Hundreds of women and men from as many as 10 states in the country came together in Delhi today for a Public Hearing to relate the experiences they had undergone while availing of family planning services in the government health system. The testimonials of the victims, presented before an eminent panel of experts and others including Member of the National Human Rights Commission Justice Cyriac Joseph, raised important questions on issues of informed choice, quality of care, youth perspective and male responsibility.

Outraged by the entirely preventable deaths of 13 young women in Bilaspur, Chhattisgarh who were merely seeking safe contraception, the National Coalition Against Coercive Population Policies and Two-child Norm, the National Alliance for Maternal Health and Human Rights (NAMHHR) and 45 other civil society organizations and networks like HealthWatch Forum Uttar Pradesh and Maternal Health Campaign Madhya Pradesh held the Public Hearing to show that what happened in Chhattisgarh was not an isolated incident. The hearing brought to the fore experiences with the family planning health system from the states of Uttar Pradesh, Madhya Pradesh, Haryana, Delhi, West Bengal, Gujarat, Maharashtra, Bihar, Jharkhand and Rajasthan.

They issued an urgent Call to Action asking the government to immediately 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 the population. The Call to Action has also asked to 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.

It asked to immediately remove all incentives (such as lotteries and awards) to the acceptors of sterilizations and disincentives to persons with more than two children, in all policies and schemes of the state and central governments.  It also wanted a immediate end to all mass sterilization camps and urged that all sterilization operations and IUCD insertions must be conducted in well functioning health facilities following standard operating procedures laid down by the government.

Describing the quality of care in sterilisation and other family planning camps, Jhamman Bai, a woman leader from the Mahila Swasthya Adhikar Manch, Uttar Pradesh, said poor women from the villages are made to lie on thin mats in corridors and courtyards while the health institutions lacked even basic facilities like toilets. She added that women were often not given sterilisation certificates and therefore could not prove that the operation had indeed taken place if something went wrong. Activist Devika Biswas said that in Kaparfora in Bihar a camp was held in a school in defiance of the Supreme Court orders. There was no pre-operative screening done here and even very young women were being herded into the camp with scant respect for privacy and dignity. A man from Madhya Pradesh said that even though he had undergone sterilisation his wife had conceived and when he complained about the failed operation to health authorities they taunted him about his wife’s morality.

The testimonies clearly brought out that as a result of poor quality of sterilisations, women ended up conceiving again, facing medical complications and in some cases even dying. Generally complications were not treated by the public health system and women ended up spending large sums of money for private treatment. In cases of failure or death when women and men or their families demanded for insurance promised by the government they were discouraged or even threatened.

The hearing also highlighted the fact that often consent was taken in a situation when the woman was on an operation table and worse still was sterilized without consent, as in a case from Uttar Pradesh where the doctor herself had decided that the woman had too many children. Pratibha, an activist from Human Rights Law Network pointed out that these violations were taking place not just in far flung rural areas not also in the national capital of Delhi.

An analysis of budget allocation at the hearing by Sona Mitra of the Centre for Budget and Governance Accountability illustrated that the family planning policy of the government is grossly biased in favour of female sterilization with over 90 percent of the allocated family planning expenditure going to it while male responsibility and other contraceptive methods have scarcely any allocation. Moreover a large part of the health budget is spent on cash incentive schemes like Janani Suraksha Yojana (JSY) to the neglect of strengthening of public health infrastructure

Responding to the stories, Justice Cyriac Joseph said, “These are stories of heartrending cruelty and it reflects not just human rights violations but also our insensitivity as a society.” He informed the audience at the Public Hearing that on November 12 the NHRC had issued notices to the government of India and to the Chhattisgarh government asking them for an explanation of the tragedy within two weeks. A month down the line the NHRC is yet to hear from them and is now pursuing the matter.

Ramakant Rai the activist who filed a writ petition in the Supreme Court in 2003 that led to the passing of the order on quality standards for female sterilisation, said, “Sterilisation is not treatment for a disease, it is an elective surgery and therefore those providing it are fully accountable to ensure that there are no adverse outcomes.” He regretted that despite the SC orders not much had changed on the ground.

AR Nanda, former secretary of the ministry of health and family welfare, regretted that although the National Population Policy of India, 2000, completely abjured targets and called for quality of care, yet so many years later “we still find targets informally imposed upon providers and motivators. He insisted, “India must uphold the international agreements and commitments made at ICPD 1994 for addressing rights violations, penalties must be imposed by the state if quality norms are flouted and independent monitoring of quality of care must take place.”

Please click here for  Call For Action.