ISSUES
: Our Changing Population
Chapter 2: Global population issues
32
Inside India’s sterilisation camps
An article from
The Conversation
.
By Sabu S Padmadas, Professor of Demography and Global Health, University of Southampton
A
sterilisation
camp
held
in
Chhattisgarh,
an
impoverished state in central
India, has claimed the lives of 13
women, most of whom were young
and marginalised. The women, who
died within hours of the procedure,
were among a group of 83 patients
sterilised over the course of just
five hours at the mobile clinic. It
now appears they died as a result
of contaminated medicines. The
incident raises critical questions
about surgical standards, infection
control protocolsandpost-operative
care in India’s reproductive health
and family-planning programme.
The tragedy that unfolded at this
clinic shows how urgently the
approach taken to sterilisation
in India needs to be changed.
Warnings have been made
before about conditions in these
camps. In 1994, as part of a team
of researchers, I observed 48
procedures carried out in just over
two hours at a camp in Kerala, a
state in the southern region which
ranks the highest among Indian
states in terms of human capital,
social and health development.
Yet, surprisingly, regulations were
being violated at the campsite and
poor hygiene standards and a lack
of decent infrastructure were clear.
There was inadequate counselling
for the patients undergoing
sterilisation and they were not
getting follow-up attention.
The history of sterilisation
The debate on the quality of care in
Indian family planning programmes
dates back even before this time
though. The Government first
introduced
mass
sterilisation
camps in the 1970s. At that time,
India and China had similar fertility
rates of six children per woman.
The two countries took different
routes in response to the problem
but both were seeking long-term
solutions to controlling their rapid
population growth.
Female sterilisation continues to
be the most popular and dominant
method of contraception in India.
This is especially the case in
southern states, which managed to
achieve a fertility below replacement
level way back in the late 1980s and
1990s – so each couple had just
enough children to replace them.
The programme initially promoted
vasectomies and targeted couples
with two or more children. The
Government set targets and
health providers were offered
cash incentives to recruit eligible
couples for sterilisation. Many men,
including those who were unmarried
and illiterate – or were political
opponents of the Government
– were coerced into accepting
sterilisation without consent.
The vasectomy programme was
deemed a major failure. There
was serious a public backlash,
blaming the Government for
forcing sterilisation on poor people.
Evaluations of the programme
identified weaknesses including
method failure, side effects and
sub-standard quality of care during
and after the procedure. The ruling
Congress Government even had to
step down during an emergency
period in 1975–77, following
allegations made about the coercive
family planning programme.
Since the 1980s, sterilisation
programmes have focused solely
on women. Now, more than two-
thirds of contraceptive use in India
is female sterilisation. In some
southern and western states, as
many as 50% of women have been
sterilised. The method has been
widely used, mostly by young
women, across India for more than
three generations. In most cases,
women have few options and rely
directly on sterilisation as the first
method of contraception they ever
use. Although the Government
removed family planning targets
in 1998, there is still evidence of
coercion in sterilisation camps in
many parts of India.
Following the rules?
There are national guidelines about
how sterilisation camps should
be organised, the clinical training
that staff need to receive and the
essential medical supplies that
should be on hand – including
antiseptic solutions and drugs.
Sterilisation camps, in mobile or
institutional settings, mostly operate
at the district or sub-district level
and are co-ordinated by the district
health administrators. For both
clients and providers, the camps
are convenient, easy to access and
cost-effective. Only qualified and
trained medical professionals are
allowed to conduct sterilisations.
Local health workers recruit women
or their husbands and usually
arrange transport facilities to
the camps. They have to provide
adequate information about the
procedure to clients including
potential side effects, indications
and contra-indications associated
with the method.
The clients are expected to declare
their age, family information,medical
history and physical and mental
health status before the procedure.
They should undergo physical and
laboratory examinations prior to
the surgery. The protocols require
“The tragedy that
unfolded at this clinic
shows how urgently
the approach taken to
sterilisation in India
needs to be changed”
“Female sterilisation
continues to be the
most popular and
dominant method of
contraception in India”
