BY INVITATION. Terminating the camps, the targets, the incentives

The prevailing anxiety over population growth and the resulting coercive population control measures target women, particularly those poor and underprivileged, be it through sterilisations, incentives and disincentives or the two-child norm.

Targeted family welfare programmes continue in different states across the country driven by an obsession to bring down the Total Fertility Rate. In states like Madhya Pradesh, Bihar, Chhattisgarh, Rajasthan and Uttar Pradesh, sterilisation ‘camps’ are often conducted in schools, abandoned buildings, make-shift camps with poor quality services leading to high morbidity rates including mortality. Health providers in parts of India confess that they are under pressure to fulfil unwritten targets coming from the top. A tubectomy has been trivialised and is not treated as a surgery that requires standard pre-operative and post-operative care. As a result, there is severe compromise on the quality of care provided during these surgeries in sterilisation camps, putting the health and lives of women at risk.

The tragic death of 13 women and the critical condition of 30 others during the recent sterilisation ‘camps’ in Chhattisgarh’s Bilaspur district is yet another case of systemic failure at multiple levels — a consequence of insensitive population policies and the callousness of the public health system. To put the incident in perspective, it is important to understand the budget approval process for population policies in India.

In the Programme Implementation Plan of Chhattisgarh 2014-2015, the “target” for female sterilisations was 1.5 lakh and male sterilisation was 8,000, which was to be completed in six months i.e. between October 2014 and March 2015. Such pressing targets have consequences in camps such as the one in Bilaspur where 83 women were operated in five hours in complete violation of Supreme Court Orders (2005 and 2012) and Ministry of Health guidelines (2008) for sterilisation camps.

As per court orders and government guidelines, a surgeon can perform only 10 operations in a day and a maximum of 30 operations can be conducted with three surgeons.

It is important to keep in mind that these operations are not urgent and are elective. In the Bilaspur camp, all these guidelines were violated with impunity and the doctors involved have violated basic medical norms ruthlessly.

In this context, several policy matters and systemic issues need to be addressed to rid undue emphasis on female sterilisation by Family Welfare programmes. The state still focuses on permanent methods of contraception rather than provide safe temporary contraceptives facilitated through better access.

In addition, the two-child norm significantly contributes to the pressures to sterilise.

The public health system, in many parts of the country, is dismal; non-availability of doctors, lack of health personnel and medicines plague it.

Despite years of planning and allocating money for the improvement of the health system, under reproductive and child health, under the NRHM, and despite years of so-called technical support to improve health management, there are no improvements at the ground level.

Yet this collapsing public health system, where women rarely receive primary and reproductive care, is used as a vehicle for promoting population ‘control.’ This entire Bilaspur episode makes it imperative to critically examine existing population policies and schemes.

(The writers are working with Sama-Resource Group for Women and Health, Delhi and Jan Swasthya Abhiyan)