India’s Sterilization Scandal
Medical Misconduct Targets Poorest of the Poor, Critics Charge
RAIPUR, India — Following shocking deaths from botched sterilization surgeries in the central Indian state of Chhattisgarh, Church officials have expressed anguish and concern over medical abuses of the poor and the target-oriented population control being quietly implemented in India.
“Poor people are being treated like animals here,” Archbishop Victor Henry Thakur of Raipur, the capital of Chhattisgarh state in central India, told the Register Nov. 20.
“How else can they conduct surgeries in unhygienic conditions and send them home with spurious drugs?” said Archbishop Thakur, who heads the Church in one of India’s poorest states.
Fourteen young mothers — most of them illiterate — died, and 60 others were hospitalized, following tubectomy surgeries performed Nov. 8 at government organized health-care camps. While eight of them died after returning home from the camp at Takhatpur near Bilaspur, five more mothers died in different hospitals during treatment. Another young mother died of medical complications from a procedure at the sterilization camp at Pendra.
The botched surgeries at Takhatpur, according to reports, were conducted in an operating theater of a private hospital — lying unused for years — with “rusty” surgical tools wielded by a senior government doctor at a breakneck speed.
Dr. R.K. Gupta, who performed 83 tubectomy surgeries in five hours — more than double the limit for one day allowed by the local health department — that led to the tragedy, ironically had received an award from the Chhattisgarh government on India’s Republic Day (Jan. 26) for having conducted more than 100,000 sterilization surgeries, NDTV reported.
During the surgeries, the victims were asked to lie down on the floor, and the victims were sent home with drugs containing rat-poison components, marketed by an obscure firm that had been banned earlier.
Earlier, Archbishop Prakash Mallavarapu, chairman of the health-care commission of the Catholic Bishops’ Conference of India (CBCI), said that the tragic deaths from the sterilization program “raise questions about whose need the government was promoting with such health-care camps.”
While Gupta was subsequently arrested and fired by the state government, he defended himself and claimed that he was only trying to meet the stiff sterilization targets set by the health department.
“It was not my fault — the administration pressured me to meet targets,” the doctor said while being arrested, NDTV reported. “The surgeries went well, but the problem was with the medicines given to the women.”
“This [tragedy] shows the shocking treatment meted out to the poor in this country,” Jesuit Father Joe Xavier, director of the Indian Social Institute (the national social-action center of the Jesuits), told the Register.
Father Xavier regretted that the impoverished poor in remote areas are being treated as “punching bags by unscrupulous government staff to achieve the population-control targets set for them.”
“We are shocked to learn that the illiterate young women were not even told about the impact of sterilization surgery,” said Archbishop Thakur.
“It has been going on for a long time. The tragedy has brought it out now,” he added.
Following the deaths, media reports have unraveled the systematic manner in which the government has been pursuing target-based sterilization as a population-control measure, especially in underdeveloped areas targeting impoverished people.
Contrary to government denials, documents have been unearthed showing that rigid sterilization targets are set for each district (Indian states are divided into districts).
While India records around five million sterilizations a year, the Population Foundation of India reported that Chhattisgarh state had set a target of 220,000 sterilizations this year. Bilaspur, the district where the deaths took place, had a target of about 15,000 surgeries, it noted.
Two weeks before the deaths, the federal health ministry had sent out a circular on Oct. 20 to remind 11 “high-focus states,” including Chhattisgarh, of the “importance of performance in sterilization.”
The circular had also announced the government decision to double the “incentives” for sterilization for all the players involved. Men who undergo sterilization surgery now will be paid 2,000 rupees ($33) instead of 1,100, and the amount was increased from 600 to 1,400 rupees for women. For village health “animators,” who recruit participants in the sterilizations, the incentive was doubled to 200 rupees for each “volunteer” brought to the sterilization camp, while the incentive for doctors varied between 200 and 300 rupees.
The sterilization deaths also exposed the violation of special legislation to protect endangered tribes. One of the 14 dead from the sterilization surgery was 29-year-old Chaiti Bai, a member of the primitive Baiga tribe. Indian law forbids sterilization among people of the endangered tribe. Once this news spread, government officials are reported to have taken the tribal mother’s “thumb impression” as proof of her consent, allegedly doing so either after her death or when she was unconscious in the hospital following the botched surgery.
But according to the special legislation, only the head of the district administration can permit the sterilization of such tribal people, even if they have given prior consent.
“Sterilization is a money-spinning business for the officials,” said Father Xavier, whose institute has a national program for tribal welfare. “They don’t care what happens to poor people.”
‘Murder, Not Surgery’
The federal health ministry admitted in the national parliament earlier this year that 707 women had died between 2009 and 2012 because of botched sterilization surgeries. This means that, on average, about 15 women lost their lives in the sterilization process each month.
“This is murder, not surgery,” charged Holy Spirit Sister Julie George, director of the organization Streevani (Voice of Women), which is based at Pune, in the neighboring state of Maharashtra.
“The lives of the poor people have no value for the unscrupulous officials. There is no point in blaming the health workers alone. The government itself is responsible for the mess with the target-oriented incentive regime,” said the nun.
While the Chhattisgarh government initially announced compensation of 200,000 rupees ($3,300) to each of the dependent families of the mothers who died, following a national furor over the shocking deaths, the state government has doubled the compensation to 400,000 rupees.
“Declaring compensation is an eyewash. Will it bring back the mothers alive for the children?” asked the nun. Most of the dead mothers in the age group of 20-32 have two to three kids.
“It looks like poor people have no right to health care. They can be treated like guinea pigs,” said Sister Julie.
Earlier in 2012, Chhattisgarh had made international news headlines following the unethical removal of the uteruses of more than 2,000 poor women, mostly performed by unscrupulous doctors in private hospitals. The hysterectomy surgeries were carried out on poor women by hospitals to claim government insurance of up to 30,000 rupees ($500) to treat poor families, a safety net provided by the government to help pay for expensive hospital surgeries.
This was followed by the scandal of dozens of poor people turning blind after simple cataract surgeries going awry due to medical negligence.
“This is sad and shocking,” said Bishop Paul Toppo of the Diocese of Raigarh in Chhattisgarh. He commented that officials were targeting “least-developed areas” with hardly any literacy in order “to make money at the expense of the poor.”
However, Bishop Toppo noted that Church leadership had managed to prevent his own flock from being among the sterilization victims, despite the communication difficulties posed by the geography of Chhattisgarh, whose literal meaning is “home of 36 tribes” and is located in predominantly jungle areas.
“Our people have not fallen into the trap, and it has not happened in areas where we work,” he said. “The challenge is to make the poor people aware of such dangers. It is not an easy task, given our landscape.”
Anto Akkara writes from
- Dec. 14-27, 2014