Botched Chhattisgarh sterilisations: Is India returning to a Sanjay Gandhi era?

Editor’s note: This post by senior editor G Pramod Kumar was first written in June 2013. But the botched sterilisations in Chhattisgarh highlight that the concerns raised in this copy remain as relevant as ever. Ten women died and some 30 others were left battling for their lives in the state. Soon after reports of the deaths came to light, the Chhattisgarh government  suspended four doctors for medical negligence. The piece deals with the manner in which poor people are lured to sterilisation camps by officials under pressure to meet targets, and how this is not only a violation of their reproductive and health rights, but also an ineffective, draconian method of trying to deal with the population problem.  If you thought the notorious sterilisation drive that Sanjay Gandhi and his gang unleashed on India’s poor women and men during the Emergency, and similar stories of American funded sterilization horrors in nearby Bangladesh are a thing of a past, you are mistaken. Luring poor people with money to make them incapable of producing children, and putting pressure on healthcare officials to make more and more women (and some men too) sterile are threatening the health and rights of millions of people in India. That too, despite global consensus in the form of Cairo Plan of Action nearly 20 years ago, and India’s own announcement of a “paradigm shift” in 2012 that preferred civilised reproductive health choices to crude and coercive surgeries. [caption id=“attachment_869311” align=“alignleft” width=“380”] Sanjay Gandhi. AFP[/caption] International news agency Bloomberg has come out with this expose, which shows how target and incentive based sterilisation of poor women continues in India. Women, out of sheer poverty and desperation, take some cash and allow themselves to be operated in hazardous conditions. The officials, who lure them with cash and incentives, are also under pressure from their bosses to show numbers of people whom they have made reproductive duds. This is Emergency-style draconian population control that India said it had given up. India’s own numbers show that it doesn’t work either. But we still do it. Besides the fundamental lopsidedness of the policy—that in the long run will make no impact on India’s numbers or health of people—the Bloomberg report shows that the way the surgeries are conducted will surely push people into serious infections and medical complications: sharing same rusted scalpels and needles to cut and poke a number of women at a stretch. What is seen at a sterilisation site in this report is just one part of the picture. The larger picture is India’s inability to stick to its commitment not to slip back into the old and crude ways of population control in which people are fooled into sterilisation than given choices for modern contraception. Instead of tying up their tubes, if these women are empowered and provided condoms, pills or intra-uterine devices, that would make a more rights-sensitive alternative. That is precisely what empowered urban women in India or most of the women in developing world do. Of course, it takes political will, enormous efforts and resources to follow such a rights-sensitive path. In the Cairo Plan of Action in 1994, India and 178 countries had agreed to follow this plan. They had acknowledged that population and human development are closely linked and instead of the old-school population control, what was required was an integrated “population and development strategy”. It required action on multiple fronts - empowerment of women; addressing issues such as poverty, health and education; reproductive health rights and services and so on. The 20-year “Programme of Action” was very clear - focus on individuals’ needs and rights, rather than on achieving demographic targets. Sounds complicated and difficult? So, better get hold of poor women in states such as Bihar, give them some money and make them sterile. In the mid-1990s, India said it abolished target and incentive based population control; and in 2012, at the London Summit for Family Planning it bragged that the country had brought about a “paradigm shift” which relied on the provision and promotion of contraceptives. In London, the government had promised that it would make contraceptives available at the doorstep of people through 860,000 community health workers. The services included condoms and pills, intra-uterine devices (IUD) and improving post-natal services for IUDs. However, the government not only failed in its claim of effecting this shift, but it also failed to transform the coercive and target-based sterilisation approach to reduce the number of births. The issue is fundamentally about violation of human rights of poor and mostly illiterate women. Just to notch up numbers and to achieve targets of population control at the state and national levels, these women are coerced into surgeries. Their reason to agree to the surgeries is not to restrict the number of children for a better quality of family life or better future, but some and cash and kind incentives. Contrast this with urban, empowered, educated and informed women - they choose their own method of contraception to plan their family. Here, there is no coercion and incentives, but just informed choices and availability of services. They might even choose sterilisation, but purely out of their own will. This is the trend in the developing world, including in the US, which is pushing for target-based population control in poor countries. In its bulletin titled Strengthening Voluntary Family Planning Services with Performance-Based Incentives: Potentials and Pitfalls, Repositioning in Action, the American aid agency USAID pushed for payments to people to undergo sterilisation. World over, sterilisation of women (and some men) is practiced in poor countries, that too among the poorest of poor people for obvious reasons. Since these are top-down programmes, in which the health officials are under pressure to show results, abuse and rights violations are rampant. For instance, as Betsy Hartman, a renowned international women’s health activist noted, during the 1984 flood season in Bangladesh destitute women were denied food until they agreed to be sterilised. Similarly between 1995 and 2000, Peru’s Fujimori unleashed a brutal drive that sterilised about 30000 men and 30000 women. The programme primarily targetted indigenous women who were either forced or uninformed. Above all, there is an unmissable similarity between the cash for sterility incentives and other conditional cash transfers that organisations such as the World Bank, USAID and government of India propose. It’s ideologically flawed because it’s exploitative - the offer of cash to people to achieve targets. Only the poor and uninformed fall for it. Most parts of India are indeed slipping into dark ages and international tied-aid is abetting it.