A national alliance of organisations working on maternal health rights today called for setting up of an independent monitoring commission to look at the audits and reports that are commissioned by the government to review its family planning programme. An oversight body of parliamentarians, women’s rights organisations and academicians needs to be constituted immediately, said Jashodhara Dasgupta of HealthWatch Forum U.P, adding that such measures would support Wednesday’s landmark Supreme Court order in the case of Devika Biswas vs Union of India and others (Writ petition (Civil) No.95 of 2012), that ruled against mass sterilisation camps and called for greater transparency in the family planning programme. Dasgupta said, speaking at a press conference organised in New Delhi today by the National Alliance for Maternal Health and Human Rights (NAMHHR) and HRLN through whom the petition had been filed, activists from across the country and public health experts welcomed the judgement as an important step towards reproductive health justice for women in India.
Petitioner Devika Biswas appreciated the order acknowledging the government’s failure opining at the same time that mass sterilisation camps should be stopped immediately rather than being given a buffer period of three years. She felt government accountability needed to be emphasised through ensuring redressal and compensation for the women who had suffered, which was currently lacking. “Civil society and media now need to vigilantly monitor the implementation of the SC order by informing communities that the practice is soon to be banned,” said Biswas.
Kavita Krishnan, Secretary AIPWA expressed concern at the press conference that the issue was still being framed as a population control problem rather than a question of reproductive justice for all women. She emphasized,”The question is not about which is the next best technological fix in contraception but about what actions will empower women to gain control over their bodies, and encourage men to take responsibility for contraception.”
Described as the single largest operation ever to take place anywhere in the world, equivalent only to the cataract eye surgeries, about 4-5 million women in India undergo sterilisations each year, and the estimate is that close to 1000 women die every year due to the appalling conditions in which sterilisations are carried out by public health system.“The family planning program in India adopted a mass surgery approach in the 1970’s in Ernakulam, Kerala, where men underwent vasectomy by the hundreds. This same approach was applied, however, to the more complicated procedure of female sterilization which involved an abdominal operation, a grossly inappropriate move in hindsight,” said Abhijit Das, Convener of NAMHHR.
Sanjai Sharma of HRLN recounted the long struggle of over two decades to highlight concerns about quality of care in sterilization camps. Specifically he referred to the Ramakant Rai v Union of India case, which the present judgment refers to and expressed surprise that the Supreme Court orders in that case from 2005 have not been implemented as yet on the ground.
Ajay Lal of the Maternal Health Rights Campaign in Madhya Pradesh spoke about the conditions prevailing insterilization camps in the state. He related observations from 28 camps in 12 districts of M.P in 2016, describing that even now camps were being held in unsanitary conditions in dharamshalas and schools apart from public health centres, and cycle pumps were being used to pump air into the abdomen, a gross violation of standard operating procedures. Rajdev Chaturvedi from Healthwatch, Uttar Pradesh who is also a member of the quality assurance committee (QAC) in the district of Azamgarh, said that the committee was constituted three years ago but no meeting has been held. He also spoke of emerging issues related to family planning, especially that of fraudulent records of post-partum IUCDs and stealth insertion of IUCDs without women’s knowledge after delivery. From Chhattisgarh Dr Yogesh Jain ofJan Swasthya Sahayog provided his observations following the Bilaspur incident where 13 women died after sterilization operations in 2014. He mentioned that the Anita Jha commission report which inquired into the matter had not inspired any confidence as it merely shifted the blame onto an external party – the drug manufacturer – even though evidence pointed to the contrary. In response to the case, the public health facilities had altogether stopped conducting sterilization camps and now women who needed the procedure had to go to neighbouring states or pay a private provider to avail of these services. This is an unintended consequence of the issue and ultimately ends up harming women.
The press conference ended with a call to use this judgment as an impetus to launch a larger public movement against the ‘violation of women’s bodily rights’ by highlighting concerns around the implementation of the family planning program with regard to quality of care and informed choice and maintaining pressure on the government for greater accountability.
Ensuring Informed Choice and Quality of Care in Contraceptive Service Delivery
Call to Ministry of Health and Family Welfare, Government of India
We welcome the judgment of the Honorable Supreme Court of India in the DevikaBiswasvs Union of India (Writ Petition (Civil) No 95 0f 2012), which recognizes that death, failures, complications and coercion as a result of female sterilization have grave implications for women’s Right to life, Right to health and Right to reproductive health. We appreciate the following aspects of the judgment :
- The system of holding sterilization camps should be completely stopped within 3 years.
- Family Planning is matter on the ‘Concurrent List’ of the Constitution and the responsibility for the programmelies ‘squarely on the shoulders of the Union of India’, and it cannot ‘pass the buck to the State Governments’. The Government of the Union of India must take ownership of the Family Planning programme.
- Coercive methods are not justified and neither are they effective;improved access, education and empowerment should be the aim of the Family Planning programme.
- The Family Planning cannot be targeted only towards women and must address men ‘at least for reasons of gender equity’.
- The consent procedure should include checklists explained in the local language by a trained counselor to avoid ‘incentivised consent’.
- The State Governments and Union Territories should ensure that no targets are fixed for health workers and others which will lead to forced or non-consensual sterilisation
- Quality Assurance Committees at the State and District Level must be activated through publishing details of members of such committees, reports of 6 monthly meetings as well as report cards indicating decisions taken, work done, achievements etc.
- Audits have to be conducted of failures and deaths and Annual Reports of the Quality Assurance Committees must include details of such audits held and remedial steps taken. The first Annual Reports should be published before March 31, 2017.
- The compensation under FPIS needs to be increased substantially with shares both from the Government of India and the State Government.
We recognise the importance of these orders to improve the quality of care of the Family Planning programme.
We call upon the Ministry of Health and Family Welfare, Government of India to take the following additional measures to ensure that women, men and couples in India are freely able to exercise their reproductive right to informed choice to safe and effective contraceptive services.
- Set up a High-level expert Committee to review the family planning program in India and reorient it such that it is aligned with reproductive health rights of women, and needs of India’s population.
- Maintain a National Registry of complications, deaths and failures in sterilization operations as a surveillance mechanism.
- Shift the distorted focus of annual budgets away from sterilization of women and promote meaningful involvement of men in taking contraceptive responsibility and promotion of spacing methods.
- Review the indicators for the family planning programme to include informed choice, quality of care and adequate promotion of spacing methods. Instead of targets/ELA’s, consider ‘community needs assessment’ to determine the contraceptive demand and prepare the health system to fulfill this demand.
- Address the contraceptive needs of young couples, and adolescents by making available a variety of spacing methods. Allocate resources (funds, human and skills) and provide comprehensive sexuality education to young people, adolescents, men and women
- Expand and make available a basket of contraceptive choices to women, especially spacing methods, at the ground level along with complete information about its use and side effects so that they are able to make informed choices related to their reproductive lives. Methods that are less invasive and woman controlled must be included in the public health program.
- Increase awareness about entitlements vis a vis contraceptives in the community and involve the community in monitoring of the quality of contraceptive services.
We urge the Government of India to take immediate steps to bring about these substantive changes in the Family Planning Programs and Policies, so that women and men have the autonomy to choose safe and effective contraception methods, and have the ability to access these towards fulfillment of their reproductive rights and the right to health for all.
16 Sept 2016.
(National Alliance on Maternal Health and Human Rights)
Secretariat- Basement of Young Women’s Hostel No2
G Block, Saket, New Delhi 110017
Email: [email protected]
Phones: DrAbhijit Das – 9871713314,
MsJashodharaDasgupta – 9910203477
In a landmark judgment on 14th September 2016, the Supreme Court of India, while hearing the case of Devika Biswas v Union of India and others (Writ petition (Civil) No.95 of 2012), directed the Central government to end all mass sterilization camps, a demand that has been repeatedly made by several health and women’s rights activists. The judgment marks the culmination of a four year long case filed by Devika Biswas after an incident in Kaparfora, Araria District, Bihar, where 53 women underwent sterilization procedures in unsanitary conditions, in a school, in complete violation of the guidelines for female sterilization laid down by the Supreme Court and the Government of India. The judgment notes that this is not an isolated incident and during the course of the hearings, evidence of poor quality of care during sterilization camps has emerged from other states including Chhattisgarh (where 13 women died as a result of botched sterilization operations in November 2014), Uttar Pradesh, Kerala, Rajasthan, Madhya Pradesh and Maharashtra. This judgment is remarkable in that it directs the central and state governments to stop all camp based sterilizations within three years and instead strengthen health facilities so that they are able to provide this care. The judgment also directs the governments to not set even informal targets so that health workers do not compel others to undergo “what would amount to a forced or non-consensual sterilization”. It further acknowledges the role of both the Centre and the State in ensuring that the fundamental rights of beneficiaries of the family planning program are not violated and reinforces the orders passed in Ramakant Rai v Union of India, to ensure that voluntary, good quality care is provided to women undergoing sterilization. Overall, the judgment recognizes the need for greater accountability and transparency in the family planning program.
As civil society organizations, we welcome the judgment as it centre-stages reproductive rights and accountability of the government to those rights, which we see as a positive development. However, even as we celebrate this victory, we recognize that this is only one part of a larger battle to reorient the family planning programme within a framework of reproductive rights rather than population control. Recently, we have seen a resurgence of the two-child norm in Assam, with a proposal to implement incentives for those with two or less children and excluding those with more than two children from certain benefits. The problems of poor quality of care and violation of consent guidelines are also being reported with other procedures such as the post-partum intrauterine contraceptive devices (PPIUCD)s, which, as per field reports, are being inserted stealthily after institutional deliveries. Moreover, the family planning program is still focussed almost entirely on married women, while completely neglecting male responsibility and the needs of young people and adolescents.
Even as the Supreme Court calls for a moratorium on camp-based mass sterilizations, several such concerns remain, and the task is far from finished. Population control is still the primary concern that drives the family planning program which is still focussed almost entirely on women – this is something that just an SC judgment won’t change. What this requires is a change in mindset of policy makers, health care providers and people at large. As part of the FP 2020 goals, India has committed to providing contraceptive services to 48 million additional users. Given the reality of non-adherence to quality of care guidelines, what is the government doing, to ensure that the health, lives and rights of women are not being jeopardized in the pursuit of this endeavour?
In this light, we call for reorientation of the family planning program to meet the contraceptive needs of India’s population, in a manner that respects their individual rights. We call for the government of India to immediately implement the Supreme Courts orders and take efforts to stop all camps at the earliest. We also call for greater strengthening of health systems so that good quality services can be provided to all people. We also hope that the media will continue to highlight emerging concerns around the implementation of family planning programs and maintain pressure on the government for greater accountability.