Is India ready to change it’s decades old reliance of female sterilization?

To just give a picture, you can witness women standing in front of a government hospital, basically farmer wives or hailing from similar class structured marred with penury. Early morning, the doctor arrives, mechanically uses the laproscope to sever their fallopian tubes so that they cannot bear children anymore. In many cases, the hygienic conditions and the doctor’s experience is appalling, leading to deaths, recently reported in Chattisgarh.

For India, one of the prime modes of sterilization and contraception is this kind of inhumane practice which literally plays with the lives of women. India funds about four million tubal ligations every year, more than any other country. This year, the Narendra Modi government, in a modern step towards this kind of culture, is introducing injectable contraceptives free of charge in government facilities. There are still questions regarding it, like how safe it is? Has it been practiced before? Nevertheless, the World Health Organization recommends their use without restriction for women of childbearing age.

United States Agency for International Development and the Bill and Melinda Gates Foundation have been supporting the usage of such contraceptives as they are comparatively safer. They say Indian women — often worn out, anemic and at higher risk of death because they bear children young and often — urgently need methods to delay or space pregnancies.

India, which is the second most populous country in the world, will surpass China by 2015. It is fascinating to just note how these kinds of policies affect the women in India. Especially, as it is predicted how it will gain 400 million new citizens and hence, it needs to be skeptical regarding its population control measures.

Though, such new contraceptives that are being introduced by the government are not away from protest. Many women’s right groups and activists are challenging these measures to control women’s fertility because they are skeptical how safe these are and also how western pharmaceutical companies which are capital hungry are forcing for them. At the same time, these contraceptives have been followed in different countries in South Asia and are popular there.

The shift in policy has come in part because the government is less concerned about opposition from civil society groups, most of them more closely aligned with the previous ruling party, the Indian National Congress. Officials were also spurred by a medical disaster in the Indian state of Chhattisgarh, where 13 women died in 2014 after undergoing tubal ligation at a high-volume government “sterilization camp.”

“I thought it was incumbent on the government to provide it as a choice,” said C. K. Mishra, additional secretary in the Ministry of Health and Family Welfare, of the contraceptive Depot-medroxyprogesterone acetate, or DMPA, which has been used in the private sector since 1993. Still, the method will be introduced gingerly, limited at first to select district hospitals and medical colleges and then expanded next year to hospitals throughout the country. Implanted contraceptives may follow.

India’s reproductive health policies are firmly rooted in state-enforced discriminatory practices, according to Abhijit Das, director of the Center for Health and Social Justice in New Delhi, India. Health care workers tasked with hitting sterilization targets deliberately seek out women and don’t inform them about the risks of the procedure or alternatives of birth control, said Das.

In 1994, global health officials at a conference on population and development in Cairo, Egypt, decided to move away from coercive sterilization methods, favoring informed consent. Around the same time, the science of female laparoscopies improved, and it became easier to perform the procedure.

We think we can push women, we can coerce women, said Poonam Muttreja, executive director of the Population Foundation of India.

Leaving men out of the family planning conversation has put the burden of population control entirely on women. Contraceptive counselors, Muttreja said, do not discuss vasectomies as a suitable alternative to female sterilization.

“Indian men think that their virility will be affected and that they become weak. That’s a myth, and the government has done nothing to correct that,” Muttreja added.

Delhi-based gynaecologist and health activist Dr Puneet Bedi says family planning has become “an obsession” with India.

“We blame all our problems on population control, so we do these sterilisation camps. But because our public health services are poor, safety measures get bypassed.”

In a largely male-dominated patriarchal society where male sterilization is still not accepted socially, with many saying it impacts a man’s virility, the family planning programme has traditionally focused on women.

It is estimated that 37% of all married women in India are sterilized. In 2011-12 alone, the government said 4.6 million women had undergone a tubectomy.

State governments regularly organise mass sterilisation camps where doctors perform serial tubectomies on dozens of women from poor families.

The women are often promised a monetary incentive if they undergo the procedure. Health workers, who convinced a woman to undergo a tubectomy, are also sometimes rewarded.

Paying people a cash incentive for sterilisation is against the law in many countries, but in India, state governments continue to legally pay some to undergo vasectomies and tubectomies.

Sometimes, campaigners say, the incentives are taken to bizarre heights. In 2011, authorities in Rajasthan offered many prizes – motorcycles, television sets, food blenders and even a chance to win India’s cheapest car Tata Nano.

Many women are forced by their husbands to undergo sterilisation for government incentives and benefits. A large number of surgeries performed at once help officials meet family planning targets but, Dr Bedi says, they are fraught with danger.

“Targets are set – like cricket scores – to impress the authorities or funding agencies. But care for the patient is inadequate. Sometimes surgeons are not even properly qualified and there’s no proper post-surgical care.”

It’s high time that India should make its own population policy. The population needs to be checked, but women undergoing sterilisation must be able to make an informed choice, they must be told tubectomy is a permanent procedure.