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“If someone has died of sterilisation, something grave has gone wrong” 

Kate Gilmore, the Deputy Executive Director, United Nations Population Fund (UNFPA) is in New Delhi to participate in the ongoing global conference on engaging men and boys in gender equality. She spoke to The Hindu about the rights of women, the need to include reproductive sexual education in schools to bring down teenage pregnancies and sexually transmitted infections and about the recent deaths of women who had gone for a sterilisation surgery camp in Chhattisgarh. On why it is important for men to participate in gender equality campaigns, she says it implicates everyone and “there is no place to run”.

Q: Your visit to India coincides with the death of eight women who had undergone sterilisation surgeries at a camp. What is your reaction?

It is a tragedy that has occurred, of course the reports need to be validated and there needs to be an investigation carried out independently to understand what took place. If this is the case, it a great human tragedy, a grave crime and cause of sorrow. 

Separate from the circumstances, which we don’t know, to die from sterilisation conducted properly is extremely rare. Look at WHO’s data, this is a clinical science done at quality standards. India has fantastic and elaborate instructions on what those standards are; so if someone has died of sterilisation, something grave has gone wrong. 

What troubles me is something still not taking call powerful enough about a shift in the public health approach that needs to be adopted for women to have what they need to make choices.

Q: Can governments carry out sterilisations camps? Is it the most popular form of contraception ?

First, in International standards, what UNFPA also upholds, a woman must have free prior and informed choices between at least three forms of modern contraception. Anything less than this risks being coercive, or can be seen as created to induce her.  

It is choice; all the talks about family planning are meant to be about choice, not methods.  

Secondly, quality, we must have great quality for those choices. Perhaps these women [in Chhattisgarh] chose sterilisation, the only popularity that one should see is if it is popular with the women. You know it is popular if that is the method they choose. If sterilisation was chosen over the pill, which was chosen over the condom, fine, but if there was only sterilisation then it was imposition.

There must be assurance of quality. If it appears and the investigation validates it, that the women had sepsis or life threatening hemorrhage then, it was not conducted at quality. The choice must be for quality sterilisation not life threatening sterilisation. 

The third point is accountability. To uphold choices and quality you must have accountability for those who offer the service, plan the service and pay for the service. Accountability has to include legal accountability; there cannot be impunity for those who have conducted the service at low standards.

Choice, quality and accountability that is what family planning is.

Q India is likely to miss the fifth Millennium Development Goals (MDGs) for maternal mortality, what are your concerns about India?

India has had a massive change under the MGD, it is incredible what has been achieved for education. Let’s celebrate that, but is it enough, no. We have fewer children dying of preventable causes, but we still have children dying on the first day or within the first year of their life.

We have many more women with access to skilled birth attendants and clinical support and fantastic outcomes, but still far from enough. No one should ever die giving birth. 

In India, we have the means and the know-how and so much skill and expertise. India can put a rocket into space, it has invented the use of communication technology to drive new ways to accessing data; look at how you are doing census. How can it be, that a single woman living in India is dying from the most natural processes of giving birth. It is unacceptable. 

Q Adolescent sex education continues to remain a sensitive issue in India. How do you propose to address that?

Earlier this year India launched a ground breaking, global best practice policy through adolescent sexual reproductive health. It is exciting, but it is 2014, how come we are still having to advocate at state level and down to provincial level and then schools that young people need to know about their bodies. How can it be a bad idea? How come we still have to convince parents and teachers that a girl ought to understand that she is sexually active, or a boy should understand what consent means in the context of sex or both boys and girls should know how to avoid sexually transmitted infections?

When you have human rights based, age appropriate sex education in schools teenage pregnancy and SITs go down because young people know how to make better choices for themselves and to stand up against those who impose sex upon them. 

Yet, there are people who think comprehensive sex education does not belong in schools. 

This is going to take a lot of political leadership, courage, budget, capabilities in teachers and principals and participation of community leaders and politicians. 

Q What are your views on legalization of prostitution?

It is quite clear to the UNFPA that criminalisation of prostitution is an imperfect public policy tool if you want to stop gender based violence, STIs and keep women and girls safe. Even the category prostitution is so imprecise; the police, people in the street and doctors and nurses making arbitrary decisions on who they believe is promiscuous, pure or prostitute is imperfect. Who are we to judge in that regard? 

What we do know is that every person, without exception is born with inalienable human rights. No one can take them away from us. And it [legalisation] does not include the right to be a prostitute per se, but the right to have sexual reproductive health, to live without fear and without violence. And that is true for us all.

Criminalisation of one category of people or behaviour must be done as the absolute last resort. What does science tell us, criminalisation does not deter prostitution, it does not help minimise the bad consequences of commercial sex work like STIs. On the contrary if you decriminalise you can regulate and keep people safe.

Q You have a meeting with the Health Ministry officials? What is on the agenda?

We will speak about the sterilisation issue. We know that the government understands that the global agenda for family planning is about choice, quality and assurance. We will offer support for the government’s work with the states, so that the state level health policies are compliant with normative standards.


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