By Cheena Kapoor * – Devex
New Delhi, India — On a chilly November night last year, Poonam Devi and three other women from her village were surgically sterilized at a health center near their village, Basoli, in India’s Sonbhadra district.
A typical government-run rural health center, that day it was hosting a mass sterilization camp. Women in large numbers — anywhere between 50 and 100 — are lined up and given an approximately five-minute procedure to tie their fallopian tubes.
Devi was one of at least 50 other women who underwent tubectomies that day. At around 8 p.m., she was called into a room for the surgery, made to rest an hour, and sent home.
She, like the others, was not informed about the procedure, its implications, risks or after-care, or any other treatment or pain-killer required.
According to a United Nations estimate, India is set to surpass China to become the most populous country in the world on April 14. Due to its exponentially growing population, the Indian government has introduced various measures over the years to curb population growth — one of them being female sterilization. But this has resulted in its own set of failures.
A month after Devi’s surgery, she started to experience severe pains as her surgery wound got infected. After an ultrasound at a private hospital, a doctor informed her that the infection was severe and she would require a hysterectomy — a surgical procedure to remove the uterus. Until then, she was prescribed medicines to manage the pain and sent home.
At 35, after bearing four children, her husband and mother-in-law convinced her that the tubectomy was necessary as they could not afford any more children on her husband’s meager salary of $120 a month. But the hysterectomy she needs as a result of the surgery complications is also costly.
“The surgery requires a lot of money we do not have. Just the ultrasound and some medicines cost us 12,000 Indian rupees [$146]. I have been buying medicines costing $75 in the last 3 months. I have been living in pain as surgery is not an option at all,” Devi said.
About 3.54 million Indians underwent sterilization between 2018-2019. Of the total sterilizations conducted, vasectomies — male sterilization — comprised only 1.4%.
“There are no reproductive rights for women. … The entire onus of population control is placed on women.”
— Jashodhara Dasgupta, a gender rights policy advocate
Of the women who were sterilized, over 7% regret having the procedure done. There have been cases where these surgeries have been performed in abandoned schools and open agricultural fields, mainly to meet annual sterilization targets.
Due to the high death rate in sterilization camps, the Supreme Court of India directed the central and state governments in 2016 to stop mass sterilization camps within three years and focus on strengthening health facilities instead to perform such surgeries as routine rather than in bulk. Between 2003 and 2012, 1,434 women died due to complications from such mass drives, with the deaths peaking in 2009 at 247.
The bulk herding and forceful sterilizations in camps may have stopped on paper, but activists say women are still coerced by family and community health workers to get this procedure done leading to several complications and even deaths.
Four women died of complications due to sterilization in August last year in the Indian state of Telangana after they participated in a mass sterilization drive. In November, 60 women were forced into sterilization in the eastern state of Bihar to meet annual sterilization targets. The case is still being investigated. In another similar event, 101 women were sterilized in eight hours in Chhattisgarh the previous year.
“The sterilization camps have ended on paper, but they continue in rural areas,” said Devika Biswas, a health activist from Bihar, who filed a Supreme Court petition in 2016 which led to the landmark judgment to stop mass sterilization camps. According to Biswas, local health centers now dedicate one or two days a week to these operations.
“On these days, community health workers bring women in bulk for tubectomy. This is termed ‘voluntary tubectomy,’ even though most women have no idea what is happening to them,” she said.
Experts say that the entire focus is on women’s sterilization to help achieve state targets and men are excluded from the conversation.
Between 2019 and 2021, the male sterilization procedure — which is much simpler and safer, accounted for only 0.3% of the total sterilizations in the country, according to the latest National Family Health Survey.
“The situation can only improve if men are encouraged to participate and we move from a target-based approach to one based on assessment of needs,” said Abhishek Singh, a professor at the Department of Public Health and Mortality Studies and head at the Center of Demography of Gender at the International Institute for Population Sciences.
Jashodhara Dasgupta, a gender rights policy advocate, said NGOs are working to spread awareness about sterilization among both men and women. They are encouraging men to get vasectomies done and in some cases provide victims of botched surgeries with compensation. But misinformation and myths still abound. Devi said both she and her husband were not aware that he could opt for a vasectomy with no complications.
“We thought such a surgery might lead to weakness in my husband’s body, which would have affected his productivity at work. It may have also affected his sexual prowess, and no man wants that,” Devi said.
In the 1970s, the Indian government had set stringent male sterilization — the only method known then — targets as part of family planning, and millions of vasectomies were performed, leading to a large number of deaths too. The incident has since led to the propagation of much misinformation about vasectomies, stigmatizing the procedure.
“There are no reproductive rights for women,” Dasgupta said. “The entire onus of population control is placed on women. Even after decades, the program is still not gender sensitive. Men are not taking responsibility, leaving women with no choice and forcing them into this.”
*Cheena Kapoor is a Delhi-based independent journalist and photographer focusing on health, environmental, and social issues. Her work has been published by The Guardian, The Telegraph, Reuters, BBC, and Al Jazeera, among many others. Her long-term project “Forgotten daughters” about abandoned women in Indian mental asylums has been widely published and exhibited across Europe. Follow Cheena on Twitter and Instagram.