In just less than a month after the Centre announced an ‘Enhanced Compensation Scheme’ for sterilisation services in 11 States having high Total Fertility Rates (TFR), more than 13 women lost their lives following botched up surgeries in a medical camp in Bilaspur district of Chhattisgarh.
There seemed no apparent urgency to organize the sterilisation camp other than to meet the ‘targets’ set by the State government and the enhanced compensation, perhaps, was an incentive for the young women. But just that in India sterilisation, somehow, is understood as a permanent method of contraception only for women — safe and simple.
Official statistics suggest that the governments — both at the Centre and States — promote female sterilisation disproportionately. Of the total sterilisations performed in 2012-13, as many as 97.4 per cent were tubectomy procedures. Similarly, an analysis by non-governmental organization suggests that in 2013-14, India spent 85 per cent of its family planning expenditure on sterilisation, the beneficiaries of which were mostly women.
On October 20 this year, the Ministry of Health and Family Welfare decided to enhance compensation for sterilisations for 11 States which were one of the “main interventions’’ under the Reproductive Maternal Neonatal Child Health plus Adolescent (RMNCH+A) programme launched to meet the millennium development goals. It also added a new component of Post Partum Sterilisation (PPS) — done soon after delivery or within 7 days — to the package for which an extra amount of Rs.3,000 would be given, of which the woman would get Rs 2,200. This was in addition to the hiked compensation of Rs.1,400 from the earlier Rs.600, but restricted for women who came to the public facility for delivery. For vasectomy, the compensation has been hiked from Rs.1,100 to Rs.2,000.
These States are Uttar Pradesh, Bihar, Madhya Pradesh, Rajasthan, Chhattisgarh, Jharkhand, Uttarakhand, Odisha, Assam, Haryana and Gujarat.
“It is wrong to describe the money as an incentive. It is just a compensation for the loss of wage which was hiked in the wake of high cost of living, increasing cost of transportation (from village to the nearest health facility) and prevailing high wage compensation for the days requiring recuperation,’’ explained an official of the Health Ministry. On Post Partum Sterilisation, he said, it was difficult — almost impossible — to, otherwise, get women back to the health centre but said no one would be coerced into opting for the permanent method.
This gendered approach takes full advantage of women’s lack of sexual and reproductive autonomy.
“We have seen in Post Partum IUCD insertions, consent of the rural women is not even taken,” Sulakshana Nandi, convenor of Chhattisgarh Jan Swasthya Abhiyan told The Hindu . In the case of PPS, there would be health implications as well, she said while pointing out that decisions regarding childbearing should be left to the woman.
An analysis done by the Population Council of India, Family Planning Association of India, Parivar Sewa Sansthan, and Common Health in a report on ‘Robbed of Choice and Dignity: Indian Women Dead after Mass Sterilisation’ suggests that in 2013-14, India spent 85 per cent of its family planning expenditure on sterilisation. In 2013-14, India spent Rs.396.97 crore on female sterilisation with the procedure being performed on over 39 lakh women. A chunk of this money — Rs.324.49 crore — was spent on incentives and compensation, and Rs.14.42 crore on the camps themselves. The amount spent as compensation was two-and-half times the untied grants given to Primary Health Centres for infrastructure strengthening. Less than 1.5 per cent of the annual expenditure on family planning went towards spacing methods and the remaining 1.5 per cent was spent on equipment, transport, IEC activities and staff expenses, it said.Focus on sterilisation
“Sterilisation, particularly tubectomy, has been vigorously promoted and pushed by the state through centrally- decided targets and on a mass scale through a camp approach, largely disregarding other currently available methods such as condoms, oral pills, IUDs,’’ suggests a fact-finding report on the sterilisation tragedy brought out by the Jan Swasthya Abhiya, Sama — the Resource Group for Women and the National Alliance for Maternal Health and Human Rights.
Sterilisation constitutes 75 per cent of India’s total contraceptive use, which is the highest anywhere in the world. From the mid-1980s, the numbers of tubectomies have risen steeply and on average 4.5 million surgeries are performed each year.