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.
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| 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.”
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| 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.
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| 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.
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| 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 26th 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.
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| 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.
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| 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')
