Chhattisgarh sterilisation fiasco exposes our deep-seated misogyny

When India’s Mars mission was declared a success a couple of months ago, it led to an overwhelming demonstration of national pride because the country had joined an exclusive club of rich nations. But on Tuesday, when ten women died and dozens ended up in critical conditions at a sterilisation camp in Chhattisgarh, what was on display was the ugly underbelly of the real India. As in the case of “Mangalyaan”, The sterilisation mishap is all over the international media. Globally, people are wondering why despite its tall claims of technological and developmental advances, such camps still happen india? And more importantly, why women still die undergoing such simple procedures. What we really don’t know, while trying to figure out this contradiction, is that sterilisation is still very common in the country and a number of women still die undergoing the procedure. In 2012, fake doctors had reportedly done botched sterilisation surgery in 53 women in a camp in Bihar. Between 2009 and 2012, government had paid compensation for 568 deaths. More women could have died, but not been counted given the poor surveillance systems in many parts of the country. [caption id=“attachment_1799379” align=“alignleft” width=“380”]  Bereaved family of those who died in Chhattisgarh. PTI[/caption] The common sensical questions to ask in the wake of such mishaps are these - One) when there are many other contraceptive methods available, why do people still undergo birth control surgeries? Two) Although birth control surgery can be done both on men and women and it’s simpler on men, why only women take it and die? The answer is simple - because it’s mainly women who go under the scalpel and they are not given any other choice. About 66 per cent of the contraceptive use in the country is female sterilisation. Going by the National Family Health Survey (NFHS) data, the percentage of women undergoing sterilisation has risen from 27 per cent in 1992-93 to 34 per cent in 1998-99. According to the latest round of NFHS (2005-2006), it has further risen to 37 per cent. In comparison, the male sterilisation is very low at three per cent, which is even lower than what it was in 1992-93. This cannot be because men (and their households) are not aware that they too can undergo a birth control procedure, which is in fact much simpler, but they don’t want to. Instead, they want their women to go. Clearly, the burden of sterilisation is on women. As Kate Gilmore, Deputy Executive Director of UNFPA, notes in this interview with The Hindu, a woman undergoing sterilisation without the knowledge of other options may be considered coercive. “A woman must have free prior and informed choices between at least three forms of modern contraception…Anything less than this risks being coercive, or can be seen as created to induce her,” she says. Were the women in Chhattisgarh informed by the health officials about the choices before them? Highly unlikely, because in most parts of india, governments still haven’t given up the vestige of the infamous sterilisation camps launched in 1976, during emergency. Cash and kind incentives for people and sterilisation targets for officials was the lifeline of this programme. Although the union government had given up the “target” approach in 1996, it’s still practised in most parts of India. This observation by a Delhi-based health activist, quoted in a BBC report tells it all: “Targets are set like cricket scores - to impress the authorities or funding agencies. But, care for the patient is inadequate. Sometimes, surgeons are not even properly qualified and there’s no proper post-surgical care.” In other words, it’s forced, unsafe and are targeted towards women and their bodies. Needless to say, it’s mostly poor women who fall prey to male pressure and inducements and attend such camps. Early this year, seven UN agencies have come out with a statement calling for eliminating forced and involuntary sterilisation. “Sterilization without full, free and informed consent has been variously described by international, regional and national human rights bodies as an involuntary, coercive and/or forced practice, and as a violation of fundamental human rights, including the right to health, the right to information, the right to privacy, the right to decide on the number and spacing of children, the right to found a family and the right to be free from discrimination,” the statement said. “Coerced and/or forced sterilization of women has also been characterized as a form of discrimination and violence against women. Any form of involuntary, coercive or forced sterilization violates ethical principles, including respect for autonomy and physical integrity, beneficence and non-maleficence,” it further said. Gilmore’s words offer clarity as to what makes sterilisation voluntary or forced. “It is choice; all the talks about family planning are meant to be about choice, not methods.Secondly, quality, we must have great quality for those choices. Perhaps these women [in Chhattisgarh] chose sterilisation, the only popularity that one should see is if it is popular with the women. You know it is popular if that is the method they choose. If sterilisation was chosen over the pill, which was chosen over the condom, fine, but if there was only sterilisation then it was imposition.” Even if it was voluntary, there should be absolute guarantee on quality. In 1952, India was the first country in the world to have launched a family planning programme. What was on offer then was the advise on rhythm control method. Since then, it has supposedly evolved along with the best practices in the rest of the world which gave importance to maternal and child health (MCH) as well as reproductive child health. Since the 1960s, the government had claimed to have adopted the “cafeteria approach” in which clients (both men and women) are given the choices for contraception. Half a century later, we are still asking (only) our women to go in for sterilisation surgery without ever telling them what are the other options possible. Sanjay Gandhi’s obsession with sterilisation (although he focussed more on men) showed ill-informed, rights-violative policies of an authoritarian state. India should learn from developed countries that the only antidote to population growth is the promise of a better life.