Medical homicide in Chhattisgarh

The deaths of more than a dozen women, who participated in a mass sterilisation camp at an abandoned hospital in the Indian state of Chhattisgarh in November 2014, have shone a lurid light on official India’s approach to questions of family planning and population control. Instead of providing family planning facilities which are safe, free and technically adequate, over the past decades the Indian state has resorted to mass sterilisation of poor men and women, often through straightforward coercion or methods bordering on coercion, as the primary means of population control.

In June 1975 the late Mrs Gandhi imposed emergency rule in India, which was to last 21 months. During this period, apart from measures to suppress all dissent and opposition, her government put into operation an aggressive mass sterilisation programme which saw more than 8 million people, by and large men, through coercion or paltry bribery, sterilised.

Nowadays it is mostly women who are the victims of this cruel and unscientific practice, as was the case in the recent Chhattisgarh tragedy. In theory voluntary, these sterilisations are the culmination of a mix of cash payments and hard-sell marketing techniques practised by state health officials, who are rewarded monetarily for each ‘volunteer’ they secure for sterilisation. The doctor who performed the female sterilisation (tubectomy) in Chhattisgarh was awarded by the state government on India’s Republic Day in January 2014 a medal for performing 100,000 sterilisations during his career.

Here are a few details concerning the circumstances in which the deaths of women took place. The tubectomy camp (for the sterilisation of women) was staged in Takhatpur Block of Bilaspur District on 8 November 2014 in a derelict facility characterised by primitive, unsanitary conditions and a complete absence of infrastructure for the maintenance of hygiene. The factory-like ethos of this mass sterilisation camp may be gauged from the fact that 83 women were operated on in just 5 hours by a single doctor who supposedly dipped his instruments briefly in a disinfectant liquid between patients. The doctor, who has been taken into custody on suspicion of culpable homicide, has, for his part, blamed the women’s deaths on substandard medicine, including antibiotics, administered to them after the procedure.

The tragedy in Chhattisgarh was waiting to happen. Indeed, it is happening all the time, though it only surfaces very occasionally through the occurrence of dramatic events that result in a large number of deaths. More than 700 women died in India between 2009 and 2012 as a result of botched sterilisation procedures in camps – 15 each month. All Indian state governments, with the health ministry in the centre turning a blind eye, are promoting the ‘camp approach’, whereby, instead of informed individual decisions, female laparoscopic sterilisations in ‘hospitals’ with disgracefully abysmal physical infrastructure are the rule, bringing about deaths that deserve to be called by their proper name – medical homicide.

The scandalous state of the under-funded public health system is an indictment of the negligent, callous and insensitive attitude of the Indian ruling class, the international funding agencies and an assortment of NGOs towards the health and wellbeing of the poor and downtrodden masses of India, especially its women.

The Malthusian theory of population, which Marx correctly described as a libel on the human race, having been totally disproved and discredited in the western countries, is desperately seeking to acquire a new lease of life in poor countries such as India. The Indian ruling classes, backed by population hacks form the centres of imperialism, shamelessly, and without a shred of evidence, assert that the poor breed prolifically thereby putting undue pressure on the country’s resources and are thus a hindrance to economic progress. Therefore, runs the argument, they must be stopped from reproducing as much as possible. In fact the truth is just the opposite, namely, that development is the best contraceptive. All over the world there is plenty of evidence to the effect that birth rates begin to decline when countries reach a certain level of economic and social development. Even within India, particularly the differential birth rates in various states attest to this truth.

Primarily consequent upon economic and social progress, and not mass sterilisation, India’s total fertility rate, according to the World Bank, dropped sharply, from 5.2% in the mid-1970s to 2.4% today, that is, just slightly above the replacement rate of 2.1% for keeping the population stable. Fertility rates are even below replacement levels in India’s most prosperous states, particularly those with higher levels of female education and empowerment. In Tamil Nadu, Kerala, Andhra Pradesh, Jammu & Kashmir, Karnataka, Punjab, West Bengal and Maharashtra, the birth rate has dropped below that of Sweden at 2.0%. In the more socially conservative and poorer Indian states, with fertility rates of 3.5, the authorities routinely resort to sterilisation as a quick fix.

Over 6 million female sterilisation operations are performed every year in India. According to reliable data, of all those who practise some form of birth control, 65% undergo female sterilisation, while 2% undergo male sterilisation (vasectomy), 3% use an IUD (inter-uterine device), 8% use a contraceptive pill (women), 10% use condoms (men) and 12% have resort to some traditional methods. It is clear from these figures that over three-quarters of the burden of birth control falls on women, and two-thirds of people use sterilisation, which is very difficult – and often impossible – to reverse. And, of all sterilisations, 97% are on women. As for female sterilisation, 77% of the women who undergo it have never used any other form of contraception.

In addition, the latest available data on abortions in India, from 2008-2009, suggest that 11.06 million abortions take place in the country every year.

It is thus clear that the totally inadequate and dysfunctional public health provision in India continues to be a major obstacle and stands in the way of the provision of suitable contraceptive facilities capable of furnishing basic counselling, screening and follow-up care to empower women to make use of reversible forms of birth control. The new Modi government, instead of making funds available for a decent health system capable of dispensing effective family planning facilities, has doubled the incentive payments for women to undertake sterilisation in ‘high focus states’ from the derisory sum of Rs 600 (£7.50) to the equally derisory sum of Rs 1,400.

Thanks to the ramshackle facilities of what passes for India’s health system, about 56,000 Indian women die during, or shortly after, childbirth, which works out at 196 maternal deaths per 100,000 births. The comparable figure for China is 32. Further, of the 26 million babies born each year in India, 309,000 do not survive even 24 hours, giving India the shameful notoriety of accounting for 30% of global first-day deaths.

Behind the shambles of its health system, and the tragic deaths resulting therefrom, lies the mindset and callous attitude of the Indian ruling classes who blame the afflictions of the poor on the poor, and for whom the health and wellbeing of the downtrodden masses, especially the women, is simply not a priority. India neither lacks resources nor expertise to be able to equip the whole country with a network of properly-functioning, hygienic clinics worthy of human beings in the 21st century. If a poor country like Cuba can achieve remarkable standards and progress in the field of health, not to speak of other areas such as education, housing and food, India can too. What is lacking is a social system that gives priority to people’s health – which puts the health and wellbeing of the vast masses before the profits of the few.

While working to bring about such a revolutionary change in the social system, the Indian proletarian must lead the masses in a vigorous campaign to force the authorities to jettison the thoroughly discredited Malthusian theory of population, to move away from its fixation on sterilisation, and to apportion sufficient resources to the health system for it to provide, among other services, proper family planning facilities.

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