Editorial: Sterilisation targets endanger lives

It is at once sobering and shocking that the sterilisation procedures (laparoscopic tubectomy) carried out on 83 women at a camp in Pendari village of Chhattisgarh’s Bilaspur district on November 8 ended up killing 11 women and leaving 69 others ill, some of them critically. In another such sterilisation camp held in Guarella in the same district on November 10, one of the 56 women sterilised has died and 12 remain in critical condition. Even as the precise cause of the tragedies is being investigated, what is abundantly clear is that the standard operating procedures were thrown to the winds. It is appalling that a single doctor and a health worker carried out the procedures on all the women in both the camps. According to a 2008 document dealing with standard operating procedures for sterilisation services in such camps, a surgeon can carry out no more than 30 tubectomies using three laparoscopes on a given day. Even a team with additional surgeons, support staff and instruments can at the most conduct 50 procedures a day. Even if more than one laparoscope was used, the detailed procedure of decontaminating and cleaning the laparoscope prior to disinfecting it for 20 minutes would have made it impossible to conduct 83 procedures in less than five hours at Pendari and 56 procedures at Guarella in such a short time. It is an irony that though laparoscopic tubectomy is a bloodless procedure, many women in the Pendari camp went into haemorrhagic shock due to excessive blood loss. Along with anaesthesia and drugs given to women, the needle of suspicion points to sepsis arising from the use of contaminated laparoscopes.

Sadly, rules will continue to be flouted and deaths will be the order of the day as long as the lethal combination of pressure to meet sterilisation targets, “compensation” amounts given to women and payment to doctors on the basis of numbers, are in place. Making it worse is the undivided attention the government has been giving to sterilisation as a means of achieving by 2020 the Millennium Development Goal on reproductive, maternal, newborn, child and adolescent health. This comes out clearly in a letter sent out on October 20, 2014 by the Ministry of Health and Family Welfare to the Chief Ministers of 11 “high focus States.” The “compensation” and payment made to all the parties have been increased for these States. Already, the number of sterilisation procedures carried out in India is disproportionately high compared with other family planning measures such as the use of intrauterine devices. If the accredited social health activists (ASHA) are under pressure to mobilise women for sterilisation, the increased focus on the 11 States would mean that women in these States are even less likely to be counselled and informed of safer contraceptive methods to choose from.

Published in The Hindu on November 14, 2014

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