 "Basic norms being flouted at sterilisation camps")
Data from the Union health ministry showed in 2013-14, 65 per cent of sterilisations in the high-focus states of Chhattisgarh, Jharkhand and Bihar were conducted in the last two quarters.
A review of the data, as well as talks with various stakeholders, points to a crisis in the making in India's sterilisation story. (STERILISATION FACT CHECK)
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The recent incident in Bilaspur, Chhattisgarh, which claimed 15 lives at a mass sterilisation camp, is a crude reminder that the public health care system in India is struggling to meet basic standards.
"There is an annual target for sterilisations. But authorities wait till the end to meet it. It is partially because of the belief that winter is a good time for healing and because authorities don't make any serious efforts," said a senior doctor working closely with the state and Union governments. "When there is pressure to complete the number of surgeries in a limited time frame, mistakes are bound to happen. Past studies have suggested the equipment is not properly decontaminated before being used on other women."
Most deaths occur due to infection, internal bleeding and use of spurious drugs.
Reports coming out of Bilaspur suggest the women concerned were lured to the camps; they were operated upon without a proper dose of anaesthesia; they were allegedly given contaminated medicines; and doctors carried out many more operations in a day than they were required to. "More or less, the situation is the same in other areas, too. Though death following sterilisation is a rarity, norms are flouted regularly at mass sterilisation camps," said a doctor from Katihar, Bihar, who has been part of many such camps.
Doctors say tubectomy, a surgical procedure for sterilisation in which a woman's fallopian tubes are clamped and blocked to prevent eggs from reaching the uterus for fertilisation, must be preceded by tests to ascertain whether the woman is diabetic, suffers from hypertension or low hemoglobin, or is pregnant. "Certain basic tests are a must to ensure the patient is ready for sterilisation. The organisers of a mass camp have to ensure these are conducted. But I doubt this is done," the doctor added.
"Most procedures related to sterilisation programmes take place at the level of primary health centres and community health centres. They are fortunate to have qualified doctors but they rarely have specialists such as anaesthetics or paediatricians. Their absence can be risky. But who cares?" asks a professor of a government medical college in Uttar Pradesh who has closely observed mass sterilisation camps in Uttar Pradesh and Jharkhand.
Data suggest most sterilisations take place at primary health centres and community health centres - in 2011-12, 68 per cent of no-scalpel vasectomies, 74 per cent of laparoscopic sterilisation and 75 per cent cases of mini-laps were carried out at these centres.
The question is if mass camps are bound to throw up complications, why do governments allow these to be organised?
Camps afford organisers an opportunity to distribute commissions on a big scale.
Another worrying aspect of India's sterilisations programme has been the significant gender bias involved. Of the family-planning methods adopted in the country, 35 per cent are accounted for by surgical procedures, of which 34 per cent involve women. This is despite vasectomy, the sterilisation procedure for men, being considered less complicated and risk-free. Doctors who have been involved with the family planning programme for long say vasectomy was preferred till the Emergency in 1975-77. Perhaps, revulsion towards the forced sterilisation programme during the Emergency resulted in the number of men opting for vasectomy seeing a consistent decline.
"The reason given for men not going for sterilisation -that they are permanently weakened - is completely baseless. Despite counselling, males rarely come for sterilisation. The fact is it is almost risk-free. I know many instances of men going on to play football just a few hours after vasectomy. Despite this, the gender bias has remained," said the doctor from Katihar. Another reason attributed to fewer men opting for sterilisation was the government's half-hearted approach in this regard due to fear of political backlash.
Experts say the government should promote the private sector and trusts to carry out such surgeries. "In India, there are about 35,000 gynaecologists and each is trained to perform these small surgeries. But why would they do it for an amount that is below the market price?" asks Dileep Mavalankar, director of the Indian Institute of Public Health. "If the government at least pays the market price, many private hospitals and trusts will join this initiative, as was the case with the Chiranjeevi programme in Gujarat."
Under the Chiranjeevi Yojana, the cost of deliveries at designated private hospitals for women from below-poverty-line households was borne by the state government.