December 30, 2016
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Sterilization in India: Women Must be Given Safe Choices

Payal Shah from the Center for Reproductive Rights calls for an end to harmful and coercive targets, incentives and penalties linked to population control in India.

By Payal Shah,

After their third child was born, Janaki and her husband decided together that their family was complete. Given Janaki’s limited options to prevent future pregnancies, she traveled to a camp in Sakri, Chhattisgarh, in central India on November 8, 2014, to undergo sterilization.

When her mother came to pick her up after the surgery, she found Janaki lying on the floor unconscious. The nurse sent her home without any information about the surgery or Janaki’s condition.

Two days later, Janaki died at the age of 24.

Janaki was the first of 13 women in Chhattisgarh who would die from complications after undergoing sterilization in government-sponsored camps two years ago, between November 8 and 10, 2014.

As we reflect on the tragic loss of these women’s lives, there are both glimmers of hope and frustrations of inaction. This September, the Supreme Court of India ruled in the case of Devika Biswas v. Union of India & Others that the sterilization camps violated women’s reproductive rights and their rights to health. Yet, since this Supreme Court ruling, we are still waiting for justice to be done and the end of unfair targeting of women that has persisted in India for years.

When the Indian government adopted the 2000 National Population Policy, it signaled a commitment “to ensure target-free and voluntary access to the full range of contraceptive methods.” But for more than 15 years, we have heard countless stories of women from socioeconomically marginalized communities who have been targeted by health workers to undergo sterilization at government-sponsored camps and end up suffering complications after surgery that lead to serious health issues – or even death.

Too often women in marginalized communities, belonging to scheduled castes and tribes, are pursued by health workers who are incentivized to convince these women to undergo sterilization. What health workers should be doing is providing women all the contraceptive options that are supposed to be available, including quality short- and long-term methods – not just one irreversible option.

The women who are targeted are often unable to read the consent forms they are asked to sign – some “forms” being merely a blank piece of paper – in direct violation of their right to free and informed consent. Women are routinely led to believe that sterilization is their only viable option, since these camps provide the surgery free of charge and their transportation costs and lost wages are covered.

These women expect and deserve quality healthcare, but instead find themselves in unsanitary sterilization camps without sufficient space or beds to even let them recuperate. Countless women face serious complications due to the poor quality of sterilization procedures and health facilities, and as in Janaki’s case, some get so sick they die. All while the government lets these human rights abuses occur with impunity.

United Nations experts expressed “grave concern” about the substandard and abusive conditions in sterilization camps in a March 2015 communication to the government of India, saying they are indicative of violations of women’s rights to be free from gender-based violence and free from torture and cruel, inhuman and degrading treatment, as well as their rights to health and life. In a September 2015 report to the Human Rights Council, the experts highlighted the Indian government’s failure to respond to the communication.

When the Supreme Court reached it decision in the Biswas case, it marked progress towards accountability for violations of women’s reproductive rights from unsafe, coercive sterilization. The court called for the government to stop sterilization camps within three years and ensure that any policy and incentive schemes do not unfairly target women – specifically to “reconsider the impact that policies such as the setting of informal targets and provision of incentives by the government can have on the reproductive freedom of the most vulnerable groups of society.”

Despite recognizing the dangers of targets and pledging to eliminate them under national policy, the Supreme Court failed to go so far as to call for the total end of targets in contraceptive and population programs, instead leaving it to each state or union territory government to determine how to adhere to the court ruling. This has done nothing to stop women from being coerced into potentially dangerous sterilization procedures.

Furthermore, the Supreme Court has placed the onus of ensuring women’s reproductive rights on states and failed to recognize the need for greater oversight from the central government. The court was “pained to note the extremely casual manner in which some … states have responded” to the petition. As a result, the Supreme Court ordered the chief justices in several states to initiate petitions in high courts to implement the decision, and specifically called on the Chhattisgarh government to address the sterilization deaths as per recommendations from a state-convened judicial inquiry committee. It remains to be seen if state high courts will ensure the effective implementation and monitoring of the orders in this case and clear elimination of targets, as required to end coercive and abusive sterilization practices in India.

The Biswas decision is a signal from the Supreme Court that governments must remedy the systematic discrimination against women and ensure reproductive rights. Yet the central government’s willingness to allow violations against women to occur with impunity fuels the abuse, coercion, discrimination and substandard care in sterilization camps held throughout the country.

The deaths of Janaki and the 12 other women in 2014 – all due to unsanitary and unsafe sterilizations – are not just personal tragedies but a widespread social injustice. Both the central and state governments must stop this cruelty and prevent the violence women face when they try to access contraceptive services. The targeted abuses against women must end by ensuring women’s rights to the full range of contraceptive information and services in a voluntary, safe, quality manner.

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