Why Does India, Top Steriliser of Women, Lag Behind in New Ideas?

• 85% of the Indian family planning budget is used to conduct sterilisations on women.
• 13.5% is on spent on equipment and salaries, and just 1.5% is on other forms of contraception.
• In 2012, 178 women died per 100,000 live births in India due to sterilisation.
• 32 million Indian women do not have access to any form of modern contraception.
• 4 million Indians sterilised every year without informing them about the risks.

85% of the Indian family planning budget is used to promote and conduct sterilisations on women, the head of a prominent charity said on Friday, calling for more funds to be channelled towards providing alternative forms of contraception.

Poonam Muttreja, executive director of the Population Foundation of India (PFI), said an analysis of the national family planning programme’s budget for 2013/14 found that Rs 3.4 billion out of a total Rs 4 billion was spent on female sterilisation.

There is a total emphasis on sterilisation in India. 85% of the expenditure for family planning is on incentives for sterilisation, 13.5% is on equipment and salaries, and just 1.5% is on other forms of contraception.
– Poonam Muttreja, executive director, PFI

What’s Killing Patients of Sterilisation in India?

India’s efforts to rein in population growth have been described as the most draconian after China. Birth rates have fallen in recent decades, but population growth is still among the world’s fastest.

The world’s top steriliser of women, India came under global scrutiny for its sterilisation drive last November when 15 women died and scores of others were hospitalised after surgery at a sterilisation camp in the eastern state of Chhattisgarh.

Investigations found the deaths in Bilaspur district were due to unhygienic conditions, dirty medical instruments and equipment and an overall lack of care for the patients who were poor tribal and low-caste women.

Incentivised, Target-driven Sterilisation

Authorities have since put in place guidelines and are training local health workers on conducting safe and sanitary surgeries, based on findings of a PFI study into the deaths, but incentivised, target-driven sterilisation continues.

Doctors, nurses and health workers receive cash incentives for promoting and carrying out sterilisations. Patients are also given compensation – ranging from Rs 600 to Rs 1,100 for tubectomies and vasectomies respectively.

The doctor is getting Rs 250 per surgery. Why would he bother to do only 10 or 20 surgeries when he can do 80? In the Bilaspur case, this is what happened. The doctor did not even change his laparoscope once during the 86 operations. He didn’t change his gloves once. He didn’t have the time.
– Poonam Muttreja, executive director, PFI

Cutting Maternal Mortality

With more than four million Indians sterilised every year, the incentive system encourages officials and doctors to cut corners and uneducated women are often given money for surgery without knowing the risks, say activists.

The government currently offers only five choices to men and women – female sterilisation, male sterilisation, Intrauterine Contraceptive Devices (IUCD), oral contraceptives, and condoms.

In contrast, other countries in the region such as Nepal, Bhutan, Bangladesh and Indonesia have seven contraceptive methods available which include injectables and implants.

An estimated 32 million Indian women do not have access to any form of modern contraception and providing more choice, together with screening and follow-up, will reduce numbers of unintended pregnancies and help accelerate a fall in maternal mortality rates.

In 2012, 178 women died per 100,000 live births in India, down from 212 in 2007, according to the UN children’s agency. Despite the falling rates, the UN says India has made slow progress on development targets on maternal deaths, assisted births and ante-natal care.