India and Women Sterilization : Pathetic Condition of Government Medical Set-Up !!

Sumati Devi knew before she arrived at the grimy government clinic in northern India that she would be paid to be sterilized.

She didn't know that she would lie on an operating table with bloody sheets, that the scalpel used to open her up would be stained with rust or that she was supposed to first get counseling on other birth-control methods before giving consent to have her fallopian tubes cut and tied.

Pic courtesy : blogs.wsj.com

The main reason Devi had agreed to be sterilized at all was because the $10 she received -- equivalent to about a week’s wages for a poor family -- would help feed her three children.

“I did it out of desperation,” said Devi, 25, as she lay on the concrete floor recuperating at the clinic in the state of Bihar. “We’re so poor, we need the money. Health officials came to our home. They told us it would be best.”

Relatives mourning death of a relative

The incident cited in this Bloomberg article (published in June 2013) is just one horrific instance of what generally is a government sponsored program to lure economically backward Indians – mainly females, towards surgical sterilization. This trend exists despite global agreement on preferring modern and non-surgical methods of promoting demography and population control.

Last week, 12 women died and over 50 have been hospitalized with over 25 reported to be critical following surgery for laparoscopic tubectomy at a government-run camp in the Bilaspur district of Chattisgarh. Four health officials have been suspended and the Director of Health Services has been transferred. Incoming reports suggest a single doctor with his staff performed 83 operations in 5 hours!  Please note that Tubectomy is a full surgical procedure where the belly is cut open. It takes about 1.5 hours to sterilize the equipment after each procedure. The equipment used in this particular case was rusted even before first woman was operated upon on that day.

All of the 83 surgeries performed that day resulted into varying degrees of infections.

Under established guidelines, a doctor can’t perform more than 10 tubectomy surgeries in one day. Reportedly Dr R. K. Gupta performed 83. This clear breach of law was then topped by distributing rat poison infested anti-biotics to camped women.

Sterilization Camps are often under resourced

Media lapped up this story since the number of deaths were ‘unusual’. Deaths of one off patients while undergoing tubectomy procedure has never raised any enquiring eyebrows in our country. Message is simple, even if stark in its apathy – as long as you are able to meet the target numbers; one or two deaths here and there shouldn’t bother us. These sterilization programs are often driven top-down where doctors are under pressure to meet the target number of surgeries. So even this incident involving 83 women will find itself unable to start any grass root change and which can bring a paradigm shift in how women make informed choice about their lives and health. A shift that India has already claimed to have achieved back in 2012 by the way, on a global forum none the less.

Pic courtesy : www.ryot.org

Instances of such deaths caused by the callousness brought upon unsuspecting rural households – women to be more precise, have been aptly termed as medical homicide by Dr. Binayak Sen. But this will be one of the rare types of homicides which is state approved.

R K Gupta, who performed the fated surgeries, has been summarily dismissed from the job. He was earlier awarded by state government on 26^th January this year for performing record 50,000 tubectomies so far.

The antibiotics Ciprocin that were handed out to women attending sterilization camp were found to contain chemicals used for rat poison. The state government said it had seized 200,000 tablets of ‘Ciprocin 500’ and over 4 million other tablets manufactured by Mahawar Pharma. Let’s put that into perspective. There were 2 lacs tablets containing rat poison which were ‘already manufactured’ and ready to go to the market. This was medical holocaust in making. We don’t know how many other such shady pharma companies are manufacturing life-threatening medicines in the name of generic and affordable drugs.

The drug manufacturing company which is in the eye of storm, Mahawar Pharmacuticals, was banned by state government 2 years ago for selling ‘duplicate generic drugs’. It has a factory in a residential area of Raipur which doesn’t even bear a signboard. Yet the government continued to buy medicines from it.

It is easier to get lost in a debate of fixing personal accountability. But the issue at hand has much larger contours and firm tentacles in the corridors of power.

Women go under scalpel in torrid conditions in shockingly under resourced hospitals where surgeries are often performed by rogue practitioners. These practitioners see each patient as another step toward meeting the target prescribed by higher authorities. Root of this practice could be found in a 1952 announcement that was seen as an effective tool to ward off hunger related misery in India. It found further heft and became more overt during Indira era of 1970, when press was subjugated and constitution briefly suspended. ‘Forced’ surgeries might have waned in the decades since, but a factor of coercion is still present in almost all rural parts of the country. Women from poor households are lured for a paltry sum of INR 1400 – barely enough to support their families for a week, and are herded into shamble of a facility called hospital where they are operated in unsafe conditions in the name of population control.

Pic courtesy : thebreakthrough.org

A glowing irony then, is the fact that, despite such inhumane and coercive initiatives pursued by almost all governments since freedom, India has missed every target it set for population control. India will eclipse China by 2021 in population with the current rate.

So this method solves no one’s problems except for those looking to meet the ‘target’ numbers.

India sterilizes more woman surgically than any other country in the world - accounting for over 37% total such surgeries performed last year globally. Of 5 million sterilizations performed last year, 96% were performed on Women. Only 4% of total surgeries were performed on men.  This despite the fact that surgeries on men is relatively safer to perform.

Are even Indian medical practices sexist?

As an attempt to project a global image which is progressive and modern – India has boasted the paradigm shift in the way medical infrastructure has been revamped to cater remotest corners of the country. Infrastructure has indeed improved in past decades, but the medical services that are supposed to use this infrastructure to take the medical care to last mile have simply been stranded. Lack of any long term planning has ensured that women are not educated about other choices for birth control which is much safer compared to surgical procedure. Educating women and ensuring a constant flow of birth control pills and devices through state managed public distribution system has been deemed ‘expensive’ way of ensuring population control and so we have opted for cheaper and easier option of performing sterilization – Tubectomy.

These camps could be molded into the harbinger of medical portal – taking awareness and medical facilities to the door step of poorest of families. But in reality the doctors at these camps are mostly constrained by resources and are assigned untenable and unethical targets. Camps themselves are filled beyond capacity and often surgeries are performed while women lay in a queue on floor – separated by no more than an arm’s length. Surgical equipment are rusted and never cleaned up between two surgeries. Medicines are bought from dealers and manufacturers who hardly meet any regulatory standard for safety.

Pic courtesy : www.businessweek.com

So some of the pertinent questions for the state and union functionaries are looming large. Will they choose to see and act on these or will the questions be brushed under the carpet till we start to discuss yet another birth control camp mishap in another part of the country -where victims are almost sure to have a predictable profile. A young woman who comes from the poor household, who knows nothing better than risking her life for a remuneration that will support her family for a few days. And who hasn’t been informed about the alternate choices of birth control by medical staff that doesn’t have anything apart from rust induced surgical equipment waiting for her.

What is your view on medical facilities in government hospitals throughout the country? How it can be improved effectively?

Is sterilization is the best way for population control? What are your suggestions?

What do you think about prevailing imbalance in male sterilization vs. female sterilization?

(Written by Manish Jha, an Alumnus of IIIT Hyderabad and currently working with Microsoft as Program Manager. He is also associated with a social initiative 'Joy of Reading')

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