What’s next for India’s population policies?

A Landmark ruling last week means mass sterilization camps will end. But what’s next for family planning in India?

Bimla (left) is a health worker in Uttarakhand who recruits women for sterilization camps
Bimla (left) is a health worker in Uttarakhand who recruits women for sterilization camps

In the world’s largest democracy, population policy has been brutal. For decades, India has primarily met its growing numbers with one crude solution: camps for mass sterilization. And for decades, many have protested these camps as horribly mismanaged and coercive.

On Wednesday, India’s Supreme Court moved to eradicate these camps for good, a decision that will change India’s population policies forever. These policies have been a critical issue for India since independence as it struggled to control the burden of growing masses.

But how will this decision affect the women it seeks to protect? The Court’s attention to human rights and protecting the most vulnerable is an absolutely necessary first step, but it doesn’t go far enough.

This decision, while moving in the right direction, leaves out the most important factor for success: empowering the women affected. Without this crucial element, any policy will fail in its pursuit of creating a healthier India.

A Dark History

Human sterilization has a dark ring to it. A eugenics ring; a stray dog ring.

In India, this is truer than anywhere and has been throughout its history.

The country is haunted by a history of forced male sterilizations under Indira Gandhi’s near-totalitarian regime in the 1970s. Millions of men were dragged from their homes and corralled into the procedure, losing their abilities to reproduce. Due in large part to this aggressive policy, Gandhi was voted out of office at the close of the state of emergency. And so, while male sterilization is a much simpler, safer procedure, this dark era in India’s history left the country with a contraceptive culture dominated by one method: female sterilization.

And until now, threatened by enormous population growth, this has been the government’s most emphatic answer.

Today, one in three Indian women is sterilized and 4 million female sterilization procedures are performed each year, more than any other nation on earth. And almost all of these sterilizations happen in “camps.” Doctors pass through the country, setting up temporary, ramshackle health centers. Local health workers recruit women to undergo the invasive procedure. The women and the health workers who recruit them both receive compensation and the doctors are under intense pressure to meet informal targets set by the state.

This dangerous combination of factors leads to deadly outcomes for women. With only 1% of GDP invested in health, India’s public health system is woefully ill equipped to handle the scale of these camps.

Underreported Ills

Sarita is a health worker who lives in a small town in Tehri, Uttarakhand, a state in Northern India. She is sterilized and is happy she underwent the procedure. She says without it she would have 4 or 5 children which would have been an economic burden. The actual procedure, however, was far from cheery. Describing her surgery she said, “I screamed and screamed a lot…and I held the doctor’s hand tightly. The doctor told me to let go of his hand. I was in pain. There was an ASHA [health worker] with me who gave me painkillers. I suffered from extreme pain for 4 or 5 days.”

Sarita’s experience is far from uncommon. Between 2010 and 2013, the government reported that 363 women died during or after surgery in sterilization camps due to poor conditions. But these numbers fall far short of the actual toll. According to a 2004 study, researchers estimated that 19 out of every 100,000 women who are sterilized die from it, five times the officially reported rate.

Sarita, in fact, is one of the lucky ones.

Looking to the future

Wednesday’s ruling was handed down in response to these issues. Devika Biswas, an Indian activist, filed a civil petition citing widespread mismanagement of camps. She highlighted an instance in January 2012 in Bihar when a doctor sterilized 53 women in 2 hours in highly unsanitary conditions. Women were operated on school desks, no gloves were used and no running water was available. The doctor moved from woman to woman in quick succession. These conditions are unfit for animals much less democratic citizens protected by the rule of law.

On Friday, activists celebrated the decision. The court ruled that this policy of mass sterilization camps infringe on the "reproductive freedoms of the most vulnerable groups of society whose economic and social conditions make them easy targets to coercion." The fact that the court highlighted reproductive freedoms and the potential for coercion within this policy is an enormous step in the right direction.

But how are the women most affected being included in India’s next era of reproductive health policy? If they are not, any new policy is bound to fall short of lofty objectives.

Thanks to the ruling, new frameworks will also be introduced ensuring that legal, medical and technical standards are in place with sterilization. The government will increase compensation for cases of complications and death and will monitor programs more closely. These are all fantastic and necessary developments.

However, despite these advancements, by maintaining a focus on the numbers, on population growth, rather than the individual women affected, these policies will be unable to be truly human rights based.

Further, they won’t be as effective. Fertility rates tends decrease when women are empowered, given an education, given better primary health care and allowed to enter the workforce. By ignoring these more fundamental issues of gender equality, India is failing to address its population growth effectively.

What’s next is making sure the future policies continue down this path. Will this decision fundamentally change how India approaches population policies? Perhaps not. But it is a step in the right direction.

The next step is making sure the women and men who are most affected remain the central focus of any future policy. “It is time that women and men are treated with respect and dignity and not as mere statistics in the sterilization program,” the Court said. More will be needed to make that a reality.

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