New Delhi: The case of Chhattisgarh’s 101 female sterilisations that took place last week in Surguja district, in a matter of hours, has thrown light on the procedure itself.

Tubectomy, or female sterilisation, is the most complicated of all available contraceptive methods. Yet, it is the most commonly used family planning method in India, far ahead of condoms, intrauterine devices (IUDs), pills and male sterilisations.

According to data from the National Family Health Survey (NFHS) 4 — the latest survey where data is available for all states — 35.7 per cent of all family planning methods practised in India is female sterilisation. Only a mere 0.3 per cent is male sterilisation.

Among states, Chhattisgarh accounts for a large proportion of the female sterilisations conducted in India, higher than the national average.

In 2015-16 when the NFHS-4 data was collected, female sterilisations accounted for 46.2 per cent of all family planning methods practised in Chhattisgarh. In comparison, male sterilisation made up just 0.7 per cent, IUCDs comprised 1.6 per cent, pills were 1.7 per cent and condoms 3.9 per cent.

In 2020, India had changed its population policy to do away with family planning based on pre-set targets. Four years before that, in 2016, a Supreme Court bench headed by Justice Madan Lokur had ordered that the “camp” approach to sterilisation be stopped within the next three years.

However, the Surguja case shows that the mass sterilisation mentality still survives, largely because of a “fill it-shut it-forget it” approach by the government, activists claim.

Also read: Study says 1.3 mn Indian women lost access to contraception, abortion services in pandemic

The tubectomy procedure ties up the woman’s fallopian tubes — the ducts that transport the eggs released by the ovaries to the uterus — thereby preventing future pregnancies. It is a permanent option and does not require the health system to follow up with the patient in the future, as opposed to other contraceptive measures such as the IUD.

Explaining how tubectomy differs from vasectomy, the male sterilisation procedure, gynaecologist Dr Prakash Trivedi, a former president of the Federation of Gynaecological and Obstetric Societies of India, said, “Male sterilisation is usually done under local anesthesia. It is a simpler procedure and recovery is faster. However, men do not come forward because there is a myth that their sexual prowess will go down.

“Female sterilisation is usually done under general anesthesia and recovery period depends on whether it is done laparoscopically or otherwise. Ideally, vasectomy should be encouraged because it is a simpler operation.”

The number of male sterilisations have remained low since it never quite recovered from the Emergency hangover when some communities were targeted.

Officials in the health ministry told ThePrint that government-set targets were long done away with, leaving it to state governments to decide how they want to implement family planning.

A look at the data reveals wide variations in statewide numbers. States with better health facilities tend to do more tubectomies. Officials say that is because the procedure cannot be done unless minimum facilities are available, such as at least a Primary Health Centre building.

According to the NFHS-4 data, in Kerala, 45.8 per cent of all family planning procedures were tubectomies; in Tamil Nadu, it was 49.4 per cent; and 17.3 per cent in Uttar Pradesh. In Punjab, the figure stood at 37.5 per cent.

However, the mindset has steeped deep into the Indian psyche, said Poonam Muttreja, executive director of the Population Foundation of India that works closely with state governments in the field.

“Targets were done away with in the national policy way back in 2000. Yet the target mindset continues. The message has not percolated. We are a scheming society…we do schemes, but do not see how it is implemented on the ground,” said Muttreja.

“A 2015 study shows that 77 per cent of women who undergo sterilisation never used any other contraceptive method; they had only undergone abortions. The focus on the other hand with young marriages and anemia in girls should be on options like spacing and postponing of pregnancies rather than doing a sterilisation on a woman who may already have had many children. We have never really evaluated our sterlisation programme,” she added.

Also read: Lower population good for India’s health. Time to get over ‘if and but’ approach

The disproportion in male-female sterilisation procedures has been a problem in India for years now. The Supreme Court, in its 2016 order, had pointed out that in 2013 and 2014, 95.09 per cent and 96.7 per cent, respectively, of sterilisation procedures were conducted on women.

The judgment also highlighted the continuation of the ‘targets’ system.

“Although the Union of India has stated that no targets have been fixed for the implementation of the sterilisation program, it appears that there is an informal system of fixing targets. We leave it to the good sense of each state government and union territory to ensure that such targets are not fixed so that health workers and others do not compel persons to undergo what would amount to a forced or non-consensual sterilisation merely to achieve the target,” the court said.

While there are no additional incentives for doctors doing the procedure, both healthcare workers and the person undergoing the sterilisation get a monetary incentive. This is what allows mass sterilisation camps to thrive.

“The Union of India is directed to persuade the State Governments to halt the system of holding sterilization camps as has been done by at least four States across the country. In any event, the Union of India should adhere to its view that sterilization camps will be stopped within a period of three years. In our opinion, this will necessitate simultaneous strengthening of the Primary Health Care centres across the country both in terms of infrastructure and otherwise so that health care is made available to all persons,” the apex court had said in the same 2016 judgment.

Muttreja pointed out an additional problem — just 6 per cent of the country’s health budget is spent on family planning, of which just 1.4 per cent is spent on temporary contraceptive methods, such as condoms and IUDs.

“The changing rhetoric of two-child norms etc will only increase the propensity of coercive sterilisations,” she warned, referring to plans to bring laws on family planning in states such as Assam and Uttar Pradesh.

Also read: Male contraceptive pills — a step towards equality or will it make women cede reproductive rights again?

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