Time for a change

The Bi­laspur tragedy calls for an over­haul of pol­icy on re­pro­duc­tive health

Down to Earth - - COVER STORY -

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

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