Sterilisation in India: Rights and wrongs

In November, 13 women in the northern state of Chhattisgarh, India, died during the course of a sterilisation procedure carried out in unsanitary conditions by doctors who performed too many operations in a short period of time. Rat poison was found contaminating the hospital’s drugs given to the women. Commentators from London to Los Angeles condemned forced sterilisations and India’s aggressive family planning policy.

And they’re right. In the process of filming a documentary about female sterilisation, we spoke to over 50 women in the northern state of Uttarakhand about their decisions surrounding family planning. India’s current family planning policy, which promotes female sterilisation above all other forms of birth control and compensates women for getting the procedure done, has serious deep-rooted issues both in its design and execution.

The policy, the pressure on states to bring down massive population growth (India is expected to overtake China for the world’s largest population by 2030), and the implementation are all serious issues that merit serious consideration. But it is important to consider these issues from the right angle.

Sterilisation has a dark ring to it, which provokes powerful emotions of injustice. But it is not the sterilisation itself that is the problem. Sterilisation can be a perfectly viable option for women or men that don’t want any more children. So what is the problem?

For starters, the conditions under which women are being operated on in many instances are abhorrent. Reforms are needed at almost every level of the process and those responsible for malpractice must be held accountable.

But more importantly, there are two underlying issues that the Indian government has thus failed to thoroughly address. The first is a lack of meaningful education for girls. Girls who are educated tend to have fewer children later in life. The second is a cultural preference for sons, an issue that we witnessed first-hand in villages in India.

Take for example Sarita, a young mother from the Tehri district of Uttarakhand. She has a high school education, unlike many women in her village, and works as a local health activist. With an unemployed husband, Sarita chose to get sterilised because she wanted to make sure she was able to provide for her children. “Prices are rising, and it’s difficult to take good care of children. You have to provide them with a good education, good food, good clothing, it’s easier to do that if you only have two kids.” The actual operation, Sarita recalls, was painful and the doctor was unsympathetic. Nonetheless, Sarita doesn’t regret her decision.

Sarita and dozens of women like her that we interviewed cite the overwhelming desire for male children as one of the causes for having large families. Under societal and familial pressure, women in Uttarakhand will give birth until they have at least one, preferably two, sons. Only then will they get sterilised, defeating the government’s designed purpose of promoting sterilisation as a means to a two-child family in the first place. The government’s failure to address gender inequality through education makes its promotion of sterilisation ineffective policy. Until this preference for boys changes, women will continue to have many children before getting sterilised, and India will continue to grow, and grow more desperate.

It’s a sobering reality that India nationally, and many women individually, face as they seek to forge better lives for themselves and for their children. The recent tragedy brought this issue again to light, a poignant reminder of the harsh realities of the unfair dangers this step entails for many women. Every woman has the right to safe family planning options.

It is of the utmost importance to realise the good trying to be achieved through these operations and to critically examine where these good intentions have gone wrong. We cannot dismiss sterilisations off hand as a barbaric procedure reserved for the poorest in a faraway land. We must see them for what they are: a grasp for agency, for control over their own bodies and futures.

Any effective long term intervention should, of course, reform the procedures currently in place. But it must also look deeper: We cannot sensationalise, we cannot generalise. To understand the deeper forces at work we must focus on the voices and choices of the women most affected by the policies. From this starting point we can begin to understand the diversity of experiences, the motivations and the areas of the policy and practices most in need of reform to prevent tragedies like the most recent one in Chhattisgarh. Some of these sterilisations are forced; others are voluntary and for sound reasons. But either way, these women deserve respect and dignity – and safe medical facilities.

Zoe Hamilton and Anne Munger are the directors of a short documentary about sterilisation choices among women in Uttarakhand, India, which is currently in post-production.