Fixing Responsibility For The Dying Women In India's Sterilization Camps
By Kandathil Sebastian
18 November, 2014
Countercurrents.org
CONTEXT
Death of women in the sterilization camps in India is not new phenomenon. As per the official data, between 2003 and 2012, there are at least 12 post sterilization deaths on average, per month. Unofficial estimates of such deaths put the mortality figure even higher. We routinely see umpteen debates and ‘blame games’ after such sterilization induced deaths. Some people blame the poor quality of services, while some others blame the carelessness of the service providers, some the contaminated drugs, and some others the dilapidated buildings where the surgery was conducted. In the recent incident in Chattisgarh state where 14 women died has also resulted in such serial blame games. The final responsibility of the latest event is likely to be placed on some impersonal entity like the inanimate ‘building’ where the sterilization camps held or the rat poison which was found near the stock of drugs used by the women victims.
FEMALE STERILIZATIONS AS PRIORITY
Poignantly, such deaths continue to occur among marginalized groups such as dalits, tribes which are being extinct and poor women who are forced to swap their fertility for some incentive money or commodity which would meet some pressing immediate needs of these women. More importantly, these deaths are happening among women who are often taken to these camps under duress, and are operated on under appallingly unsafe conditions.
As per the official data released by the Ministry of Health and Family Welfare, in the year ended in March 2013, there were 4.5 million female sterilizations under the government run programs and facilities in India. Interestingly 97.4 per cent of all these sterilizations are performed on women, even when the option of male sterilization was available in government clinics. In 2005-06, researchers found that around 37% of the married women had undergone sterilization in India.
Though, female sterilization has been the main method used in India’s Family Planning Program for several years, the augmented focus on women sterilizations is not an India specific one. Activists have reported that during the 1984 flood season in Bangladesh destitute women were denied food until they agreed to be sterilized. Between 1995 and 2000, the Government of Peru has targeted 30,000 indigenous women who were either forced or uninformed and got them sterilized.
It is not that India never tried to implement a male sterilization program. It did. But subsequent to the forceful sterilization of men in vasectomy camps during the Emergency (1975-77), the ruling Congress party was voted out of power and thereafter vasectomy was never considered as priority in any family planning policies. Consequently, India now enjoys the dubious distinction of having the highest percentage (36%) of female sterilizations, compared to the global average (19%).
MULTIPLICITY OF FAMILY PLANNING PERSPECTIVES
Family Planning in India has many stakeholders. These groups passionately provide varying perspectives and many of them want the debate on family planning to be directed to further their political, religious, corporate and moral interests. Some groups raise the rhetoric of ‘choice’ and they would want women to be provided with other less invasive procedures and long acting contraceptives. Some groups raise the slogan of ‘quality of care’ and would want the family planning clients’ rights, infection prevention measures and the health care providers’ needs to be particularly respected and supported. Those who academically engage with the issue raise names of numerous conferences held in Cairo, London, Beijing etc. in the previous years to make things incomprehensible for the ordinary Indian.
All these lead to utter confusion in the minds of people of India and they developed some kind of indifference to discussions around family planning. At the end of it we are unable to fix the responsibility of these continuing deaths to anyone. All the systemic issues of quality of care and rights based approaches which intellectuals and activists regularly raise are important, but they unfortunately address only the peripheral issues while women continue to die in the sterilization camps. Let us examine what is fundamentally wrong with the systems, processes and technologies to have a realistic understanding of what or who is responsible for the dying women in India’s sterilization camps.
KEY APPROACHES TO FAMILY PLANNING
In the post-World War era, ruling elites of the newly independent nations introduced the concept of ‘development’ in the former colonies, and in the new political discourse, ‘subjects’ of these countries were treated as ‘populations’. India started its ‘community development programs’ and ‘family planning programs’ simultaneously, in early 1950s. Debate on the means and tools for development with a focus on reasons and solutions of poverty is still being intensely debated in these countries.
There are three basic debates around the issue of family planning in the world today:
The first one views population growth as the basic reason for poverty. The supporters of this view want coercive population control measures to attain demographic targets to realize development.
The second view diametrically contradicts the first view and argues population growth is not a problem at all. The supporters of this view feel that the powerful white nations use a false notion of ‘over population’ to maintain their hegemony over the resources of poor countries. Interestingly the Catholic Church too supports this view.
Proponents of a third view feel that the issue of population growth is used as a smoke screen to cover up inequalities and resource depletion due to over consumption of Western countries. If nations take care of their under development issue, population growth and related issues will be automatically wither away.
The first two viewpoints are extreme while the third one is considered as moderate. All these three positions have many supporters, though knowingly or unknowingly all of them blame women’s fertility as a reason for environment degradation and poverty.
DOMINANT DISCOURSE ON FEMALE BODY
The demise of joint family, growth of agro-enterprises, industrialization and modernization has changed traditional modes of production and women’s role as a food producer in the traditional societies. In the changed scenario, women’s body has been perceived differently by different discourses – to Marx it was an economic body, to Freud a sexual body, a fertile body for population controllers and so on. A new patriarchal construct of female body common to colonialism, racism and capitalism has come in to existence during this stage of history. Modern society has added additional restrictions on female body along with already existing proscriptions based on pollution rituals, chastity rules and fertility cults.
The male dominated medical profession portrayed both fertility and infertility as pathology, pregnant woman as patient, and child birth as a clinical crisis. Eventually women’s body became an area of medical intervention and manipulation by the male dominated medical science.
Patriarchal control over women’s body and reproduction ultimately led to the control over women’s sexuality, labor power, resources and even their mobility. This control was implemented through ideologies, legislations, religious orthodoxy and the notion of impeccability of modern medical science. Examples of cultural practices which exerted such control include African female circumcision, Chines foot binding, European chastity belts, and Nepalese menstrual huts. This control of woman was actively supported by agencies and institutions which benefitted from this control immensely, such as the moral guardians, commercial interests of pharmaceutical companies and even the media.
FAMILY PLANNING TECHNOLOGIES AND THEIR INHERENT FEMALE BIAS
The technological imagination of the modern society was guided by the patriarchal notions suitable for the market economy in which ‘capital’ decided ‘what kind of reproductive technology should be promoted’ and ‘who will be subjected to become targets of such technologies’. If population control was the reason for contraceptive research, the technologies for it should have targeted ‘men’ because a woman can have only one child in a year while a man can theoretically father hundreds of children in a year. It is not true to say that scientists have never tried to develop male hormonal contraceptives. They have initiated some research, though got abandoned later. The excuse given for abandoning research on hormonal male contraceptives such as GnRH (Gonadotropin releasing hormone) antagonist and LHRH (Luteinizing releasing hormone) antagonist was their potential risks in lowering the male libido.
The idea of birth control is said to have originated in the minds of the nomadic tribesmen who wanted to keep their camel from getting pregnant during their long treks across the desert. For this end, they started putting some stones into their animal's uterus. Historically, the birth control technologies had practical applications for the commerce and industry not only at the time of ancient camel caravans but also throughout the history. Recently we have seen that modern corporations like Apple and Facebook covering ‘egg freezing expenses’ of their young female employees. Egg freezing, which involves a two-week process of hormone injections and extraction of eggs under sedation, was offered to the female employees of these companies. It can enable these companies to use uninterrupted time of their young staff members in their highly productive age. It can also free the company from providing paid family leave, child care and flexible work arrangements.
It will be injustice to the reproductive health researchers, if we say that there was no focus on male birth control techniques, though it was restricted to only two methods, namely, condoms and sterilizations. The earliest method used was perhaps ‘coitus interruptus’ (withdrawal) found in the Bible in a story written about 2500 years ago. Though there was mention of linen sheaths used by Egyptians living around 1000 B.C. as a barrier method, it was the Chinese who developed it from lamb intestines in the 1870s. Charles Goodyear’s vulcanization of rubber in 1839 eventually leads to the creation of the first rubber condom in 1844 and in 1920 the latex condom was ‘officially’ invented. Despite many improvisations which followed, the male condoms were not widely used until the arrival of HIV/AIDS in the later part of last century, but used mainly for infection prevention, not as a family planning method.
Positioning half a lemon in the vagina was an example of an early form of the cervical cap. The stones kept in camel uterus is the predecessor of intra uterine devices (IUD) used by women today. Unfortunately the earlier version of IUD, known as Dalkon Shield was a disastrous product. A multifilament string attached to it led pelvic infections and deaths and the product eventually disappeared from the market. In 70s it reappeared again with an attached mechanism to release a micro-dose of progestin which can even regulate menstruation.
Materials used as spermicides in woman’s vagina included olive oil, pomegranate pulp, ginger, tobacco juice, crocodile dung, acacia gum etc. Most of it caused infection, inflammation, irritation and burning sensations of the vagina and cervix.
As directed by early shamans and physicians women used to drink controlled dosages of poisonous mixtures and substances such as water which blacksmiths used to cool metals. Though these potions were partially effective in inducing miscarriages, these were often resulted in serious damage to the liver, kidneys and other major organs and even in many cases death of women. The first commercially produced birth control pill (called Enovid-10) made an appearance in the market only in 1960.
Currently a wide range of birth control technologies are available for women in the market. They are: combined oral contraceptives, progestin only oral contraceptives, injectable, Norplant implants, tubectomy (sterilization), condoms, IUDs, spermicides, diaphragms and cervical caps. Available methods for men are only condoms and vasectomy (sterilization). From these listing, we find that most of the technologies are reserved for women whereas just two methods are available for men. As we have seen earlier, the male sterilization technique is hardly used by men in India. Interestingly more research on male methods of family planning was dropped because the researchers thought that men may think male pills would lower their libido and hence no ‘choice’ was offered to men. Women are offered a basket of choices, despite unpleasant side effects and in some cases adverse impacts.
From the above discussion it is obvious that the power structure in the patriarchal industrial society is mainly responsible for the continuing death of woman in the sterilization camps of India. Until women defend their rights, take control of their bodies, and have choice in determining the direction of development, such incidents will continue to occur in India.
GOING BEYOND THE SLOGANS AND THE RHETORIC OF FAMILY PLANNING
There are many slogans like ‘quality of care’, ‘rights’, ‘choice’ etc. which many of the key players in the family planning sector vouch for. It is not only international NGOs belonging to pro-choice, pro-life denominations, multilateral and bilateral agencies involved in family planning, and UNFPA, but also medical practitioners and pharmaceutical companies shout these slogans.
Quality of care essentially involve infection prevention by passing the passage of infectious organisms through techniques of washing hands, wearing gloves, avoiding unnecessary vaginal examinations, cleaning client’s skin and so on. ‘Right’ implies clients making their own decisions. ‘Choice’ implies clients of family planning choosing from a range of methods. Choice also implies alternatives within technologies women may choose from. While quality of care is essentially an infrastructural issue and a function of the overall infrastructural development in the larger society, choice is about choosing between long acting and short term methods of family planning.
Reproductive choices and rights have meaning and significance only when poor woman are able to look beyond their survival. Unless their economic situation is improved and they have political and social rights, these things will never work in real life and remain as empty jargons. Presence of a range of factors like education/literacy, quality public health services, low infant mortality rates, easy access to safe contraception etc. could help families to make informed choices about the number of children they want.
Empowerment is often not a charity offered in a platter to the disempowered communities, it perhaps never happened in that way in the history. Despite several criticisms about the Kerala model of development, there are still some lessons which could be learned from the Kerala state. Thanks to a variety of historical factors ranging from early presence of missionaries, Marxists, powerful social movements, progressive maharajas, literate mothers etc. people got educated and empowered irrespective of their gender and caste. Despite objections about family planning from powerful religious priests and other interests, Kerala has achieved the lowest fertility rate in the country. Any strategy to avoid the continuing deaths of women in the sterilization camps should consider the fundamental realities of the existing power structures today. It would perhaps need several years of grass roots level mobilization of woman and resistance against patriarchy to finally end the phenomenon of dying woman in Indian sterilization camps.
Kandathil Sebastian is a Public Health Researcher and Development Consultant. He is also the author of two novels – Dolmens in the Blue Mountain and Wisdom of the White Mountain (forthcoming)
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