On Tuesday, health officials in India reported eight deaths and nearly 70 more hospitalizations following a horrific sterilization procedure in a government run "health camp." While mass sterilizations under unsanitary and inhumane conditions like this have been known to lead to the deaths of women, this marks the largest loss of life during a sterilization drive in recent history.
Women in the Bilaspur district, in the state of Chhattisgarh, had begun to fall ill about five hours after the procedure, reporting "giddiness, vomiting and low blood pressure," symptoms of septic shock. Ellen Barry and Suhasini Raj at the New York Times describe the surgical conditions that led to the deaths, conditions that are completely normal in the sterilization camps:
The women were paid 600 rupees, or almost $10, apiece for undergoing the procedure at the camp, said Amar Singh Thakur, joint director of health services in the central Indian district of Bilaspur. One surgeon performed surgery on 83 women in the space of six hours Saturday — meaning he could have spent only a few minutes on each patient, Dr. Thakur said.
Dr. Raman Kataria, who works with an NGO that also performs sterilization procedures, says that under safe conditions (including the proper cleaning of tools), a doctor could only perform two to three tubal ligations per hour.
"This incident is a reflection of a very bad, poor system, of a nonexistent and nonaccountable public health system, where such tragedies are waiting to happen," Dr. Kataria said. He said there were regularly reports of one or two deaths after health fairs, as the events are also called, but this was the worst incident he could remember.
"This is nothing but coldblooded murder," he said.
All of the victims were poor women (Chhattisgarh is India's poorest state) who would be willing to undergo a procedure for such little money just to make ends meet for a week or two. Policy mandates that potential patients be provided with counseling rooms and must be given consent forms in their mothertongue—guidelines that were clearly and roundly ignored.
As a result of the deaths, four Chhattisgarh senior health officials have been suspended, and a criminal report has been filed against R.K. Gupta, the doctor who carried out the procedures. Unfortunately, the conditions that led to the deaths of the Bilaspur women are not uncommon; Gupta may just be a scapegoat for a much more widespread issue. Doctors often operate on hundreds of women in just a few hours.
In India, sterilization procedures focus on women. India is the world "leader," responsible for 37 percent of all female sterilizations, while vasectomies only accounted for 4 percent. According to New York Times, between 2002-2003, there were 114,426 vasectomies and 4.6 million tubal ligations. Female sterilization accounted for 71 percent of contraception of the 48 percent of married couples who do use contraception.
But India's relationship with sterilization goes back decades. During a period of time of political disarray between 1975-1977, known as "the Emergency," forced sterilization was enacted as a way to combat the country's ever-rising population, though they mainly focused on vasectomies. While the compulsory aspect of the sterilization was condemned shortly thereafter, since 1977, India has promoted the idea of sterilization and the two-child norm (TNC), meaning women who had already given birth to two kids were perfect candidates for tubal ligation.
For decades, the country maintained sterilization goals, targets to be met by any means necessary. Then, in 1996, the Indian government endorsed and committed to the Cairo Consensus, a plan set out by the International Conference on Population and Development (ICPD) in 1994, taking on a "target-free" approach to sterilization that included providing potential patients with more information and other options. While India's central government and even state governments have dropped their targets, the system is still very much alive and well at the district level. And at the district level, the target system has been propped up in large part through intimidation of health workers.
A 2012 report by Human Rights Watch describes the high-pressure situations and coercive strategies that lead to mass sterilizations:
[S]ome health workers pressure women to undergo sterilization without providing sufficient information, either about possible complications, its irreversibility, or safer sex practices after the procedure.
"Health workers who miss sterilization targets because they give proper counseling and accurate information about contraception risk losing their jobs in many parts of the country," said Aruna Kashyap, women's rights researcher at Human Rights Watch.
HRW interviewed more than 50 health workers from two districts in the Gujurat state who specialize in female health and family planning. All claimed that district and sub-district authorities maintain targets "with a heavy focus on female sterilization" and that these authorities threatened a reduced or withheld salary, negative performance assessment or even suspension and dismissal.
In one case, a health worker reported that she was asked to falsify records to show she had met targets or else she would be reported for poor performance.
But the disconnect between India as a national government and its state-level and local level is an issue that plagues nearly every aspect of Indian policy. India's national positions look a lot different by the time they make it to the local level—like a Gestaltist Frankenstein. And it seems cruel that the very issue that most affects India's bureaucracy—overpopulation—is also at the heart of its sterilization crisis. Still, it in no way justifies subjecting Indian citizens, particularly women in poverty, to the sub-par conditions maintained in the "health camps."
This past September, world leaders reunited to mark the 20-year anniversary of 1994's ICPD. At the conference, India reiterated its commitment to the Cairo consensus. It's tragically ironic that while expressing India's commitment to "ensuring gender equality, promoting women's empowerment and combating discrimination and violence against women," women are still dying after being coerced to undergo a needlessly dangerous procedure in circumstances that are strikingly similar to those 20 years ago.
Image via AP.