Why India’s Family Planning Program Is Not Good for Poor Women
NEW DELHI—The death of sixteen women from a sterilization camp last month raised critical questions about India’s family planning program and the culture that led to the creation of sterilization camps.
On Nov. 8, eighty three women in the central city of Bilaspur, were sterilized in six hours with the same laparoscope, the same gloves, and the same needles.
Sixteen of them died the next day, and while their deaths were initially attributed to the drugs they were given post-procedure, an investigative report by four NGOs said the deaths were mostly likely caused by infection.
On paper, India’s family planning program includes a wide array of birth control options to help stabilize the 1.25 billion population. In practice, however, the main form of birth control advocated by the government is sterilization, and sterilization of females in particular.
It is 80 percent easier to sterilize men than women, according to Florence Jasmine David, a nurse and program director at International Services Association, a community health organization in India.
Despite this, sterilizations are still exponentially more common for females in India than they are for males, as birth control is still seen primarily as a women’s responsibility.
“There’s a misconception that [for men] sexual power goes off because of sterilization,” said Dr. S.K. Sharma, a psychotherapist at a holistic care clinic in New Delhi called Ethos Health Care.
What is more, the mini laparoscopy that studies show produces better results is not being used because there aren’t enough surgeons trained in it, the report says.
“What they [the doctors] know right now is laproscopy, so they just continue to do it,” said said Poonam Muttreja, the executive director of the Population Foundation of India, and a member of the investigative team that authored the report.
She said it has to do with the patriarchal attitudes that place a higher value on males than females in India.
“The point is, when you don’t care about the women, why would you change the situation?” she said.
The family planning program works on a system of incentives. The women at the sterilization camp in Belispur were paid $22 (1,400 rupees) for the surgery, which is about a months wages for unskilled labor in that area.
Looking at India’s 2013-2014 family planning budget of $624 million, incentives for female sterilizations accounted for 85 percent of the total expenditure. Only 1.45 percent was used for other contraceptive methods and 13 percent for equipment, transportation, and staff expenses.
“The huge spending on compensation/incentives only to bring women to non-functional facilities with poor quality services that are a health risk, is inappropriate and unacceptable,” the report said, adding that the program should focus on quality of care instead of numbers.
In addition to the patient’s compensation, the health care worker who recruits the patient and the medical staff are also paid per patient, which activists say creates a system where the patient is pressured into the surgery without being properly informed.
“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, a researcher at Human Rights Watch, in a statement.
These incentives and targets violate the norms India agreed to at the UN’s International Conference on Population and Development in 1994, and its own National Population policy that emphasize informed, free choice for family-planning programs.
According to Muttreja people in the community know that women have died from sterilization procedures, but because of the lack of alternatives and information, many are not aware how risky it is.
“They don’t know what kind of conditions are needed for a surgery, or what kind of treatment,” she said. “They are always treated badly, and they see these filthy, badly equipped, badly managed, primary health care centers in any case, so they don’t know any better,” she said.
From 2009-2012, 707 women died in India because of botched sterilizations procedures, according to the report.
Muttreja said the death of 16 women at once brought a lot of attention to the issue, but this is not a new problem.
“The point is not to shame and blame the government but the point is to learn from this case and that’s why we did this investigation—to see how we can improve the family planning program for women of India,” she said.