The death of 12 women after tubectomies at a sterilisation camp organised by the Chhattisgarh government in Bilaspur underlines how India’s family planning burden rests disproportionately on women’s shoulders. This despite the fact that male sterilisation is actually a relatively easier and risk-free procedure.
Consider this. In Chhattisgarh in 2011-12, the most recent year for which data is available, 1,27,114 tubectomies were performed against just 6,765 vasectomies — this means almost 19 times as many women were sterilised as men.
This reflects a nationwide trend: the gap is consistent across all states with the worst being Tamil Nadu where the ratio between tubectomy and vasectomy is 165. Tamil Nadu, interestingly, has some of the 19 times as many women sterilised as men in state best health indicators so the figure there reflects how little attention is paid to this skew.
In Assam, the ratio is 101, in Gujarat it is 93, in Karnataka 70, in Bihar 72 and 27 in Uttar Pradesh.
Delhi with a ratio of 6.5 is actually the best state in terms of gender parity when it comes to sterilisation. The number of tubectomies was 6.5 times the number of vasectomies though the absolute figures remain dismal with 2705 vasectomies and 17,744 tubectomies. It is followed by 8 in Punjab, 9 each in Jharkhand, Sikkim and Himachal.
Vasectomy is a means of permanent birth control in men. The male vasa deferentia is cut and sealed so that sperm fails to enter the seminal stream. Tubectomy, also known as tubal ligation involves a similar tying or clamping of the fallopian tubes to prevent eggs from reaching the uterus for fertilisation. Vasectomy is a simpler procedure than tubectomy and the government offers a higher incentive for the former, especially since it started promoting non-scalpel vasectomy about ten years ago.
In a recent decision the incentive for tubectomies has been increased to Rs 1000 from the earlier Rs 600 and that for vasectomy has been increased to Rs 2000 from the earlier Rs 1100.
Says Poonam Muttreja, executive director of Population Foundation of India: “Tubectomies contribute to 38% of India’s family planning efforts while vasectomies are just 1%. There are strong social reasons, there is a myth that men lose their virility or become weak after vasectomy and the government has not done anything to dispel that notion. There are fewer trained people now that we have done away with the male health worker. We do not have targets for vasectomies but we have targets for tubectomies. Women undergo the procedure in sub human conditions.”
While the ratio in the small states is astounding, the actual numbers there being very small, the figure is not representative of the actual skew. In Pondicherry, for example, only four men were sterilised in 2011-12 as against 973 women.
Says Jay Satia, advisor to the Public Health Foundation of India who works on family planning: “In many cases, it is actually the women who volunteer to do it because they are scared about loss of livelihood should the men undergo the process. Strangely enough these fears persist though vasectomy is actually an easier process than tubectomy, especially the non scalpel one that the government has been promoting for ten years.”
Both Satia and Muttreja emphasised that the quality of care at sterilisation camps remains a cause of concern and incidents like the one in Chhattisgarh prove that basic guidelines like a maximum of 20 surgeries per person per day, are brazenly flouted.
The Union Health Ministry, meanwhile, tied itself in knots over the Bilaspur incident with Shripad Naik, MoS (independent charge) Ayush, saying: “What has happened is very unfortunate and we have formed an inquiry committee to look into what happened. We will wait for its report.” In the evening, however, Health Minister J P Nadda denied that such a committee had been formed. “We have received a preliminary report from the state government. We have asked them to give us a detailed report. We will wait for it (before taking any decision).”