Sterilisation: Does the government even care about women?

Jitni Devi broke down as she narrated her experiences in a sterilisation camp in Kaparfora Bihar in January 2012, where 53 women were operated upon at night in the light of a torch in a filthy and dilapidated school, by a doctor who did not even care to wash his hands or even change his gloves during the procedure. When benches ran out, women who had undergone the surgery were made to lie down in an open yard, even when some were bleeding and still in pain. Jitni Devi was already pregnant and miscarried soon after. This traumatic experience made her wonder, “Are we really considered human beings by the government?”

Three years and a court case on, a doctor awarded for conducting 50,000 sterilisation operations is arrested in Bilaspur, Chhattisgarh, after 13 out of 83 women he operated upon in a couple of hours in a dusty cobweb-festooned abandoned private health facility, lose their lives, leaving behind small babies crying to be breastfed.

The common thread between these two outrageous incidents is the family planning programme run by the government of India that wages a kind of war upon the bodies of women from poor and marginalised communities, determined to control their reproductive capacity at any cost. Despite an official "target-free" policy, targets for sterilisation cases are covertly imposed by the government upon health providers who in turn begin targeting the vulnerable. With no other option to regulate their own fertility; no information about safe, non-invasive spacing methods; with their male partners unwilling to take any responsibility for birth control, desperate women are herded by the dozens into "camps". There they wait for hours for the skilled doctors - few in number and much in demand, who when they arrive do not think twice before operating on each woman within two to three minutes - completely violating all standard operating procedures.

Shocked by the findings from a study of sterilisation camps in Uttar Pradesh in 2002 that found doctors violating all ethical and surgical norms, the Supreme Court in 2005 directed the government to set up Quality Assurance Committees (QAC) in each district, and provide insurance cover to all the women who underwent the surgery. Almost ten years down the road, the QAC are barely visible or functioning. At a recent public hearing in New Delhi in December 2014, a large number of women reported horrifying personal experiences during the sterilisation surgery. Undetected pregnancies, infected incisions and failure of the operation leading to children they did not plan for were some of the most common grievances women reported. Most women had never received any information about their insurance cover, while those who had the information, too, failed to get any compensation even several years after the failed operations.

Around four-and-a-half to five million women are sterilised each year in this country, which is approximately 98 per cent of all sterilisations, which is almost twice as much as any other country in the world. This has been the antiquated practice for several decades now, even when a vasectomy performed on a man is far simpler, far less risky and barely needs any recovery time. Moreover, the predominantly younger reproductive age-group of the 21st century requires more information about sexuality, delayed age at first conception, and a wide array of safe spacing methods.

A recent outcry in the media about surgeons using bicycle pumps to inflate the abdomen of women during sterilisation, instead of the mandated insufflators, has led the government in the state of Odisha to put a ban on sterilisation camps and provide fixed-day static services at health facilities to ensure quality standards are maintained. The government of India would do well to set up a high-level body to review the entire family planning programme to make it more gender-sensitive, more accountable in terms of quality standards, and in tune with the needs and aspirations of India’s largely young population.

Perhaps that may provide an answer to Jitni Devi’s question.