Unethical Sterilization in India to Be Pushed Into the Procedure, Often with a Glaring Lack of Informed Consent

Female sterilization in India overwhelmingly dominates the contraceptive method mix used across the country, at a colossal 75%. In addition to this, 85% of Mistreatment and Coercion: the family planning budget is used for promoting and implementation of female sterilization through camps in rural India. Through these camps, women continue Unethical Sterilization in India to be pushed into the procedure, often with a glaring lack of informed consent. Sterilization in India has long been used as a means of target-driven population control, disregarding the reproductive autonomy of women in favour of curbing population growth. Although the National Population Policy 2000 broke new ground in prioritizing reproductive rights over population control, the existence of sterilization camps and the rampant, disproportionate promotion of the INDIA'S FAMILY PLANNING PROGRAMME procedure demonstrate that implementation 18 years on remains to be fully realized. In 2015, the Devika Biswas v Union of India case challenged appalling sterilization camps that were taking place across the country, rounding up poor women and loading them like cattle into abandoned schools, sterilizing them in barbaric and highly unsanitary conditions, without anesthesia. These camps resulted in many deaths, and in the overwhelming majority of cases, the women did not consent to the procedure – many of them were young and in the reproductive age group of 18-39. In a landmark judgment, the Supreme Court outlawed the camps and directed various states to provide compensation to the families of the victims. Nevertheless, sterilization in India is still problematic. Ground level health workers are heavily incentivized to encourage women to undergo the procedure, rather than promoting condom or oral contraceptive pill usage. Sterilization remains a procedure that is performed at a disproportionately high rate when compared with other nations. This book will look at sterilization through a rights-based lens, to shed light on how sterilization has been used for years as a weapon to impede reproductive autonomy and champion coercive population control tactics, at the expense of women's bodies. The book also highlights the struggle through the use of law to change the way family planning programmes especially female sterilization was being implemented ISBN 81-89479-94-6 European Union 9 788189 479947 European Union Mistreatment and Coercion: Unethical Sterilization in India Human Rights Law Network’s Vision ● To protect fundamental human rights, increase access to basic resources for marginalized communities, and eliminate discrimination. ● To create a justice delivery system that is accessible, accountable, transparent, and efficient and affordable, and works for the underprivileged. ● Raise the level of pro-bono legal experience for the poor to make the work uniformly competent as well as compassionate. ● Professionally train a new generation of public interest lawyers and paralegals who are comfortable in the world of law as well as in social movements and who learn from such movements to refine legal concepts and strategies. India’s Family Planning Programme Cruelty in Sterilization Camps © Socio Legal Information Centre ISBN: 81-89479-94-6 Editors: Madhulika Masih, Sarita Barpanda and Zahra Wynne Sub-Editors: Leon Rauch, Sangeeta Banerjee, Mahima Duggal Design & Print: Shivam Sundram Published by: Human Rights Law Network (HRLN): A division of Socio Legal Information Centre 576 Masjid Road, Jangpura New Delhi 110014 India Ph: +91-1124379855/56 E-mail: [email protected] Website: www.hrln.org Disclaimer: Since writing the original report, newer information and data have been published and have shed new light on female sterilization programme in India, and phasing out of sterilization camps in the various states of India. We have made an effort and have tried to update the publication, but then there is a need to understand that there will be gaps in the information. We would be grateful if you could share with us relevant information and we will ensure that it is incorporated in the next publication. Note on Footnote and Endnote: HRLN has employed a simple and straightforward formatting style to maximize the usability of the sources cited. Any section of this volume may be reproduced without prior permission of the Human Rights Law Network where it is for public interest purposes and contains appropriate acknowledgment. 2 ACKNOWLEDGEMENTS Going through the entire process of bringing out this book, the notion that, by ourselves, we would have been inadequate was reaffirmed. Many of our friends have helped us in several ways in their various capacities. We thank members of civil society groups in general and especially Jashodhara Dasgupta, Advisor, Sahayog, Bijit Roy, Population Foundation of India (PFI) and Ms. Devika Biswas, Social Activist who was the first to travel and help us with the testimonials on these forced, coercive sterilization camps which ultimately lead to mortality and morbidity amongst women. We are deeply grateful to our friends and interns who contributed during the case and compilation of the book. Finally, we would like to thank our colleague Mr. Colin Gonsalves for giving us the first thought of bringing out this book and appearing as the counsel for the petitioner. 3 TABLE OF CONTENTS Introduction 9 History of Family Planning in India 17 Violations happening across India 30 Camp culture Target based approach Lack of informed consent Futility of FPIS Fallacies With India’s Focus on Sterilization 40 Female-centric Cattle culture Sterilization drives Non access to information Two child norm Case Study of Two Important Supreme Court Rulings & Analysis of the Fallout of the Family Planning Programme in Recent Times 48 Ramakant Rai Devika Biswas Case Chhattisgarh Massacre Critique of the Target-Based Approach in 135 Family Planning International Law and Cases on Sterilization 145 5 India’s Family Planning Programme Findings from the Field 171 The Way Forward for India’s Sterilization Programme 246 Summary of the Judgment in WPC Devika 251 Biswas v UOI 95/2012 Conclusion 254 Annexures 256 Judgment passed in the Ramakant Rai v UOI, WPC 209/2003 Anita Jha Commission Report Judgment in the matter of Devika Biswas vs UOI,WPC 95/2012 Guidelines 6 ACRONYMS ADMO Assistant District Medical Officer ANC Ante Natal Checkup ANM Auxiliary Nurse Midwife ASHA Accredited Social Health Activist AWC Anganwadi Centre AWW Anganwadi Worker BPL Below Poverty Line CDMO Chief District Medical Officer CEDAW The Convention on the Elimination of all Forms of Discrimination DQAC District Quality Assurance Committee FPP Family Planning Programme FPIS Family Planning Indemnity Scheme HRLN Human Rights Law Network HTTS Health Department Operated, Incentive-based, Target-Oriented, Time-bound and Sterilization- focused IUCD Intrauterine Contraceptive Device ICPD International Conference on Population and Development IPHS Indian Public Health Standard INC Indian National Congress IEC Information, Education and Communication JSSK Janani Shishu Surakshya Karyakram JSY Janani Surakshya Yojana LPS Low Performing State LGBT Lesbian Gay Bisexual Transgender MCH Maternal and Child Health MMR Maternal Mortality Rate 7 India’s Family Planning Programme MOIC Medical Officer in Charge MoHFW Ministry of Health & Family Welfare NHM National Health Mission NRHM National Rural Health Mission NFHS National Family Health Survey ObGyn Obstetrician/Gynaecologist OT Operational Theatre PIP Programme Implementation Plan PHC Primary Health Centre PPH Post Partum Haemorrhage RCH Reproductive and Child Health SQAC State Quality Assurance Committee SOP Standard Operating Procedure WHO World Health Organization 8 1. INTRODUCTION “My name is Saraswati Devi. I was sterilized at Kapafora camp, Bihar. I had to be hospitalized for 8 days after that. We had to spend money our own money so that I could get better. I did not know anything about operation.” In September 2016, the Supreme Court of India directed the Union Government to ensure the discontinuation of ‘sterilization camps’ within the following three years and to induce the state governments to follow suit. It also charged the government to ensure proper monitoring of the programme, investigate sterilization failures, complications or deaths, and increase the compensation amount in these cases. It further ordered the implementation of established legal, medical and technical standards for sterilization. These directives came as a result of a 9 India’s Family Planning Programme 2012 petition filed by a health activist through the Human Rights Law Network, the case better known as the Devika Biswas vs. Union of India. This was the second public interest litigation filed on the subject of widespread negligence and human rights abuses occurring regularly in sterilization camps across India. Newspaper reports and research by a multitude of human rights groups paints an appalling picture of the conditions under which the sterilization surgeries take place. Reports assert that the women who were being convinced to go through these sterilization surgeries were below 30 years of age and illiterate with most being completely unaware of other forms of birth contraceptives. Most of them, as stated earlier couldn’t read, so the consent form hadn’t made sense and many had never even signed or affixed their thumbprint on any form. The camps were set-up in makeshift locations, with no generators, oxygen cylinders or running water. The equipment used for the surgery

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