The Common Minimum Programme of the United Progressive Alliance promises to be committed to the daily well being of the common man, but among its provisions is a line which if pursued diligently will surely lead to misfortune for thousands if not lakhs of women. It is hardly surprising that the line A sharply targeted population control programme will be launched in the 150-odd high-fertility districts is present in the section on women and children. In common perception not only is there a big population problem but women are the sole targets through which this problem can be resolved.
The 'population problem' has become a myth of epic proportions which we are carrying over without questioning, from our earlier generations. Statistics amply prove that the overall growth rate of the country is the lowest in the last fifty years. The large proportion of youth and adolescents in the country contribute to a momentum effect which is natural and will die out with time. Further the poor distribution of family planning services leaves a significant proportion of the citizens without access to contraceptives. The National Population Policy is in favour of population stabilization in harmony with social and human development. However the point of this article is not to argue whether population is a problem or not, but to bring to light what could happen to women if a sharply targeted population control programme is launched in 150 districts.
Uttar Pradesh has the highest maternal mortality figures in the country. Every year nearly 40,000 women lose their lives to pregnancy or maternity.
Uttar Pradesh with its 80 odd districts and 170 million people is certain to contribute the lion's share to the 150 districts that the CMP mentions. The family planning programme, even without a sharp population control focus is causing untold misery to millions of women in the state. Some examples and evidence is given below.
Mauli Devi of village Lohra Ahrora in Sonbhadra district lost her life during a sterilization operation on 7th February 2004. Nirmala Devi of village Belaparasa of Ambedkarnagar district died in similar circumstances just a week later. These are not isolated incidents. Women are coaxed, cajoled or coerced into agreeing for sterilization operations because they are easy targets. However once they have signed on the dotted line and the operation is over they are forgotten. But for women the operation is often the beginning of a new ordeal. For many the operation table becomes the death bed. There are hardly any recorded deaths from sterilization, but community level observations are showing that these are not uncommon.
Parwati Devi of village Kodwari in Mirzapur district underwent her second sterilization operation in April 2003. Four years ago she had her first operation and then after having two more children she went in for her second sterilization operation. Failures are a common feature of sterilization operations. According to international standards the failure rate is roughly one in two hundred operations. By these conservative estimates the number of failures in the state should be in the range of 2250 failures every year because roughly four and a half lakh sterilization operations take place in the state every year. However a study conducted by a state agency indicates that the failure rate could be a very high five percent which means the failures are ten times higher. But there is very little documentation of these failures and even less is done to support these women.
Besides failures and repeat pregnancies, infection of the stitches or the operation wound site is also common. These women hardly get any care for dressing of their wounds or receive other medicines. It is hardly surprising that women suffer from various complications after sterilization operations. The condition of sterilization camps is abysmal in the state. There has been more than one report in recent years of bicycle pumps being used for putting air into the abdomen before laparoscopic operations. A recent study conducted by the group Healthwatch Uttar Pradesh showed that all the norms of standard practice are thrown by the wayside in the hurry to notch up one more case towards meeting the target. Government norms indicate that there should not be more than 20 cases in one camp and not more than 6 cases in one hour by one operating team. Evidence indicates that more than hundred cases are being done in camp situations and cases are completed in less than 3 minutes.
In addition to the hurry, and the concomitant risk of mistakes, there is hardly any attention paid to prevention and control of infection. Tubectomy operation of women, in contrast to the vasectomy operation of men, is a major operation. It requires that same care in terms of infection control as any major abdominal surgery for example removal gall bladder stones, or removal of the appendix. However such camps are found to take place in schools where classrooms become makeshift operation theatres. Surgeons dont remove their gloves after completing an operation (this can also add to the risk of HIV transmission) and instruments like the laparoscope are inadequately sterilized.
The family planning programme in the country is now respectfully referring to its targets, the women who undergo these operations, as clients. However this respect was hardly found in evidence during the conduct of the eleven camps surveyed by the group. Women were made to sign or add their thumb impression to consent forms without explaining what they were consenting to. They were not provided with any clean clothes, and the local anaesthesia was given to them outside the operation theatre a long time before the actual operation. During the operation the women were made to lie with their heads tilted down on a makeshift operative table with their petticoat covering their heads. They were heard moaning and screaming while the doctors were busy asking them to keep quiet. In one place the operations took place without any anaesthesia.
The case of Uttar Pradesh also highlights how targeted population control programmes not only affect women who seek sterilization but any woman who needs government health care support. The whole health machinery in Uttar Pradesh is geared to implement the family planning program. The impact of this single minded devotion has been described earlier. But what also needs to be highlighted is the fact that there are no other services available for women. Uttar Pradesh has the highest maternal mortality figures in the country. Every year nearly 40,000 women lose their lives to pregnancy or maternity. According to the last round of the National Family Health Survey only 4% of pregnant women received all the required check ups, immunization and tests. Nearly 80% of the five million births that take place in the state are unsupervised and the government nurse reaches a measly 7% of these women after her delivery within 2 months.
This is the state of health services that is available to women in Uttar Pradesh even without a 'targeted' population control programme being implemented in the state. The other states whose districts will complete the tally are Bihar, Rajasthan, Madhya Pradesh and Orissa, where the situation is hardly better. Among these states Orissa, Rajasthan and Madhya Pradesh already have restrictive two child norms which affect women far more adversely than men. The UPA government claims that it is concerned about the poor, the disadvantaged and for women. There hasnt yet been cause to believe that they are not so. Surely, there must be some way to convince the United Progressive Alliance government that what women in these 150 districts need is a functioning health system and not another population control program.