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The deaths this week of at least 15 women who were sterilized in an Indian health camp allegedly stocked with tainted drugs has resurfaced memories of the country’s mass sterilization campaigns during the 1970s, when millions of Indian men were forced to undergo the procedure as part of former Prime Minister Indira Gandhi’s family planning policies.
Forty years later, though, India’s sterilization campaign has mostly claimed female victims. That, in part, is explained by the nature of the medical procedure — vasectomies are safer, medical experts say, than the operation women undergo, which involves cutting and tying fallopian tubes through a keyhole-sized opening in the abdomen.
Another explanation lies into sheer figures, which began to shift radically in the mid-1990s. Less than one percent of the Indian male population chooses to undergo the sterilization procedure, while nearly four out of ten women choose sterilization — the highest percentage in the world, according to the World Health Organization. Men’s reluctance, centered on cultural taboos, comes despite more generous financial compensation for the procedure: In most states, men who choose to be sterilized are paid $33 by the Indian government. Women, on the other hand, typically receive $23.
India’s reproductive health policies are firmly rooted in state-enforced discriminatory practices, according to Abhijit Das, director of the Center for Health and Social Justice in New Delhi, India. Health care workers tasked with hitting sterilization targets deliberately seek out women and don’t inform them about the risks of the procedure or alternatives of birth control, said Das.
“There is no other method being provided consistently,” he said, adding that a fear of overpopulation in Indian policy circles drives politicians to prefer female sterilization over other methods of population control. Das said lawmakers regard poor women in rural areas — where 850 million Indians live — as “irresponsible breeders.”
The massive demand for sterilization means that at clinics that house six beds up to 100 women lie on floors waiting for surgery, said Das. Some state-employed surgeons operate on as many as 13,000 women per year, like Dr. R.K. Gupta, who was arrested on Wednesday on charges of breaching government protocol when he plowed through more than 83 surgeries in less than three hours at a health camp in Chhattisgarh state.
“It’s basically like cattle camps, it absolutely inhuman,” said Das. “These venues are not meant for so many people.”
In 1994, global health officials at a conference on population and development in Cairo, Egypt, decided to move away from coercive sterilization methods, favoring informed consent. Around the same time, the science of female laparoscopies improved, and it became easier to perform the procedure.
These two influences, said Das, influenced India policy makers to focus sterilization campaigns on women instead of men. Women, furthermore, are considered less politically powerful and more susceptible to pressure, said Das.
“We think we can push women, we can coerce women,” said Poonam Muttreja, executive director of the Population Foundation of India.
Leaving men out of the family planning conversation has put the burden of population control entirely on women. Contraceptive counselors, Muttreja said, do not discuss vasectomies as a suitable alternative to female sterilization.
“Indian men think that their virility will be affected and that they become weak. That’s a myth, and the government has done nothing to correct that,” Muttreja added.
India’s family planning policies hit the country’s poor and underprivileged women hardest, say experts. Laws, for example, that bar people with more than three children from holding office in local village councils disproportionately affect socially disadvantaged groups, according to a study backed by the United Nations’ Fund for Population Activities (UNFPA). The policy also led to a rise in forced abortions and abandonment of female fetuses, the researchers found.
“India’s a democracy,” Muttreja said. “It’s not necessarily a democracy for poor women. But for men if you’re poor, you still have choices. If you’re a woman, you have less.”
With news wires
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