A mandate that spells coercion

On April 8, Bala Devi (35), mother of four, of Hudia village of Rajasthan’s Nagaur district died during a sterilisation operation in the Manana public health centre where a sterilisation camp was organised. Her death was a small news item in the Nagaur edition of Dainik Bhaskar. Investigations by a Bundi-based organisation working on women and adolescent health issues showed that Bala Devi had not been counselled about the possible side effects as mandated by the Central government rules nor was her health status checked. She was just one more case to boost the government’s sterilisation targets. The doctor said she had died of a heart attack while being operated. In fact, the government guidelines mention intra-operative emergency complications like vasovagal attack and cardio respiratory arrest that necessitate preliminary tests before the operation.

Cut to Madhya Pradesh, where the population control mania has led to a frenzied drive to attain a ‘voluntary’ sterilisation target which even in 2010 was as high as seven lakh and the late Sanjay Gandhi is showcased as a hero who tried to bring family planning to people’s doorsteps during the Emergency. The District Collectors were issuing notices to government employees including tehsildars, naib tehsildars, patwaris, and anganwadi workers to meet the targets.

There is even documentary evidence of a warning letter (dated February 2, 2012) being issued to an anganwadi worker in Chhindwara district for not meeting the targets. Many people (both men and women) have claimed they were forcibly taken for sterilisation. Others were lured with promises of material benefits by motivators who are largely government health workers.

Disturbed by these reports, health rights activists have formed a National Coalition against the two-child norm and coercive population policies last December. The Coalition, housed in the Centre for Health and Social Justice (CHSJ) in Delhi, has as its chairperson former secretary of the Ministry of Health and Family Welfare, A.R. Nanda, who was responsible for the National Population Policy 2000 that marked the radical shift from incentive and coercion to a more people-centred policy. The Coalition also has civil society partners from Bihar, Rajasthan and Madhya Pradesh.

Dr. Abhijit Das, director of the CHSJ and convenor of the Coalition, says the two-child norm in India is modelled on China’s one-child policy and was recommended by the National Development Council's Committee on Population in 1992.

The International Conference on Population and Development (ICPD) brought a significant change in the way population and reproductive health is conceptualised and India as a signatory committed itself to adopting ‘reproductive rights’ through the ‘target-free’ approach. However, in practice, many States continue to have deeply coercive policies due to official pressure to meet “family planning targets”. Different policies were designed like making sterilization a pre-condition to access development schemes and prohibiting persons with more than two children to contest for panchayat/ municipal elections in certain States.

Owing to the negative impact of the two-child policy and its discriminatory nature, four States — Haryana, Himachal Pradesh, Madhya Pradesh and Chhattisgarh — had revoked this policy. However, out of the nine States where the policy was being implemented, Rajasthan, Andhra Pradesh, Orissa, Maharashtra and Gujarat still continue with it.

The Coalition challenges the two-child norm as it is anti-democratic , anti-women and anti-children and affects dalits, adivasis, women and the poor. The norm has affected the participation of youth, who comprise 50 per cent of the population, as it is they who are disqualified on grounds of having more than two children, while elderly couples with more children are not touched.

Given the strong son-preference in India, a mandatory two-child law leads to pre-birth elimination of female foetuses. Evidence from Himachal Pradesh reveals that districts with highest juvenile sex ratio have had the highest disqualifications compared to districts with lowest sex ratio. This indicates the danger of sex selective abortion in an environment where political gains are underlying. Evidence also shows that dearth of women of marriageable age leads to abduction, sex slavery and other forms of violence.

On the other hand, women whose husbands nurture political aspirations at local level are known to undergo forced abortions. Men who are keen to continue as members in panchayat even desert their wives. Many a time, children are given away for adoption to retain position in panchayat leadership. The forced separation of children from their families may have severe repercussions on their minds.

The Coalition has found that female sterilisation continues to be the most used method of family planning in many States. Camps are the most common platform of service delivery and quality of care is compromised.

Despite these facts, policymakers are concerned that the family planning programme has not performed adequately and the population is growing rapidly, says Dr. Das. “While a majority of our couples are young and need means to stop their first pregnancy or increase the interval between births, policymakers seem intent on promoting sterilisation or permanent methods.”

A major problem of performing sterilisation on young people is that failure rates are high and there are possibilities of long-term consequences. Unfortunately, the government has yet not carried out studies on long-term consequences of early tubectomy on young women. Millions of women are being sterilised when just 21 years or less, alleges Dr. Das.