Time for a change
The Bilaspur tragedy calls for an overhaul of policy on reproductive health
Sthe tragedy in Chhattisgarh, doctors, INCE THE policy-makers and public health experts have been trying to find ways to avoid a repeat. A team of doctors from aiims in Delhi went to Bilaspur to help the doctors there provide the best treatment to the ailing women. Teams of non-governmental organisations too went on fact-finding missions. The state government has set-up a judicial inquiry, as well as a health department probe while police investigates the case. While the probe reports are yet to be released, public health experts and other concerned people have suggested some short-term and long-term solutions.
Asking for the operations to be shifted from camps to proper health facilities, Brinda Karat, former member of Parliament and a prominent voice on women's issues, said, “The choice of whether to reproduce, method of birth-control and time should rest with the individual. Sterilisation as an individual’s choice has to be provided in a proper health facility through the year.”
Consensus among the experts is that in the longterm India needs a thorough review and overhauling of its family planning programme. An overwhelming demand is to stop using monetary incentives to attract people to unsafe family planning practices. Target-based sterilisation must end. Instead of camps,family planning programmes should be available as part of regular healthcare services.It has to be ensured that women alone are not targeted for sterlisation and a basket of contraceptive methods is made available to families. They demand that the women in Bilaspur be provided justice and their healthcare needs be met.They also suggest that government doctors be trained to carry out such surgeries safely. In the light of the alleged role of contaminated medicine, experts suggest that drug procurement policies should also be reviewed.
It is being pointed out that the rate of population growth in India has now decreased and the anxiety for speedy population control must stop. According to census of India, the decadal population growth from 2001-11 came down to 17.6 per cent. It remained above 21 per cent for the preceeding five decades.
“There is a concept called population momentum. It means that population is growing because of a large number of people in the reproductive age group. So, even if they have two to three children only, population growth will be high.We can’t do anything about it," Rao says. Around 60 per cent of the population growth today is due to population momentum,20 per cent due to unmet demand of family planning servic-
es and 20 per cent is due to unwanted reproduction, according to a Planning Commission report. Still, India continues to spend a large part of its population control budget on sterilisation (see ‘India’s lopsided approach’on p32 ).
This iterates the need to give up the camp approach to family planning.“The goalpost of the family planning debate has shifted. Now women themselves seek family planning services.They do not want more than two-three children. We have to see to it that their demand is met,” says T Sundararaman, founding director, Chhattisgarh State Health Research Centre. Integrating family planning with the rest of the public system would remove the need for incentives to meet targets.“We do not need separate camps.The government can fix one day a week when a laparoscopic surgeon would be present for sterilisation,” he says.
The main challenge is shortage of trained surgeons. “Bilaspur has two surgeons in the district hospital who are trained in laparoscopy. These surgeons perform other surgeries too.How can we start a weekly service?” asks S K Nanda, superintendent, Bilaspur District Hospital. To this, Sundararaman suggests training more doctors.
Alok Banerjee, member of technical committee on family planning of Government of India, says that minilaptubectomy should be encouraged. "It is a simple and inexpensive procedure. While laparos- copy requires high competency, this can be learnt faster. Also, equipments for minilaptubectomy cost a few thousand rupees, while one laparascope costs ` 10 lakh. Its success rate is also higher. It is not promoted because even a trained surgeon would take 1015 minutes to perform one surgery. But it is time we cared for meeting demands and providing safe operations than rushing to sterilise more people," he says.
Jashodhara Dasgupta, convenor of National Alliance for Maternal Health and Human Rights, says it is disappointing that India has not been able to provide basic human rights to women. A pledge to ensure this was taken 20 years ago. In 1994, at the UN conference on population and development held in Cairo,a 20-year action plan was adopted.This action plan asked countries to consider women’s needs instead of blindly following demographic demands when planning population control strategies.
Basket of different options for sterilisation also includes male sterilisation which does not receive any focus.Apart from the fact that women are seen as easy target for motivation to sterilise,awareness is also an issue."Vasectomy is surrounded by many myths like impotency.Government should create awareness and motivate more men to opt for it," says Sri.
A report by a fact-finding mission says that the tragedy in Chhattisgarh was waiting to happen. In 1974,Karan Singh,the then health minister had declared: “development is the best contraceptive”.This was ignored at that time.The time has now come to understand this basic concept.
The choice of whether to reproduce, method of birthcontrol and time should rest
Son of Dularin, who died after sterilisation, still thinks that his mother is at his maternal grandmother's house and will return in a few days