A coercive family planning programme and criminal negligence on the part of state health officials appear to have been responsible for the death of 13 women in the Bilaspur district in Chhattisgarh. Officials reportedly flouted the guidelines and procedures outlined for carrying out laparoscopic tubectomies, a birth control method for women. The surgeries on Saturday appear to have been conducted in unhygienic conditions, followed by little or no post-operative care, after many of them were allegedly coerced by health workers to undergo sterilisation to meet targets set by the state — a grim throwback to the compulsory sterilisations of the dark days of the Emergency that discredited the idea of family planning itself.
The Bilaspur tragedy also highlights the fact that over the years, the public health system has unfairly shifted the onus of population control to women. Though male sterilisation (vasectomy) is an easy and less risky procedure, 98 per cent of the 4.2 million sterilisations in India last year were tubectomies — India is the only country where tubectomies outnumber vasectomies. Though the country’s family planning policy doesn’t officially give preference to sterilisation of women — in fact, vasectomies are offered better incentives — lower-level state functionaries evidently see poor women as more vulnerable to coercion and have tailored the programme to facilitate tubectomies. This skew is also a reflection of the fact that the state envisages family planning as a purely clinical issue, ignoring social contexts. Patriarchy has dominated notions of sexuality and procreation in India and in many places, especially in rural India, the Indian male’s apprehensions in this regard can pit him against the idea of family planning. Yet little has been done to effectively address male anxieties regarding sterilisation
Family planning must be a purely voluntary exercise. Making it target-centric with incentives for public health officials inevitably turns it into a coercive programme. It must also include male health workers, who should be trained to educate male members of the family about family planning. The Bilaspur tragedy could have been avoided. It cannot be allowed to recur.