WUNRN
Why Indian Women Are Pressured
Into Risky Sterilizations
By Barbara Crossette on Nov 17, 2014
Women meet in Chhatisgarh, India, on development
issues. The area recently came into the news for the deaths of women from
forced sterilization. RAKESH SAHAI/ADB
The tragic deaths of more than a dozen women in India
recently, after being sterilized in assembly-line style by a doctor and his
assistants eager to cash in on as many procedures as possible on a given day —
at least 83 in a few hours in this case — are the symptom of a disastrous
family planning system that deprives most poor women of any other choice. They
know they are risking their lives.
“Unmet need for contraception is not a
demand failure,” Poonam Muttreja, executive director of the independent Population Foundation of India, said in an
interview in 2011. “The demand exists, the supply does not.”
In November, Muttreja said in a statement:
“Family planning saves lives. When it ends up taking the lives of young
mothers, or inflicts them with lifelong morbidity, it is a tragedy of
monumental proportions as we have seen in Chhattisgarh. PFI urges the
government to make available a wide range of quality temporary contraceptive
methods, give clear and adequate medically accurate information, including the
benefits and risks, so that individuals can choose the method they want to
adopt.”
Fewer than half the women of childbearing
age in India use any “modern” contraceptive, United Nations data show, and for
most of them that means sterilization.
The breakthrough International Conference
on Population and Development, held in Cairo in 1994, made the case for choice
very clear: reproductive health, most nations of the world agreed, included
“the right of men and women to be informed and to have access to safe,
effective, affordable methods of family planning of their choice.”
The medical abuse of women in often filthy
“sterilization camps” set up on designated days in India is not strictly a
result of population control policies, as many have surmised. Those policies
were largely abandoned after forced sterilization of men took place in the
1970s.
The situation arises instead from
indifference to the health and rights of women and the failure to offer
alternatives. A major problem is the setting of targets, often in corrupt local
or state health care systems, which allow doctors to offer incentives, such as
a small amount of cash or a gift, to a poor woman who may want to limit the
number of children she has, while contributing something to the family’s meager
resources. The doctor is rewarded according to the number of women he
sterilizes.
Human Rights Watch, which has tracked
sterilization in India, said earlier this year that in addition, “women and
girls with intellectual disabilities continue to be sterilized without their
consent.”
India is not alone in relying on
sterilization as a major birth-control tool, though it stands out for denying
poor women, many at a very young age, a choice of other and reversible methods.
Globally, according to the UN Population Division, 18.9 percent of women,
married or in an established partnership and using any “modern” birth control
are sterilized, compared with 2.4 percent of men.
India, with 1.2 billion people, leads the
world numerically in female sterilization, with almost 36 percent of women
seeking contraception undergoing the procedure, while only 3.6 percent use
birth control pills, and statistically virtually none use injectables or
implants that are popular — and available — in many other developing countries.
Sterilization for women in Africa is statistically
low: in single percentage digits except for South Africa, Namibia and Cape
Verde, according to recent data from the UN Population Division. Figures are
higher generally in Latin America and the Caribbean, with the Dominican
Republic reporting 47.4 percent of women using sterilization as a family
planning method, a higher percentage than in India, but far lower numerically.
In Asia, China and Thailand are the leaders
in percentage terms — 28.7 for China and 23.7 for Thailand. In many of these
places, however, tubal ligation procedures are performed in a hospital or
clinic, reducing complications. To add to the sad story of Chhattisgarh, women
were sent home with phony antibiotics and painkillers, a widespread problem in
India, where pharmaceutical products are often found to be fraudulent.
In a report in September this year, the Guttmacher
Institute, a leader in family planning research, looked at 109 low- and
middle-income countries, including India, where contraceptive practices were
skewed inordinately to one method.
The report made this important distinction:
“Skewed method mix is not a definitive indicator of lack of choice or of
provider bias. Rather, it is a potential red flag, worthy of further
investigation at the country level. If the preference reflects cultural or
societal norms (in the presence of reasonable access to a range of
contraceptives), then there is no reason for concern. By contrast, if the
predominance of a single method results from lack of access to multiple methods
or provider bias, then choice is compromised.”
The deaths in the Indian state of
Chhattisgarh have provoked outrage in the Indian media. The Hindustan Times, in
an article titled “Death by Sterilization in India: Chhattisgarh Is Just One
Horror,” pointed out that the procedures that left at least 13 women dead and almost
140 ill, some of them critically, directly violated a 2005 Indian Supreme Court
ruling that a medical team should conduct only 30 tubal ligations a day, with
each doctor limited to 10.
“In 2012, India committed to providing 48
million additional women and girls with access to contraceptives by 2020,” the
newspaper reported. “However in India about one in five women of reproductive
age do not have access to [a] modern method of contraception.”
As a result, millions of women are herded
into sterilization camps and clinics. The newspaper added that this number may
in fact grow as India tries to meet its targets in providing family planning
and takes the easy way out by expanding sterilization.
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