India's Sterilization Horror

(Brinda Karat is a Politburo member of the CPI(M) and a former Member of the Rajya Sabha.)

The Chhattisgarh government is guilty, at the least, of culpable homicide for the deaths of over a dozen women in government-run sterilisation camps in the last few days.

But the government and in particular the Health Minister think they can escape from their own responsibility by arresting the doctor who did the operations and setting up a judicial enquiry.

Really? You need a judicial enquiry to tell you that the targets you fix for female sterilisation can only be met if doctors do production line surgeries as was done in Bilaspur? You need a judge to tell you that this is bound to lead to serious health consequences for the person being operated on?

Sure, the doctor needs to be arrested and prosecuted. But who set the targets he was following? Who incentivised utterly unethical medical practices? Who rewarded the  same doctor with a state award on Republic Day this year for his success in completing 50,000 surgeries, a reward for using the very same methods of one surgery in every two minutes, which led to the deaths of the women?

The Chhattisgarh Government set a target of 1.75 lakh sterilisations for the year 2014-2015, the same as last year and 30,000 more than the targets of the previous two years from 2010-2012. It has also employed 126 doctors specifically for female sterilisation operations along with other personnel. Last year they were close to their target with 1.57 lakh sterilisations done. This year so far 54,000 female sterilisation surgeries have been performed. The numbers are way below the targets so the doctor was in a hurry, the government was in a hurry, that's why even after the shocking deaths in Bilaspur, another camp started the very next day where also two women have died.

These surgeries were not out of informed individual choices by the women. The system is not demand driven. It works by orders from the top down to the ANM and the ASHA worker who are given targets to fulfil on the threat of losing their jobs. These equally poor health workers become instruments of the system that exploits the poverty of the target groups to provide cash incentives to meet targets.

Clearly treating poor women as cattle or worse is acceptable as long as they suffer in silence, as long as their bleeding and pain does not make headlines,  and of course, as long as they don't die.

Yet some of them do. Quite a few. In  ten years, from 2002 to 2012, going by figures given to Parliament, on an average twelve women died every month due to botched up sterilisations in different states.These are only the reported cases. But this has not taught governments any lessons. The camps continue.

And what about the suffering of those who survive these butchery camps? The women in Malda, West Bengal, 300 of them in a hospital which could cater to only 30, bleeding out in the open field; the women in the Bihar primary school building where the so-called camp was held, being operated on in torchlight; the mentally-challenged women in Madhya Pradesh who had no idea what was being done to their bodies.

Why? It is because they are poor, it is because they are women, it is because they are the easiest targets for a coercive obsessive population control policy, which legally and officially is not even supposed to exist.

Look at the utter hypocrisy of our system. In 1994, India became a signatory to the Cairo declaration, one among 179 countries. The declaration was extremely significant because its basis was that development is the best contraceptive. In the Indian context it meant a recognition that it is socio-economic indicators like literacy, public health, high infant mortality rates that determine family size that must tackled not the imposition of coercive population control policies.

This target-free understanding was further developed in the National Population Policy document of 2000 and once again in the Declaration of the National Rural Health Mission in 2005. A high sounding Community Needs Assessment Approach was supposed to be the alternative, but it was followed only in its breach.

The actual practice on the ground was in total violation of these policy documents.  It was driven by a Malthusian ideological framework that population has to be controlled before development. With rare exceptions, governments worked to "control" populations. Many adopted a coercive model of the two-child norm. Laws were enacted to punish the poor by depriving them of ration cards as in Andhra Pradesh, or in denying them the democratic right to stand for elections if they had more than two children as in Rajasthan, Odisha, Madhya Pradesh, Haryana. And then the way they thought easiest and best... sterilize the women.

India has the dubious record of an extraordinarily high number of female sterilisations as a percentage of different patterns of contraceptive use by women between the ages of 15-49 years. Compared to the global average of 19 per cent, in India the percentage is a high 36 per cent. The provisional figures put out by the Health Ministry in the year ended March 2013, show that the number of female sterilisations was a whopping 4.5 million. 97.4 per cent of all sterilisations were performed on women.

Learn from the Kerala experience. With the lowest fertility rate in the country, Kerala has proven that indeed development is the best contraceptive. Better indicators like education and literacy, public health services, low infant mortality rates, easy access to safe contraception, help families make informed choices about the number of children they want.

The central government has sent a team to the state. It needs to do more than that. It needs to reiterate India's commitment to the Cairo declaration and approach. It needs to initiate a review of central and state policies regarding family planning to end target and quota-based policies. If women want to get a tubectomy done, they should be helped by providing services in safe and hygienic clinics. Put an end to target driven sterilisation camps. And to send the message that the target based policy is over, the Health Minister of Chhattisgarh should be held accountable. He should be forced to quit office, right now.

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