By Kavita Krishnan:
15 women dead after an assembly-line series of operations in a sterilization camp in India’s Chhattisgarh state. Spurious drugs with traces of rat poison, from a dubious pharmaceutical company that didn’t have its licence cancelled in spite of having a record of manufacturing sub-standard drugs. Horrific conditions of hygiene, and callous unconcern for the niceties of informed consent from the women. Sterilization as the favoured method of contraception. And a policy of ‘population control’ by the Indian State and international funding agencies – disguised as a concern for women’s reproductive health. The entire story raises the spectre of concentration camps and Goebbelsian eugenics.
‘Development’ and ‘Clean India’?
The massacre in Bilaspur is a grim reality check on the model of ‘development’ of which India’s governments and ruling parties have been boasting.
An advertisement by the Chhattisgarh Government (ruled by the BJP that is also in power at the Centre) recently boasted of the forest cover and mineral wealth that the State could offer investors. The unspoken truth is that the forests and minerals are being grabbed from the adivasis (indigenous people) by force. But more importantly, who is that model of ‘development’ benefiting, if the state’s poor are condemned to receive no healthcare, except what is made available in ‘camps’ from time to time? This camp-based healthcare has taken a grim toll before. In 2012, nearly 7000 women were subjected to forced operations to remove uteruses, in Chhattisgarh’s private hospitals within a period of 30 months. The private hospitals had done the operations to profit from the Rashtriya Swasthya Bima Yojana (National Health Insurance Scheme) package money. Between 2011-2013, around 100 people lost their eyesight due to botched up cataract operations in an eye camp the same state.
During the ‘Clean India’ campaign flagged off by the Prime Minister recently, many MPs, MLAs and bureaucrats got themselves photographed holding new brooms. The sheer hypocrisy and superficiality of the campaign is underlined by the contrast with the conditions in which the women were operated upon in Chhattisgarh: operations taking place on floors, filthy surroundings, and dirty drugs to boot.
Deadly ‘Targets’
The Chhattisgarh Government is desperately trying to insulate itself from responsibility for the mass deaths, restricting liability to the doctor who performed the operations and the drug company that manufactured the spurious drugs.
But this doctor is the same one that the Chhattisgarh Government awarded a medal on Republic Day, for performing a “record number” of 1,00,000 laparoscopic sterilizations in his career. How can the Government that was thus encouraging doctors to set records for numbers of sterilization surgeries, wash its hands off responsibility for the massacre that resulted from the same urge to break records?
The fact is, that the state policy of setting targets for ‘population control’ has led to the race to perform operations in an assembly-line manner, in ‘camps’, and this had led to botched surgeries in Bihar and Madhya Pradesh before – and now the massacre in Bilaspur.
The Human Rights Watch in a report published in 2012 established that target-based sterilizations, pursued by the Indian Government, are coercive and endanger women’s safety. They quoted ASHA and anganwadi workers saying that they and doctors are under pressure from Governments to “meet targets”. The report observed that “Two years after the 1994 International Conference on Population and Development, India announced that it would take a “target-free” approach to family planning. Since then, the Indian government has stopped setting centralized targets. But in practice, state-level authorities and district health officials assign targets for health workers for every contraceptive method, including female sterilization. In much of the country, authorities aggressively pursue targets, especially for female sterilization, by threatening health workers with salary cuts or dismissals.”
How can the Health Minister, whose house is a few kilometres away from the spot where the sterilization massacre took place, possibly keep his job after this horror? He claims to be unaware of the target-driven surgeries, filthy conditions of the camps, and procurement of drugs from a company with a record of sub-standard drugs. Wasn’t it his job to know? Surely he should lose his job for his very lack of awareness of these facts?
‘Demand-Driven’ Sterilization?
A BJP spokesperson, responding to the allegation of target-driven sterilizations in India and Chhattisgarh, responded by claiming that the sterilizations are in fact, ‘demand-driven’.
This is a deliberate obfuscation of facts.
The truth is that women demand contraception. Why is sterilization offered by the State as the first option for contraception? A piece in the Guardian quotes an HRLN lawyer who met the affected women in Bilaspur, “Only three of 15 women (spoken to) had heard of any other form of contraception,” and quotes one of the women saying, “This was the only way to stop more children from coming.” So, if women are not informed of other forms of contraception and not told that in fact, sterilization is the most invasive method, there was no informed consent.
The women demand contraception. But the State, and international funding agencies, are clearly not concerned with offering contraception to women. They are interested in regulating women’s wombs, so as to ‘control population’. Sterilization takes the decision out of the hands of women, permanently. And this suits the ‘population control’ agenda of the State much more effectively than other forms of contraception that women, and couples, can start and stop at will.
The Indian State and the funding agencies may tell each other the convenient lie that ‘target-driven population control’ has been given up in favour of ‘demand-driven contraception’ and ‘women’s reproductive control’. But the fact remains that women will continue to be herded up and cut up in sterilization camps, unless there is an urgent reversal of the very notion of ‘population control’.
Population Control
‘Population control’ and ‘family planning’ policies promoting contraception are not viewed by the Indian Government and international funding agencies in the framework of women’s rights and control over their bodies and reproductive rights. Rather, the policies are framed as a way to control ‘overpopulation’ in India and other similar countries.
The very question of ‘overpopulation’ is a racist one, of Malthusian origin. The premise is that unchecked ‘overpopulation’ is responsible for poverty, and for climate change. And this is a lie. Poverty is due to skewed distribution of resources – whereby a tiny fraction of the world’s richest people and countries control and hog the world’s resources. And climate change happens due to the way in which this tiny minority ravages those resources and the earth for the sake of profit. Blaming the ‘teeming millions’ of poor people and poor countries is a deliberate, racist myth.
But shouldn’t a poor country like India worry about exploding population? Well, in the first place, we need to ask, why is India poor? Isn’t it because it was colonized by England?! Now, how can the same England turn around and tell Indian women that they need to produce fewer children in order to end India’s poverty?! And inside India too, people are poor not because they have too many babies but because they have too little access to land and other resources! Our resources are grabbed – not by the millions of poor people – but by the tiny slice of richest corporations!
Adivasis and State Control
There is one issue that especially disturbs me. There have been several news reports that among the women who died in the sterilization massacre was a woman from the Baiga tribe. Papers reported that the tribe was exempted from ‘population control’ measures. The truth is more complicated.
The Down to Earth reported in November 2012 that “During the Emergency period when the Indian government had initiated forced sterilisation to control population, five primitive tribes in Chhattisgarh were left out because they were having very few children. The reason for their dwindling numbers–acute poverty and lack of health facilities–was ignored”. But in 2012, the government again began extending family planning facilities to these tribes, including the Baigas.
Another story recounts how Primitive Tribal Groups (PTGs) in Chattisgarh, India, struggle to provide for their families and were forced to lie about their identity to overcome the restriction on family planning owing to a three decade old order of the Madhya Pradesh government that restricted PTGs from being targeted during the family planning drives of the time. So, the adivasis themselves, are considered incapable of deciding if they need contraception or not! They are infantilized, just as all women are, and the decision is taken by the State!
Meanwhile, government representatives on TV channels have spoken blithely about how certain states and regions are “high fertility” and therefore “high focus” for population control.
What these stories bring home, for me, is the casual way in which we in India accept that the State can decree which states, regions or communities are “high” or “low” fertility; which need to be denied access to contraception, and which need to be subjected to mass sterilization drives!
This is a very far cry from contraception being an individual woman’s decision. Women, in this scheme of things, are mere wombs – and the State decides which wombs must be harvested and which neutered.
The decision to bear a child or to avail of contraception cannot be one that anyone other than the would-be mother must make. For the State to decree that abortion is illegal (as some US states still do); for the State to decide that abortion must be illegal because the ‘population rate is too low’ (as the Soviet Union did under Stalin); for the State to decree that a woman can only be allowed to bear one child (as the State in China does) because the ‘population rate is too high’ – these are all instances of unconscionable control of the State over women’s bodies.
We in India have to tell our Government to put a firm end to the framework of ‘population control’. Governments simply cannot be allowed to regulate and control women’s bodies. If they do, there is little we can do to prevent horrors like Bilaspur from recurring. And the horror doesn’t lie in the deaths alone. The horror lies in the reality of poor women denied the informed choice and access to safe contraception – and instead at the mercy of a system that incentivises sterilization.
The ways in which incentives are offered is especially shocking. A newspaper reported last year that touts in Madhya Pradesh are offering a Nano car for anyone who brings 500 patients (male and female) for sterilization; a fridge for 50 and a 10gm gold coin for 25! In Rajasthan in 2011 (then ruled by the Congress), health officials themselves endorsed such incentives, approving offers by a local charitable trust of “a car, motorcycles and television sets to men and women who volunteer for sterilisation”.
Literally, our so-called ‘family planning programme’ has become a head-hunting game, where touts herding people into sterilization camps can get some quick cash and commodities.
Funding Agencies – The Hidden Hand
The British Government’s DFID, USAID and the Bill Gates Foundation are some of the agencies that are rendering India’s poor women at risk in the name of ‘family planning’. But these agencies and the Governments that back them, have learned to speak a more politically correct language. For instance, British MP and DFID Minister Stephen O’Brien, speaking on behalf of the British Government on World Population Day 2011, said “the Coalition Government does not support programmes that coerce individuals and couples to have fewer children. Population control, in the sense of government edicts and targets on fertility levels, has no ethical place in contemporary rights based development policy making.” Instead, he claimed his Government was only interested in promoting women’s control over their bodies and right to choice. But the truth is quite different.
The DFID has funded ‘population control’ in India – and is thus implicated in the mass sterilization deaths that took place in several states. Not only that, DFID has promoted contraceptive implants that have been proven to be unsafe for women. As Kalpana Wilson writes, “DFID (is involved in a joint operation) with Merck to promote the long-lasting implant Implanon to ‘14.5 million of the poorest women’ by 2015’. Implanon was discontinued in the UK in 2010 because trained medical personnel were finding it too difficult to insert correctly, and there were fears about its safety. As well as a series of debilitating side-effects, the implant was reported as ‘disappearing’ inside women’s bodies. Merck has introduced a new version Nexplanon, which, although almost identical in other ways, is detectable by X-ray, but have been allowed to continue to sell their existing stocks of Implanon.”
Similarly, the Gates Foundation was involved in a clinical trial of the HPV vaccine against cervical cancer in India in 2009, (that) falsely claimed to be a ‘post-licensure observational study’, for which 23,000 girls aged 9-15 from impoverished communities were selected and requirements for parental consent were bypassed. The trial was suspended following the deaths of seven adivasi girls aged between 9 and 15. A government enquiry found that the process of obtaining consent amounted to ‘covert inducement and indirect coercion’, and expressed concerns over a ‘hidden agenda’ to push the expensive vaccinations manufactured by Glaxo Smith Kline and Merck Sharp and Dohme into India’s Universal Immunisation Programme.
Earlier, other contraceptive implants like Net-En (Depo-Provera) have been promoted in India, that had widespread side effects on women’s reproductive health and safety.
We must of course demand action against Chhattisgarh’s Health Minister. But the matter cannot end there. We must demand a moratorium on the Indian Government’s policy of sterilization as a form of family planning, and a review of the whole ‘family planning/population control’ framework. Instead, we must demand an expansion of women’s access, through informed choice, of a range of safe methods of contraception, with non-invasive methods being promoted instead of surgery. Indian women must not be seen as ‘wombs’ needing to be controlled by Indian Government and imperialist funding agencies. Indian women and Indian children are not the cause of their own or the world’s poverty and destruction of the environment – that responsibility lies with the world’s corporations and the rapacious capitalism that promotes profit over people and environment. Target-based sterilizations – as well as other invasive forms of contraception, should be recognized as a form of violence against women that can no longer be tolerated, in any overt or covert way. Instead of viewing women’s reproduction as a ‘problem’, the policy thrust should be to enhance the rights of women – over their bodies, but also over resources and environment. For this, corporate control over bodies, resources and environment must be dismantled and resisted!
(Kavita Krishnan is Secretary, All India Progressive Women’s Association and tweets at@kavita_krishnan)