No right to plan their fam­i­lies

A 38-year-old gov­ern­ment or­der de­nies Baigas the choice of un­der­go­ing ster­il­i­sa­tion

Governance Now - - CONTENT - Ar­chana Mishra

A 38-year-old gov­ern­ment or­der de­nies Baigas the right to un­dergo ster­il­i­sa­tion

Bhadiya from Bhan­pur Kheda vil­lage does not know her age. She has five chil­dren – the el­dest one is 12-year-old while the youngest is an in­fant. con­sid­er­ing she got mar­ried in her teens – like most women in her vil­lage – Bhadiya must be in her 30s. af­ter giv­ing birth to five chil­dren she no longer wants to have an­other child. she feels phys­i­cally weak now, says Bhadiya. But no one in her vil­lage, which is al­most 50 km from Mandla in Mad­hya Pradesh, is ready to help her. Not even doc­tors in the Mandla district hospi­tal or nearby com­mu­nity health cen­tre in Bich­hiya.

“We want Bhadiya to get an op­er­a­tion done so that she can­not have babies. But the doc­tor re­fuses to help us,” says ramkali, Bhadiya’s mother.

in the same vil­lage lives sukhwati. she has been giv­ing birth to one child af­ter an­other, fail­ing to keep a gap in each de­liv­ery. sukhwati has four chil­dren and is re­luc­tant to con­ceive any fur­ther. There­fore, she, along with her mother-in-law sukrati, went to the com­mu­nity health cen­tre in Bich­hiya for ster­il­i­sa­tion. “They re­fused to do an op­er­a­tion. We don’t know what to do now. she (sukhwati) can­not have babies ev­ery year,” laments sukrati.

like Bhadiya and sukhwati, many women in the vil­lage as well as in Mandla district are de­nied health and re­pro­duc­tive rights. More im­por­tant, they are de­nied the right to choose whether they want to have chil­dren or not. There is no re­stric­tion on their hav­ing chil­dren, but they are not al­lowed to sub­ject them­selves to any per­ma­nent mode of fam­ily plan­ning rea­son. They are Baigas – a ‘par­tic­u­larly vul­ner­a­ble tribal group’ (PVTG) which is not al­lowed to adopt per­ma­nent fam­ily plan­ning mea­sures, as per a 38-year-old gov­ern­ment or­der.

in 1979, the pub­lic health and fam­ily depart­ment of Mad­hya Pradesh is­sued an or­der which dis­al­lowed Baiga women and men to un­dergo ster­il­i­sa­tion, un­til per­mis­sion is sought from the gov­ern­ment au­thor­ity.

“ear­lier Baiga fam­i­lies had to take per­mis­sion from the block of­fi­cer but later they were sup­posed to take per­mis­sion from the sdm (sub-di­vi­sional mag­is­trate). in my knowl­edge in last two to three years there is a com­plete ban on ster­il­i­sa­tion of Baiga women,” says dr Ja­muna Prasad chicham, gen­eral physi­cian at the com­mu­nity health cen­tre, Bich­hiya.

other doc­tors have the same in­for­ma­tion. They say as per the let­ter re­ceived from the chief med­i­cal of­fi­cer based in the district head­quar­ters they can­not op­er­ate on any Baiga woman or man. “Th­ese women fre­quently visit us. They also come dur­ing health camps. al­though we know they have four or more chil­dren we have to send them back be­cause of the gov­ern­ment or­der,” says chicham.

de­fend­ing the gov­ern­ment’s move,

dr ra­jan Peepre, fam­ily plan­ning of­fi­cer of the Man­dala district hospi­tal, says that the pur­pose of this or­der is to in­crease the pop­u­la­tion of Baigas. But when i ask him if he has a copy of the orig­i­nal or­der, he says that he took charge of the depart­ment only this year and doesn’t have a copy.

dr Madan Peepre, who han­dled the fam­ily plan­ning depart­ment for 10 years be­fore ra­jan, is equally clue­less about the whole process. The depart­ment doesn’t have any data on the ster­il­i­sa­tions con­ducted with the gov­ern­ment per­mis­sion. He doesn’t even know whether per­mis­sions from the SDM or block of­fi­cers were be­ing given at all.

An on­go­ing le­gal bat­tle

un­til two years back, ster­il­i­sa­tion was hap­pen­ing se­cretly in hospi­tals and health camps, con­firm health work­ers and lo­cals work­ing with them. But it stopped al­to­gether af­ter an in­ci­dent in 2014. Thir­teen tribal women, in­clud­ing a few Baiga women, died in ch­hat­tis­garh af­ter un­der­go­ing ster­il­i­sa­tion surgery in a health camp in 2014. The state gov­ern­ment ap­pointed a ju­di­cial com­mis­sion to in­ves­ti­gate the mat­ter. Med­i­cal neg­li­gence and use of sub-stan­dard drugs were re­vealed to be the pri­mary rea­sons for the deaths. The probe also pointed out that the ster­il­i­sa­tions vi­o­lated the law that pro­hibits Baiga tribe from ster­il­i­sa­tion.

“since then ster­il­i­sa­tion has not been hap­pen­ing in our district,” says an ac­cred­ited so­cial health ac­tivist (asha) who used to pre­pare a list of Baiga fam­i­lies for the op­er­a­tion.

The Baiga tribe is con­cen­trated in a few dis­tricts of Mad­hya Pradesh like Mandla, din­dori, shah­dol and Balaghat. Th­ese dis­tricts share bound­ary with ch­hat­tis­garh, which was part of Mad­hya Pradesh be­fore it was es­tab­lished as a sep­a­rate state in 2000. Many Baigas live in some dis­tricts of ch­hat­tis­garh like ra­j­nandgaon, Bi­laspur and Kawardha.

al­though the state is di­vided now, the 1979 or­der holds equally true for Baigas in ch­hat­tis­garh. in Fe­bru­ary, 10 Baiga fam­i­lies filed a PIL in the Ch­hat­tis­garh high court. Jan swasthya ab­hiyan and Jan swasthya sahyog are cope­ti­tion­ers who have chal­lenged the gov­ern­ment or­der say­ing it is ar­bi­trary and vi­o­lates the right to life and lib­erty, which in­cludes the right to health and re­pro­duc­tive rights.

it is also dis­crim­i­nates tribal on the ba­sis of their re­pro­duc­tive rights and vi­o­lates ar­ti­cle 14 of the con­sti­tu­tion, says su­lak­shana Nandi, na­tional joint con­vener, Jan swasthya ab­hiyan (Peo­ples’ Health Move­ment, in­dia). “once we get di­rec­tion from the ch­hat­tis­garh high court, we will take up the case in supreme court for the tribe re­sid­ing in other states. it is also a pos­si­bil­ity that states can take their own call af­ter the high court judg­ment is given or else a sep­a­rate PIL has to be filed,” Nandi says.

The Pil cites the 2014 high-level com­mit­tee’s re­port on so­cio-eco­nomic, health and ed­u­ca­tional sta­tus of tribal com­mu­ni­ties of in­dia: “such a pol­icy de­nies mem­bers of PVTGS the au­ton­omy to make free and in­formed re­pro­duc­tive choices, and par­tic­u­larly de­nies any agency and bod­ily au­ton­omy to women of th­ese com­mu­ni­ties, who

have to bear the bur­den of the de­nial of ac­cess to ster­il­i­sa­tion fa­cil­i­ties. More­over, it side­steps the real fac­tors con­tribut­ing to high mor­tal­ity rates such as chronic mal­nu­tri­tion, star­va­tion and lack of ac­cess to ad­e­quate health fa­cil­i­ties.”

Poor con­di­tion of fam­i­lies

it is heart wrench­ing to see an or­der more than three decades old push­ing Baiga fam­i­lies to the brink. earn­ing less than ₹600 a month through mi­nor agri­cul­ture pro­duce and labour work, there is no con­sid­er­a­tion for the poor liveli­hood con­di­tion of th­ese fam­i­lies, who are forced to breed. “No­body is think­ing about how we will feed our chil­dren when there is no source of liveli­hood. What we get from ra­tion shops does not last for more than 10 days,” says Bhadiya, whose hus­band is an un­skilled labourer and has mi­grated to ch­hat­tis­garh for work.

as she nar­rates her woes to me, one of her daugh­ters snatches the take­home ra­tion packet, given by the an­gan­wadi, from her hand and starts gulp­ing the pow­der.

“at the time when the law was be­ing framed, law­mak­ers did not an­tic­i­pate the liveli­hood is­sues,” says Nitin Ba­j­pai of the Pop­u­la­tion Foun­da­tion of in­dia, delhi. “at that time pro­tec­tion of the vul­ner­a­ble tribe was im­por­tant. Pro­tect­ing the unique­ness of the tribe was cru­cial. Trib­als are an easy tar­get to show high fig­ures of ster­il­i­sa­tion on pa­pers. But now it needs se­ri­ous con­sid­er­a­tion when we know that the lives can­not be pro­tected just by grow­ing in num­bers,” he says.

Fall­ing health

Ba­j­pai cites sev­eral stud­ies that con­cluded that mul­ti­ple de­liv­er­ies with­out much of a gap be­tween chil­dren are fa­tal for the mother. “There are high chances of mal­nour­ish­ment for both mother and the child and poor cog­ni­tive abil­ity and growth po­ten­tial is al­ways at stake for chil­dren,” he says.

on June 7, the for­est depart­ment held a screen­ing pro­gramme for preg­nant women in Bich­hiya. al­most 270 women from nearby vil­lages were trans­ported to the spot in cars, jeeps and am­bu­lance vans. i was at the camp through­out the day to ob­serve the health sta­tus of women in the re­gion. ev­ery sin­gle woman who at­tended the

There were 27 ma­ter­nal deaths in Man­dala district in 2014-15, 31 moth­ers died in 2015-16, and 35 in 201617. The most com­mon rea­son cited for deaths was se­vere anaemia.

camp was found to be se­verely anaemic. Few Baiga women were also seen, who were there to de­liver their sixth or seventh child.

as per the data on ma­ter­nal deaths in Man­dala district, ac­cessed by gov­er­nance Now, there were 27 ma­ter­nal deaths in the district in 2014-15. The data of de­ceased women, how­ever, does not clearly men­tion how many of them be­long to Baiga or other tribes. But for all the deaths the most com­mon rea­son cited was se­vere anaemia. in 2015-16, 31 moth­ers died, while in 2016-17 there were 35 deaths. The data re­veals com­pli­ca­tions aris­ing due to poor health of the tribal women.

armu, an an­gan­wadi worker in in­di­ra­van vil­lage in Bich­hiya block, says that lack of fam­ily plan­ning mea­sures is one of the rea­sons be­hind poor health con­di­tion of women and chil­dren. “The preva­lence of con­tra­cep­tive use is the least here. it re­sults in suc­ces­sive preg­nan­cies with­out any gap be­tween chil­dren. With each de­liv­ery women be­come fee­ble, not strong enough to give birth to a healthy baby. due to this low-weight births are com­mon here,” she says.

No buy­ers of tem­po­rary mea­sures

With a ban on the per­ma­nent method of fam­ily plan­ning, tem­po­rary mea­sures are not very pop­u­lar. sukhwati was not aware about con­tra­cep­tives and other tem­po­rary so­lu­tions. asha work­ers have never dis­cussed about con­doms with men or use of cop­per T with women. as a re­sult, there is lack of aware­ness about them.

What is more sur­pris­ing is that in the wake of this or­der, the fam­ily plan­ning depart­ment is un­aware of pro­mot­ing other tem­po­rary meth­ods of spac­ing. “We have writ­ten sev­eral letters to se­nior au­thor­i­ties to get clear guide­lines but we have not re­ceived any re­ply,” says dr Madan Peepre. doc­tors, on the other hand, say women are not will­ing to opt for any in­tra-uter­ine de­vice (iud) due to their cul­tural in­hi­bi­tions. Mean­while, in the ab­sence of any fam­ily plan­ning fa­cil­ity, vil­lagers are fol­low­ing their tra­di­tional meth­ods of hav­ing some jadi-boo­tis (roots of plants).

an­thro­pol­o­gist Ver­rier el­win, the pi­o­neer in Baiga stud­ies, talks about th­ese tra­di­tional con­tra­cep­tion meth­ods in his book, The Baiga. He writes that though he tried very hard to find some tra­di­tion of con­tra­cep­tion among the tribe, it was a lit­tle suc­cess. He wrote: “The Katai (Fla­cour­tia romontchi) is be­lieved to have in­flu­ence on con­cep­tion. if a woman eats the root she will be fer­tile and if she eats the flow­ers then she will be bar­ren.” He also men­tions lachkur, a small shrub, which is used as a con­tra­cep­tive.

el­win also men­tions other tra­di­tional be­liefs which con­tinue to ex­ist. “if, when a child is a born, the par­ents de­cide it should be the last then if they lay the pla­centa with the foetal side up­wards on the ground, the mother will not con­ceive again,” he wrote.

abor­tion is also a way of deal­ing with an un­wanted child. Vil­lage-based dais (mid­wives) give a heavy mas­sage on the belly, which re­sults in abor­tion, con­firm ASHAS. Even El­win men­tions this prac­tice in which one woman stands on the belly of a preg­nant woman and stamps her feet till the child within is aborted. There are some tra­di­tional medicines like a mix­ture of gun­pow­der and phuli liquor; also a con­coc­tion of amar­bel creeper (Cus­cuta re­flexa), tinsa (Ougeinia dal­ber­giodes) bark along with other ingredients, he writes. ac­cord­ing to el­win, the cu­mu­la­tive ef­fect of th­ese mea­sures is al­ways suc­cess­ful.

Bhadiya with her five chil­dren

Eight tribes in MP that can­not opt for sterli­sa­tion A nurse do­ing a check-up of a preg­nant Baiga woman dur­ing a sur­prise visit to angwan­wadi in Bhan­pur Kheda vil­lage Baigas Maria Biar Birhul/birhar Korba Keer Ma­jhi Andh

Sukhwati with her mother-in-law Sukrati. Sukhwati has four chil­dren and is re­luc­tant to have any more

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