No more births... or deaths

The Hindu, Sunday Magazine, Nov 23, 2014

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PTI Women who underwent sterilisation surgeries receive treatment in Bilaspur, Chhattisgarh

Should we forget about the 14 poor women in Chhattisgarh who died earlier this month? Can we write this off as another “unfortunate” incident? Or should we see it as reminder of the fundamental question that Indian policymakers need to ask: are Indian women, especially poor women, entitled to respect and rights due all human beings or will they continue to be viewed as baby-producing machines whose bodies the State can appropriate and control when it deems they have completed their assigned task?

The debate has been sparked by the ghastly tragedy that befell some of the 83 women who were herded into a disused hospital in Takhatpur, Bilaspur district, and subjected to laparoscopic tubectomies within a few hours. The same instrument was used. No time for sterilisation. No time to check if the women were in good enough health to undergo the surgery. And no time to relax and recover before being packed off. And, of course, no one to follow up to see whether they survived the journey home.

Within a day, eight women were dead. In the next days, in other locations where similar sterilisation camps were held, another six died, 14 in all. The doctor who performed the 83 tubectomies – he was rewarded earlier this year for having performed 50,000 tubectomies – was arrested. He says he was not at fault and insists that the women died from consuming contaminated drugs post-operation. It is suspected that the ciprofloxacin tablets given to the women were contaminated with zinc phosphide, a rat poison. And the state government refuses to explain why such a camp was held at a disused, run-down private hospital.

Everyone is blaming someone else. In the midst of all this noise, and the silence that has descended on the homes of the dead women, we must remember that what happened in Chhattisgarh earlier this month is not an exception, a one-off aberration that we can all forget about once the blame is fixed. Between 2003 and 2012, on an average 12 women die due to botched tubectomies. That is 12 too many. No woman should die from this procedure.

Also, whatever government officials might say to the media, the reality is that health workers are expected to fulfil targets by bringing women to these sterilisation camps. If such pressure was not exerted on them, it is possible that fewer women would come. But at least those who agreed to be sterilised would do so after having understood the consequences. And doctors would not rush through with the procedure at the vulgar speed as did the doctor in Chhattisgarh.

Government officials have consistently argued, as they do even today, that sterilisation is the best option for a poor woman with more than two children because she cannot insist her husband uses a condom and she cannot use other spacing methods, such as injectables for instance, because of the absence of health care in the case of complications. But by the same measure, how do governments justify sterilising women and sending them back to their villages without any follow-up? The women who died did so because they could not access emergency health care in time.

Even if poor women opt for sterilisation, surely they are entitled some dignity while undergoing the procedure. We thought the days when women were lined up like cattle, as depicted so starkly in Deepa Dhanraj’s path-breaking 1991 film “Something like a war” (https://www.youtube.com/watch?v=6Fq7HSIPVq4), was something in the past, harking back to the days of the 1975 Emergency when mass sterilisation campaigns were implemented ruthlessly across India. But Chhattisgarh reminds us that this is happening even today, although on a smaller scale.

So respect for poor women is the very minimum that must inform any population programme. India has signed an international convention in 1994 committing itself to guaranteeing women their reproductive choice and rights. Simply put, this means that all women have the right to choose the kind of contraceptive method they want to use. It also means that population programmes must be centered on women’s health and choice.

Clearly, this is so much talk without substance. In 20 years, under one guise or another, central and state governments have continued with the policy of targets and camps. And women are those who are targeted, not men. The skew in the population programmes is more than evident, even if one looks at government data.

Also, despite scores of meeting, conferences, policy documents, including the National Population Policy (2000) that links a decline in fertility to many other aspects such as education, overall health, housing, drinking water and sanitation, the desire to fast-forward population programmes through sterilisation appears irresistible to policy makers of all political hues.

As a result, women continue to pay the price for this persistent myopia – especially poor women. 

(To read the original, click here.)