Foreign Aid Tied to Sterilization in India

Human-rights activists are calling for stricter enforcement of Indian laws regulating sterilization.


When Saraswati Devi awoke from the anesthesia, her clothes were soaked in blood. She was lying on a grass mat on the floor in excruciating pain, and there were no medical staff to answer her cries. She was one of 53 women who underwent surgeries at a “sterilization camp” sponsored by the government of India in its national campaign to drastically cut population growth.

The campaign is underwritten by tens of millions in American and British foreign-aid funds.

According to papers filed in the Supreme Court of India last month, the 53 women of low caste were recruited by government “motivators” who took them to a government middle school in Bihar this January. Anay Jumar Chowdhary, a government doctor, performed sterilizing procedures on the women, who were laid out on school desks and anaesthetized by untrained staff. He worked at night by the light of a flashlight and a single generator light bulb.

There was no running water at the school, and the doctor did not wash his hands or change gloves between the procedures, which took about two minutes each. None of the women had presurgical screening, and at least one, Jitni Devi, was three months pregnant and miscarried days after the procedure. The doctor left as soon as he finished the surgeries.

“I tell you they treat them not as human beings, but as cattle or goats. They just cut and take out veins. They were bleeding profusely. It is butchery,” said Devika Biswas, a health-rights activist in Bihar with the Human Rights Law Network, who filed the petition in court along with videotaped evidence of the camp and affidavits from the women’s families.

The lawsuit asks the Supreme Court to demand enforcement of existing sterilization guidelines (both national and international). It shows those guidelines to be flagrantly disregarded throughout India.

“All of them are forced,” Biswas told the Register. “Generally, the people in the village are very simple. They are very poor. Some of them married at the age of 12 or 13. They do not know what it means. They are told it will be good for them. They are not told it will make them permanently unable to bear children. No risks are explained to them.”

The petition states that “unsafe sterilization camps are the norm throughout India,” and it cites a number of fact-finding missions in the past decade that found widespread disregard for international, national and state guidelines implemented to prevent such abuses.

A 2010 Centre for Health and Social Justice report on sterilization in the state of Rajasthan, for example, found that poor and uneducated women did not have mandatory presurgery health screenings or counseling on potential complications. More than half (58.2%) of the sterilized women had at least one adverse side effect.

Hastily performed surgeries are commonplace, insisted Biswas. In a previous court case, one prominent doctor boasted that he could do 40 tubal ligations in one hour.

Not surprisingly, death is common following sterilization in poverty-stricken countries. One study cites a 19-in-100,000 mortality rate following sterilization in India.

In February this year, 35-year-old Rekha Wasnik, who was pregnant with twin girls, bled to death following surgical sterilization in the state of Madhya Pradesh. Infuriated, local villagers put her body by the hospital gates and demanded justice for her six surviving children and her husband, a poor laborer.

India’s national sterilization-vasectomy campaign to curb population has waxed and waned since the late 1950s, when modern concerns about “population explosion” were propounded. It was most aggressive during the presidency of Indira Gandhi, whose son Sanjay directed a notorious program of forced sterilization in the 1970s: Buses and trains of poor, predominantly Muslim, men were stopped, and they were forcibly sterilized. Riots halted the program.

Luring People In

Today, policies vary by state and district, but quotas and incentives for sterilizations are openly publicized. In 2008, Shivpuri district in Madhya Pradesh introduced fast-tracked gun permits to men who agreed to undergo vasectomies. In 2011, officials in Rajasthan were offering mobile phones to men undergoing vasectomies and lottery tickets for cars, motorcycles and refrigerators to people agreeing to sterilization in order to meet the district’s target of 1% sterilization.

Sterilization “camps” like the one in Bihar are common, as are government “motivators,” who visit women at their homes to encourage them to attend and receive incentives for each surgery performed. Most of the sterilized are poor women. Many give their consent by thumbprint.

Foreign aid from the U.K., U.S., World Bank and others underwrites Indian population-control programs. The national flagship Reproductive Child and Health Programme (Phase II) was granted 166 million pounds ($268.5 million) from the U.K.’s Department for International Development (DFID) from 2005 to 2013.

“British aid has not been used for forced sterilization now or in the past,” a DFID spokesperson said in a written statement in late April. “The government of India has strict guidelines for quality of family-planning services, which include ensuring consent. It takes action when any evidence of coercion is uncovered. There are no longer family-planning targets.”

What’s more, DFID said: “The program started in 2006 under the last government. Support will end completely next year.”

DFID added that its spending was “closely monitored” in India. But Britain attached no special conditions to the funding for the project, which has among its stated goals reducing the country’s total fertility rate from 2.9 to 2.1 children per couple.

In the United States, the 1999 Tiarht Amendment prohibits the U.S. Agency for International Development (USAID) from funding any family-planning program that has targets or quotas, is coercive, has financial or other incentives or involves non-consensual experimentation. If any of these requirements is violated or a “pattern or practice of violations” emerges, the administrator of USAID has 60 days to submit a report of findings and remedies to the Committee on International Relations and the Committee on Appropriations of the House of Representatives and the Committee on Foreign Relations and the Committee on Appropriations of the Senate.

In 2010, according to a Congressional Research Services report, India received $126.6 million from USAID, including $22 million for various family-planning programs.

A 2008 USAID document discusses implementation of the “population policy” in India’s state of Uttar Pradesh, whose major goal is reducing the country’s fertility rate from 4.3 in 1997 to 2.1 by 2016. Sterilization of women is a preferred method in the state, where 450,000 women undergo tubal ligations each year.

A spokesman for USAID, Alex Glass, said it is “committed to improving the health of vulnerable people in India. USAID programs provide technical support to improve family-planning information and services. USAID assistance has helped improve maternal health and reduced infant mortality across India.”

He said that USAID’s budget for health programs in India for Fiscal Year 2011 was $78 million, of which $23 million was designated for “voluntary family planning and reproductive health activities.” Glass also said that USAID has not sponsored trials of vasectomy in India and that no USAID funds for the Maternal and Child Health-Sustainable Technical Assistance and Research Initiative have been or are directed to any sterilization program in India.

Glass said that “given the immense health needs in northern India, USAID has focused maternal, child and family programming in ... Uttar Pradesh” and other areas.

‘Bad Science’

In April, The Guardian newspaper referred to a 2010 DFID working paper that cites “climate change” as a key reason for pressing ahead with such programs. The document argued that stemming population growth would cut greenhouse gas emissions, although it allowed for “complex human rights and ethical issues” in the strategy.

Steven Mosher of the Population Research Institute said that elitists have long used environmental crises such as food and water shortages or global warming to justify eugenic campaigns against the poor. Forced sterilization has been documented wherever population-control measures have been implemented, from China and Peru to the latest reports of maimed women in Uzbekistan amid official denials. “They’re using bad science, outdated theories of population and an unproven theory about climate change to justify real harm to real people in real time,” said Mosher.

Indian human-rights activist Biswas said she would like to see India focus on changing the culture for girls, requiring them to stay in school longer, enforcing the legal age of marriage, and, in so doing, elevating their status and delaying the age of first pregnancy to maturity, rather than sterilizing them in their 20s.

Biswas’ own views have changed. She recalled accompanying a young woman who had been harassed by motivators to a sterilization camp: “She was 25, and she didn’t know she was pregnant; and the sterilization caused her to miscarry, and she lost her baby. And she didn’t know she would never be able to have another baby.

“Without any anger, she said to me, ‘In the eyes of government and these others, do our lives have any value?’”

“If it was my own daughter …” said Biswas, trailing off. “How can we look at these girls in their eyes?”

“I didn’t used to think this way. I used to say, ‘We need help. Yes, give us money, and help us.’ I didn’t know they wanted to target the poor women,” said Biswas bitterly. “If we are for human rights, we must say No to all this funding. If this money is going to something that is not the need of the people, it will do more harm than good.”

Celeste McGovern


writes from Scotland.