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November 13, 2014

Sterilising women to death

A doctor conducted sterilization surgeries on 83 women in 5 hours in an abandoned hospital with no infrastructure. The women were made to lay on floor for the surgery and there are allegations that the medicines came from a small, one room factory that is owned by close affiliates of the party that is ruling the province. Of these women, 11 are dead and 60 others are being treated in different hospitals. One more woman died today in Gaurela in a similar surgery with three survivors being treated. The place is around 100 kilometres away from Bilaspur where first deaths occurred. Any government should be expected to jump into action to stop the tragedy from recurring, but the Chhattisgarh Government has not.

The only action taken by the government is blaming it all on the doctor and arresting him. The facts, however, show that he might be the least responsible for it. He was merely doing his duty and has been rewarded by the state government for conducting 100,000 surgeries on the Republic Day this year. In fact it is the government that pressures doctors working for it to meet family planning targets - the euphemism India uses for population control - despite repeated calls from both the medical fraternity and civil society to abandon the target centric approach. Family planning policy in India has never taken the views of the people it affects the most. It has never tried to educate the people and then take their informed consent. It has always bullied them into accepting what government thinks is the best for them.

Unfortunately, this septic practice is not limited to “family planning”. On February 2013, Amar Agrwal, health minister of Chhattisgarh, admitted in the state assembly that the government organised health camps in Balod in 2011 left 44 people blind. He had also admitted that similar camps left 4 people blind in Durg in march 2012, and 14 people blind in Bagbahra in December same year. 

 The recent sterilization deaths might have surprised but they are not anomalous. At least 363 persons have died during sterilisation operations and 14,901 surgeries failed to achieve the intended result between 2010-11 and 2013-14, according to the Government’s own data submitted to the parliament this year. Going back further, Government data shows that of 1,434 people have died in sterilization surgeries in India between 2003 and 2012. That is an average of 12 people dying each month for a decade.. . It is easy to assume that women are a majority of these deaths as 97.4% of all such surgeries are conducted on them.  Chhattisgarh and Assam are the states sitting on the top of this dubious list.

Sterilization camps generally lack of any facilities and often operated in open; most of the women coming to are from the most marginalised sections of the society. They come to these camps because of the meagre remuneration that they get. In fact, from the woman to village health worker to surgeons, everyone involved in these surgeries get rewarded. Also, though no one knows if there is a “quota” set for states by the central government, the rewards that the employees of central government - air force, navy and railway employees for instance - get for getting sterilized indicate a heavy possibility of that.

Further, the remuneration is not the only thing that pulls the women into such camps. Often this gives many of them their first contact with real doctors; most Indian villages do not have anyone qualified to care for the health of residents. Many of the women genuinely believe that the sterilization doctors will listen to their other problems and give advice and treatment. In reality, it is impossible for the doctors charged with daunting task of conducting surgeries to do so, the time they have is simply insufficient. For example, the situation in this case, 83 surgeries in 5 hours, is not an exceptional rate.

This is why seeing this case in isolation and punishing a few scapegoats will not succeed in closing the wound. The problem is multilayered with many interested parties on the wrong side. It begins with India’s family planning policy that tries everything from begging to bullying hapless people to get sterilized. Offering remuneration to everyone involved in such surgeries to restrict people with more than two children from local body elections, shows the extent to which government will go to achieve its targets. The lack of healthcare infrastructure in the countryside combined with often corrupt politicians forcing the department to buy substandard medicines and equipments from people affiliated to them leaves the program unequipped to handle the medical needs of their patients. Abandoned vans with a red triangle upside down, the symbol of family planning, or the abandoned government buildings, as in Bilaspur, forces most of the camps to be operated in open and significantly increases the risk of infection and the system becomes a death trap.

However, it is not merely the state that is responsible for such deaths. The silence of civil society and media over issues plaguing rural India play a role in allowing the system to flout the rules and put the lives of the poor at risk. Hardly anyone seems to care, or even notice the daily atrocities being committed on the marginalised and the poor of the country unless something that is spectacularly disgusting happens. It is as if the country has internalised the violence on the less fortunate and is shaken only when something as tragic as this recent spike in deaths takes place. Rajdeep Sardesai, a senior Indian journalist, expressed the sentiment best in his tweet: “outrage on twitter over the AMU 'story', but none over Chhattisgarh! I guess that tells us a bit abt social media too! Have a good day!”[sic] .


The only way forward is to break the death trap by challenging the system at all levels: from family planning policy to its implementation on the ground. It is time to treat all Indian citizens as equals and not to treat the poor as people who can be coerced or bought without informed consent. The success of family planning in Bangladesh, where it is much more voluntary show that engaging the people and making them stakeholder in things that impact their lives works, the system of coercion and allurement in India does not.

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