Sri Lanka – Restricting sterilization: To what purpose? #Vaw #rightoabortion #reproductiverights


 

March 15, 2013,http://www.island.lk/

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I was appalled to read a recent newspaper article that reported a government ban on irreversible methods of contraception. Later I learned that the ban prohibits non-governmental organizations (NGOs) from the provision of sterilization services. According to reliable sources, sterilization services continue to be available through the public sector albeit with additional counseling requirements implemented at some points of access. As this newspaper item coincided with protests against ‘family planning’ held by extremist Buddhist factions concerned about the diminishing ‘Sinhala race’, it is surprising that neither the government nor the Ministry of Health has thus far provided clarification on this issue. In this article, I would like to highlight a few problems with the existing sterilization policy that are unlikely to be resolved through bans or other forms of restriction. Rather than restricting women’s access to contraception to accommodate the views of reactionary groups, it might be more useful to focus our efforts on addressing some of the issues outlined below.

 

General Circular No. 1586 issued by the Office of the Director General of Health Services (1988) includes the following eligibility criteria for sterilization procedures: “1) The clients should be over 26 years of age and should have at least 2 living children; the younger being over 2 years of age. Confirmation of mother’s age should be done by checking the Birth Certificate, Identity Card or any other valid document, which is available; 2) Clients who are over 26 years of age and having 3 or more living children could be sterilized at any time; 3) A client under 26 years of age, and his/her spouse insist on a sterilization, the Medical Officer concerned could use his/her discretion, and perform the sterilization provided the couple has a minimum of 3 living children. In such a situation the officer concerned should personally check the validity of the information provided, in respect of the number of living children, prior to performing the sterilization; and 4) In the event of any medical indication, which warrants sterilization, the client should be referred to a specialist in the relevant field who should make the final decision.”

 

As the subtext of the circular implies, like most contraceptive programmes offered through Ministry of Health, the criteria for sterilization target women. For instance, references to the “mother’s age” and the insistent appeal of the spouse (when the ‘client’ is under 26 years) suggest that women are primary targets of the sterilization programme. In my experience of working for the Ministry of Health, sterilization procedures were, in fact, freely available and did target women, both in terms of availability and accessibility. This is confirmed by data from the most recent Demographic and Health Survey (2006/7): 16.9 % of ‘currently married women’ were sterilized compared with 0.7% of women whose husbands were sterilized (the Demographic and Health Survey is administered to married women and specifies these categories). These statistics must also be considered in light of the fact that the sterilization procedure for men is ‘simpler, safer, easier, and less expensive’ than the procedure for women (WHO, 2007).

 

Importantly, the criteria listed on the circular do not require the ‘client’ to obtain her/his partner’s consent to undergo sterilization (although spousal insistence may add weight to requests from those who are under 26 years of age). Nevertheless, spousal consent is routinely obtained in government institutions before providing sterilization procedures to women (my experience; see also CEDAW Shadow Report, 2010). In my work, I witnessed numerous instances when women’s pleas for sterilization were rejected during Caesarean section simply because the spouse was unavailable to sign a consent form. If these women decide to undergo sterilization on a later date, they are exposed unnecessarily to a second surgical procedure. In this way, doctors take on the role of gatekeepers to contraceptives services, restricting women’s access based on their own gendered presumptions.

 

The Circular of 1988 referenced above was introduced because “[it had] been observed that a significant proportion of females who [underwent] sterilization [were] under 25 years of age, with a notable number being less than 20 years” (General Circular No. 1586). These concerns were valid in the 1980s, a time when coercive tactics were being used as part of the population control agenda imposed on the third world. In 1980, a monetary incentive of Rs. 100 per sterilization procedure was introduced and was subsequently increased to Rs. 500. Surprisingly, this monetary incentive was not omitted in the Circular of 1988 and remains in place today. In fact, another circular was introduced in 2007 in order to “streamline” the payment process so that ‘clients’ would be able to obtain this payment from the institution that provided the sterilization procedure (General Circular No. 01-09/2007). Furthermore, healthcare providers (including the surgeon, anaesthetist and assisting nurses) can still claim, if they so do wish, a negligible sum for sterilization. While Rs. 500 may seem trivial to some of us, continuing to provide incentives for sterilization is problematic and warrants omission.

 

The provision of incentives can be interpreted in many ways, especially when sterilization procedures are mostly sought by particular groups of women. Sterilization is most popular among women in the plantation sector (presumably not Sinhala contradicting the claim of extremist factions in Colombo). According to the Demographic and Health Survey (2006/7), 61% of estate women used a modern method of contraception (including sterilization, contraceptive pills, intra-uterine devices, Depo-Provera, implants, condoms and complete breastfeeding) and 41% resorted to sterilization. In contrast, 54% and 44% of rural and urban women used modern methods of contraception, while 16% and 13% resorted to sterilization (the survey used urban, rural and estate as distinct categories). This set of data completely debunks the proclamations of extremist Buddhist groups who are hell bent on protecting Sinhala women from coercive sterilization. It also makes it incumbent on us to ensure that plantation workers are not coerced into sterilization. On the other hand, the large numbers of estate women accessing sterilization may signify a lack of access to temporary contraceptive options.

 

Imposing restrictions on sterilization may have other implications for women’s health. For instance, it is likely to increase the incidence of unplanned pregnancies. According to the Demographic and Health Survey (2006/7), sterilization is popular among the following categories of women: estate women, women above 35 years of age, women with lower levels of education and women with three or more children. While these associations may point to a need to ensure that these particular groups of women are not coerced into sterilization, it also reflects on who will be most affected by restrictions on sterilization. Not surprisingly, this profile bears similarity to that of women seeking abortion services; induced abortion is most common among rural, married women with at least two children (Senanayake & Willatgamuwa, 2009). Then restrictions on sterilization could result in more women resorting to unsafe abortion, a service that has moved underground since the government led shut down of abortion clinics in 2007.

 

Religious extremism is frequently accompanied by restrictions on access to reproductive health services for women. Although the existing policy is problematic for the reason that in targeting women it burdens them with the responsibility of adopting contraceptive measures, the policy does ensure that sterilization is quite easily accessible to women through the public sector. While there is much room for improvement around health policies governing contraceptive services, such as the removal of incentives and the unofficial requirement of spousal consent for sterilization, imposing restrictions or banning sterilization altogether is hardly the solution. Such restrictions are not only an extension of policies that assume that women are incapable of making decisions concerning their health, but may well be interpreted as an attempt by the state to regulate women’s reproduction in the service of a retrograde agenda of nationalism.

 

Ramya Kumar, MBBS

 

Kandy

 

Mr. Minister, my name is Sunanda Deshapriya. I am not a terrorist.


5 Feb, 2012,  Sunanda Deshapriya      

Tamil rebels in a pickup truck in Killinochchi...

Image via Wikipedia

An Open Letter to Srilankan Minister Keheliya Rambukwella

Mr. Minister, I don’t know whether you have seen the film called ‘my name is Khan. In it, the main character played by popular actor Shah Rukh Khan Repeats the lines ‘My name is Khan. I am not a terrorist’ at different points in the film, in order to affirm his innocence. I too am about to tell you a similar story. ‘My name is Sunanda Deshapriya. I am not a terrorist’. This is my theme.

The story of ‘My name is Khan’ centres around the harassment a Muslim man with the name of Khan has to endure following the terrorist attacks on the World Trade Centre in New York, USA. These attacks on the Twin Towers generated both fear and anger in the minds of the American people. Some extremist groups tried to unleash the feelings of anger against ordinary Muslim people living in the US. The film’s narrative is set against this background.

You are trying to do the same thing today. You are trying to use the fear and anger generated in the minds of the Sinhala people because of the brutality of the LTTE against those of us who have been advocating respect for human rights in Sri Lanka, including respect for the rights of the Tamil people of our country. When I say ‘you’ I do not only mean you as an individual, Mr. Minister. I include the entire gamut of people who do your bidding, including those media persons who sing your praises with no shame.

Do you know what baseless and venomous lies the media under your control has spread about me in the past few weeks? Have either you or your acolytes ever tried to behave in accordance with universally accepted media ethics and asked me for my comments on your revelations? Isn’t your talk about media ethics therefore to be understood as mere political hogwash?

In the film, Sameer, the young son of Khan and his wife Mandira is brutally killed by a gang of boys of his own age. This act of savagery became possible only because the feelings of anger and hatred that I described earlier had been let loose in their community. There can be nobody who watches this film whose heart and mind are not captivated by the tragedy of the child’s murder and the subsequent events. In the past weeks I too have read newspaper reports about your children. How disturbed you would have been after reading such stories? Can you imagine how many deaths my family, my children, have gone through as a result of the vicious campaign being carried out against me by you and the media that serves your will?

I fervently hope that one day you will be able to think about others as you think about yourself; this is the preaching of the Lord Buddha.

You talk over and over again about media ethics. You order news websites to be shut down because they are acting without respect for these ethics. You warn us that you will bring about a Code of Ethics for the Media that will be very special to Sri Lanka.

You are levelling charges against a group of journalists, accusing them of receiving money from the LTTE and carrying out a traitor’s agenda. You say that these media persons and journalists are now living abroad. You say they cannot be prosecuted because the Sri Lankan law does not permit it.

Mr. Minister, while your media people broadcast your words on this subject, they project images of me at various media freedom demonstrations on the screen behind them. With respect to which Code of Ethics are you displaying my photograph to illustrate baseless allegations? You say that it is because you cannot prosecute these persons who have obtained money from the LTTE under existing Sri Lankan law that you are not revealing their names. But your media institutions carry my photograph as an illustration to this statement. What is the intention behind this? Is it NOT to implicate me in your statement? Why is it that your acolytes have permission to do what you don’t dare to do? It must be that you think you do not need to be bound by any ethical standards because you are in power.

You advise the media about the use of language. Yet the media under your control continue to use the vilest forms of hate speech against me, shamelessly and without any proof to back up whatever they are saying. You reward these acolytes of yours with awards of media excellence.

Is it your theory and your practice that only your opponents should be held responsible for respecting media ethics? Is this how you devalue your own use of the media?

Wasn’t it your media that repeatedly broadcast the canard that at the session of the UN Human Rights Council in Geneva in September last year, the Maldivian President said that ‘Sunanda Deshapriya is a traitor to the nation’ even after it had been proved to be false and inaccurate? Where were the media ethics that you preach, then? The first ethical consideration of any journalist or media person is that of respect for the truth. Doesn’t the media under your control break this principle every day? Is the proverb ‘Practise what you preach’ not applicable to Ministers of this government?

Since a while ago I have publicly challenged your government to prove that I have received even one cent from the LTTE. The truth of the matter is that neither you nor your government nor anyone else holds on shred of evidence to prove this. If your government is capable of indicting members of the military and the Police for having accepted money from the LTTE, why should we believe that you are not able to do the same in the case of journalists who have received money from the LTTE? I accuse you of trying to unleash the same forces of extremism that Khan and Mandira faced on the murder of their son Sameer against me and all others working for the defence of human rights and media freedom in Sri Lanka today.

It is no secret that I hold an extremely critical view of the Rajapakse regime. As Media Minister, you are obliged to defend my right to hold those views. Instead, you are engaged in taking away that space from us and terrorizing us. Please remember that the right to hold dissenting views is one of ethical bases of media freedom.

On ITN, in the ‘Athulanthaya’ (Interior) programme, you said something ridiculous: That because you cannot take these charges before the law, lacking evidence, you are instead placing them before the people. What does this mean? Why must you take information that has no basis and therefore would not stand scrutiny in a court of law into the public arena? Doesn’t this show us that you are trying to build a hate campaign against me in the minds of the people?

In June 2009, award-winning journalist and Secretary of the Working Journalists’ Association, Poddala Jayantha, was abducted and brutally assaulted because of a similar hate campaign. You who are levelling the most absurd of charges against media persons fighting for media freedom today, what have you done to bring the perpetrators of the attack on Jayantha to justice, almost three years after the attack? Tell us if there is even one example where you and your government have brought any of those responsible for killing, beating and harassing journalists and media persons to justice.

As Media Minister, you are raising against unfounded allegations against us. But the allegations we raise against you as media freedom fighters are completely factual.

When cartoonist and media activist Prageeth Eknaligoda was abducted three years ago, it is you who confidently told us that he would return in two weeks time.

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