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India – Family planning deaths must not go unpunished

Last week, the criminal trial of the surgeon who conducted laparoscopic tubectomies which resulted in the deaths of 13 women in Chhattisgarh was quashed by the Chhattisgarh High Court. After telling the Supreme Court in Devika Biswas’ case — a PIL filed by a social activist — that the prosecution would be conducted properly once the case ended, the State government assisted the doctor by refusing to grant sanction for prosecution. As a result, the prosecution was quashed.

On November 8, 2014, the surgeon and an assistant performed over 80 surgeries within 90 minutes at a State-run family planning camp, in an abandoned building near Bilaspur. Within 24 hours, many of the women began complaining of abdominal pain. Thirteen women died while 65 others were injured.

The State government responded petulantly to the Supreme Court’s decision of 2016 in Devika Biswas’ case — where the court had criticised governments for the manner in which sterilisation camps were run — by threatening to stop all such sterilisation operations in the rural areas. Women are now being forced to approach the prohibitively expensive private sector.

Turning point

In one of the first decisions on reproductive rights, the Supreme Court, in 2005, was shocked by a Uttar Pradesh and Bihar Health Watch report which showed photographs of women after laparoscopy tubectomies. They were lying on straw on the floor with blood-stained sarees. The photographs prompted the filing of the landmark Ramakant Rai case in the Supreme Court. The court set out directions such as the qualification of empanelled doctors, physical examination of women prior to the operation, informed consent, quality assurance committees to be set up, an insurance policy, compensation and an inquiry after every death. These directions were ignored.

In 2012, the case of a government doctor together with an NGO, going to an abandoned school in Bihar at night, dusting the tables, having unqualified staff administering 61 women anaesthesia, and then operating on them in torch light shocked the world.The doctor hardly spent 3 minutes on each woman. There was no sterilisation of the laparoscope, no change of gloves, no running water and no arrangements for disinfection, counselling, medical examination or post-operative care. Against a maximum of 30 sterilisations a day with one laparoscope, twice that number was operated upon. The women were placed on straw on the floor, still bleeding. The doctor and the NGO then left. Biswas then filed a petition in the Supreme Court in 2012 highlighting similar horror stories from Maharashtra, Rajasthan, Madhya Pradesh, West Bengal, Punjab, Odisha, Himachal Pradesh and Uttar Pradesh.The spread of this gruesome crime against women in the face of the Ramakant Rai case of 2005 demonstrated that human rights decisions of the Supreme Court are routinely defied on the presumption that the poor will be unable to proceed further in contempt. The response of the Union of India was typical. It resulted in a series of publications in English setting out new standards and procedures. The manuals specified that women are to be informed of all the methods of family planning and that they have the option of refusing to be operated upon. Post-operative care required that the woman rest overnight at the facility. All complications were to be documented, cleanliness to be maintained and sterilisation of needles and linen to be done. While the case was going on, the Chhattisgarh incident took place in 2014. A district judge observed in a judicial investigation report that consent was not taken, the operation was done in utterly unhygienic conditions, that targets were set by the Central government, that each surgery took only a few minutes, gloves were not changed, the floors and sheets were dirty, health checks were not done prior to the operation, that the insurance scheme had failed, and that deaths were due to infection and spurious drugs.

Focus on female sterilisation

In September 2016, the Supreme Court decision in Devika Biswas’s case recorded the statement of the Union that such camps would be phased out. The Court also recorded the submission of Devika Biswas that 97% of all sterilisation procedures were conducted on women and 85% of the family planning budget exclusively went towards female sterilisation. Virtually no attention is paid to male sterilisation. Biswas also pointed out that between 2010-13, 363 people died due to sterilisation. She also said that unrealistic targets have been set resulting in non-consensual and forced sterilisations including on the physically and mentally challenged and young persons.

Once the camps are stopped, the operations are to be performed in government institutions such as primary health-care centres, community health-care centres and district hospitals. The reported reduction in sterilisation operations in the State has forced poor women to approach the private sector which they can ill-afford.

It looks as if gruesome crimes against women in this country will always go unpunished. Perhaps the only way forward, as in the right to food case, is to have civil society monitoring integrated in court orders. Only this will make governments wary and afraid of contempt proceedings. Otherwise it will be business as usual, court orders notwithstanding.

Colin Gonsalves is the founder of the Human Rights Law Network

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