The recent laparoscopic tubectomies conducted at Bilaspur district in Chhattisgarh, which claimed the lives of 14 women and rendered 30 in a critical condition, reminds the nation of the Emergency (1975-1977), when women were forcibly operated upon to achieve family planning targets. Even if the cause of deaths was the administration of a spurious drug, a look at the population control strategy is still valid.
At that time, too, many women died due to the negligence and callous attitude of the authorities, something which went against the Indira Gandhi government. The Janata Party, which came to power in 1977, changed the government’s policy. Family planning was rechristened “family welfare”. A new slogan, hum do hamare do, with an eye-catching red triangle was seen everywhere indicating the shift from coercion to education.
India, along with 178 countries, signed the Cairo Declaration in 1994 and agreed to abolish the old population control techniques and target-based programmes in recognition of the global philosophy that population and human development were closely linked. The new agenda emphasised action on multiple fronts—women empowerment, health and education, eradication of poverty, etc.
The national population policy document 2000 and the National Rural Health Mission, launched in 2005, were based on this declaration. During the London summit held in 2012 to discuss family planning, India promised to reach out to the people, deliver contraceptives at their doorstep and improve post-natal services. Two years later, the government seems to have not only forgotten its promise but also failed to have abolished the target-based coercive sterilisation.
States like Chhattisgarh lure women to take part in government-run sterilisation programmes by offering cash incentives. It is said to have paid `1400 per person. Even doctors are given incentives to achieve targets set for them.
Most of these camps are makeshift, lacking basic infrastructure. Sometimes, even medicines are inadequate to operate all patients. Incidentally, the doctor, who conducted the surgery, was honoured for conducting 50,000 tubectomies in January 2014 alone. On November 9, he is said to have conducted 83 surgeries with a single instrument within five hours, against the guidelines of conducting not more than 30 surgeries in a day and 10 surgeries with one equipment.
Even the medicines used were not purchased after following set procedure. The state government had set a target of 1.75 lakh sterilisations during 2014-15, for which 126 doctors were employed. But, it could conduct only 54,000 female sterilisation surgeries.
Despite its strong population control policies and coercive methods, India has failed to check population growth. India is projected to surpass China and be the largest populated country in 2030. Although the population growth rate has come down from 2.3 per cent in the 1970s to 1.6 per cent now, it is not expected to bring any relief as every year around 18 million people get added to the population. For the poor, every new child is another earning hand in a few years. As such, sterilisation camps are considered the cheapest and most effective method of implementing population control—a practice largely followed by poor and developing countries.
In a male-dominated country like India, women are mere scapegoats and mute spectators, who have no option but to act as directed by their male counterparts. As per the latest UN data, 37 per cent of world’s women who undergo sterilisation belong to India. Of the total 49 per cent of people practising birth control measures, 75 per cent adopt female sterilisation. Modern birth control methods are still a taboo.
About 4.6 million women were operated upon last year. Vasectomies—comparatively safer than tubectomies with zero side effects—account for only 4 per cent of the total sterilisations. Ironically, the government also promotes tubectomy, which causes post-hormonal disturbances and has health implications. Twelve women die every month due to botched sterilisation camps in various states. The cases are not even reported unless the deaths are in large numbers.
The government, in the end, announces a compensation package in an attempt to pacify the relatives and orders a judicial enquiry, if a case deserves so or gets a lot of media attention. From 2009 to 2012, the government had paid compensation to the families of 568 women, who died soon after they underwent tubectomy.
Going by the precedents, the Chhattisgarh government also announced compensation packages of `2 lakh for the families of the women who died and `50,000 for those hospitalised. No doubt, the Centre has turned a blind eye to such incidents. The new family planning enhanced scheme announced this year also provides for an incentive of `200 for every mother undergoing tubectomy within a week of delivery!
Though the central government has done away with target-based programmes, states still follow such practices and usually allocate the first few months of the year for sterilisation drives—labelled as “sterilisation season”. A survey of a few such camps revealed most women weren’t even aware that they would not be able to give birth to a child after the operation.
Money is the only thing they come for. People in states like Bihar, Chhattisgarh and Jharkhand with poor literacy and high poverty rates are easily influenced by cash incentives for sterilisation. The government finds it easy to convince them for surgeries, instead of contraceptives and other methods of controlling childbirth. In Kerala, where the female literacy rate is 92 per cent, child birth rate is less than that of many developed nations. The government must learn from Kerala. Fertility rate has also come down from 4.1 to 1.7 children per woman. The family planning programme cannot be successful unless people make an informed choice. Coercive methods, target-based approach and promotion of female sterilisation as the only effective way of population control only add to a nation’s problems. A more focused effort is needed to educate people, raise availability of other contraceptive methods and improve the quality of care.
The family planning programme needs to be reviewed from a broader perspective with focus on education and development as per the Cairo Declaration. Had the government followed what it agreed to two decades ago, the country would have been in an entirely different position.
Standards and protocols must not end on paper only. It is time to walk the talk.
The author is a company secretary and can be reached at jassi.rai@gmail.com