Death in Operation Theatre: Patralekha Chatterjee | How many deaths will it take to realise that too many young women in their prime have needlessly died? Despite the anger and outrage in the wake of the Chhattisgarh sterilisation horror story, the depressing answer is that it is hard to tell what will change and how soon. There are, however, the certitudes — 13 young women in their prime are dead. Many more are in a serious condition. The final death toll? Who knows? Almost all the women who died in Chhattisgarh’s mass-sterilisation drive this month left behind a child less than an year old. They were, without exception, dirt poor. A field report in a newspaper has chronicled the background of the women who died. The husband of first victim, 26-year-old Janaki, is a daily labourer. The couple and their three children lived with her parents as Janaki’s husband found no work in the village. Twenty-five year-old Dularin, another victim, was from a family of landless labourers and masons. Twenty-nine-year-old Chaiti Bai, another casualty, was a Baiga, a vulnerable tribe protected under the law. Who is responsible for the death of Janaki and Dularin and all the other women casualties in this sterilisation drive? Was it contaminated medicines, possibly mixed with rat poison, as alleged now or was it non-sterilised equipment, violation of standard protocols by a much-awarded surgeon as alleged initially or all of the three which caused these deaths? The buck passing is in full flow. Meanwhile, chief minister Raman Singh has ordered a judicial probe. The local police has arrested the surgeon, who conducted the sterilisations and drug manufacturer, who supplied the tainted medicines. Everyone who is in the dock denies wrongdoing. The Chhattisgarh branch of the Indian Medical Association is in protest mode about what it perceives as scape-goating of the doctor who conducted the operations — more than 83 tubectomies in just a few hours in a ramshackle private hospital. The allegations and counter-allegations about who is guilty in this specific episode will continue till the next disaster knocks Bilaspur off the news map. But there are broader concerns we must not sweep under the carpet irrespective of what final probe report states. Here are some key questions that need to be at heart of public discourse. First, why is female sterilisation cornerstone of India’s family planning programme? Second, what does “consent” to such sterilisation mean when it is from people who have little knowledge, awareness or access to other family planning options and when their marginalised status makes them too ill-equipped to negotiate safe surgery? Finally, if government doctors are being pressured to meet official sterilisation targets, and in the process there is scant attention to the government’s own clinical guidelines, what should they do? Should or should they not collectively speak up about the potential risk to patient safety? This is not the first time that women are dying during a sterilisation drive in this country. Two women died after undergoing a sterilisation operation at a primary health centre in Bihar’s Purnea district in 2010. Many incidents go unreported. “Government doctors are under pressure to meet sterilisation targets. Camps are sometimes held in the rural interior where basic facilities are lacking and standard procedures are not followed. But what can a doctor do? He is asked by his bosses to go to a camp and perform surgeries. If the government wants its guidelines to be strictly followed, it should take the necessary steps. Why blame the poor doctor who is just doing a job?” Dr M.K. Saraf, former president of the Chhattisgarh branch of the Indian Medical Association told this writer in course of a telephone conversation. Dr Saraf is saying nothing new. Anyone who has travelled through rural India and spoken to government doctors and frontline workers will tell you pretty much the same. “Health workers who miss sterilisation targets because they give proper counselling and accurate information about contraception risk losing their jobs in many parts of the country,” asserts Aruna Kashyap, women’s rights researcher at Human Rights Watch, an NGO. Government manuals exist, as do Supreme Court directives. But as a public statement by Jan Swasthya Abhiyan, Sama Resource Group for Women and Health and host of other NGOs and health advocates recently pointed out: “The surgeries (in Chhattisgarh) were conducted in complete violation of the Supreme Court orders (Ramakant Rai vs Govt. of India, 2005 and Devika Biswas vs Govt. of India, 2012). These orders instruct that a maximum of 30 operations can be conducted in a day with two separate laparoscopes only in government facilities. Also, one doctor cannot do more than 10 sterilisations in one day. Despite this, the surgeon in Chhattisgarh performed about three times the permissible number of surgeries (83) in less than six hours in a private hospital, which has reportedly remained closed for 15 years. This is evidence of how these operations were not done under standard protocols.” In the public imagination in this country, coercive mass sterilisations are associated with the dark days of the Emergency in the mid-seventies when many Indian men were forced to undergo the procedure as part of the national family planning programme. Today, nearly 40 years later, men are barely part of the family planning conversation, and the burden of population stabilisation appears to be entirely on women, mostly poor women. India has one of the world’s highest rates of female sterillisations. Men’s unwillingness to use contraceptives or be sterilised pivot around cultural taboo. This continues despite higher cash incentives for male sterilisation. India’s new health minister J.P. Nadda says “Sterilisation is not a target but demand driven programme and doctors have been directed to strictly adhere to the norms to ensure that Chhattisgarh-like tragedy doesn’t reoccur.” But how often do frontline workers discuss vasectomies as a suitable alternative to female sterilisation and how often are women counselled on other options? How functional are mechanisms to make sure that universal precautions are followed and standard clinical protocols are observed during sterilisation surgeries in rural India? It is important to get to the bottom of the specific lapses in the way the sterilisation camp in Chhattisgarh was organised. But one should not lose sight of the role played by the policies and practices of successive governments in the area of family planning services in the country. What do women want? When it comes to family planning, it often depends on what they have been told. It also depends on whether they are allowed to exercise their choice. If Mr Nadda means what he says, he can start a serious conversation on all these issues. Will he?
Posted on: Thu, 20 Nov 2014 08:35:00 +0000
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