its third nuclear test.

South Korean officials declined to say the exact range of the missile but said it could hit targets anywhere in North Korea.

The Defence Ministry released video footage of the missiles being launched from destroyers and submarines striking mock targets. The weapon was previewed in April last year and officials said deployment was now complete.

"The cruise missile being unveiled today is a precision-guided weapon that can identify and strike the window of the office of North Korea's leadership," ministry spokesman Kim Min-seok said told reporters.

North Korea has forged ahead with long-range missile development, successfully launching a rocket in December that put a satellite into orbit.

The North's ultimate aim, Washington believes, is to design an intercontinental ballistic missile capable of carrying a nuclear warhead that could hit the United States.

North Korea, which accuses the United States and its "puppet", South Korea, of war-mongering on an almost daily basis, is likely to respond angrily to South Korea flexing its muscles.

North Korea, technically still at war with the South after their 1950-53 conflict ended in a truce, not a peace treaty, carried out its third nuclear test on Tuesday, drawing condemnation from around the world including its only major ally China.

The test and the threat of more unspecified actions from Pyongyang have raised tensions on the Korean peninsula as the South prepares to inaugurate a new president on February 25.

"The situation prevailing on the Korean peninsula at present is so serious that even a slight accidental case may lead to an all-out war which can disturb the whole region," North Korea's official KCNA news agency said.

(Reporting by Ju-min Park; Editing by Nick Macfie)

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Ex-CNB chief found not guilty of corruption

SINGAPORE: Former Central Narcotics Bureau (CNB) chief Ng Boon Gay is not guilty of corruption in a high-profile sex-for-contracts trial.

The verdict was handed down by District Judge Siva Shanmugam on Thursday afternoon.

The judge said there was no corrupt element involved, and found Cecilia Sue's credibility to be successfully impeached.

He said her explanations on inconsistencies in her statements to the Corrupt Practices Investigation Bureau (CPIB) and evidence in court were inadequate and unconvincing.

The judge also found Ng's evidence to be consistent and credible.

Ng, 46, was charged in June last year with four counts of obtaining sexual favours from Ms Sue, who was a sales manager for two IT vendors.

Ng allegedly breached the Prevention of Corruption Act by engaging in sexual acts with Ms Sue on four occasions, between June and December in 2011.

Ms Sue, 36, was the sales manager of Hitachi Data Systems from June to November 2011.

She joined Oracle Corporation Singapore in December in 2011 as its senior sales manager.

In exchange, Ng was accused of furthering the business interests of the two IT companies in their dealings with CNB.

After a closely-watched 14-day trial, both the prosecution and defence made their closing arguments on 28 January 2013.

- CNA/xq

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One Billion rising up in the cause of women's safety

NEW DELHI: People from all walks of life will come together today to pledge their commitment to put an end to violence against women. A series of cultural events have been planned across the country as part of the global campaign which is being called 'One Billion Rising'.

The campaign was started by playwright and activist Eve Ensler (known for her play The Vagina Monologues) against all forms of "sexual abuse". The word "billion", say the organizers, refers to the one billion women who are survivors of abuse.

Women organisations, elected representatives, legal luminaries, actors, artists, NGOs and academic institutions apart from individuals are expected to participate in the day-long programme, its organisers said. The campaign will simultaneously be held in 200 other countries.

In New Delhi, its highlight will be a cultural event at Parliament Street between 5 and 8 PM, which will feature a play followed by song and dance performances by students of Lady Shri Ram College, Miranda House and Kamala Nehru College.

"We thank Delhi Metro for joining OBR campaign to make Delhi a safe, gender-friendly and inclusive city," Anjlee Agarwal, executive director of Samarthayam, an organization working for the rights of the differently-abled, said.

South Asia Coordinator of the OBR campaign Kamla Bhasin said, "We are launching Indian women`s and girl`s freedom struggle tomorrow and we are going to question every patriarchal establishment including ourselves. We seek freedom from patriarchy and freedom from violent masculinity.

(Inputs from PTI)

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