The botched up sterilization of women at a government health camp in Bilaspur District of Chattisgarh, that resulted in the deaths of 13 women and hospitalization of a large number others for shock and trauma triggered by post-operation complications, has once again highlighted the murky world of sterilizations in India.
As many as 83 tubectomy operations were performed in three-and-a-half hours, with one doctor and his attendant spending, on average, two minutes per surgery. Sixty of the 83 women, mostly from OBCs and Satnamis (who are Dalits), had to be hospitalised after the surgeries were performed on them by Dr R K Gupta with a single laparoscopy machine. The surgeries are believed to have triggered hypovolemic shocks in the women, leading to heavy blood and fluid loss, in turn disabling the heart from pumping enough blood to the body.
Health experts blame the increasing deficiency of health personnel in government health centres for recurring incidents of this kind, wherein the women went into toxic shock, primarily because of instruments not being sterile. Although laparoscopic sterilization is now the technique of choice because it enables quick recovery and least invasion, but it can also be the cause of tragedy if proper procedure is not followed during the operation. According to experts, laparoscopic surgery requires a higher degree of skill and also a more complicated method of sterilizing the equipment. Using inadequately sterilized instruments will lead to infections.
The larger truth hidden in the government’s sterilization efforts is that it is almost exclusively directed at women. This is because men are under the misapprehension that sterilization will affect their ‘manliness’ or virility. So, women are encouraged to get themselves sterilized. There is an additional benefit; they get Rs 1400 for getting the procedure done, while the ‘motivator’ gets Rs 200.
The tragedy in Chhattisgarh exposes the gender skew in mass sterilizations in India where 98 per cent of the 4.2 million such operations conducted last year were tubectomies, that is, female sterilizations. While vasectomy (male sterilization) is a simpler procedure, doctors say the government does not target men given their misapprehension that sterilization would diminish their virility. Instead, say experts, women become victims of such drives where unsterilized equipment and lack of qualified health professionals lead to deaths, time and again.
Almost 37 per cent of all tubectomies in the world are done in India. In fact, India is the only country in the world where female sterilization predominates among various birth control measures. This explains why it is women who are the victims of the government sponsored mass sterilization camps, time and again. While death of women due to sterilization procedures have ranged from 153 to 184 a year between 2010 and 2012, cases of post-operative complications have more than doubled in the past four years; from 131 in 2010 to 267 in 2013.
Earlier, according to Lok Sabha data, 707 women died between 2009 and 2012 because of botched sterilization procedures. This works out to about 178 deaths every year or almost 15 deaths a month. And the official data is notorious for not registering all the deaths. Many women are sent soon after sterilization to their distant homes, where they would not have the resources to seek medical help if there are complications. Even a fatality is likely to go unreported.
Public health activists and civil society groups have pointed out that the surgeries were conducted in complete violation of Supreme Court orders, which instruct that a maximum of 30 operations can be conducted in a day with two separate laparoscopes only in government facilities. Also, one doctor cannot do more than 10 sterilizations in one day. Despite this, the surgeon in Chattisgarh performed about three times the permissible number of surgeries (83) in less than six hours in a private hospital, which has reportedly remained closed for 15 years. The single-storey dilapidated building showed seepage of rain water and fungus on its walls. The operation theatre doors were rusted and on the verge of falling off.
Why have camps at all? Why can’t individual women access sterilization when they need it, at a government health facility? That way, there would not be so much pressure to do hundreds of surgeries at one go. The ‘camp method’ needs to be stopped immediately as the quality of care is seriously compromised in mass sterilization camps conducted to meet earmarked targets of family planning; even though India claims to have dropped the target-driven approach to family planning.
A recent document titled ‘Family Planning – A Right and a Choice brought out by the government along with the United Nations Population Fund (UNFPA) for India, declares; ‘Family planning programmes focusing on sterilization only limit the programmatic impact on child and maternal mortality.” Yet, the entire national family planning programme revolves around sterilization. Neither the UNFPA nor the government seems to find this strange.
Dr Gupta whose botched up sterilization claimed the lives of 13 women and left 60 ailing in Chhattisgarh, has been arrested after an FIR was registered against him for negligence. Ironically, he was earlier honoured, on this year’s Republic day, with a state award for conducting a record 50,000 surgeries in his career.
Chhattisgarh CM Raman Singh has ordered a judicial probe into the incident, and said that all possible ‘angles’ of the tragedy were being investigated in order to pin-point the cause of deaths. “The guilty won’t be spared,” he said.
A preliminary report of the inquiry committee probing the botched sterilization, has revealed medicines given to the victims were contaminated with zinc phosphide, a rodent killing chemical. The report said traces of zinc phosphide were found in Ciprocin 500mg tablets, manufactured by Mahavar Pharmaceutical Pvt Ltd. These tablets were distributed among women, who underwent sterilization at the camp.
Autopsy reports of victims support claims by the inquiry committee members that medicines might have been the cause of deaths mainly pain-killer Brufen and antibiotic Ciprocin. It is said zinc phosphide traces, which led to organ failure, were found in blood samples of the victims. The Chattisgarh government has now banned sale of six medicines that were used in health camps.
Experts say, zinc phosphide mixed with food is commonly used to kill rodents. Acid in the digestive system of rodent reacts with zinc phosphide and generates toxic phosphine gas. A similar reaction is triggered in humans too. It reacts with water and stomach juices to release phosphine gas, which can enter blood stream and adversely affect lungs, liver, kidneys, heart and central nervous system.
Most countries offer women a mix of modern methods of contraception. In India, this exists mostly on paper; as women being herded to sterilization camps are not even counseled about alternative contraception methods.
