Why India’s acclaim for protecting reproductive rights rings hollow #Vaw #Womenrights


STEPHANIE NOLEN

KAMRORA, INDIA — The Globe and Mail

Noni Raja was married in 2004 at the age of 20, then gave birth to a son a year later. After having two more children – a girl and a boy – Ms. Raja did something unexpected. She caught a bus into Mahoba, the nearest town, and presented herself at the hospital for a tubal ligation. She spent a couple of hours recovering, took the bus home and informed her startled in-laws that she had had “the operation.” (Simon de Trey-White For The Globe and Mail)

Noni Raja did just what she was supposed to do. She married when she was 20, in 2004, and gave birth to a son a year later. In 2006, she had a daughter. And a year after that brought the second son she needed to fulfill her obligations in the eyes of her in-laws, farmers with a tiny plot in this hardscrabble hamlet in the Indian heartland.

Then Noni Raja did something rather less expected. She got up one day, caught a bus into Mahoba, the nearest town, and presented herself at the hospital for a tubal ligation.

She spent a couple of hours recovering, took the bus home and informed her startled in-laws that she had had “the operation.”

Years later, her mother-in-law is still affronted. “I didn’t like it,” Kiran Devi says as the two women sit in the spring sun on their front stoop. “She went against our wishes.”

At the time, Ms. Raja wanted the best for the children she already had, which meant ensuring there would be no more.

Being surgically sterilized seems an extreme form of contraception for such a young woman, but India’s approach to family planning left her with no other choice.

Even worse, her defiance would come back to haunt her.

India began grappling with the magnitude of its population even before it became independent in 1947; it was labelled a crisis in the 1970s when the government of Indira Gandhi carried out mandatory sterilizations, en masse.

But since those dark days, the country has emerged as a leader in the field, adopting the language of “reproductive health and rights.”

That means, in the words of the World Health Organization, that India is committed to ensuring its people have “the capability to reproduce and the freedom to decide if, when and how often to do so” – and that their decision be “free of discrimination, coercion and violence.”

This official position – which contrasts starkly with China’s strict one-child policy – has won India international plaudits; last year, it was invited to co-chair a prestigious international summit on family planning held in London, and feted for its progressive approach.

Yet spend some time talking to women in Kamrora – and dozens of villages like it in the “Hindi belt,” the poor states that span India’s middle bulge and are home to about 450 million people – and you learn something that never came up at the meeting in Britain: The policy this country has on paper is markedly different than what happens in real life.

The reality is harsh and repressive and targets the most marginalized, often the lowest-caste, women. It is also far from effective in areas with the highest birth rates, paradoxically driving the rate up and making poverty worse in the process.

Beijing has been widely criticized for limiting families to only one child, but India has adopted many aspects of its policy. With 1.2 billion people and on course to overtake China as the planet’s most populous country in about a decade, India is taking steps many consider nearly as harsh – but cloaking them in the far more benign-sounding “two-child norm.”

And despite all the government rhetoric about how its citizens have choices and condoms are brought right to village doorsteps, the truth is that, in the northern half of the country, the Indian health service consistently delivers only one form of contraception in the rural areas, where 70 per cent of the population lives.

That is tubal ligation, often performed at “camps,” where dozens of women are sterilized in a day; more than half of them are 25 or younger, and they are often illiterate and unclear about what the surgery means.

Unlike many women, Noni Raja knew exactly what she was doing when she got on the bus to the city: She has been trained in family planning, which she is charge of delivering in Kamrora, and is responsible for distributing a government-funded supply of condoms and oral contraceptives. It is the only access to birth control people here have, as most cannot afford a trip to the city. Yet, in a situation typical of India’s badly managed social schemes, it has been two years since Ms. Raja last received anything to dole out. Today, her kit contains one desiccated packet of prophylactics and an expired pregnancy test.

So, when a village woman confides that her in-laws have given her permission to stop having babies, Ms. Raja knows that the only option is sterilization. To make sure that she promotes it, the government pays her $3 for each woman she brings in – and, if she does not deliver as many as the government expects, she stands to lose the only wage-paying job in Kamrora, other than breaking stones in the quarry.

Ms. Raja is the best-educated woman in the village – she finished 10th grade before her health-worker training – but she says with a sigh that it’s sometimes hard to explain the surgery to her neighbours. Research from the Centre for Health and Social Justice in Delhi shows that state governments aggressively target women from the poorest aboriginal and Dalit (once known as “untouchable”) communities.

Those who undergo the operation may not understand what is being done, but they know that there can be severe consequences if they do not comply with the two-child norm.

“We’re on the track to be just like China,” says Leena Uppal, an earnest activist who co-ordinates the National Coalition Against Two-Child Norm and Coercive Population Policies. “It’s entirely coercive – for the women, for the health worker, who will lose her job if she doesn’t bring in enough people. The whole focus is on closing off wombs, of making sure these women don’t have any more babies.”

China’s one-child campaign, adopted in 1979, forced women to have abortions if they conceived again without state approval, or fined couples heavily, especially in urban areas. India’s policy involves no such direct punishments, but its impact can be harsh in a place such as Kamrora.

Parents with more than two children are denied access to everything from a subsidy for babies delivered in hospital and school bursaries to the right to run for political office. A law now being considered would deny them access to subsidized food – a tactic The Times of India, the country’s largest newspaper, recently reported, favourably, on its front page.

The problem, says Abhijit Das, an obstetrician who runs the Centre for Health and Social Justice, is that, while the government’s policy has changed since Mrs. Gandhi’s era, when the rural poor were seen as strangling the country’s chances of progress, its mindset has not. There is a genuine commitment to ending poverty and a sincere desire to see families better able to care for their children. Yet officials based in air-conditioned offices in the capital still believe that ignorant rural poor people are dragging the country down by mindlessly having babies, and simply do not know what is best.

“The construction of the population problem is a middle-class creation,” Dr. Das says, “and it has caste and class distinctions: The ‘wrong’ people are the ones who have eight kids.”

In this, India is not unlike the West, where there is public debate about the higher birth rate of “welfare moms,” aboriginal people and immigrants. The idea is entrenched, and it results in policy entirely disconnected from the reality of life in a place such as Kamrora, where families have many good reasons for having more than two children.

First, mortality rates remain high – children, as Ms. Raja will tell you starkly, die here. Almost one in 10 do not live to see their fifth birthday. Subsistence agriculture remains the only employment option, so the young are needed to work in the fields and later, in the absence of any real social-welfare net, to care for their parents in old age.

And couples have children because there is no way not to have them: Those unwilling to undergo sterilization – newlyweds, for example – have access to no other form of birth control.

The two-child norm flies in the face of the idea of “reproductive rights,” Ms. Uppal notes. “What is a more basic right than deciding how many children to have – and when to have them?”

It also punishes women when the decision is not really theirs to make. Ms. Raja’s family expected her to have a third child, but when she did, she became ineligible for a central government allowance to provide extra food while pregnant and breastfeeding (a policy supposedly aimed at poor, Dalit women like her). As well, she lost the right to run for the local council, and her daughter was disqualified from a bursary program designed to boost girls’ education.

The policy is enforced by local-level officials, often haphazardly. As part of her health-worker job, Ms. Raja has succeeded in obtaining the bursary for having a baby in a maternity centre for a number of women with more than two children, even though it is theoretically denied. At the same time, she says, other women in Kamrora have been denied a state bonus for mothers who have daughters – a measure designed to discourage sex-selective abortion, an especially grim side effect of the two-child policy. The desire for sons, to carry on a family name and inherit land and assets, is so strong that families may abort girls to get the two boys they want and stay within the limit.

India already has one of the world’s more sharply skewed sex ratios. As in China, millions of women are “missing” from the normal population balance. And yet the mandarins in charge of its population policy reject any comparison with China.

“There is no grounds to call [Indian policy] repressive,” says S.K. Sikdar, who heads the family-planning division at the national Ministry of Health in Delhi. “We learned our lesson [in the 1970s]. … This isn’t a population issue any more; it’s a mother-and-child health intervention.”

Energetic and driven, Dr. Sikdar insists that “we don’t have a two-child norm.” He says that the only message to women from government is about the benefit of having children later and at least two years apart.

“Our only intervention is to give people free access to [child] spacing. … I know our women are quite happy with what they have,” he says, adding that the government has had great success in delivering condoms and oral contraceptives directly to rural doorsteps – that kit of Ms. Raja should be replenished every month.

Many of the more punitive policies in place today have been set by state governments, but the two-child norm also applies to a number of benefits, such as nutritional support for pregnant women, that come from the national government. Dr. Sikdar acknowledges this, but he says that “low-performing states” (the poorest ones with highest fertility) are exempt.

That news has not reached Kamrora – or dozens of other areas where poor women, often Dalit, are denied access to school meals, clean-water schemes, the female-child bonus and the maternity-home payment because they have more than two children. All state family-planning programs are run on money from the central government.

A.R. Nanda, who was once in charge of population policy for India and established its family planning department, says that not only is there a two-child policy, it was explicitly borrowed from China: “The idea of withholding benefits comes from

China … ‘If China can do it.’”

After taking its hard line in 1979, China saw its population growth fall sharply, and many in the Indian government were impressed. But they failed to grasp the basics of population science, Mr. Nanda says: “The highest drop in Chinese population came before the one-child policy; it came from equitable access to education, health care, including family planning, and a rise in income” following the communist revolution. From 1952 to 1979, China’s fertility rate was more than cut in half, falling to 2.75 children per woman from 6.5.

“If you want to emulate, emulate the positive,” Mr. Nanda says. “We ought to focus on equity.”

In the 1990s, he oversaw the adoption of a rights-based approach – only to see it quickly and quietly usurped by politicians who still believed that the key was to move fast and stop the “backward classes” from breeding.

India’s population is rising, but because of what demographers call “momentum growth.” Sixty per cent of Indians are of reproducing age. Even if tomorrow India attained “replacement level” fertility – if people had only enough children to replace themselves when they died – the country’s overall population would keep growing because the number of people being born will exceed those dying for several decades.

Despite alarms raised regularly in the media, fertility rates are, in fact, falling, and have been for two decades. In 21 Indian states and territories – including all of the more prosperous south – average fertility is at or below replacement level of 2.1 children per couple. The problem would take care of itself, says Dr. Das of the Centre for Health and Social Justice, if people in the high-fertility areas had access to jobs, education and, in the short term, condoms, birth-control pills and intrauterine devices.

Sterilization actually pushes population growth, he notes. “The largest amount of reproduction now is young women having their first and second children; sterilization does nothing to change this.

“The message [from government] is, ‘Have your children quickly and terminate your reproduction.’ When you give that message, you speed up the rate of delivery and you speed up momentum.” You wind up with even more reproducing adults.

When India’s policy was overhauled after Mrs. Gandhi, eliminating government-set targets for contraception and sterilization was seen as key to being less repressive.

But bureaucrats and health officials did little more than change their terminology.

“Targets and camps are back with a vengeance,” according to Mr. Nanda, saying he has seen officials who meet their targets handsomely rewarded by, for example, having a government car at their disposal.

In 2011, Shivraj Singh Chauhan, the chief minister of the state of Madhya Pradesh, announced a drive to sterilize 750,000 people a year. Those who underwent the surgery or brought in new recruits were entered to win prizes, including washing machines, DVD players, gun licences and a Nano, the ultra-low-cost Indian car.

Often sterilizations are done at breathtaking speed, with a doctor performing as many as 35 a day; rates of failure and complications are much higher than the international norm.

Dr. Sikdar, as chief of national policy, says the camps are supposed to take place in medical facilities, and organizers of those that don’t face criminal prosecution. But last year in Kaparfora in the state of Bihar, a doctor sterilized 53 women lying on benches in a school without electricity, and charges have yet to be laid.

Research by Dr. Das’s centre consistently finds that it is women from the poorest communities, usually aboriginal people and those at the bottom of the caste system, who are targeted when a region needs to reach its quota. They may have no idea that the procedure is permanent, he says.

Navin Kumar, the health information officer who supervises Kamrora, says the state government gave him a target (for the 875,000 residents of Mahoba district) last year of 4,100 women and 400 men.

And yet, Dr. Sikdar insists: “We do not give targets – we have … ‘estimated levels of achievement’ … It’s a management tool. A doctor has to make a plan based on numbers.”

If local officials, such as Mr. Kumar, are being told otherwise, and health workers, such as Ms. Raja, are pushed to meet quotas, he says, it’s a local aberration: A district politician may be keen to boost his reputation and “if, in his over-enthusiasm, he does something …”

Anjali Sen, director for South Asia with the International Planned Parenthood Federation, says India’s policy was drafted with the best of intentions, but she does not buy Dr. Sikdar’s claim that there are no targets. State family-planning budgets come from Delhi, she explains, and “cash incentives are tacit acceptance [of targets] from the central government.”

Ms. Uppal, the activist, says national officials could easily make sure the system is target-free: “They’re the cops.”

Dr. Sikdar says India is launching a new incentive program under which 860,000 health workers such as Ms. Raja will be paid $10 for every woman persuaded to delay her first child for two years after marriage, and another $10 if she waits two years before having a second.

Left unexplained is just how the women are supposed to avoid getting pregnant.

Certainly no one is relying on husbands to sort it out. During the Indira Gandhi era, most sterilizations were performed on men – there was no way to do a tubal ligation without invasive surgery, and female doctors, whom women patients prefer, were rare.

Vasectomies are still less complicated, but 95 per cent of the operations are now on women. Mr. Kumar says Mahoba district achieved 80 per cent of its target for women last year – but sterilized none of the 400 men.

There is a widespread belief, rarely challenged by doctors, that sterilization weakens a man and “robs him of his powers,” as women in Kamrora say.

All of the government outreach about family planning – all the home visits and chat circles Ms. Raja organizes – focus on women. But ask the women if they actually make the decisions about children and birth control, and they burst into laughter.

Even Dr. Sikdar acknowledges the problem – he oversees a $20-million program that distributes free condoms to women who have “no control over fertility.”

Or as Ms. Uppal puts it: “These completely disempowered women take condoms home to their husbands as if somehow they are going to be able to convince them to use them.”

Dr. Das says the service delivery will not change as long as policy springs from a belief that the “wrong” people are having children.

“Our development priority is not to reduce family size, it’s to raise income. We’re not ashamed of the inequalities, of low education attainment, of poverty – why are we ashamed of population growth?”

Noni Raja has thought a lot about choices, and who gets to make them. Two years after her bold decision to have a tubal ligation, she received a brutal reminder of her place in the family hierarchy.

In 2008, her younger son died at the age of 1 from pneumonia that the local health centre failed to treat. She lost her bold, chattering boy – and something else. Her in-laws were unwilling to accept a daughter-in-law they felt had failed in her most important responsibility.

So they scraped together a small fortune, and took Ms. Raja to Jhansi, a city about eight hours away by bus, where they paid a surgeon to reverse her tubal ligation – a rare and complicated surgery.

The operation went badly. “I nearly bled to death,” Ms. Raja recalls flatly. But she came home and, two years later, produced that mandatory second son. Her place in the family was once more secure.

Today, that last baby is everyone’s mop-haired pet; mother and grandmother compete over whose lap he will lounge in.

Ms. Devi is defensive – but unrepentant about the extreme lengths they went to in the quest for another boy. “All the neighbours said it was not done, to have only one son,” she explains. “We were under pressure.”

 

#India – Sterilization for Accomplishing Targets -टारगेट पूरा करने के लिए बंध्याकरण! #Vaw #Womenrights


jUNE 13, 2013, Prabhat Khabar

ये है हकीकत..

बंध्याकरण पर दबाव नहीं
बंध्याकरण शिविरों में महिलाएं दबाव में नहीं आतीं. वे अपनी मरजी से आती हैं. देश में कुछ ऐसी जगहें हो सकती हैं, जहां इस तरह के मामले हों, पर सब जगह ऐसा नहीं है.
एसके सिकदर, संचालक, जनसंख्या नियंत्रण कार्यक्रमपिछले कुछ समय से महिलाओं के बंध्याकरण से जुड.ी खबरें आती रही हैं. सबसे दुखद पहलू यह है कि गरीब महिलाएं थोडे. पैसे के लिए बंध्याकरण करवाती हैं. यह भी खबर आती है कि डॉक्टर बिना किसी सुविधा के ही ऑपरेशन करते हैं. जंग लगे चिकित्सीय उपकरण से भी ऑपरेशन करने के मामले सामने आये हैं. इससे महिला के इंफेक्शन होने के खतरे बढ. जाते हैं. कई बार महिलाओं की जान भी चली जाती है.भारत में एक साल में 46 लाख महिलाओं का बंध्याकरण

ये है हकीकत..बंध्याकरण पर दबाव नहीं

बंध्याकरण शिविरों में महिलाएं दबाव में नहीं आतीं. वे अपनी मरजी से आती हैं. देश में कुछ ऐसी जगहें हो सकती हैं, जहां इस तरह के मामले हों, पर सब जगह ऐसा नहीं है.

एसके सिकदर, संचालक, जनसंख्या नियंत्रण कार्यक्रमबिना किसी सुविधा के ऑपरेशन

यह एक साई है कि डॉक्टर बिना किसी सुविधा के ही ऑपरेशन करते हैं. ऑपरेशन के लिए प्रयोग में लाये जाने वाले उपकरण पुराने और गंदे होते हैं. कई बार डॉक्टर बिना ऑपरेशन थियेटर के ही सामान्य टेबल पर ऑपरेशन करते हैं.बंध्याकरण के लिए कतार में खड.ी महिलाएं.पिछले कुछ समय से महिलाओं के बंध्याकरण से जुड.ी खबरें आती रही हैं. सबसे दुखद पहलू यह है कि गरीब महिलाएं थोडे. पैसे के लिए बंध्याकरण करवाती हैं. यह भी खबर आती है कि डॉक्टर बिना किसी सुविधा के ही ऑपरेशन करते हैं. जंग लगे चिकित्सीय उपकरण से भी ऑपरेशन करने के मामले सामने आये हैं. इससे महिला के इंफेक्शन होने के खतरे बढ. जाते हैं. कई बार महिलाओं की जान भी चली जाती है.सेंट्रल डेस्क

जब भी भारत में परिवार नियोजन की बात उठती है, तब महिलाएं ही सबसे आगे होती हैं. यह जानना महत्वपूर्ण है कि दुनियाभर में होने वाले महिला बंध्याकरणों में भारत की 37 प्रतिशत महिलाएं होती हैं. पोपुलेशन फाउंडेशन की संयुक्त निदेशक सोना शर्मा के अनुसार, बंध्याकरण मुहिम में महिलाएं ही निशाने पर होती हैं, क्योंकि भारतीय समाज में पुरुषों का आधिपत्य है. पुरुष इस बात से डरते हैं कि वे ऑपरेशन से कमजोर हो जायेंगे या वे अपनी र्मदाना ताकत खो देंगे. बंध्याकरण कराने वाली महिलाओं को सरकार द्वारा दिये जाने वाले पैसे और साथ ही डॉक्टरों को भी इसके लिए अच्छी रकम दिये जाने के कारण महिलाओं के बंध्याकरण में तेजी आयी है. पिछले साल 46 लाख महिलाओं का बंध्याकरण किया गया. इनमें से अधिकांश महिलाओं ने पैसे के लिए बंध्याकरण करवाया. जबकि पिछले साल होने वाले कुल बंध्याकरण में महज चार प्रतिशत ही पुरुष थे. नयी दिल्ली स्थित ह्यूमन राइट्स लॉ नेटवर्क के ‘रिप्रोडक्टिव राइट्स’ की डायरेक्टर केरी मैकब्रूम के अनुसार, इससे समझा जा सकता है कि भारत में महिलाओं की क्या स्थिति है, उन्हें अपने प्रजनन संबंधी अधिकारों पर भी नियंत्रण नहीं है. वह कहती हैं महिलाएं आसानी से बलि का बकरा बनायी जाती हैं, चाहे इसके लिए सरकारी अधिकारी जिम्मेदार हों या फिर उनके पति. संयुक्त राष्ट्र के डाटा के अनुसार, प्रजनन पर नियंत्रण करने के लिए उपाय करने वाले 49 प्रतिशत दंपत्तियों में तीन चौथाई महिलाएं ही बंध्याकरण के लिए आगे आती हैं.

कमाई का जरिया

जब भी परिवार नियोजन के लिए बंध्याकरण शिविर लगाये जाते हैं, वहां महिलाएं कतार में खड.ी रहती हैं. डॉक्टर बस उन्हें एनीमिया टेस्ट के लिए बोलते हैं. इसके बाद डॉक्टर बड.ी तेजी से ऑपरेशन करते हैं. प्रत्येक ऑपरेशन पर केवल तीन मिनट का समय दिया जाता है. डॉक्टर को अपनी कमाई से मतलब रहता है.

पूरा करना होता है टारगेट

नयी दिल्ली स्थित सेंटर फॉर हेल्थ एंड सोशल जस्टिस के डायरेक्टर अभिजीत दास कहते हैं भारत में बंध्याकरण शिविरों में आने वाली अधिकांश महिलाएं पैसे की लालच में आती हैं. स्वास्थ्य अधिकारियों को भी अपना टारगेट पूरा करना होता है. दास का मानना है कि भारत में परिवार नियोजन एक कोटा तंत्र बन गया है. यही कारण है कि चीन के बाद भारत में परिवार नियोजन के लिए अपनाये जाने वाले उपाय सबसे खराब हैं. हमें यह जानना चाहिए कि सरकार ने 1996 में ही बंध्याकरण के लिए टारगेट पूरी करने जैसी नीति को छोड. दिया था. पर आज भी अधिकांश राज्यों में पहले वाली ही स्थिति है. वर्ष के पहले कुछ महीनों को तो ‘बंध्याकरण सीजन’ कहा जाता है. यह सब इसलिए कि 31 मार्च को वित्तीय वर्ष समाप्त होने से पहले बंध्याकरण के लिए निर्धारित लक्ष्य को पूरा किया जा सके. स्वास्थ्यकर्मियों पर बंध्याकरण के टारगेट को पूरा करने का दबाव भी रहता है.

‘ब्लूमबर्ग’ में सर्वप्रथम प्रकाशितझारखंड

राज्य में 29 प्रतिशत महिलाएं परिवार नियोजन के लिए बंध्याकरण करवाती हैं. जबकि ग्रामीण इलाकों में नसबंदी कराने वाले पुरुषों की संख्या 0.4 प्रतिशत और शहरी इलाकों में यह 0.6 प्रतिशत है.बिहार

प्रत्येक वर्ष साढे. छह लाख महिलाओं का बंध्याकरण जबकि नसबंदी कराने वाले पुरुषों की संख्या महज 12 हजार ही है. बिहार में इस साल 13 हजार से अधिक महिला बंध्याकरण शिविर लगाये जायेंगे

Religion and governance: strange bedfellows #Vaw #womenrights


BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f3715 (Published 7 June 2013)

Cite this as: BMJ 2013;346:f3715
  1. Anita Jain, India editor, BMJ

Author Affiliations

  1. ajain@bmj.com

An unexpected turn of events saw a woman referred to as Beatriz get a life saving caesarean section, thanks to doctors in El Salvador who supported her cause, and a rousing international movement. She was earlier denied an abortion, it being criminalised in predominantly Catholic El Salvador, with the ensuing imprisonment of women and doctors (doi:10.1136/bmj.f3612). Timely intervention prevented Beatriz going the same way as Savita Halappanavar did a few months back in Ireland. Savita died after being denied an abortion on the grounds that “it [Ireland] is a Catholic country” (doi:10.1136/bmj.f2208). Her death and Beatriz’s struggle for life raise the question: Why does religion interfere?

A parallel conflict between religion and governance is taking place in the Philippines. At the Women Deliver conference I attended last week, it pained me to hear Filipino women with 16 and 22 children talk of how they were tired of having children, of having to provide for them under conditions of extreme poverty, and fearful of dying in the process of childbirth. Senator Pia Cayetano provided an inspirational narrative of having the reproductive health bill passed last year after five congresses and nearly 15 years. Recognised by President Aquino as a “matter of urgency,” the law marks a momentous achievement to make available free contraceptives, sex education, and comprehensive obstetric services (doi:10.1136/bmj.e8535). The struggle is not over however. With a largely Catholic, conservative, and patriarchal hierarchy, the constitutionality of this law has been challenged in the Supreme Court.

In a review of abortion policies worldwide, Sophie Arie reports a threat that countries may be headed towards being more restrictive (doi:10.1136/bmj.e8161). Closer to home, India may laud itself for a progressive abortion law but it continues to have one of the highest rates of unsafe abortions. Suchitra Dalvie, coordinator of the Asia Safe Abortion Partnership, shares grim statistics whereby, “every year about 11 million abortions take place [about 700 000 are reported] and around 20 000 women die due to abortion related complications.” Clearly the law has not translated into enabling physical, social, or financial access to these essential reproductive health services (doi:10.1136/bmj.f3159). Contrary to what may be expected, states are further imposing severe curbs on medical abortion pills (doi:10.1136/bmj.f1957). In the latest BMJ poll we look forward to hearing what you think of this.

Signifying a commitment to make comprehensive family planning services a reality globally, the London Summit on Family Planning (FP 2020) laid the ground for collaboration among donors and governments (doi:10.1136/bmj.e4160). At Women Deliver, Kavita Ramdas from the Ford Foundation emphasised, however, that “access to contraceptives” needs to be the message, and not just family planning. The importance of this is immediately evident in a similar conflict between the state and religion in Muslim dominated Indonesia where unmarried women are denied reproductive health services including contraception. Shereen El Feki, author of Sex and the Citadel, shared voices of young unmarried men and women from the Arab region who are “sexually active, but not sexually informed” as “marriage remains the only the only socially accepted context for sex—state-registered, family-approved, religiously-sanctioned.” The needs of this large and growing community of single men and women often tend to be neglected in the discourse on family planning.

Nozer Sheriar, secretary general of the Federation of Obstetric and Gynaecological Societies of India (FOGSI), shared that, with an estimated 21.6 million women worldwide experiencing an unsafe abortion each year and with about 70 000 deaths, it is a silent tsunami knocking door to door. As symbolised by Salvadoran doctors who stood strongly behind Beatriz so she would not die giving birth, there is a role for healthcare providers to support women’s choice on this reproductive right that society is so reluctant to give.

Notes

Cite this as: BMJ 2013;346:f3715

Footnotes

  • Follow Anita Jain on Twitter @ajain247

#India -Do you know incentive and target based health services can be coercive ? #Vaw


Permanent sterilization-incentive based and target based health services: a glimpse from Rajasthan

– Leena Uppal

My elder sister in law was the one who suggested that I should go for female sterilization, if I get lucky I may win a motor cycle in the lottery….. 

The Ration Unit and Fair Price Shops in Bundi District of Rajasthan have been given instructions by the State Health Department to meet the target of at least two sterilizations before 30th March. There is also an incentive attached. The dealer s with the maximum cases will be certified and rewarded.  Targets are distributed further to the fair price dealers because the health department workers could not meet their family planning targets, which focus heavily on sterilization….. (Source: local newspaper, Rajasthan Patrika, 22.03.2013).

In a family planning camp held in a Community Health Centre (CHC) in Raipur Block of Pali district of Rajasthan on 22.03.2013, though the district collector announced various prizes including motorcycles, Colour TVs and home appliances to be distributed to ‘lottery winners’ among couples who opted for permanent sterilization as well as targets of village health providers to motivate women for sterilization; this camp did not see much of a turnover. The service providers shared that this could be because of Holi (a festival of colours in India) and during Holi people in the villages were busy.

Women present in the camp at Raipur were going under the knife without fully understanding the risks, precautions, consequences and their rights as claimants in case of failures, as nothing was explained o them or read out to them from the consent forms on which they gave their thumb impressions.

There are national guidelines of the Ministry of Health and Family Welfare that have a detailed description of the contents of medical history, Personal characteristics and reproductive history, menstrual history, obstetrics history, contraceptive history that is to be recorded in detail before female sterilization is done, however, this has not yet been built into the MIS system of the facilities. The only records that were maintained were the social-demographic profile and the consent form of the acceptors.

Follow up instructions, discharge cards, monitory incentive to sterilization acceptors were not given to the women before they left the facility. The families of women arranged their own transport to get back homes after the camp concluded at 3:00 pm on 22.03.2013.

Family planning should be regarded as a matter of choice and rights by both the service providers and the community. But this is not at all the case of what is being recorded and reported. While the National Population Policy has seen no place for targets, rural women continue to be seen as family planning targets and family planning camps as best models to meet these targets. This approach is problematic as there is no equal precedence given to post operative care and follow-up.

The government must audit and ensure strict compliance to the quality assurance mechanisms that have been established. There is an urgent need to understand both population issues and health service delivery within in the perspective of ‘women’s rights’ and justice, by the service provide

Srilanka Bans Birth Control Surgery to Protect Dwindling Sinhala Race #Vaw


Govt Bans LRT on Women and Vasectomy on Men After Bodhu Bala Sena Protested Against Birth Control to Protect Dwindling Sinhala Race

24 February 2013, 6:10 am

By Chrishanthi Christopher

Last week the government sent out a communiqué to all government hospitals and private institutions banning all irreversible family planning methods that control birth.

Following the ban Maternity Hospitals and Non Governmental Organizations (NGOs) that do Ligation and Resection of Tubes (LRT) on women and Vasectomy on men shelved their plans and struck off all scheduled procedures from the hospital registers. This follows an announcement by the government that the procedures should not be carried out on women and men unless it is done for medical purposes.

Maternity Hospitals, Gynaecology Units of Base Hospitals and NGOs dealing with population control came under deep shock. They say that the government’s call comes without any warning.

Health Ministry, Secretary, Dr. Nihal Jayatilake said that the procedure hitherto being done on men and women should not be carried out unless it is for a medical reason. He refused to explain the reasons for the ban but stressed that none of the NGOs are allowed to carry out any permanent birth control methods. “This is government policy,” he said.

Ironically this call come at time when the Bodu Bala Sena (BBS), a movement claiming to be protecting Sinhala culture and values called on the government to put an end to all irreversible methods of birth control claiming that the Sinhala nation is dwindling.

Against their will

They say that women and men of the productive age group are pushed into accepting the procedure against their will by certain NGOs who have vested interests. The BBS General Secretary, Gala Boda Atte Gnanasara Thera told Ceylon Today that the Sinhala women who go to the hospitals to give birth are unwittingly opting for the procedure. He blamed the midwives and attendants in the hospitals for misleading young mothers who come there for confinement. “They are trained to advocate the procedure to young mothers. We are against this type of behaviour. Our women are misled or pushed into believing that they should not have more than two children,” he said.

Gnanasara Thera said that the Family Planning Law of 1973 is outdated and cannot be applied today. The Act states that women in the age group of 26 years and above are eligible for family planning “Those days men and women got married early and they had many children at that age. But now they start life at 30 years,” he said.

“The government has got to intervene and ban the procedure before it is too late. There is a conspiracy, our Sinhala population is declining,” Gnanasara Thera added.

He claimed that in the Tamil populated areas, the doctors inform the women and men of the repercussions of the surgical procedures and do not advocate it till they are over 40 years.

Government has to intervene

Pointing a finger at the NGO Marie Stope International, he said that funding for the birth control procedures are done by them. In addition he says that illegal abortions are also being carried out by the institution. “They have a sinister aim behind it,” he said.

However, the Family Health Bureau and the Family Health associations who are in collaboration with Marie Stope International and help it perform the sterilization procedures say that it is totally wrong to say that the mothers and fathers are pushed into this. “It is a misconception. It is purely voluntary and only if they opt for the procedure the surgery is done,” Family Health Chief Dr. Deepthi Perera said.

“Now even we are trying to revise the age limit for this procedure. We are thinking of raising the age limit to 35 and above,” she said.

However, critics argue that the ban will only put older women at risk and drive them to illegal abortion. It is reasoned out that with the ban the older women who have teenage or adult children and would like to have an LRT procedure would be deprived. They maintain that women with grown up children would like to have a permanent method of contraception.

In such instances when and if they get pregnant they would not like to get help from the family planning units and would be pushed to other resources. Most often than not they will seek the help of illegal abortion clinics that would charge them exorbitantly and even put their lives in danger.

It is also argued that abortion parlours which would mushroom and quacks and half baked doctors would perform abortions on mothers most often using makeshift theatres and often not following sterilization methods that could turn aseptic and put the mothers at risk or even kill them.

The Family Health Association (FPA), also a family planning organization has shelved all its scheduled LRT procedures until further notice.

“It is banned, we cannot challenge the government’s decision … the repercussions would be unplanned pregnancies,” said a doctor at the FPA who wished to be anonymous.

“We use to do around 30 procedures once a month and now everything has to be cancelled,” the doctor said.

The Human Rights Commission welcomed the move and said that it is the right to life. Its Chairman Prathiba Mahanamahewa said according to the Human Rights Declaration of 1948 and the Political Rights Convention, everybody has a right to life.

“It is an individual right and this is another issue,” he said.

The Colombo Archbishop’s House also expressed its pleasure for the move to ban the birth control methods. “We believe that birth control and abortions are sinful and we welcome the move,” Fr. Benedict Joseph of the Archbishop’s House told Ceylon Today.

“The ban opens up for birth and it is in keeping with the teaching of the church,” he said.

LRT

LRT is a simple procedure done under local anaesthesia and is performed in a theatre for 20 to 30 minutes. The patient goes home the same day. The procedure will not have any effect on the menstrual cycle of the women.

Vasectomy

Male sterilization or vasectomy is a minor surgery taking only 10 to 15 minutes, also done under local anaesthesia. Post surgery there will be no effect on the sexuality or quality or quantity of the ejaculatory fluid of the person.
COURTESY:CEYLON TODAY

Rajasthan Government’s disdainful response to women’s plight after family planning operations #Vaw


 

According to the latest news report (December 7, 2012) Rajasthan Government is having plans to compensate Rs. 30,000/- for female sterilisation failures, but it is also to be noted that once again the government is claiming that people are responsible for failure of operations because they do not take ‘precautions’ due to which!  (See the images below)
The Coalition Against Two-Child Norm and coercive Population Policies and a team of organisations in Rajasthan are jointly holding a consultation in Jaipur on the 13th of  December to discuss similar unacceptable issues related family planning policies and their connection with the two-child norm. It is also planned to include a few of the Panchayat representatives from a few areas in Jaipuir.
Inline image 3
Inline image 4

 

UP Govt announces target sterilization against National Policy # Coercion


 

The UP Government announces sterilisation targets for Azamgarh District for the months Novermber and December:

 

According to the letter issued by the Chief Medical Officer (Azamgarh), dated 30.10.2012, number P.K. Camp/2012-2013/14896-03

  • The target for sterilisation announced for the district of Azamgarh for the months of April-November 2012 was 23085.
  • The targets met by the government in the month of November 507.
  • The sterilisation camp locations and dates along with the doctors responsible for conducting operations have also been announced through this letter.
  • The CHCs and PHCs can organize additional sterilisation camps as per their convenience.
  • Third and forth camps have been deemed as ‘special camps’

There are clear directives and indications to show that the states governments announcing targets for family planning in various states, like in the district of Azamgarh. This approach is clearly is not aligning with the National Population Policy (2000) which specifically talks about bottom up planning and community needs assessment approach.

It is urgent that a vigil is kept on these camps. This is possible such information and letters are circulated among all of widely.

It is an appeal from the Coalition Against Two-Child Norm and coercive Population Policies that such news and orders if widely circulated will help generate momentum to the advocacy against coercive family planning programmes in India.

Please share information from states with us. Visit our website www.2cnpop.net.

 

The original letter as cited above is attached herewith.

Family Planning Camp- download

 

Adding It Up: Costs and Benefits of Contraceptive Services Estimates for 2012


Wekker voor anti-conceptiepil / Alarm clock fo...

Wekker voor anti-conceptiepil / Alarm clock for birth control pills (Photo credit: Nationaal Archief)

HIGHLIGHTS
June 2012

  1. In 2012, an estimated 645 million women in the developing world were using modern methods—
  2. 42 million more than in 2008. About half of this increase was due to population growth.
  3. The proportion of married women using modern contraceptives in the developing world as awhole barely changed between 2008 (56%) and 2012 (57%). Larger-than-average increases were seen in Eastern Africa and Southeast Asia, but there was no increase in Western Africa and Middle Africa.
  4. n  The number of women who have an unmet need for modern contraception in 2012 is 222 million. This number declined slightly between 2008 and 2012 in the developing world overall, but increased in some subregions, as well as in the 69 poorest countries.
  5. Contraceptive care in 2012 will cost $4.0 billion in the developing world. To fully meet the exist-ing need for modern contraceptive methods of all women in the developing world would cost$8.1 billion per year.
  6. n Current contraceptive use will prevent 218 million unintended pregnancies in developing coun-tries in 2012, and, in turn, will avert 55 million unplanned births, 138 million abortions (of which0 million are unsafe), 25 million miscarriages and 118,000 maternal deaths.
  7. n  Serving all women in developing countries who currently have an unmet need for modernmethods would prevent an additional 54 million unintended pregnancies, including 21 millionunplanned births, 26 million abortions (of which 16 million would be unsafe) and seven million miscarriages; this would also prevent 79,000 maternal deaths and 1.1 million infant deaths.
  8. n  Special attention is needed to ensure that the contraceptive needs of vulnerable groups suchas unmarried young women, poor women and rural women are met and that inequities in knowledge and access are reduced.
  9. n  Improving services for current users and adequately meeting the needs of all women whocurrently need but are not using modern contraceptives will require increased financial com-mitment from governments and other stakeholders, as well as changes to a range of laws, poli-cies, factors related to service provision and practices that significantly impede access to and use of contraceptive service.

Download full report here

Civil Society Declaration: Rights must be at the centre of the Family Planning Summit


Women on Top: How Real Life Has Changed Women'...

Women on Top: How Real Life Has Changed Women’s Sexual Fantasies (Photo credit: Wikipedia)

CALL FOR ENDORSEMENT

 

Amnesty International, Center for Reproductive Rights,  Development Alternatives with Women for a New Era (DAWN),  International Women’s Health Coalition and RESURJ have prepared a statement *Rights must be at the centre of the Family Planning Summit *in advance of the DFID/Gates Family Planning Summit which will be held in London on 11 July 2012.

 

We would like to invite you or your organization to endorse this statement (at bottom of this email), which will be presented to the organisers prior to the Summit.

 

To endorse this statement, please send the following information to CRR’s Kate Meyer (kmeyer@reprorights.org).

 

Name of organization or individual (please specify which):

Country:

Name and email of contact person:

 

Please also circulate this statement to your contacts and networks. The deadline for endorsements is Monday, 11 June 2012.

 

* We will circulate the statement again after endorsements have been received.

 

——————–

 

Rights must be at the centre of the Family Planning Summit: Civil Society Declaration

 

We, civil society organizations working to promote women’s and young people’s human rights, call on world leaders on the eve of the “Family Planning Summit”, hosted by the UK Government and the Bill and Melinda Gates Foundation, to ensure that sexual and reproductive health and rights are at the centre of all efforts to meet reproductive health needs, including family planning.

 

Contraceptive information and services – “family planning” – form an essential part of the health services that women need throughout their lives. Any steps to increase demand for contraceptives must actively support efforts to improve comprehensive and integrated sexual and reproductive health. Contraceptives must be provided through primary healthcare, with full regard for women’s human rights and the specific needs of young and unmarried women and other groups.

 

Our experience, built over decades of work around the world, has taught us that the failure to take actions guided by women’s human rights – to health, to life, to live free from discrimination among others – can have devastating consequences. Policies that accept or tacitly condone forced sterilization, the coercive provision of contraceptives, and the denial of essential services to the young, poor and marginalized women that need them every day have violated, and continue to violate, women’s human rights.

 

Nearly twenty years ago, governments at the International Conference on Population and Development agreed that respect for women’s reproductive autonomy is the cornerstone of population policy. Any return to coercive family planning programs where quality of care and informed consent are ignored would be both shocking and retrograde. The Family Planning Summit must ensure that the clocks are not put back on women’s rights: women’s autonomy and agency to decide freely on matters related to sexual and reproductive health without any discrimination, coercion or violence must be protected under all circumstances.

 

In order to expand contraceptive access with full respect for women’s human rights, we urge governments, donors and other actors supporting the Family Planning Summit to:

 

·           Take all possible measures to ensure that this initiative is designed with quality of care and human rights at its core, so that no coercive measures are introduced in the provision of contraceptives;

 

·           Ensure that meaningful participation by women, including young women, is built into all stages of program design and implementation to ensure that services are responsive to their needs and to prevent any human rights violations;

 

·           Ensure that the provision of contraceptives is integrated into existing and new sexual and reproductive health services, and that a full range of contraceptive methods is offered;

 

·           Design and implement a system for monitoring, evaluation and accountability to track and measure its impact on the rights of women as this initiative is rolled out, and urgently make necessary corrections should violations come to light;

 

·           Commit to tackling the existing legal and policy barriers that hinder access to contraceptive information and services, without which efforts are likely to be ineffective and exacerbate disparities in access.

 

In 2012, nothing less will do.

 

Endorsed by:

Center for Reproductive Rights

Amnesty International

Development Alternatives With Women for a New Era, DAWN

International Women’s Health Coalition

RESURJ

Prof. Sarah Hodges on Reproductive Health in colonial India


Prof. Sarah Hodges, University of Warwick, explains her research on “family planning” and reproductive health in colonial India. Her  work  is on the social and cultural history of modern South Asia, specifically the politics of health in colonial and postcolonial India (particularly the Tamil-speaking south). Her  interests lie at the intersection of a number of fields: modern South Asian history, gender studies, anthropology, and the history of science, technology and medicine.

She is  currently at work on a book about the contemporary history of medical garbage in Chennai, India, provisionally titled, Biotrash: The Urban Metabolism of Medical Tourism in India.

Dr Mohan Rao  interviews  Sarah Hodges.

 

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