Awful truth of mass sterilisation: Government butchers women's bodies

Long before the unfortunate women in Chhattisgarh opted for sterilisation and walked into a death trap,  this little-noticed video surfaced in February, 2013. The footage shows unconscious women being ferried out on filthy stretchers from what looks like a hospital building. They are then dumped on the ground as bleary eyed men and women huddle around them, furiously fanning them or rubbing their feet.  Some, wrapped in dirty sheets, are lying next to parked rickshaws, a few others are hauled on to vending carts, presumably by family members.

These women who look as good as dead, had just undergone a sterilisation procedurs at a government hospital in Malda, West Bengal. The ticker on the NDTV video says that 103 women were sterilized by two doctors in one day in the government hospital. Unable to accommodate all the patients, the women were dumped all around the hospital campus and left to the care of their families to recuperate.

So let’s not pretend that none of us could have seen the Chhattisgarh tragedy coming. Or predict that the victims were likely to be a) women, b) poor.

Mass sterilisations of both men and women have long been the accepted, standard solution for population control in India. However, there’s a rider. Women are offered Rs 1400 fora tubectomy, while men don’t get any financial incentive for a vasectomy.  Consequently, due the lack of financial benefits and myths about impotency, the men’s sterilization drive has failed to take off.     And this despite the fact that, from a medical point of view , vasectomy is a far less complicated surgery than tubectomy. A Times of India report from 2003 notes that men constitute just 2.1 percent of the government sterilisations done in India, a number which is unlikely to have changed in the last decade.

The burden of population control in India falls disproportionately on women, or to be specific, poor women.

As this article on The Indian Express reveals, most of the Bilaspur victims are impoverished and therefore dependent on government healthcare.  One is a labourer’s wife, another a woman who gave birth just a few days ago in her village. They had both been coaxed into the surgery by a health worker – who earns Rs 200 for every patient he/she gets to the sterilisation camp. It is also clear that they would not have put their bodies in peril’s way if not for the princely amount of Rs 1,400 ( ie the monthly mobile phone bill of the urban middle class Indian).

This is not the first time a mass sterilisation camp has flouted every rule in the government’s own book.  A document titled Standards for Female and Male Sterilisation Services, prepared and issued by the government of India in 2006, sets down the following requirements:

“The client may be discharged when the following conditions are met: After at least 4 hours of procedure, when the vital signs are stable and the client is fully awake, has passed urine, and can walk, drink or talk. The client has been seen and evaluated by the doctor. Whenever necessary,  the client should be kept overnight at the facility.”

The documents also suggests an elaborate medical screening of the client and a holistic counseling session for the client and the spouse.

Needless to say, practice is vastly different from theory.

Writing of a patient in Bihar, a 2013 expose by Bloomberg news reported, “She didn’t know that she would lie on an operating table with bloody sheets, that the scalpel used to open her up would be stained with rust or that she was supposed to first get counseling on other birth-control methods before giving consent to have her fallopian tubes cut and tied.”

In fact, an article on JSTOR titled “ Female Sterilisations in Small Camp Setting in Rural India ’, outlines the structure of facilities used for these operations. It notes that most of these health centres have no more than five beds and a labour room. They also have no properly equipped operating room and usually rely on natural light for surgeries.

As the NDTV video shows and the IE report reveals, women are treated as bodies on an assembly line, where the emphasis is not on safety but speed – to sterilise the most number of women in the shortest time span. In Chattisgarh, the doctor and his assistant performed 83 tubectomies in three hours, which is on average 2 minutes per surgery.

And this 18 years after the government announced in 1996 that the target-based sterilisation drive will be scrapped and women will be educated on other methods of contraception.  The quota mentality is very much in place even today, notes a detailed report on Human Rights Watch.

“In much of the country, authorities aggressively pursue targets, especially for female sterilization, by threatening health workers with salary cuts or dismissals. As a result, some health workers pressure women to undergo sterilization without providing sufficient information, either about possible complications, its irreversibility, or safer sex practices after the procedure.”

The paper also cites a damning survey conducted on health workers from Gujarat:

“More than 50 health workers told Human Rights Watch that district and sub-district authorities assigned individual yearly targets for contraceptives, with a heavy focus on female sterilization. Almost all said that their supervisors or other higher-ups threatened them with adverse consequences if they did not achieve their targets. These included threats to withhold or reduce salary, negative performance assessment, or suspension and dismissals. In one case, a health worker reported that she was asked to falsify records to show she had met targets or else she would be reported for poor performance.”

That much-touted campaign for safe contraception has, in contrast, been a miserable failure. A  Wall Street Journal article from early this year stated: “Just over 37% of females aged between 15 and 49 years who are married or in a sexual relationship say sterilization is their method of contraception. That compares to 3.1% who use the pill and 5.2% who said they use a male condom to keep from getting pregnant.”

With the several myths surrounding male sterilisation and the low power of negotiation that most women hold in a patriarchal Indian rural family set up, the burden of family planning lies squarely on the shoulders of the women. Men won’t wear a condom, birth control pills aren’t free, and there is a financial incentive for sterilisation up and down the chain of authority from the target-achieving babu to the incentivised health worker to the victim and her family.

Everyone is happy to jump on the  population control and family planning bandwagon. But few of us will acknowledge the bodies that are butchered in its name. Will Bilaspur rip those blinders off? Let’s hope so.