THE news of the death of 13 women in Chhattisgarh, India, after undergoing faulty surgical sterilisation procedures is shocking. The target-centric mass sterilisation drive and the resultant tragedy is appalling and unimaginable in any civilised society. It is puzzling that such incidents happen while India is considered to be a preferred medical tourism destination. Poor women are offered a paltry incentive to undergo sterilisation surgery highlighting the risks women face in reproductive health in a country struggling with high rates of poverty.

Deaths due to sterilisation are not new in India. According to records, 1,434 women died after sterilisation procedures between 2003 and 2012. These deaths point to the alarming condition of the public health system in rural India. Despite allocating a reasonable amount of money for public health in the budget, things have yet to improve.

India has made tremendous advancement in the area of health care for the past few years. However, it’s equally true that the benefits of medical advancement have not reached rural India. The disparity in terms of care between public and private medical facilities in India is shameful and ranges from state-of-the-art care for international health tourists to situations of the kind now seen in Chhattisgarh.

The loss of precious human lives is due to the insensitivity of the state administration to extend quality medical care to the poor and the downtrodden, and the negligence of the state health department officials. The tragedy raises questions about the safety of Government-organised medical camps in rural India. There are many such incidents due to the unhygienic and improper use of medical equipment in such camps. The Government must also explore less invasive medical options.

But the real cause of deaths is already painfully clear — a woeful lack of birth-control choices for women in India and a government policy that focuses on female sterilisation as a cornerstone of the nation’s family planning programme.

In fact, some 4.5 million women were sterilised in the year that ended March 31, 2013. It is inexplicable that this is the only option available to most women. India’s number of female sterilisations as a percentage of all forms of contraception used continues to be highest in the world.

In a patriarchal society like India, it is women who have to bear the burden of undergoing sterilisation rather than men. Women bear the brunt of short-term so-called solutions without actual care for their long-term well-being. The tragedy at the mass sterilisation camp in Chhattisgarh has put a spotlight on the prevalence of sterilisation as a method of contraception in India. In fact, the country has one of the world’s highest rates of sterilisation among women, with about 37 per cent undergoing such operations compared with 29 per cent in China, according to a 2006 report by the United Nations.

In India, 98 per cent of cases of sterilisation involve women, and these are forced on them either by the men of the house or as a result of inducement by officials with monetary benefits. These small incentives coerce the poor women to submit to sterilisation too often. For instance, the women sterilisation in Chhattisgarh programme received 1400 rupees, which is the equivalent of a monthly wage for many poor villagers. The paltry sum offered can result in women being pressured by their families or by their extreme poverty into having these procedures, often at a young age and against their wishes. Incidentally, targets set for health-care workers also indirectly contribute to the coercive measures. Indeed, paying women to undergo sterilisation at family planning camps by default limits their contraceptive choices. Activists blame that incentive payments as well as sterilisation quotas set by the Government pressure patients into surgery, rather than advising them on other forms of contraception.

The deaths reveal another gender-biased practice. Though vasectomies are far less invasive and much simpler to perform than tubal ligation, tubectomies are about 10 times more common in India. Men are offered double the financial incentive given to women but only one per cent of households reported using male sterilisation for birth control. Male sterilisation is a much easier and safer method but not adequately promoted or available in official family welfare programmes.

Of note, India’s family planning programme has traditionally focused on women and male sterilisation is still not accepted socially. And other forms of contraception are not available on an adequate basis because of the lack of health-care facilities. Government survey shows that only 5.9 per cent reported using condoms, 4.2 per cent birth-control pills and 1.9 per cent use intrauterine devices.

Many health and women’s activists have long criticised the Government’s overemphasis on female sterilisation, saying that it is following the easy way out thereby avoiding the difficult task of educating a vast population about other options. With 1.2 billion people India has been struggling to control its population by following the path of least resistance through aggressive sterilisation campaigns. These camps for women are seen as cheaper options than contraceptives in remote villages. Teaching poorly educated women in remote communities how to use pills or contraceptives is more expensive than mass sterilisation campaigns. And, despite successive years of economic growth, governments have systematically chosen the cheaper option. In a recent government survey, 34 per cent of households said that female sterilisation was their family planning method.

Clearly, the problem is complex and multifaceted. Improved access to modern contraceptives and greater choice in long-term contraceptive use should be a top priority for India’s family planning programme. There is no question that providing greater choice and improved access to modern contraceptives should become an important component of India’s health and gender-equality programme. Informing the people about the benefits of family planning and replacing crude and coercive surgeries with access to a range of modern reproductive health choices should be an integral part of India’s health strategy and overall development policy.

Since these deaths are a direct outcome of policies deliberately articulated by the government, it should shed its mindset of chasing unrealistic and unethical targets. Above all, political culpability of the rulers must also be acknowledged, not glossed over with remarks like “it is doctors and not ministers who operate”, as the chief minister is reported to have remarked. If reduced birth rates are the goal, it can be achieved by raising the standard of living and reducing inequality. Indian mindset also has to grow to accept that it is okay for a man to undergo a far simpler sterilisation procedure.

India is forecast to become the world’s most populous country in 2030, with numbers approaching 1.5 billion. And Prime Minister Narendra Modi has promised to reform India’s health system. Besides calling for a thorough investigation of what led to the women’s deaths, as the PM did last week, let’s hope he leads the way for a new approach to family planning that empowers women to take control of their bodies and achieve good family planning outcomes without putting their lives at risk.

Sunita Vakil is a Delhi-based journalist and can be reached at: sunitavakil@yahoo.co.in