Why India won't stop sterilising its women
Over a dozen Indian women have died after a mass sterilisation operation, reportedly carried out in barbaric conditions. Presenter and author Anita Anand, who spent years working in the region, explains the conditions and that led to this appalling crime
By Anita Anand, Radio presenter and author
For years I worked as a political journalist specialising in the Asian subcontinent.
Often I would find myself, once the microphones had been removed and the cameras packed away, chatting informally with Indian politicians, almost all of who were men. They were much less circumspect than they had been just moments before, on the record.
Conversations invariably took the same form. First there was the monologue: “India is on the way to greatness… ” they would assure me. “Do you know what holds us back? The only thing that holds us back? Too many Indians”.
Then came the catechism, grindingly familiar no matter what the political party: Poverty? Caused by overpopulation. Disease? Caused by overpopulation. Problems with infrastructure and corruption? Overpopulation…
With a wistful look, and defeated shrug I was told, time and again, that overpopulation was both cause of the problem and ultimate block to a solution.
This week, more than 15 years after I left that job, at least 13 women have been killed in India as a direct result of that same old catechism, and dozens more are in pain.
The victims were among those who received tubectomy operations at a government-run mobile sterilisation clinic in Chhattisgarh - one of India's most impoverished states. The procedure involves clamping, or severing a woman's fallopian tubes so the eggs can no longer reach the uterus for fertilisation.
The clinic was run as part of a national campaign to slow India's population growth. Over a six hour period, a Dr R K Gupta carried out 83 procedures. It was a conveyor belt, where he spent, on average, two minutes on each ‘problem’ - cutting her open and tying her tubes.
Now there are reports that - apart from obvious concerns about his fitness to perform so many surgeries in such a short space of time - his instruments may have been dirty and his post-operative drugs faulty. The families of the women have claimed they were forced to undergo the procedure against their will.
The doctor went on the run as the first women began to die and was arrested on Thursday, just as worrying news of other potential ‘Gupta killer clinics’ started to come to light. His face is now plastered across all Indian newspapers, and he is being vilified across 24 hour news networks on a loop.
A woman at the sterilisation camp in Bilaspur. Photo: India Today
However it would be useful to widen the focus and depth of vision, and look further back than the 10 minute news cycle allows. Because, only in January this year, the same Dr Gupta was being presented with an award by no less than the Indian health minister Amar Agarwal, for conducting a record number of sterilisation surgeries in his career. (One national broadcaster puts the figure at 100,000 operations).
Sterilisation camps are not new to India; they have been part of the struggle to contain its population for more than forty years. At one point they weren’t even voluntary. In 1976, Sanjay Gandhi, the son of Indira and grandson of founding father Jawaharlal Nehru, initiated a widespread compulsory sterilisation programme. The IMF and World Bank were demanding action to curb India’s population. If numbers were not brought under control, the fledgling nation risked losing vital funds just as it was getting on its feet (after the Raj and partition).
A state of emergency was underway in the country at the time and, with democracy suspended, the Prime Minister’s son was free to take extreme measures. Sanjay, along with a cadre of highly motivated goons, bullied men and women into mobile operating theatres. They targeted the poorest of the poor.
Those who could not be convinced to go under the knife for the good of the nation were lured in with promises of money, land and food. Undergoing operations they did not understand, some 8.3 million people were left to struggle with very little post-op care. When the scale of Sanjay’s ‘vision’ became apparent, there was widespread international condemnation. The scandal deeply hurt his chances of succeeding his mother into office but they did not end them. Only his death in a plane crash in 1980 did that. Some people still rue his passing today, claiming that Sanjay was “the only iron man with the guts to deal with the population problem.”
India is undoubtedly overcrowded. Photo: AFP/Getty
For there is no doubt that India does have a problem.
With around 1.25 billion people, the country has the second-largest population in the world after China. It is also true that the burden of constant pregnancy, infant mortality and poverty lies heaviest on women - but so too does the ‘solution’.
In Sanjay Gandhi’s time, vasectomies were widely used, however now women find themselves disproportionately in the spotlight. Despite the fact that a vasectomy is a much simpler procedure than the tubectomy, figures collected in 2003 show that just under 115,000 vasectomies took place in India as compared to 4.6 million tubectomy surgeries. Today, tackling the penis causes India to squirm, as if its very virility was at stake. No such qualms about women’s bodies.
Just as the gang-rape of a student on a bus in Delhi, in 2012, threw India’s attitudinal problem with women into sharp focus, so too does the ugly case of Chhattisgarh and its deadly sterilisations. Both events were the tip of the iceberg and indicative of systemic issues with governance and policy. Why not provide women with birth control pills, inter-uterine coils or condoms? Why not give them power over their own bodies? Even choices?
Indian women protest against how authorities handle sex crimes. Photo: SAURABH DAS/AP
I suppose I do know the answers, even as I ask the questions. For women to be in control of their own fertility, it would require ongoing funding and also a degree of mass education, neither of which is as cheap as the chop.
It would also require women to be able to talk about sex, something that is still seen as a 'besharam' - or ‘wanton’ act. Even though India has recently graduated from being a ‘poor country’ to one of ‘middle income’ it still faces tremendous challenges. Women are the ones to suffer most, according to all important metrics. Maternal mortality rates in rural areas are among the highest in the world. Women are disproportionately the victims of violence, even if they don’t report it. Malnutrition disproportionately affects them, partly due to the traditional expectation that girls and women eat last - even during pregnancy and when they are lactating. All of this devalues India’s female population and makes them invisible when the politicians are carving up the cake.
Perhaps most tellingly, according to a census taken in 2011, 82.14 per cent of men have effective literacy rates compared to 65.46 per cent of women. Literacy is the strongest predictor of contraception usage among married couples, even if the woman has no economic independence.
This week I have spent a lot of time thinking about my old role and the Indian politicians who crossed my path. Their catechisms really needed to be interrupted – and they still do.
Yes, population is at the heart of many of India’s problems and yes it needs to be brought under control. But how about herding women into classrooms rather than squalid operating theatres, where ‘award-winning doctors’ take just two minutes of care?
How about filling girl’s bags with books rather than post-op drugs that might kill them? Give them access to good medical care. Teach them, don’t cut them. Then and only then will India finally get to grips with its population problem once and for all.
Anita Anand is the presenter of BBC Radio 4’s Any Answers. Her book : ‘Sophia. Princess Suffragette, Revolutionary’ is published by Bloomsbury January 15 2015.