It is one of independent India’s darkest chapters. In June 1975, Indira Gandhi, then prime minister, declared a state of emergency and suspended democratic rights. Over the next 21 months of authoritarian rule, India unleashed an aggressive mass sterilisation programme, during which more than eight million people, mostly men, were cajoled, paid or forced to be sterilised, all in the name of population control.
The emergency is considered history. Yet the deaths this week of more than a dozen women who participated in a mass sterilisation “camp” at an abandoned hospital in rural Chhattisgarh reflects how the emergency mindset and methods still haunt India’s official approach to family planning and population control.
Sterilisation, though now mostly of women rather than men, remains India’s biggest single contraceptive method by far, encouraged by authorities seeking to fulfil ambitious targets, now referred to by the Orwellian term “expected levels of achievement”.
Though ostensibly voluntary, submission to sterilisation is encouraged by a combination of cash payments, and hard-sells from state health workers who are paid for each recruit they secure, or sterilise. Yet perhaps the biggest force is the lack of other available forms of birth control, especially in rural areas.
Of the estimated 4.6 million women sterilised in India last year, around 77 per cent had never previously used any other form of contraception. Campaigners say India’s failure to make modern, temporary birth control methods available to its women is itself coercive, negating claims of sterilisation as a voluntary choice.
“Where is the choice for women?” asks Poonam Muttreja, executive director of the Population Foundation of India. “Women don’t have options, so they end up getting sterilised.”
Along with the explicit and implicit coercion, human rights activists have long raised alarms about the primitive, unsanitary conditions, and factory-like ethos, in which mass sterilisations are performed, often with unclean equipment in makeshift settings.
In the lethal Chhattisgarh camp, 83 women were operated on in around five hours by a single doctor, who witnesses said briefly tipped his instruments in disinfectant solution between patients. The doctor — once lionised for performing more than 50,000 tubal ligations but now in custody on suspicion of culpable homicide — has blamed the women’s deaths on substandard medicine, including antibiotics, given to them after the procedure.
India’s total fertility rate — the average number of children born to a woman — has dropped sharply, from 5.2 in the mid-1970s, to 2.4, or just slightly above the replacement rate of 2.1, now. But that is mainly a result of social and economic progress, rather than mass sterilisations.
Fertility rates are lowest, even below replacement levels, in India’s most prosperous states, and those with the highest levels of female education and empowerment. It is more socially conservative, poorer northern Indian states, where fertility rates remain as high as 3.5 and which are most aggressively pushing sterilisation as a quick fix.
In international forums, New Delhi has recently promised to bring more modern birth control methods to its women — half of whom are of reproductive age — so couples can control their fertility, including planning when to have children, and spacing births.
But on the ground, the dysfunctional public health system is not even up to the job of providing basic counselling, screening or follow-up care to facilitate women’s use of modern, reversible birth control methods.
Yet instead of pouring money to strengthen its public health system to provide genuine family planning services, India’s new administration is now doubling the incentive payments for women’s sterilisation in “high focus states” from Rs600 ($10; Dh35.73) to Rs1,400.
Yet every year, around 56,000 Indian women die in, or shortly after childbirth — or around 190 maternal deaths per 100,000 live births, compared with a maternal mortality rate of just 32 per 100,000 in China. More than 309,000 of 26 million babies born in India each year do not survive 24 hours, accounting for 30 per cent of global first-day deaths.
A significant reason for these tragedies is women having children in quick succession. Sterilisation does not address this. Three decades after the emergency, it is time for India’s government to jettison its sterilisation fixation and offer family planning services worth the name.
— Financial Times
