Following massive protests over the death of 13 women who underwent the sterilisation procedure of tubectomy in Bilaspur district of Chhattisgarh last November, the Ministry of Health and Family Welfare has written to all States reminding them that every person should be counselled about the different family planning options available. The letter completely contradicts the Union government’s intent of achieving population stabilisation almost exclusively through sterilisation. In a letter sent in October 2014 to 11 high-focus States, the Ministry had noted that the 2020 family planning goals had “underlined the importance of sterilisation” surgeries in these States. Even the recently released draft National Health Policy 2015 highlights the “challenge” of population stabilisation in six of the 11 States. In order to achieve the annual targets, the government recently increased the compensation given to women/men, motivators (Accredited Social Health Activists) and doctors. If the revised incentive given to motivators is Rs.200 for tubectomy and Rs.300 for vasectomy, the amount is as high as Rs.1,000 for a “permanent limiting method” (tubectomy or vasectomy) in the case of couples after up to two children. The higher incentive earmarked for permanent limiting methods is another reason why more women will now end up on the operating table. The government recently added a new component — post-partum sterilisation done soon after or within seven days of delivery. This approach works to the government’s advantage as more women are opting for institutional delivery to avail of the cash incentive earmarked for it.
Given the government’s primary focus on permanent and irreversible family planning options, the question of counselling women on the different options and giving them full freedom to choose the best one, will at best remain on paper, and not in practice. Sterilisation is the most prevalent form of contraception in the country, constituting nearly 75 per cent of the total cases. The proportion of tubectomies to total sterilisations has been around 95 per cent since 2005; nearly 4.5 million tubectomies have been performed each year since 2000. With a high number of tubectomies conducted every year and in a camp-based approach, tubectomy-related deaths as a result of poor quality of care will be inevitable even when they are done in health-care facilities. Unfortunately, the camp-based approach is set to continue. The pressure to meet targets, the incentives given to motivators and doctors and the permanent nature of sterilisation would mean that the question of counselling men and women of the different options may remain on paper.