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Chhattisgarh Sterilisation Camp_Press Compilation |
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PRESS COVERAGE
ON
CHATTISGARH STERILISATION CAMP
NOVEMBER 2014
KNOWLEDGE MANAGEMENT CENTRE
Population Foundation of India
B-28 Qutab Institutional Area, New Delhi-110016
Tel. +91-11-42894140, Fax: 91-11-42894199. Library@populationfoundation.in
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Bilaspur district of Chhattisgarh, laparoscopic sterilization camps were held on 8th
and 10th November 2014. Around 83 women were sterilized, and out of them 13
unfortunate women died who had undergone sterilizations in the camp. The tragic
deaths of women, all were in their 20s or 30s. Around 70 women were admitted in
critical condition in different hospitals of the state. This incident was in the
headlines in worldwide media. Mostly national and international organizations,
agencies, activists raise this issue. Government has appointed an enquiry
commission that has to submit report within three months.
PFI Knowledge Management Centre compiled this document from online/offline,
print and electronic media coverage. Now KMC prepared it in a shape of
hard/electronic document, and make available in the KMC portal.
Rakesh C Joyal
Knowledge Management Centre
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PRESS COVERAGE ON CHATTISGARH STERILISATION CAMP
November 2014
KNOWLEDGE MANAGEMENT CENTRE
Population Foundation of India
B-28 Qutab Institutional Area, New Delhi-110016
Tel. +91-11-42894140, Fax: 91-11-42894199. Library@populationfoundation.in
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CONTENTS
Source
Indian Express
Indian Express
Indian Express
The Hindu
Times of India
Times of India
Times of India
The Statesman
The Tribune
Asian Age
The Pioneer
Indian Express
Deshbandhu
Hindustan
Times
Hindustan
Times
Hindustan
Times
The Wall
Street Journal
Date
12 November 2014
12 November 2014
11 November 2014
12 November 2014
12 November 2014
12 November 2014
12 November 2014
13 November 2014
13 November 2014
12 November 2014
12 November 2014
13 November 2014
13 November 2014
13 November 2014
13 November 2014
13 November 2014
13 November 2014
News Headings
1 surgery every 4 minutes, in an abandoned
hospital.
19 times as many women sterilized as men in state.
Sterilisation’s sexist skew.
4 Women dead, 20 critical after sterilization camp
in Minister’s district.
11 women die after sterilization surgeries in
Chhattisgarh.
Sterilisation death a great human tragedy: UN
Botched tubectomy at govt camp kills 11.
60 of 83 women were hospitalized.
C’garh govt suspends four doctors.
Cong seeks Raman Singh’s resignation.
Lucky to be alive, I saw women die around me.
Doc Performed Surgeries Within Minutes: Survivor.
Women undergo 98 % of sterilizations in India.
Sterilisation death: criminal cases filed HC seeks
report.
Mortally skewed.
To cut fertility rate, C’garh sterilized 344 women a
day
Chhattisgarh sterilization cmap: 14 in hospital.
Botch-up kill 11 women.
Meeting targets led to tragedy.
PM talks to CM, urges swift action.
11 women die after going under ‘sterile’ knife in
Bilaspur: PM Tells Raman Singh to ensure thorough
probe, four suspended.
Even after deaths, 26 more tubectomies were done
in one hour at another camp.
Hospital trust had no clue about camp.
13 ki maut, 93 bharti.
Chhattisgarh Death: Rusty, infected tools killed
women?
Deadly violations plague India’s Sterilisation drive.
Seeing people just as number: Coercive methods of
controlling population result in avoidable tragedies
Deaths put spotlight on India’s sterilization camps:
Activists criticize making surgery cornerstone of
Family Planning.
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The Hindu
The Hindu
Hindustan
Times
Deccan Herald
Asian Age
The Hindu
The Hindu
The Hindu
Asian Age
Indian Express
Asian Age
Times of India
The Hindu
Indian Express
Deccan Herald
Hindustan
Times
Chhattisgarh
Hindustan
Times
Times of India
IBN Live
The Pioneer
The Hindu
13 November 2014
14 November 2014
14 November 2014
14 November 2014
14 November 2014
14 November 2014
14 November 2014
14 November 2014
14 November 2014
14 November 2014
14 November 2014
15 November 2014
15 November 2014
15 November 2014
15 November 2014
15 November 2014
15 November 2014
16 November 2014
16 November 2014
16 November 2014
16 November 2014
16 November 2014
Sterilisations stepped up to meet target: Report.
Despite SC order, daily number in each camp high
in Chhattisgarh.
SC refuses to take suo motu action.
Doctor blames medicines for sterilization deaths.
Surgery deaths expose unhygienic practices, stress
to meet targets.
Chhattisgarh Govt orders judicial probe, sacks
surgeon; AIIMS doctors say drug reaction may have
caused the deaths.
Sterilisation deaths shame India.
Chhattisgarh tragedy: India needs answers.
Accent on male sterilization.
Stop ’camp method, focus on male sterilization:
Activists
Contaminated medicines may have killed women:
AIIMS.
Probe will unravel the mystery (Q& A: Amar
Agrawal, Health Minister, Chhattisgarh)
Drugs & targets: 14 deaths later, the buck passing
begins, probe on. (Sterilisation Deaths)
Sterilisation death toll climbs to 13.
Suprious drugs, non-sterilised equipment cause
C’garh tragedy?
2 tribals sterilized against law; 1 dead, other critical.
Major coverup feared in botch-up tragedy.
Sterilisation deaths: Drugs had rodent-killing
chemical.
Retired judge to probe sterilization deaths.
Sterilisation deaths in Tamil Nadu highest in the
country.
Delhi learns from Chhattisgarh deaths, says no
targets set for any facility: Sterilisation workshop at
Trade Fair.
Spurious drugs may have caused tubectomy deaths
C’garh deaths: Rate poison in antibiotics.
C’garh health dept backs bogus drug units for a
‘cut’.
Nasbandi ko mardangi se jodte ‘Mard’
Bilaspur deaths: Rahul meets kin, slams govt.
Drug firm under lens closed for 3 months.
Killer camps claim 15 lives a month.
Women were lured to sterilization camp with
promise of money.
A grievous tragedy plays out in Chhattisgarh.
State trying to cover up: Rahul ‘Not just
megligence; corruption played a role.
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Indian Express
The Statesman
Latin American
Herald Tribune
Indian Express
Indian Express
Indian Express
Times of India
New York
Times
Times of India
16 November 2014
16 November 2014
17 November 2014
17 November 2014
18 November 2014
18 November 2014
19 November 2014
20 November 2014
20 November 2014
Many women of protected tribe sterilized, they got
no cash, only 5 eggs, half kg dal.
IMA slams government for action against doctor:
Chhattisgarh Sterilisation Boutch Up Cases.
12 women die after sterilization operations in India.
Tubectomy Deaths Chhattisgarh govt to adopt
babies, pay for education.
Revisiting an outrage: In the wrong hands,
sterilization remains an immoral, intrusive act.
Sterilisation Deaths: Protest outside residence of
Chhattisgarh health minister.
IMA wants doc’s suspension revoked, calls bandh
on Nov 20.
Health min unperturbed, won’t resign: Amar
Agarwal says He dind not conduct surgeries or give
medicines.
India’s Lethal Birth Control.
With 1.25L sterilizations a year, C’garh a fertile
ground for docs.
Times of India
Navbharat
Local Paper
Dainik Bhaskar
The Tribune
The Hindu
Reuters
20 November 2014
21 November 2014
21Novermber
2014
23 November 2014
26 November 2014
25 November 2014
Locked OTs and missing doctors.
Nasbandi kand: Bisra Report Pahunchi.
Opration ke baad apne aap khul rahe mareejao ke
taanke.
Kendriya Prayogshalaon ki janch main siprocine mai
nahi milli chuhe mar dawa.
Bilaspur nasbandi kaand, dawa ke jahar ne li hai
mahila ki Jaan.
Sterilisation Oops, sorry, we’ve killed you 16
women dying in a sterilization camp in Chhattisgarh
…………
Public health, private tragedy.
Indian sterilization targets remain in all but name
critics say.
Live Mint
26 November 2014 Indian sterilization remain in all but name, critics
say.
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65-71
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76-77
India Today
Times of India
27 November 2014
27 November 2014
Mass camps that horrify, doctors who hurt,
medicines that poison and a state that targets
women. The Chhattisgarh tragedy spills wide open
the sordid underbelly of public health across India.
Report: Contamination, filthy op theatres killed
sterilized women.
78-80
81
Compiled & prepared by PFI/KMC
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Times of India
Hindustan
Times
Indian Express
Times of India
Business
Standard
Zee News
The Tribune
Mail Today
Mail Online
The Tribune
Oman Tribune
Down to Earth
Miscellaneous
cmo.cg.gov.in
30 November 2014
02 December 2014
02 December 2014
02 December 2014
02 December 2014
01 December
02 December 2014
02 December 2014
02 December 2014
03 December 2014
December 2014
31 December 2014
02 December 2014
November 2014
Cycle pump used in 56 sterilisations: Odisha doc
says It’s fairly safe, routine procedure.
Fatal Negligence: Failure to follow Protocol let to
sterilsation deaths, say NGOs.
NGOs say infection killed women, not spurious
drugs.
Infection, not just fake meds, behind 16 C’garh
deaths
Social activists urge central govt to remove
incentives for sterilization process.
Independent Probe demanded in Chhattisgarh
sterilization deaths.
Experts say drug theory a sham, hint at cover-up.
Bilaspur victims stripped of dignity.
India probe uncovers shared needles, poor hygiene
after sterilization deaths.
Tragedy waiting to happen: Deadly lapses in the
rush to meet the target.
Serious lapses in sterilization drive exposed
Operation cover-up
Survivors of Bilaspur sterilization tragedy face
locked gate at inquiry panel office.
Retd. District and Session Judge Anita Jha to
investigate the case
(Commission to submit report in three months)
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110-13
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Indian Express, 12 November 2014
•I
1
I
!',BHUl'OSH: Blt4JIDWAJ
-i3-ii,ASPUR, N(WE!vfBER I {"
STIf£ death toll rose
to 12 on 'lucsday,
three days after Gle
sterilisation camp organised
by the state government in
'Iakhatpur block of Bilm~plll'
di;,1ric:t on Saturday, enquiries
reve,lled that besides medical
negligence, guidelines and
procedures outlined for such
operations wcre also seem-
inglyviolatcct
Of the 83 women who UI1-
cknvent lap,lfoscopic tubec-
tomies, over 50 are still ill hos-
pital.l,1,vcnly-five of th(~m are
reported to be critical.
According to the central
govellunent'S guidelines, a
medical team cannot conduct
tIlGre than 30 laparoscopic
tlJbectomies in a day, with
thre\\;~separate laparoscopes--
that means not more than 10
tuboctomies with a single in-
stnlHl'O"nt, ",~;teachinstrnment
needs to be properly steriliscd
aftt:! every uperation,
'T'he guidelines state that if
there are additional smgcOll>,
CON flNUEO ON PlM;;!.: ?
lf1~haspi'!:,"1 wh-eretarnp
W&l" held has been sealed
I Tollrises to 12; state govt suspends four
19 tirnesas
manywolnen
steri edas
nlen in state
___..,A.-RAN·~lKA GHOSH _
NEW DELHI, NOVEMBER 11
Nem !lei's children wait 'for her body outside the mortuary of
the Chhattisgarh Institute of Medical Sciences,
ASHUTOS~ BHARDWAJ
ong~..v.$.ietaIms:new, m er,
tes patlen't7 a
ASJWTOSH UHAIDJWAJ
BILASPUR, NOVEMBERll
hlnatic
JU ST day;; before t l;~.!;terHisati;}~
camp in -Qilaspur, 1'lenl Bai had givell
birth to a chi1ct Her family did not
want her to opt for a tubectomy, but
su<:cumbed to the pressure of a local
health worker.
Chandakali, who worked as 11
tabourerwlth her husband in Pune,
was visHlng her family here. They
were reluctant to allow her to go for
the upcration, but later agreed,
l11c two women are among the
12 who have died sofaI', following an
o!lcratioll theyneverw3nted. Over 50
others, including many who were
medically untit for the operation, are
in hospltal. At least 21 women who
are critical have been referred to the
Apollo Hospital, .Among these are
LumJi Sahu, who was sllfferingftom
anaemia, and Manorama, a diabetes
plltienL Doctors said they should not
CONTINUED ON PAGE 2
THEdeathofl2women after
tubectomies at a sterilisa lion
camp organised by the Ch11at-
tisgarh goveI1'unent in Bilaspur
illlclerlincs how India's family
planriirlg burden rests dispro-
portionately on women's
shouldem,This despite the fact
thatmale,SterUisationis actu-
ally a relatively easier andrisk-
free.procedure;
Consider thkln Chhattis-
gad\\ in 2011·12, the most re-
CC111 year for which data is
available, 1,27.114 tubec-
tomies were performed
agalristjusl6,165.vasi;JCto1tlies
,~" this means ahll()st 19 times
as many women were sterilised
as men.
'nlis reflects a nationwide
trend: the gap is consistent
across all states with the worst
being Tamil Nadu where the,
ratio he!:\\veen tuhedomy and.
vasectomy is 165. Tamil Nadn,
interestingJy;hassome of the
COflfflNUED ON 'PAGE:.!
wm:n£ me S'fATES STANLl
rAGIHi
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E
liON'S
EXISTS
w
programme gone wrong in Chhattisgarh
more women undergo the procedure than men. Figures for 20 .
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li~fl c,:":
~I .
,a 1
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cut fertility rare, C'garh sterIDsed 344 women a day
I"llWDf'.LlU, l'IO\\II!MBEl\\ 12
(.11hattisgarb has been
rt~;;nrting to mass sterilisa-
tiNl all
itsexce
ft,rtillty
in a ehild-bearing age, will
have. Chhattisgarh is not
alone in pushing female ster-
ilisations as the single largest
mode
to match
TFR
The
rest - Up, MP, Bihar, Jllark-
Rajasthan - are
rihem
SUspended doc was
!!!~~d on R-Day
.Or Rl(iGUpta;)the sus- .
pended doctor who
tie takes suo motu cognlsanf.;o. se9'~S r{~')(lrt
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.Chhattisgarh sterilisation camp: 14 in hospital
Iottb-upldlls 11WOQI8I1
~~lli
RAIW:R, NOV, 11
~~d $fm-ilisatiol)
~\\~i~t~ gQY .
. s}:lOOsot'edfami1y
c~mp at Pendari, m
Ch~U~$lilllrll's ~UllSP\\:ll'
diStrict, nearly 12(1 kill
from here, have led to the
death of 11 women, all aged
between 28 years and 32
years.
At least 14. of B2 other
women admitted to differ·
ent hospitals in tilt' district
headquartl}fs town of
Bi1aspur are suffering
complications following
the botched surgeries and
are in critical condition, a
senior district offic-er told
this newspaper on
Tuesdav.
"The 'death toll in the
tragedy hllS mounted to 11.
A total of 62 WQmen have
been. admitted to four dif·
fereut hospitals in
Chhattisgarh chief minister Raman Singh meets patients
and relatives after a botched sterllisation operation at a
government camp in 8ilaspur on Tuesday.
- PTI
Bill1spur owing to post-
surgery complJcatlons.
Fourteen of them are in
critical condition, It is a
\\:hallenging situation,"
Bilaspur commissioner
Sonmani Bonra told this
newspaper.
A team. of doctors from
AllMS in New Delhi was
being flown to Bilaspur to
attend to the victims of the
sterllisation tragedy after
a request was made by the
Chhattisgarh govermnent.
according to Union health
mentat a
at Pendari on Saturday.
Allor th¢m Were dis·
cllarg¢d immediately after
surgery.
"Several belWficiaries of
the health camp started
feeling nauseous barely a
few hours al:ler surgery on
Saturday nigllt and were
rushed to the district head·
quarters hospital at
BUaspur. While four
women died on Sunday,
four others succumbed on
Monday, Two others died
on Tuesday," an official
spokesman bere said.
Chief nlinisier Raman
Singll, who visited the vic·
tims of the botchedsterili·
sabon surgery in hospital
IIITlJrn to Page 4
'Meeting targets led to tragedy'
RABiNDRA NAlli
CHOUDHURY
Ministw _SLAMS I1I18tt
geries for such a large decade", another doctor
nnmber of women," the in the district hospltal
RAJPUR, NOV. 11
sparbrow
C'GARH. GIM', doctor told this newspa· here said.
per on Tuesday request· The mess up in the
SEEIS_' One of the doctors SoUS·
pended in connection
• State health min-
ing anonymlt}:
health camps had led as
According to him, the many as 83 elderly per-
with .the botched sterill· ister Amar Agrawal state government sudden· sons to lose their eye
sation surgery tragedy sparked a row by
ly wakes up to achipve sigh! in the government· AGE CORRESPONDENT
that ela imed life of 11
women so far: on Momhl\\'
blamed the sratl' goverrl.
saying, 'My prompt
intervention could
ment for the ineident, prevent the death
the target set under dif·
ferent Central govern·
llwut·sponsored scheme"
in the second half of
sponsored health camps
in Balod, Mahasamuml.
Durg, Kawardhu and
Rajnandguon in the state
NEW DELHI. NOV. 11
Expressing "deep shock",
the Congress Oil Tuesday
saying. "Safety in health toll from crossing
financial year apparently in 2013.
targeted the Raman
camps are being compro-
mised in the name of
meeting targets".
10. Otherwise, 30-
36 women would
"We have been asked to have died."
to stop fund lapses.
"Usually, the health
camps are organised in
October- March. There is
Meanwhile, the opera·
tion theatre (OT) used for
conducting tubectomy
surgeries on(!3 women in
Singh government in
Chhaitisgarll over the
death of YOllllg women
after botched sterilisa-
achieve the target set for
no proper system 10 take a government-rull camp tion procedure at a state-
each of us in such health
care of the beneficiaries in Bilaspur district .had run camp and demanded
camps. The anganwadi planning camps, where of the camp in the post· remnined unused fortonr
the dismissal of state
workers are virtually nobody bothers if there surgery period, which is months, preliminary health minister Amar
herding the women from are enough provisions to very vitaL This has heen invest.lgatlun
has Agmwal.
villages to the family pel'fonn s!erili.satioll sur· happening in the past one revealed.
WhlIe pln'!y chit->f Sonia
Gandhi expressed "deep
PMtalks to eM, urges swift action shock and grief Over the
unfortunate inCidont of
deaths and critical illness
of unsuspecting women"
at the government storiIi'
AGE CORRESPONDENT
Asia summit and was in pitailsed due to the has also set up a commit· sation camp,party
NEW DELHI, NOV. 11
its capital Naypyiww, botched procodure at a tee to probe the sterillsa· spokesperson Shobha
even spoke to M1' Singh govel'nmen t·organised tion deaths. "The min· OrAl said that the incident
Expressing concern over regarding the matter. caml). Around 60 women istry has asked tor report deserves a judicial
the sterilisation tragedy "The PM spoke to the were admitted to differ· and constituted a eom- inquiry. Citing previous
in BiIaspur. Prime Chhattisga1'h CM. Dr Hut hospitals after they mittee to investigate the incidents. Ms Oza alleged
Minister Nanmdra Modi Raman Singh, em the complained of eomphca· matter. Action \\vill be that under the tenure of
on Tuesdav asked unfortunate tragedy in t!OllS following swrilisa· taken after the report is the same health minister
Chhattisgarh chief min· Hllaspur: The PM tiOll .surgery at the camp suhmitted, We are expect, uterus of 200 women
Ister Raman Singh to expressHd concern over held at a private hospital jng the rep(H't soon," said were operated upon to
ensure thorough investi- the tragedy. The PM has in Ponda!'i village on out· Shripad Naik, minister of "usurp" the money under
gation and action In the asl,e<l Dr Raman Singh to skirts of Bilaspur town state tar health.
theNRHM.
incidlmt in which eight ensure a thorough inves on Saturday, Bi1aspur col- A team of cxpetis from
"Dismiss the health
women died duo to the tigathm & action in the lector SiddharthKomal All-India Institute of minister immediately.
botched procedure.
entire issue." the 1'1'110 Par<loshi said earUer in Medical
Sciences Actuallv chi.ef minister
Mr Modi, who left for saId in a tweeL
tho dav.
(AHMS} has also been himself should resigKMC/Pg 13
Myanmar in the morning Eight women died and The 'Union ministry of sent to enquire into the after the Incident." Ms
to attend Asean and. Ealit 52 others have been hos· health and familY welfare issue,
07..a sa.id ..
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iii-. "i.~,I ••••
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i ~~:::m~:rr::JH:;o'spl
,
Jain
ital, when it
'tbtbeper-
anagement.
I
!
I
.
; campswereheldheresincetbe
Ii
'tal shutdQwn.ln fact,
Gupta, whd headed
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Deshbllndhu. 13 November 2014
'i3aft fJfIa ,'3 3Uff , ··~stlfll\\HI "«11milHifil(}" ~ ~ ~M:f1&14,
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Cc'€~"civemethods ofcontrol1illg
population result Ll1 a'V-oidable tragedies
oth:hig much seems to have changed in the mani'1er
in which both the central and state governments
view population. It is seen as a problem that must··
to reproductive choices and the
chi).dren one wants to fu1ve are inalie
ing seems to be going1n.the opposite
seelng
·merelyas statistics that must be trimmed down..
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3.8 Page 28 |
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THE WALL STREET JOURNAL.
Deaths Put Spotlight on India's
Sterilization 'Camps'
Activists Criticize Making Surgery Cornerstone of Family Planning
Jagdeesh Nirmalkar, who lost his wife after a sterilization surgery, sits with his daughter at his home in
Bilaspur, Chattisgarh, India, on Wednesday. EUROPEAN PRESSPHOTO AGENCY
By
SHANOOR SEERVAI and
GABRIELE PARUSSINI
Updated Nov. 13, 2014 2:56 p.m. ET
CHICHIRDA, India-When Janaki Suryavanshi asked local health workers about birth control, she was
told her only choice was surgical sterilization-the same method used by her mother and neighbors in this
village.
Assured it was safe, the 26-year-old mother of three signed up to undergo the procedure, which was
performed by a single surgical team on Saturday Nov. 8 on her and 82 other women at a government-
sponsored population-control "camp" in the central Indian state of Chhartisgarh.
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Ms. Suryavanshi and 11 other women died in the aftermath. A 13th woman died after undergoing
sterilization surgery on Monday at a nearby clinic as part of the same campaign.
Fal1lilyPlaDDiDs
Female steriJizationisa common form of birth control
in many parts of the world. CountriQs with the highest rates:·
Dominican Republic
Puerto Rico
Mexico
India
EI Salvador
Colombia
Nicaragua
Brazil
China
Costa Rica
~·(Shareofwomenages·15-49,lTlarriedor in.a·.reiationship,whoaresterilized.
Note:Daterangefor data 2002-12 Source:United•Nations
TheWalrStreet Journal
State authorities say they are investigating what killed them and sickened dozens of others. Among the
possibilities they are probing: improperly sterilized surgical instruments or adulterated medicines.
Health activists say the real culprit is the Indian government's focus on female surgical sterilization as a
cornerstone of the nation's family-planning program.
"We only know the world of sterilization," said Ms. Suryavanshi's mother, Anjora, standing in her one-
room home in Chichirda, a village of2,600 in the state ofChhattisgarh. If any other birth control had been
KMC/Pg 22
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3.10 Page 30 |
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available, she said, the family wouldn't have opted for surgery. In a recent government survey, 34% of
households nationwide said female sterilization was their current method of family planning.
Ram Avtar. who also lost his wife during a surgery, sits with his children in their house in Bilaspur, India,
on Wednesday. EUROPEAN PRESSPHOTO AGENCY
On Wednesday, police detained the doctor who performed Saturday's surgeries, R.K. Gupta, on suspicion
of having committed culpable homicide. He was in custody but hadn't been charged and couldn't be
reached to comment by The Wall Street Journal.
In an interview with Reuters, Dr. Gupta said he was wrongly being made a "scapegoat" and said he
suspected the women died because of what he described as adulterated medicines given after surgery.
The state suspended the sale of five brands of drugs as well as cotton wool used in connection with the
Nov. 8 operations while tests are conducted to determine ifthey contributed to the deaths, a state
spokesman said.
The medicines include Indian-made brands of ciprofloxacin, a commonly used antibiotic, and ibuprofen, a
painkiller, as well as the anesthetic lignocaine.
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4 Pages 31-40 |
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India's government, seeking to curb population growth in the country of 1.2 billion, offers cash incentives
to women, physicians and health workers participating in the surgeries. Around 4.5 million women were
sterilized in the year ended March 31, 2013.
R.K.Gupta, center, the doctor who performed the sterilization surgeries, at a police station in Bilaspur on
Thursday. REUTERS
Activists criticize these payments to promote sterilization. But women in this part of Chhattisgarh said
that what led them to be sterilized over the past few days was the lack of practical alternatives.
Her parents say Ms. Suryavanshi was struggling to raise her three children, age 7, 3 and 1, with the
money her husband earned-about 50 rupees (around 80 cents) on the days he could find work.
When Ms. Suryavanshi arrived at the hospital, she and 82 other women were lined up on sheets on the
floor in an operating room. Within three hours, all the operations were done, said her mother.
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A hospital staff member at Chhattisgarh Institute of Medical Sciences hospital in Bilaspur, India, takes
blood on Thursday from a woman who had sterilization surgery at a government "camp." AN/ND/TO
MUKHERJEEIREUTERS
"Some people said, 'How could it be done so fast?' but the doctor just said, 'It's done, it's done, go
home,' " the elder Ms. Suryavanshi said.
The government's manual on sterilizations says surgical teams should do a maximum of30 procedures a
day with three laparoscopes, and not more than 50, regardless of the number of instruments. It is
considered minimally invasive surgery and entails tying the fallopian tubes.
When more women than expected show up-in part due to the motivational campaigns of local health
workers--doctors often ignore the limit, said Ramanesh Murthy, medical superintendent of the
Chhattisgarh Institute of Medical Sciences. health
After her procedure, Ms. Suryavanshi's health deteriorated. Her parents said she felt dizzy and vomited
up the only meal she was able to eat on Sunday morning.
Her parents called an ambulance at 5 a.m. Monday to take her to the district hospital in the nearby city of
Bilaspur. She died two hours after she was admitted. The parents said their daughter's doctor didn't tell
them the cause of death.
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4.3 Page 33 |
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Patients of sterilization surgeries lie on hospital beds in Bilaspur, India, on Wednesday. EUROPEAN
PRESSPHOTO AGENCY
On Thursday, the Chhattisgarh Institute of Medical Sciences and other area hospitals were treating dozens
of other women suffering postoperative complications after Saturday's procedures.
Women sterilized on Monday in several camps were also being hospitalized. India's state governments
periodically schedule opportunities for mass sterilization at established hospitals and medical centers that
"We're very scared," said Maniram Surya, the husband of 26-year-old Dayamati Surya, who was
sterilized on Monday and then complained of pain and began vomiting.
Ms. Surya had her first child at the age of 16, and now has three, her family said. Mr. Surya said he earns
2,500 rupees, or $40, a month as a daily wage laborer.
"The health worker never told us about the risk," Mr. Surya said, standing outside the hospital's
admission ward, holding the couple's crying 2-year-old daughter.
Women at hospitals in Bilaspur who were sterilized in Monday's camps said they had never used a
condom, birth-control pills or intrauterine devices. The hospitalized women from Saturday's procedure
couldn't be interviewed.
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4.4 Page 34 |
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A woman who underwent surgery in a mass sterilization sits in a hospital bed in Bilaspur, India, on
Thursday. REUTERS
The sterilization deaths should sound an alarm about the lack of birth control choices for women in India,
said Poonam Muttreja, executive director of the Population Foundation ofIndia, a New Delhi think tank.
"It is inexplicable that this is the only option available to most women," she said.
Local officials and doctors said the sterilized women had fevers and abdominal pain. One doctor said the
cause of death appeared to be multiple organ failure. That can result from a severe infection that causes
septic shock.
"There was a violation of operating procedures and sterile conditions in the camp," based on preliminary
investigations, said Sonmoni Borah, the divisional commissioner in Bilaspur.
A visit Thursday to the site of Saturday's surgeries discovered a hospital with windows missing glass and
floors covered with animal feces. The operating rooms were padlocked and couldn't be entered.
"The hospital was not frequently used," said Amar Singh Thakur, a physician and the joint director of
medical services in Bilaspur.
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NLARGE
A woman who underwent sterilization surgery at a government "camp" lies in a stretcher before being
shifted to a private hospital in Bilaspur, India, on Wednesday.AN/NO/TO MUKHERJEE/REUTERS
Police on Thursday visited the premises of two local pharmaceutical companies that had supplied some of
the drugs for the sterilization program, said Mr. Borah.
In Chichirda, the Suryavanshi family received a govemment check of around 190,000 rupees, about
$3,090, as compensation.
Ms. Suryavanshi's mother said that they will use the funds to raise the children. Asked whether
she's planning to take any further action, she shook her head: "We're poor people, no one's
going to listen to us."
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4.6 Page 36 |
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sterif 1• 0
Despite SC: order, daily nllmber in each camp high inChhattisgarh
camp, it was found that earli-
er, even 600 cases of steril-
RAIPUR: The Health
- isation were performed by
ment has set "targets
surgeons in the State in a day
male sterilisatwn
or camp.
Chhattisgarh, accordin 0 "This practice has been
an unpublished survey of witnessed in many parts of
the, family planning pro-
State. But the At'lM
gramme in the State
Nurse Mi ]
ducted by the Pub'
not be blamed' the
Resource Network
mess,» said Sulakshna Nandi
a year ago,
Ofthe Chaupal Grami
The synopsis of the r
Prashikshan Evam
accessed by The lfindu
"During discussions
vario respondents~ w e
ca
out the survey, it
that still fo-
ent
s
the
to achie
,State.
th this, i$ the.
whoaremajo
r sterir on
wh the number of male
sterilisation
lags far
behind."
The report says that de-
spite the Supreme Court is.!.
suing orders for performing'
no more than 30 cases of
sterilisations per day or
Sansthan, Chhattisgarh,
who was part of the PHRN
team.
The report had also rec-
ommended::Target free ap-
proach"
in
the
operationalisation of the
family planning programme
and "more intensive and de-
centralisedplanning'.t for ar-
eas with high unmet needs.
Reacting to the Pendhari
incidentin Bilaspur where 11
1
women died because of
faulty sterilisation at a fam-
ily planning camp, Ms. Nan-
di said unhygienic condition
was the main reason for in-
fecti
C
ister
avail
uty
Chha
did
pe
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4.7 Page 37 |
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,or bla
£ sterilis
edicines
aths
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Deccan Herald, 14 November 2014
Sterilisation deaths
shame India
The death of over a dozen women after undergoing
sterilisation in a medical camp in Bilaspur district
in Chhattisgarh lays bare gross criminal negligence
and callousness on the part of health officials. The death
toll is likely to soar as 60 more women have been rushed
to hospital. over half of them in a critical state. That a
simple laparoscopic procedure such as sterilisation cul-
minated in death is a damning indictment of In dia's public
health facilities. The doctor who cOlJducted the proce-
dures at the Bilaspw' camp is under arrest. Standard Op-
el-ating Protocols (SOP) established by the central gov-
ernment for sterilisation camps forbid use of a single
laparosropic instrument for more than 10 tubectomies
and permit a doctor to perform only 30 procedures a
day. Thedoctorat Bilaspurwason arecord-makingspree;
he condu<.'ted 83 procedures with one instrument over a
span of five hours i.e. he devott'd k"SS thanf()ur minutes
to each procedure. Deaths from othersterilisation camps
in the .state have been reported too indicating that such
deviations from protocol are widespread. Questions have
been raised about the quality of painkillers and antibiotics
administered to the women.
Free sterilL"atioll camps are held
routinely across the cOt.mtryas part
of population control campaiglls.
With their emphasis being on the
numbers sterilised, women are co-
erced into undergoing these proce-
dUl'es. pnder pressure from above
with· an eye on creating records,
health workers race through surger-
ies and pay little attention to sterilis-
ing equipment, keeping the opera-
tion theatre. hygienic, proviQing
post-operative care, etc, In West
Bengal's Maida district last year,
more than a hundred worn ell Who
underwent sterilisation were left to
recover in open fields near the hos-
pital. In 2012, three men wefe ar-
rested in Bihar for operating on 53 women in two hours
in a field and without using anaesthetic. Aggressive stefil-
isation campaigns with unrealL"tic targets that are imple-
mented by unfeeling health officials are a toxic combina-
tion. It has re&u1tedin 1,434 women dying aftt..'l'sterilisation
procedures between 2003 and 2012 in India.
f'reemedical caOlpsarewelcome as theyprovidelndia's
poorestwith access to surgeries, However, the practice
of rewarding doctors and health wor1,crs for the number
of surgeries performed has encollragedcarelcssnessand
undermined ethics. It has converted sterilisattoncamps
into virtual death ttaps. A differeIlt$tfategy, one that in-
volves rewardinghealtPworkersWhofollowmedical pro-
tocols diligently and n'eat patients with care. and com-
mitment must be adopted. 1\\n independent probe into
the Chhattisgarh tragedy is necessary and its findings
made public. Those who violated rules deserve stringent
tmnishment.
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THE
HINDU
Published: November 14, 2014 14:10 1ST I Updated: November 14, 2014 17:08 1ST
Accent on male sterilisation
Health officials conducting an awareness campaign on vasectomy in Salem Old Bus Stand in this file photo.
Between :1009 and :loJ:l,families of 568 women had to be paid compensation qfter they died during or post sterilisation surgeries
Between 2008 and March 2012, the Centre, under its Family Planning Insurance Scheme, had to pay compensation
for botched sterilisation procedures which included 438 cases of complications, 18,887 failure cases and 675 death
cases.
In 2012, the Ministry of Health informed the Lok Sabha that between 2009 and 2012, families of 568 women had to
be paid compensation after they died during or post sterilisation surgeries.
Statistics show despite female sterilisation being invasive, more time consuming and involving more risks, the
government has failed to encourage male sterilisation, which is less intrusive, needs little post-operative care and is
safer.
Citing this data, activists and health care professionals are demanding that the Centre should now focus on male
sterilisation and expand the bouquet of temporary contraception.
Poonam Muttreja, executive director of Population Foundation of India said there is a need to review the family
planning programmes and also wean away from the practice of giving incentives for meeting targets.
"Family planning programmes in India have never been assessed and evaluated. There is lack of counselling and poor
management of side effects for women who undergo permanent and temporary contraception. Also, we need to give
incentives not for meeting targets by sterilising more numbers, but for meeting the quality requirements of the
procedures," she said.
In 2011, the government conducted sterilisation of 150,540 women as against 201,715 in 2012 -- a jump of 33.99 per
cent; the number of men who were sterilised during this period grew by 3.03 per cent.
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THE
'HINDU
Published: November 14, 2014 02:13 1ST I Updated: November 14, 2014 02:13 1ST
Stop 'camp method', focus on male sterilisation: activists
Special Correspondent
A collective of non-governmental organisations has demanded that the 'camp method' of sterilisation needs to be
stopped with immediate effect as quality of care is seriously compromised in mass sterilisation programmes to meet
earmarked targets.
Expressing shock at the death of several women after sterilisation surgery at a camp in Chhattisgarh recently, the Jan
Swasthya Abhiyan, Sarna Resource Group for Women and Health, CommonHealth and National Alliance for Maternal
Health and Human Rights in a statement issued here said the morbidities are a result of a "botched-up sterilisation
operation camp."
The groups have demanded an epidemiologically-sound investigation into the incident.
"A three-member probe team has been constituted but these members are a part ofthe state, which signals a serious
conflict of interest and thus, there should be an independent inquiry committee," the statement said.
The groups have also demanded competent medical care for women who developed complications after the surgeries.
"This tragedy raises grave questions about the unsafe, unhygienic conditions and the slipshod attitude under which
these operations were conducted. Moreover, the women who are presently critical continue to get treatment in dismal
conditions exposing them to further risks and danger," the statement further said.
Activists and health workers say it is time to shift focus from sterilisation of women to men and introduce more forms
of contraception.
Statistics show that despite female sterilisation being invasive, more time-consuming and risky, the government has
failed to encourage male sterilisation, which is less invasive and safer and needs little post-operative care. Citing data,
activists and health-care professionals are demanding that the Centre focus on male sterilisation and expand the
bouquet of temporary contraception.
Poonam Muttreja, executive director ofthe Population Foundation ofIndia, said family planning programmes should
be reviewed and the practice of giving incentives to meet targets stopped.
Keywords: Bilalij)ur sterlisatiou deaths, family planning, mass sterilisatiou programmes, tubectomy, vasectomy
Printable version I Dec 18, 2014 11:54:58 AM I http://www.thehindu.com/news/national/other-states/stop-camp-
method-focus-on-male-sterilisation-activists/
article6S9627 4.ece
©TheHiudu
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5.3 Page 43 |
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diem sm
i-
tal,
e
extremely critical and five
of them are on life support.
These women had devel-
. oped severe complications
post surgeries • cardiomy-
opathy (disease of abnor-
mal heart muscle),· pul-
monary oedema (fluid in
lungs), pleural effusion (flu-
id around lungs), ascites
monitoring
track l>loodmovementincar~
diovascular system'to assist
better1reatment) anddiab'sis
macb:ines."
The AlIMS team also
records the fact that though
24 WOmen are adnutted to
Chhattisgarh Institute of
Medical Sciences and 17 in
ers.AIrMS
have "suggested
garh doctors to
engorged (swollen)
of lactating 'NOme
breast abscesses".
The team:said it
the state to address
ority the sho'
monitoring
dialysis machines".
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'Probe will unravel the mystery'
What went \\VrOIlg In the Pen· '
dari family j:I1anningcamp. that
it led to $ucha grave tragedy?
['rima faqie it' appears that
spurious drugs may he the key
l1lasonl-.ehind the tragedY, But
only the probe ordered by oUr
gover»trllmtC<\\hbtihg. out the
mItt). I concede It is Shem' med-
icalnegligence,
Serious lap8es incondU<:t of
the calnP h;lVe come to surface.
The ofilclals who organised the
camp hlatantly flouted stan-
dard pl"otocollaid down for Sf.~t-
tilll'l up such. camPS. As per
gUideliiles. at blO<;k lewl such
amps should be orgall-
. ed commu·
'. But in
eMari the Caln.p was held irla
]:Il'iv-ate facility in violation of
lil.an!iarrl protocol. Even the
g'1.iitlhlines set for doctors for
peJ'forming surgeries in such
camps were flouted.
As per the recently revised
shmdard protocol. a doctor is
rl}(lllired to conduct a maxi·
mum of 4() operations ina
camp. Y one doctor (R.K.
Gupta)
63 surgeries
in a day
i camp. IUs
l1lally shoci\\:ing.
But the ~ doi;tor WII$ Jwn.
(luredafthe last Republic ~~.
lNulcl:10nby the
.•
ment fotW11ducting
sti!l'-
ilisation surgeries t
?
Chhattisgarh health
minister Amar Agrawal.
in the Bharatiya Janata
Party government of
Raman Singh, struggles
to blunt the growing
demand for his
resignation in the wake
of the tragic death of 13
young women following
botched sterilisation
surgeries in a govornment-
organised free health
camp in Pendari.
Bilaspur district, by
saying his good work
should not be belittled
for a "one-off' incident
In an interview to
Rablndra Choudhury,
Mr Agrawal says the
tragedy is '''mysterious''_
programmes is dOlle dOwn to
the distrid level and it's done
tbr the year.
This is the second such tragedy
in. Chhattisgarh in two years.
Last year, because of botched
eye surgeries in different gov-
emment-organ1sed health
camps in the state. 63 elderly
people lost their eyesight.
Dlle&n't the recurrence of such
~~~~ttd=r~fa~~
The entire health department
or health services should not be
blamed for SIH:h one-off inci-
dents. After the eye surgery
mis • we reVised the stan-
liar rotor~ll. setting strict
g
(.'8 lor condu(:ting such
camps. Besides. we have
ensured the ilUilty are Subjed-
edto severe punishmhnt.
Suspensions were revoked fol·
lOWing court orders.
What's your reaction to
demands for your resignation
from several quarterS, includ-
ing OppositiortCongl"llSS.
I had rushed to Chhattisgarh
Institute of lvledical Science
(elMS). Bilaspul'. the moment I
was alm,tOll about the impend-
ing tragrldy. I Ibtind the atmos-
!lhere in the hospital gloomy.
Fifty-eight women. suffering
from post .s. urgery complica-
tions, had boon admitted and all
of them were in critical condi-
tioll. IIK'tcd swiftly on the spot.
aTl'angiilg private dodors from
spocialised hospitals and other
places to provide the best ])08$i-
ble medical care to them. My
pfflmpt measures %lVed thr-
Uves of many patients. The
AnM.<: doctOr!!' team which vis·
ited the hospital lat/tl' hl:lS com·
mended our job. At the s81ne
tim(l, I am greatly disturbed
iliat we could not save the lives
of 13 women.
As fur as the demmld fhr my
resignation by the Congress is
conce.rned. it is purely }lol.itkal.
The party is bent on cashing on
the tragedy to enhanc(~ their
I}l'()S!Klcts ill the coming civil
body elections in the state. J
own full moral r(;'spmlsibility
for the incident.
As far as my resignation is
considered. it is for chief
minister nlillian Singh and the
party to take the decision.
There lIl'e WhiSpers in power
corridors that you COt1l.e out
unscathed after every such
mishap' because of yourprox-
imity to the chief miniSter.
Your comment.
tit is beyond my com-
prebension how a doc-
tor Of his standing could
do such a blunder. I find
it not only shocldng but
~rlQus... Theentire
beaitlt,department
shoUld not be blamed
for SUCh OR$-off Inel •.
dent$... I own full
moral responsibility.'
There were allegations that
therll Wll$ an attempt to cover
up ilie lbcident by destroying
evidence. It is being ll.1l~
that the drugs used in the camp
were bumt. Your comment.
This is an absolutely basel¢$
aUeg..1tion. The material being
referred to was biomedical
wllste that is rotltlnely
destroyed by elMS. There WliS
no question of tamperi.ng wiili
evidence sin~ the sat:rI.Ples of
drugs used in the rendad ei\\ll1p
were immediately sent to drug
testing laboraWry ih Kolknta.
There Were also. allegatiQntI of
the inv01vem~ ofoooofyour
kinintbe lncidentandtbatyou
lIl'e ti:y:Ing to save hiS skin.
I challenge anybody to prove
such charges. I au'i rcady for
investigation by any agency. J
have always maintained pro-
bity in Ilub!ic life.
It·s been 14 years since
Chhattlsgarh came into being.
But it seems the state is still
struggling to develClp bailie
health i.rlftastrucmre.
We have achieved many rnile-
stones in health sector by way
of l'educing infant l11(lrlalitY
rate from 61 per 1,000 in 2006tCl
41 per 1..000 in 2013, and mater-
nal lJ1prtality rate from 407 per
lakh deliveries in 2001 to 230·in
2013. We are also planning to
put ill place a "full-proof mech-
anism" to prevent recurten(.'(J
of such incidents by!nvolving
ail the agen¢ies associattl(! with
suchprogran'imes.
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5.5 Page 45 |
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respom;ibie for
of the medicines.
A day after the han, the
Food and Drug Controller on
'aided a manufac-
turer, Mahawar Pharma Pvt
l:.td. The company has a small
in a residential colony
., of Raiput, which
I-~ I does not even have a
eus medicines. The H~gHh
Minister is responsible. I am
heing.made -thescf!pe,gQat/~
said Gupta. who is in judicial
custody.
"Ciprof1oxacin seized
from the spot had October
2014 manufacturing date,
whereas the ones I purchased
are of September. 2014. I
don't know how the other
.bed the <:amp. I
it;" said
om-
plaint. How is it t it
showed these results only at
the government camp'!" said
Mahavar PharmaPvt Ltdma
statement.
"They test the stock even
before paying for it. pay-
ments
! ;;:r~7:;af:t:~
the surgeries.
urgent cases, the CMO also
Both Gupta and has a reserved quota to pur-
Bhange accused the chase from the open market.
gov~rnn:tent .of
The maJ,lufacturets put
shielding those who the onus on the government.
are actuallyguilty. "1
"We never sell directly to
done any- the government. We sell in
e the open market to drug
were supplied spuri- traders, who later supply it to
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Sterilization deathS:· Pmgs had: rodent-killing
Raipur: A preliminary re-
port of an inquiry committee
probing botched sterilizations
.
vealed
equality in state's family wel-
fare programmes
Bllaspur divisional com·
mis.<;ioner Sonmani Borah
s:lid tra(~ of zinc phosphide
Itacalls for sIriie apinst does' saddngs
'1" he lnOlal1 Medk:alAssociation has called for astatewide strike
i
Gupta and
R
sackedror
the sackings
judge Anita Jha to probe into
incident, which claimed 1a
liVeS<llld left: 122 ailing.
The probe would suggest
means to prevent stich trage·
dies and maintain gender
havar Pharmaceutical
Ltd. These tabw,ts were dL<;-
trihuted among women, who
unden.vent sterilizations at
three camps in Bilastmr.
For steps
Experts said zinc phos- to_ tINt Alive app, seeP 2
phide mixed "'itl!fOOdis com·
monly used to kill rodents. phosphinegas, A similarreac-
Add in thedigesti:ve system of tionistriggered ill humans
rodent reacts with zinc phos-
"It reacts with wat",:r and
phide and generates toxic stomach juic6$ to release
phosphit:m gas which can en·
ter blood s1NaID and advcr8e'
Iy affect Inngs, liver, kidneys.
heart and central nl"xvous sys·
lem," said an e:>"']:lerl.
Police have arr('sted
havarPharma director:,
mesh Mahavar allc! his
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5.8 Page 48 |
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5.9 Page 49 |
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5.10 Page 50 |
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Spurious drugs may have caused tubect
medications used
could be a strong possibility;'
the s~n·member expert
t
AIllndia Institute
of
Sciences(AIIMS)
said in its report. a copy of
. iJ~ewithDeccall vember 12 after news of the
women's death hit the bead-
tearn. which was lines, submitted its report to
rushed to Chhattisgarh on No- the health minister J P l'Va~__
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6 Pages 51-60 |
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6.1 Page 51 |
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Hindustan Times, 15 November 2014
m•
Thursday and has been sent for officials
further tests,
Officials said a significant
quantity of burnt medicines
was Ihund on the promi~"l,
The symptoms shown by the
women who became nnwcl1 after
undergoing botched steriliza·
j ions is similar to how the body
rmlcts to zinc phosphide, doctors
"Waha
acrossthe
lakh similar
by
M'iliawar Pharma,"Bilaspmcom-
missionerSonmoni Borah toldIfl
Mahawar Pharma director
Ramesh Mahawar and his son
Smnit were arrested by Raipur
police on ,Friday.
the antibiotic
in 500 revealed
s adtllterated
wlthzmcphosphide, a chemical
sevJt>dfi'vrn
in Bilaspur said,
After the surgery, the women
had complained of nausea,
vomiting and a
.
The 1a died of
kidney failure
CONTINUED ON PAGE 8
" SPURiOUS DRUGS, P11
maceutk:a1
Pharmnon
breakdown. "
rosultsinWgh
C'~1teaIth dept
b.
sdrug
'Newborn s dieafter
Guj llnisation camp
set up on the occasion
units for a 'cut'
UR~ Long before the
ttlsgarh government Was
galvanlsed illto a sudden flurry
!fI activity - suspending doc·
tors and health workers and
banning six drugs - tIle World
ever, were purchased locally for
theca-trips" He said around 25%,
medicines in the state are still
procured from local companies,
W1W"Local purchases bring
in good "commissions". Who
are these local drug suppliers?
Generally, small companics-
o\\\\<nedby people With political
without au)'
. facility
AHMEDA8AD: Twin 45-day-old
brothers died in a government
hospital in SurendrWllIgar dis·
trict of Gujarat on Thursday, Ii
day after getting vaccine shots at '
an immunisation camp. Another
cl1ild is in critical condition.
Snrondranagar disttit:trollec-
tor K B Bhatt said the twins, Nitin
and Nikul, were administered
Bacillus Calmette Guerin (BOO)
vaccine. whicl1 provides immu·
mty ~n~bereulosis. ~tacamp
Di
1m
our health otflrors." Bhatt said,
Poor public health service is
already in the spotlight after 13
womendied inagovernment·run
Cllilic ill Chhattisgarh afew da.vs
ago due to botched sterillsation
surgeries.
Meanwhile, Congress MLA
Shaktisinh GohiI attacked the
action by the administration
could have saved the kids."
tlfedr~
kat.
Centre and fuestate ··are nnani·
.ty of spurt-
, ponsi-
ble for the death of 13 women in
Bilaspur ill a botched-up sterUi-
on Novemher 11.
who run the state-
run health camps regularly pre
dole out sulrstandard
to patients in clear vi0-
lation of the state's mucl1·puhli·
Sinro they offer generic drugs
t:hey can
they can·
numbers.
In.W:t, these klcal()tll:Upaniescan·
notsell their p
harma·
cb4S. Their sole
the state government. Therlaythe
drug ball \\\\1asnotifled, several of
thesedrug;.s were bumtat Pencll.'1i,
Guarola and Bllaspnr
cised health policy of providing
safe and effective essential drugs.
The district-level officials of
the state healthdeparlment still
continue to exploit a provision
thattheycantq:lOt-purehase medi·
cines for running health camps,
The Raipur·based Mahawar
Pharma Private Limited - its
dit'ector and his son weroarrested
on Friday - is onesucl1 company.
NADDA ASSURES SUPPORT
NEW DEtHl: Unloli health millister
JP NaddavisitOO the Ail India
Institute
seven doctors sent to Bllaspur
guided local doctors in managing
patients and helped formulate
proper guidelines for treatment.
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6.2 Page 52 |
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6.3 Page 53 |
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••••
(1'\\
z
~
oN
~KMC/Pg46
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6.4 Page 54 |
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KlILtER CAMPS CLAIM
lSUVES A MONTH \\j'~
Despite these shocking stats,
Indian \\>\\-!Omen are being
herded to sterilization carrlps "
instead of being qffered a mix
of controception rnethods
very· actor jn the
Chhattisgarh
tragedy is respon-
sible for the 13
deaths at the steri-
lization camp_
There is the
heiUthsYstem which allowed a
camp ill an nnnsedbospital
When lapatpscopic steriliza-
tions are supposed to be (jone
only in community health
centre-level hospitals. Then
there is the doctor who did 133
surgt1nes in Mew hol.lrSwith-
out sfutiliZillg theslltgkal in-
str'nments. """hat about the Of"
ficialsand the minister who
ignored thea1)ysmal qUality of
~rvice? Or the lack of quality
oontrolatthe phl.trmacy'?
The Union health ministry
has churned out more than triet level babtiS, is aware of
half a dozen how-tdmanuals 011 this. Yet they have expressed
quality control Jor steriliza" shock over the d.eaths.
tion." training of doctors,step-
According to Lok Sabha
bY'stepdetalis of pre- and post data, 707 women died hetween
operative procedUI'C$ and so on. 2(X*land2012becauSllOf botched
If the consequences of noHol- sterilization procedures. This
lowing this ideal proeess were workS out to about 176 deaths
not so tragic, the man~lals every year or almost 15 deaths
would make for a jok!l. More a month. And the official datajs
otlenthi.tn not, none of the pro- notorious fornot registering all
cedU+cs •described in these the deaths. Many women are
~lU'l:l.followeda@wom-
sent soon after sterilization to
en, especially Dalits, tribals tl1eirdistant homes. where they
and other POOr WOmen, are sqb- would not.have the resources to
jectedto
nditions in seel< medical help if there are
steril . ." . ..•
ssthe complications. Even a fat.ality is
oount1)i: Qff'Icla!dom, from the likely to go unrel;lQrtect.
central healthministty to dis·
Sevtlral public healthac-tiv-
TUBES TIED: INDIAtSDUBIOUS
ists. academicians and civil
society gronps have issue'!d a
staternent pointing ontthatthe
surgeries were conducted in
complete violation of Supreme
Court orders (Ramakant Rai V s
Govt of India, ZOOSa.nd Devika
Hiswas Vs Govt of India, 2<)12).
"These orders instruct that a
maximumof30 operations can
becondncted.in a day with two
separatelaparoscope$ only in
government facilities. Also,
one doctor cannot do mornt.han
10 sterilliatio,nsin one dll.y: De,
spite this, the sUrgeon in
.Chhattisgarh performed about
three times the per:missibl~
number of surgeries (83}inless
DISTINCTION
Ulan 1\\hours in a private hospi·
tal which has reportedly re-
mained closed for 15 years,"
said the statement.
"Why huve camps at all?
Why can't individual women
access sterilizati911 when they
need it, at a governrnentlleaIth
facility? That way there would
not be so much pressure to do
hundreds Of Sl
alone
go?1'l'Je 'cmrtP
tlonpro
moot€!'
Saroj ini of Sa:1l'1a, a
group wOl'kingon reproductive
health for women.
India claims to have
the target
family plal
exist, as admittOOby the
arrested in Chhattisgarh.
Health workers arepressmi7.ed
and incentivized to bring in
women for sterilization,
A recent document titled
'Family Planning - A Right
and a Choke', bronght out by
the government along with the
United Nation
Fund,
The same .document also
says that the biggestis$uetoday
is the lack of access to family
planning information and/or
supplies and services. It also
points to a perceived l<lckof
qtmJItyof servicesthatd.iscour ..
ages couplesfmm $t'eking them
no such shill.
Five to six million WU{11ell
are sterllized in India every
year in the name of contracep-
tion and population control,
according to one of the gov-
ernment's training manuals.
India haS the dubious distinc-
tion of being the only country
thai uses female sterilization
as the dominant
contraception. 1'h
the huge risks of running a
sterilization programme in a
heaHh system that is j;loorly
funded. badly equipped and
understaffed.
1,2 8.7 5.8
'LAM or the lactational a;;ellOrrhea method Is the U5C'~i'brt'!llstfeeding as a b;;;j;";;;;nlrol technique
Source: fllIlJily Planning Progress Re1lort 2020· 2llU.14 <:<1nl/IiU'InQus. of mO<JemtOfltraceptlw. metllod$ln 69 ilf:.•••loplnQ countries
~:"<r;>:::r:"'ft';'--_:<,:;,,' ',' -' '~'~~~~~'"><;:-:-,:,"','"_" ' ,::,:'.,"':.:::::::-:..:.,:"::,-:,,:,::>•.; .•,.,,;y::,;.,;::.;::::;/,.:':i";''':::';~:::::''::':::>:'':::::''':'''::;::'>--':-"",;c-:_.-:-,:.,-.:.,{:;;::;;;~t:ddtk+k~-
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6.5 Page 55 |
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6.6 Page 56 |
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AGlUEVOlJSTRAGEJ)V PLAYS our
SundJ.>:.IJ, t6NmJembf'r:rc'4 t
Kan~htul Gupta Iin Co/freBreak.
IN CHHATnSGARH
In Which other half-decent country are medicines. iI$ has been claimed, laced ,,"ith rat poison? In which othet· COtmtry
does thestateaUow the manllfactttre of tainted medicines and also lIm' themfor mass distribution?
A grievous tragedy is unfolding in Chhattisgarb, a tragedy that could have been avoided if officials in the State administration had
been more honest than they have been found to be. But first. the facts as they are known, and have been •.•i.delyreported by media,
till now.
On NoVember 8 and 11 sterilisation camps were organised by the State Government's Department of Health for women from
impoverished families, nearly all triba!s, in B~ur district. The purpose Was two-fold: To ensure better maternal health for women
who tend 10be U$edilSbrood mares by men loath to use contraceptives; and, to encourage the concept of smaU, sustainable families
among the less affluent in a State that suffers from endemic poverty for a "ariety of social,politic<1l and economic reasons.
The intention behind the camPs, therefore, was neither evil nor remotely comparable to what happened during Indira Gandhi's
Emet1et1CYwhen men, including teenaged boys, were forcibly sterilised. Public memory is short and Emerg"JlCYexcesses ar•. rarely
recalled; they have di$appeared from India's collective memory. That does not mean they did not happen and COnltl"Elsvsice
president Kabul Gmdh1. grandson of hllura Gandhi, would be well a<l\\ised not to shed crocodile tears over the misfortune that has
visitoo Chhattisgarh. If he has sailed forth to fish in. troubled. waters at the beIlest of charlatans like Ajit Jog! and Dlgvijaya Singh, it
was extremelyfQOlish of him.
Let's ~ to thll facts as tbey have .etaerged V"er the past week. Many of the 8S .women who underwent lqaroscopy (minimally
invasive surgery) .foftqballigati<m (stllri!isation) on NV"ember g began complaining of sever stOmach cramps within 24 hours; at
least ~of them died. Dr R.KGupta. Who conducted the operations in an assembly line manner in live hour!;, was blamed for nOt
following fuUprocedure.
It was alsopolnted. out that sanitary conditions at the health centre where the .camp ",as held. were way less than hygienic.
Apparently, the health centre at. Pendari village had remained unused for a long tiJne (which by itself is a scandal in a country
statved of primary health caN}. Dr Gupta, Who was felicitated by Chief Minister Raman Singh on R<lpublic Day this year for
eondncting a record. number ofmbal.ligation operations, has been arrested: an FIR has been filed and he has been suspended from
service.
The story would havundll'i there had more sbol:lcingfa~ not flDerged ovtr the following daYs .inthis nnrelenting tragedy. Women
who undenvent tubal ~tion sUTReryat a sterilisation camP on NOvelnber 10, condncteclby anotberdoctor, bej(atl com~
of
stomach cram$ and showed symptoms similar to those exhibited bywomen who fell ill at Pendari. Oneof them died.
Then there were reports that people treated for flu were complaining of stomach cramps and showing similar symptoms -' nausea,
swelling and dizziness. TWo mpn treated for flu died on Thursday. That triggered the hunt for a rommon factor and it was found to
be the antibiotic tablet clprofloxacin or Ciprocm that had been prescribed to both men and women who had fallen ill, and those who
died.
QUiclt la.b tests on the tablets showed they contained zinc phosphide. a chemical compound that is used for making 'rat poison' .
Rodents when they consume zinc phosphide, die a rather painful death.
The contaminated antibiotic tablets were handed out to the women as part of post-surgery medication at the sterilisation camps.
They were also presen'bed to those who went to clinics 'h-ithflu or flu-like symptoms. Vv'heredid these killer pills come from? They
had .been manufactured and supplied to th41administration by Mahawar Pharmaceuticals. They were also supplied to local
drugstm'eS from. where they were sold to and consumed by unsuspecting .ictims.
Repo$ say a .search of the premises where Mahawar manufactures Ciprocin led to the horrifying discovery of zinc phO$Jlhidestocks.
$aJ:11pJt.sof Ciprocin 500, theSUsp4lCledkiller .dl'llg, haw been sent for furth<>rlab tests. The owner of the firm, Ramesh Mahawar,
and his son have been arrestll'i. It now transpires this that Mahawar was found to be producing sub-standatd medi.c:inesin 2012 and
it was shut dol.'n for three months. Strangely, itS lieence was not mnce.Jled.
It is equally imlxplicable as to why the Health Department had. to source. cipro&xacin from a tainted firm. The question gains
further relevance in view of the administration's statement that there was sufficient ciproflaxacin, .sourced from elsewhere, in stock
and there was no ruled to use Ciproein manufactnred by Mahawar. Who, then, took the decision to procure Ciprocm from Mahawar,
ignoring theciprofloxacinlablets that were in stock?
HOpefully, these and other questions will be. answeroo in the l'Omingdays - either Chief Minister Singh can instruct his officials for
a fun inquiry and disclosure or he can await embarrassinJ details. which may not beentirelyJactual, in the media. Glossing over
sevetela.pses,. ~
of whether they "W1!fQmoti¥atedor not, will not do, nor shall sweepi~ the inconvenient truth unde.1'the
carpllt will help. People across the country hold Sinllh tohiRher standards than those of run-of-the-mill cynical politicians, and for
good reason too: HisexcelleDt governance track record is there for all to see.
H~,no
lIl:iltterhowpraisl!.worlhY his Government's ACOI'l1, Singh cannot escape from the simple fact that but for huge gaps in
the adtninistfatinn he heads. !laps that are Illore to do with probity and honesty than bureaucratic 1ethal'ltVand callous n~ence.
such a trapdy would not have visited Chhattigilrb. The.loss of human lives is ODedimension of the trag«ly;the other two are· no less
coJ1St'<lUential.
firSt, popular faith in .Govertmt4lllttuD healthcare camps is bound to be shaken: In tradition-steeped tribal commlUlities, th4lrewill
bef1.eat~ distrnstofdoct0r.s and m.edicines and ~ surgeon's scalpel ~ evo.ke fear, n~t faith. Worse, thOSe opposed to
stertJisation, and they are legum. rangmg from IMl-llbefaljholmvallohs to Right-WIng nuts, Will have a field day. As "ill a TRP-
hungry media for which fiction is more important than fact. That would be most unfortunate. not in the least becau~ women from
indigent families will suffer th41most.
Second, last Wfi'k's horror has Sel'W to underscore some ugly re.alities of India, realities which we turn 00. faces away from rather
thanwoa to change<them for the better. fake al'd contaminated drugs and healthcare essentials are not a problem limited to
backward ateas and under-developed States; surveys and tests have shown th<!},are sold in Delhi too. right under the nose of the
Unioll60vernment.
The criminally inadequate infrastnlCture required to test drugs and ensure manufacturers are not cutting comers should have
engagll'i the atlentionof su~e
Go""mments at the Centre and in the States but has not been thought of as something either
urgent or neeeuary.OUrpoliticians and babusknow they "ill not be exposed to the dangel'$ posed by fake or contaminated drugs.
Sothl!Ydon't care. Convol11toola'lVSjand laws that have more loopholes than plugs, facilitate fly-by-night operators to become
mi$ufactul'et$ of life-saving drugs. Drugstores that follow rules and procedures in sourcing and dispensing medicines make the
situation .terrifying.
Last, it is ameasurt\\ofthe depth to wh.iehcorruption ha$ eaten into tM system of governance in this l'Ountrythat buteat1eratsand
theirftunldesin babudom think nothing of soul.'cingmedicines ~r the masses from suspect and t:ainted man~.
They know
nothing shall ever happen to them even if they ;Ire caught red,handed:for eviden~, lookat how th!>S<b!ehind the.fake !Dedicine
S4:aJ:l1.i.n~
prad¢Sh have gone unpunished. Owners of the nrm S\\1pplying contamiJ:tated intrilvenoW! fluids to. hospitals in
KOlltatahaWlsuccessfullY thUl1lbedtheir n!>S<a!t COl1lpliciat nd compromised 1",,'''4nforcing agencies. Such stories abound.
The solution to all these problems does not lie in asking for Singh's resignation. Hi!; exit from the Cbief.MiniswTs offit'EIis not going
to ~e the Ulllv reality ofChbattisRarb or, for that matter, rest of India. Nor will it in any manner diminish tbe fact that India's
image ball suffered a huge blow. In which other half-dectnt countty are medicines (as bas be<mdaim~) Jac«l with rat pojson?
(71Ie luriter is a current rrffairs analyst based in NCR)
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6.7 Page 57 |
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o In
rh
In which other haff..fiecent country are medicines, as Ills been claimed, laced with rat poisoo? In which other
!;ountry doesthesta
manufa taintedmedicinesandalsobuythemfor massdistribution?
~~
"""h .lr.lf:",h W''l,lil
, rim m~ Tif~ Ch-".tt>j;"" T!I<-
lot< of h<Ut\\ti1 b'~ Ii l·tW' dln-.
....."J!""t~IJ.t,,"''''''''_
m,'no,,~"c~frcl.
l'''>t. "",!"uhf f.JU, Ht
(~'1em~1
ru'nbt-~hb~'}""l"Jt"mp~
Ii ~
W N ihmffi: j" tt..mtJ,c.n-
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6.8 Page 58 |
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6.9 Page 59 |
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Many women of protected trib~d~t;';ins~a
l~ri0tno cash, 'only 5 eggs, half kg da';
DHANAUlI (8'l.A5PtJ~ , NO'! 15
WHEN ChaitiBai, a member of
the protected Baiga tribe died
earlier this week following a la-
paroscopic tubectomy in Bi-
laspur, the ChhattiSgam govern-
ment termed it as an isolated
incident. However, despite the
government prob1bitingthe ster-
iH~atio.nof people belonging to
th~ tribe, many Baiga women
have beensterilised in theinte-
rior villages of Bilaspur over the
years.
Admitting this, Pendra 8DM
o P Verma said, "We have re-
ceived informatitmthat Ba:igas
were sterilised. We will inform
senior officers about the cases."
Verma said a Baiga man or
woman has to seek the permis-
sion of senior officers to undergo
sterilisation.
The Baigatribe is among the
most primitive in centraUndia
4 CON1lNUEf) ON PAGE
confil1ed to just a few forested ham-
lets in the border districts of Mad-
me hy!! Pr?.desh and Chhartisgarh. M-
though government has spent
0m. .•';•j'.1\\J1· ..... C'''l'n'.J .0.. '£1 unl;·fo·tC.Sil;.:t;I".t.l!".C\\d,.·
fI'obn ..e 5t1.eJr'1h'iS.e.o'
several croreSOnschemes for their the operation someyears ago. Koi
welfare, th~conrinue to be among baat ha.i kya.? (Is there an issue?)"
the most deprived commtlllities. said Chaiti'saunt, Rahmati Bai, a
While the administrative ma- . grandmother.
chinery rarely reaches these. Vil-
Two other women, Lamiya Bai
lages, hea1thvvorkersarnve tohe!1:l and Budhwaria Bai, could not re-
the Baigawomen to the sterilisation member when they had under-
camps, not sparing even those who gone the operation.
are grandmothers. The women
Another woman, Sampatiya
don'tknow that they have been no- Bai, in her forties, is the mother of a
tified as a protected tribe andtlielr married daughter and a son in his
sterilisation is prohibited. All of twenties. Shelast gavebirth over 20
them claimed that they had not re- years ago. Yet,she was taken to the
ceivedany cashincentive for under- sterilisation camp last year.
going the operation, as mandated "Money? They only gave me five
by the government.
eggs and half a kilogram of dal.
On Saturday, in Chaiti Bai's vil- That's .all,"she said. Askedwhy she
lage ofDhanauli, over 120 kilbme- went for the sterilisation, she
treS from Bilaspur, many women replied, "What can I say? They
from the nearby hamlets assembled asked metogo, SoIwent."
to pray fbr her. Most of them had ,.TI1eelectedpanch ofDhanulivil-
been sterilised. wrl1ey took me for lage, Saroariya Bai, in her late thir-
ties, has aIse been sterilised. A,
mOl:.1erof three children, she was
cp~~tedupcn a fe">J~lYe&""S·bac:.1c. S~'1e
also did not get any money. "Kuch
na.hi mila. 71lagayga:y~(I didn't get
anything, I was duped},"she said.
"Many of us undergo this operation
here. You will find many such
women in our villages,"she added.
Mb$tofthe women belong to the
poorest ofthe poor .~tyodaya fcuni-
liesand have little means ofsurvival
except subsistence agriculture or
their work as dail.ylabourers.
Over 30 kmsawayis Kevachi,
another Baiga village. p~rn.va·ti.
40, who did the tubectomy about
seven-eight years ago, said over 20
Baiga women from her village had
the surgery.
"It's only after Chain's de~th
that we learnt that thesterilisation
of Baiga women is prohibited,"
Said Bahuran Singh tJtti, a Gond
tribal and a school teacher in a
neighbouring village.
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6.10 Page 60 |
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~
IMA I
The Statesman, 16 November 2014
rnment
for action against doctor
ated by the fact that the patients have been
NEWDFJ.HI,15 NOV: The Indian Medicalt\\ssoci· bought to the hospital within 24 hours Of the
ation (lMA) on Saturday demanded [he release sterilisation operations after consuming this
of Dr R K Gupta besides revoking his suspen- drug, This probability is further strengthened
sion order in connection with the botched stet· by the reports of other patients, who have tak·
·ilL~ationcase in Chhattisgarh,
en Ciprof1oxacin of same batch & have suffered
Expressing unhappiness against the Chhattis- from vomiting and other similar reactions,
garh authorities, the 1Mi'\\. has demanded Union "Even the suspension and attest of a medical
Health Minister's intervention for the release of professional without a prima facie case against'
Dr Gupta and along with proper investigation him!her is grossly against the Supreme Court's
into the matter,
judgement in this regard.
The medical body has also written a leuer 10 It is pertinent to note that a doctor is respon-
Chhattisgarh Chief Ministt~ras well as the state's sible for performing surgery, The pre and post
Home Minist(~rseeking Dr Gupta's release, The surgical procedures and, drug supplies and ex·
IMA alleges that many noteworthy f,lets where perienced paramedical assistance arc the re-
neglceted before taking action against Dr Gup- sponsibilities of the hospital authorities. Lapses
ta.
on these stages only reflect on the lapses in the
IMA further emphasised that the camp was working of the authorities," said the 1MA.
conducted as a part of the government pro- Lastly lMA stated in its letter that holding a
gramme where all the infrastructure, drug sup- doctor responsible for an action which he has
plies and paramedical assistance was provided not committed. is neither in the interest of the
by the state and preliminary post mortem reo profession nor' the health of the general public,
ports show no flaws in surgery.
For prOViding health services including drugs,
The reports establish a probable case of spu-
rious drugs (specially Ciprot1oxacin) being
used in the above procedures.
Adding further IMA said that it is substalHi·
is the responsibility of the health ministry.
7 Twelve women had died after steriliZatiOn i.n
government camp at Pendhri in Bilaspur distric
of the state some days ago.
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7 Pages 61-70 |
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7.1 Page 61 |
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'"f Latin American Herald Tribune - 12 VIoOO1en Die after Sterilization Operations in India
Nllv :La \\1f'
NEW DELHI - The number of women who died after
undergoing sterilization in India increased to 12 on
Wednesday, with a new case that uncovered rampant
medical malpractice and serious irregularities in the
government's family planning campaign.
A total of 83 women were sterilized by a doctor and his
assistant through laparoscopic tubectomies Saturday at
the Takhatpur block of the Bilaspur district in the center
ofthe country.
This method violates several medical guidelines and
procedures, said local government spokesman Rajat
Kumar.
"These are cases of medical negligence, which violate government protocols ,n said Kumar, who confirmed the
death toll had climbed in the last few hours.
The spokesman said that the doctor who performed the operation, Dr. K. Gupta, exceeded the limit of 30
operations with a single laparoscope. He also did not sterilize the laparoscope and did not properly medicate
his patients to avoid infection.
R.K. Bhamge, one of the health workers present at the camp, said they faced routine pressure to hurriedly meet
the targets set under the central government's family planning scheme.
Each year a government-set number of these procedures need to be conducted by law. The 83 operations were
done to meet these targets, Bhamge told local broadcaster NDTV.
Shortly after undergoing surgery, some patients began vomiting and complaining of abdominal pains, and on
rv1ondaymorning one ofthe patients passed away. Four new deaths occurred on Wednesday.
Around 70 women are currently hospitalized, three of them in critical condition, the deputy director of the
Department of Health and Family Welfare, Amar Singh Thakur, told Efe.
Thakur stressed that the causes of these deaths is not yet clear, but one explanation could be septic shock.
Autopsies would reveal more information, he said.
The government has dismissed Dr. Gupta, who was honored in 2013 by local authorities for conducting 50,000
female sterilizations throughout his career.
Three health workers have been suspended and a committee has been formed to open an investigation into the
incidents. The government has also announced compensations of$3,267 to families of the victims and $816 to
those now in a critical condition.
In 2013, Indian health authorities conducted 4.6 million sterilizations, 72 percent of which were applied to
women, due to the refusal of many men to have vasectomies because it is widely believed that such surgeries
could affecttheir manhood, said the director of India's population foundation, Sona Sharma.
According to data published by the Hindustan Times newspaper, 1,434 women died in 2003 and 2012 after
undergoing sterilization procedures.
Sharma added that neither medical nor safety protocols were not followed. The medical instruments were not
sterilized and patient follow-ups were inexistent, Sharma said.
Each woman who undergoes this kind of surgery receives a compensation of $22; but, according to Sharma,
KMC/Pg54
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7.2 Page 62 |
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TUBECTOMV
Chhattisgarh
govt to adopt
babies, pay
!Qreducation
EXPRESS NEWS SER'V1.CE
'''''~'·_'·'''''·'·''·''''_·_'·'''·'·''''·'·>''·n~~.u.."~. .......
.. ..... ...•."'V •. ·NN,h~
••••••••
RAIPUR NOVEMBER
16·
FOLLOWING The Sunday
Express report that almost
the 13 women killed after
Bilaspur laparoscopic tube\\.>
tomies have left behind an
fant baby, the Chhattisgarh
government Sunday an-
nounced that it would
the babies of these w()men and
ensure free education for then).
In a high-level meeting,
the state government decided
to make a fixed deposit receipt
of Rs 2 Iakh in the name of
each baby. The amount would
be given to the child after he
or she attains the age of
The government.
ever, continues to be absent at
ground zero.
Eight days have passed
since the surgeries, hut state
Woman and Child Develop-
ment Minister Ramshila Sahu
is yet to visit the patients or the
place where surgeries \\vere
earned out. CM Raman Singh
has briefly visited the patients
only twice so far. State Health
Minister Amar Aganval also
visited the patients only tvvice
- both times with the CM ,e_eo
despite Bilaspuf being
home constituency.
Meanwhile, aU 122womcn
who underwent the pnKcdure
are in the hospitals of BiJaspuf,
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7.3 Page 63 |
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Revisiting an outra
MRINAL
PANl>E In the wrong hands, sterilisation remains an immoral, intrusive act
I R lffH be told. the philoso· . two doctors. But four decades after nefariousChhattis
phy of population control i Delhi's infamous 11.rrkman Gate
on four
: disaster, the sametroublesome
i familyplanningphilosophybased
i onmonetarycompensationhas
; re,'.'urfaced.Fivetosixmiliion
the record number of surgeriCJhe
performedina day. But obviously,
II nothingwas spent on the creation
I mediealfacili·
i womenare
1 India. Gov
II knowllfor
reveals that bot
II have killed 707 women between
2009and2012.
1 The key component ofall
nthatin·
volves surgical procedures may
safely he carried out in the re-
motest parts of the country by
i health serviees under the National
I Rural Health Mission. tlleprinle
i "motivator" forsterilisation
! camps, is the ASHA (accredited
holdirrgspecial
odicalfy, i social health activist). a locally reo
evenif the area
health· (..TUitedwoman. Preferably literate,
care .facilities. And fou1', given the
urgency oftlle situation, promo- A terminal method like sterilisation must be carried out
tion of irreversible sterilisation
without pressure and with the futl knowledge and
consent of the patient, under safe circumstances,
she is trained to service her com-
. ularlywomenand
..................-.-...-.. ....
!
I health
1 inBa
I veale
i tive he
of at-
tent ion on quality pre· and
post-opetativeeare. The grouP
I
found that the performance of
health officials is mostly meas- I
6- ured in terms uf targets achieved,
I., _"_._ ._..~ ~ .._ 'c, "c
.. 19/1111 ~$$~ressindia.CIlm
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7.4 Page 64 |
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STERILISATION DEATHS
outside IMA wants
ence of
suspension
Chhattisgarh revoked,ca
h. Ith minister bandh on
EXPRESSNE"~SER~CE
NOVEMBER 17
EXPRESS NEWS SER.VlCE
••......•.•.•.....• _.., ... _._ ...••_ •••••...•......... •.••... ·.•··· ..·__ ···w· ••••••••__ .•.... __ ·.•··._ ••••__ .__ • ••..:,..;.._ •••.. __ ..:.._. _
NEW DELHI, NOVEMBER 17
A MA'iiSIVE protest was held outside the resi·
dence of Chhattisgarh Health Minster Amar
Agarwal on Monday' '11sthe failed 1aparo·
scopictubc<..-1omiiensB ur, with agitators de·
manding his
taking responsibility
for the death
n,
Agarwal and Chief Minister Ra·
urderers", the protesters accused
ent of not taking sufficient action
against the guilty. Agarwal's residence is adja-
.,
cent to Raipur 10office.
The
protesters
accused the
,state
but the protesters still
managed to ghearo the
premises.
Thirteen women
have died and 122were
still in hospital following
government
of not taking
sufficient
action against
the failed sterilisations at
different government
camps in Bilaspur.
Sources said many
senior ministers want
the guilty
Agarwal removed and
were annoyed tbat Singh
did not even reprimand
him in public. "The CM must act now. The re-
moval of a block medical officer or a doctor
makes no sense. The people have become angry
with us," said a minister.
Congress spokesperson S N 1tivedi said:
"Raman Singh must disclose the reasons whyhe
continues to praise Agarwal in whose district
the Crimetook place."
Meanwhile, the doctors association has
sought the release of Dr R K Gupta, who had
conducted the operations in Takhatpur, and
hasgiven an ultimatum to the state government
.t.batifhe Isnot released, the dOL'tOrswouldgo on
a strike on November 20.
THE Indian Medical Association on Monday
called for a "medical bandh" in Chhattisgarh
on November 20 if the suspension of the doc·
tor who conducted the failed sterilisationsur-
geries was not revoked and FIR~gainst him
not withdrawn.
The lMA representatives ' if their
mands were not met
be called. All Emergency medical sel'Vices,how-
ever, shall be exempt from the bandh.
':As already con·
veyed earlier, IMA is
deeply aggrieved on
the punitive action
taken by the authori-
ties of Chhattisgarh
against Dr R K Gupta
ThelMA
also demanded
resignation of
the state health
of BHaspur in the reM minister saying
cent case related to un-
fortunate death of 13
women after sterilisa-
'providing
health services
tion operationsatgov- is his
emment camps.
·respOll5i1J11ty'
the suspension a ar-
rest of a medical pro-
fessional without a prima facie
himlher without a proper medi
wry, is
grossly against the judgement given by the
Supreme Court in
d
been considered bef,
sion of Dr Gupta," the lMA
ment, which also demanded resignation
from the~'tate health minister.
·1
I "Holding a doctor responsible for an ac-
tion which he has not commit
therinthe
interest of the fession
health of
the general pu
-
l eluding drugs, isfb l
minister," the lMA stated.
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7.5 Page 65 |
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Raipur: As the c1amour for
res:ign~tion of
. health
ter Amar
Agrawal gets
louder in con-
nection with
botched ster-
ilisations, the
adamant minister ruled out
possibilities stepping
do,,'U on gr
that nei-
ther he had conducted the
surgeriesnor
ed
the medicines,
e
to be cause of
the
"Why shoul resign? 1
did not eond
botched
ions," said the de-
minister to the
media adding that his rosig·
nation would not set things
theopposi-
. ing the
his resignation
ns.
minister's
defense dOOlrnot seem to be
going down well with people.
A senior
sity profes-
SOfoncon
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7.6 Page 66 |
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The Opinion Pages EDITORIAL
India's Lethal Birth Control
There's no secret to reducing population growth: Women who are informed about and given
access to contraception choices have fewer children. Yet India persists in a cruel strategy of
bringing down birthrates through mass female sterilization. In poorer states with high birthrates,
health workers are driven by threats and induced by incentives to cut any corners necessary to
meet government targets.
In the 12 months ended in March 2013, 4.6 million Indians were sterilized. Between 2009 and
2012, India's government paid compensation for 568 women who died as a result ofthe
procedure. All told, 37 percent of all the female sterilizations performed in the world are done in
India, many in unsanitary, assembly-line conditions.
Thirteen women died shortly after undergoing tubal ligations on Nov. 8, in what in India is called
a "sterilization camp." They were part of a group of 83 women who. enticed by a payment of about
$22 and the promise of contraception, had assembled in a filthy public clinic where a doctor and
two assistants performed tubal ligations on them that day.
The women were not medje.allyexamined before the operations, nor kept for medical observation
afterward. They were simply sent home \\\\ith some painkillers and antibiotics. The antibiotics
appear to have been tainted, quite possibly by rat poison. About 60 of the women soon began
writhing in pain and were taken to local hospitals.
Faced with public outrage, Prime Minister Narendm Modi has ordered an investigation into what
caused the sickening and deaths of so many women this time. The victims' families were
immediately paid compensation.
But last month, India's Health Ministry directed 11 state governments to double the payments for
sterilizations as a means of hitting even higher targets. This is the wrong approach. India's poor
women have a right to informed reproductive choices, and to medical care that meets minimum
standards. Mr. Modi should call for an immediate end to mass sterilization of poor women,
prm,ide men and women with the means to make educated reproductive choices, and invest in
fixing a dysfunctional health system.
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7.7 Page 67 |
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With l.25L sterilizatio..s,mi'Yiir,
C'garh a fertile ground for docs
Pocketf93L
Annually For
Surgeries
Anuja.Jalswal@timesgroup.com
Ralpllr: Marathon stl1rillza·
!lons at Takllatpur health
camp In Chhattlsgarh trIg·
gared speculation that gov·
ernment doctors were cllas-
Ing stiff targets. forcing an
unprecedented one tubecto·
my ('wry two minutes.
Though the Cllhattisgarh
government denIed alloeat-
Ing tIlrgets after thH tragpd};
TOI found the state has been
conducting 1.25 lakh stern·
IZlltions annually to ach leve a
total fert1l1ty rate (TFR) of2.1.
\\Vlth tOOgovernment gty.
Ingattra~'t1veIncentives to doc·
tors Mth Rs 2OQ':&"iO per sur-
gery and motIvators drawing
Rs 300 to bring patients to
Relativeswailbesidethe body
ofa womanwhodiedafter a
sterilizationsurgeryInBilaspur
camps, ster1llzatlons have
turnod IntOlucrative buslnHss.
Greedy dOL1:orsand moti·
vators exploltlng l1I1tera(Q
women to lllake fast buck can·
not be ruled oUt.,say experts.
ThLs was eorroborated bY
theh usband of deadBalga tt'lt..
al WOlnan.Chalt1Bal, who saId
they nevpr tllOught about fam·
ilyplannlng. 11leBalge trloo Is
ot!p of the Sf.'Yct'alpttmltlve
trloos InChhattlsgel'h that can·
not l)'OOlyllartldpate In family
.netWorkofa dozen-plus organizations working on public
A health sought an answer from the government over the
sterilization deaths in Chhattisgarh, questioning the need for a
makeshift'camp' approach despite years of planning and
allocating money to improve the health system, under
reproductive and child health, under the NRHM. Theydemanded
fixingof accountability aod culpability "for the deaths of
otherwise healthy women following a medical procedure".
The activists demanded an enquiry to fixresponsibility in terms of
criminal negligence not only on the medical team which perform-
ed the operations, but also In identifying other officials who
sanctioned and were involved in managing this camp. TNN
ForthI.' full report,log on to www.timesofindia.com
planning programmps rlne to
their dWlmUingpopulation.
Disgraced doctor, HK Gu p-
t.a.who condncted 8-3sterlllz<l·
tlons In thme·and-l1alf !lours
al tlte Ill-fated Takhatpur
camp. earned morl! than Rs
6.225allove hlssak1ry Within a
short perIod, This works ont
to almost Rs 30per mlmlte or
Rs 1,800per hour. This would
mean WithclOSeto 125,lXlOsur-
gprles every ypar. surgeons
eonducting thpse proc'('dures
am paid lllore than Rs m lakb
aboV('t1ll.'lrr<!gularsalary.
Otl1cla1s said there are
abollt 150 "a(~tlw" surgeons
pet1bl'mlng tl\\bl.•~•.toml(lSm. ak-
ing It an average of Rs 62,500
!)(']'sUJ1i,'l'{pmer ypar. With thp
!,'Overmllent pnhanelng thp
amount to Rs 200per surgery.
annUal earnings fbrrhem !l'om
st('l'1llsatlon alone would go up
to Rs l.66lakh per year.
For IIlejl/1I report. log Oil fo
www.ttmesojlrtdtQ.com
"Where are the other pa·
tients?'
As a member of the
Planning Commls·
slon. I had gone to
. .. . Takhatpur In 20m.
SU(mc:e.
"How manv lJe(l~?"
"ThirtY," '
"How lIIany people does this
Very few In Imlta had heard
CHCcover'!"
of tbls sleepy tehsllln Chhat·
"Twolakh."
t!sgarh's Bllaspur (l1strlcl
"How many S!lllClailsts?"
back then. Now, wIth the
"Nona"
death of 16 young trillal
All of the above was.part
women post ster1l1zatlon,
of my ft1110rt and my bOOk.
Takhatpur llas gone viral an
Looking back, ! can see
overthe world.
that It was at such a centre
Theplu'posoof nly\\1slt to
that the sterilizations were
Takhatpur WllSto look at the
cal'rl('<.O1 Ut.At thattl.llle.I saw
work of agmupOf~l)Ungdoc· SICK SYST£MW: illany lesson be learnt from the mass
all sIgns of a possible dlsaste1:
fin'llwM had set up a hospital sterilization camp that went horribly wrong?
At the alUluHIPlan dlsctL~s1on
In fill!;remote part of the statp
w1th the state, whIch WllSan
to gIve decent: lu\\alt:heare to them lIP as worthy of emulat· drove through Achanakmaar 1IIlpot1:3Uptart of OUIw' ork at
poor trlbals. ArtlUllll 20% of Ing amI upscallng. At the end National Park. On the way I the Planning Commission,
the dlstrlet's population ())ll. of Illy first t('rm at Ow wm· saw a sign: CHC Block Hpatl· thffielllcts were bnJl@l!tothp
gIsts of tribes such as Gond. m.l.sslon.I had also tlUlled Illy quarters. Kola. AS was Illy attention of the chief minis·
Mur1a,B1mrnja.Bal~'l\\.Kanm; experiences Into 3 hook.
practice, I stopped the gOY· tel: He took cognlzanco of my
KawaI' and Halba. Most of
My experlenee of ,Jan ernment vehicle amI went fleld report and pers<JIllllly
them are PrImitiVe TrIbal Swasthya Sahyog. the or· Insldp the faclllty, The bUHcl- Wpntto s('('thp work of ,JSS.I
GrtlUPS(P'rGl. whose pnllec;- ganlzatlon which hat! set up Ing itself was desolate. No felt a great sense of fiI.1llJ.llllent
t!on Is mallrlated by law the hospital for thesp PTGs doetor was In sight. The OIl· thatmv work hadach1evoo the
because they arp becoming In a vlllage called Ganlyarl, oratlon theatt'e was locked. d('slred result:. BUt with 16
eXtlnct. Despite this clear was one of the hest. I saw Outsldp, I spotted a young deaths of YOlmgwomen In a
fll~~lve, itwas yOlmgwomen how this team of dOL1:orpsro· man In a whltf' lah L'oat.
!Jotehed·up case (If alleged
fi'oll1thIs group wl10b{'()ame vlderl tltem with earlng and "Why Is the OT loeked?"
medleal nHgl1gpnceIn a deso-
vlct1msof the SlaWs targeted cUgn1t1e(1treatment, subsl· "Madam, It Is for safpty - to latf'. ullused hospital adminIs-
approach to populatIon stahl· (l!zlng thell' tTI()(Ilclnesand ensure Ihat: no equIpment Is tering spurious lllE'rllci11es,
l1Zatlonlast week.
giving t!WIl!nll\\U'lshlilent to stolen."
then) was 0!J\\1o\\lsly110follow·
Elghtye-arsago,! had wrIt· enable the medicines to he "\\Vhere Is the key? Open It" up -- a hugp gap between in·
ten a report 011Illy visit as a llffectiVe.I had seen how thev
He shlft(>(llUlcomfortahly terltlon antl1lllplemen1:atlon.
wake-upcan to the central and had usL'Cllocally (level oped on his feet. "It Is with the
Last week. 40eMI society
stlite governments on the pub· health Innovations to cut medical officer."
groups preS('ntpt! their char·
I1chealth sltllatlon.My ohjec· costs -Ihllll water purifiers "Callhllll."
tel' of demands to the slarp
tlyewlls IOshowcasethe WOlK to cheaper diagnostic equIp- "He is not here. "
govprnment on the d\\';!tl)Sof
of the group of prlvatedoctors ment to detect sIckle cell
I realized then tilat he young trlhal mothers. It
WhOhad set m>l:h'eilt*Ufilr:lU'l! anemia whIch t~rampant was the only one In Wls needs to heed that, take 011
tor the t11l1alsasa contrast to amongst this population,
tlesolatH place.
boarcl good practices, and
what the state had pnJ\\1doo.1
The publle hfillIlh set-up "Where are thil othllr (Ioe· transform Its t\\1Slttat publlc
r wanted to Ih't good practices stood In starK contrast. tors? What If therp Is an health scenario.
sUch as thIs, WhIch saw Wll1le going to the Jail emergency?"
The wrltQr 1stormer membel;
lII;l'OS$the l'()lmtry, and hold Swasthya Sahyl)g faclllty. I
Silence.
PlannIng Commlsslon
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7.8 Page 68 |
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Locked on and missing doctors Times of India, 2014 Nov 20
The sterilization tragedy that clainled 16 tribal \\VOlnen in (~hhattisgarh
was lvaiting to happen. Notes from a visit n1ade eight years ago...
As a m~mber of the
Planning Commis-
sion, I had gone to
Takhatpur in 2006.
very few in India had heard
of thts sleepy tehsil tn Chhat-
tisga.rh'S BHaspur district
back then. Now, with the
death of 16 young trlbal
women post sterU1zatlon,
Taknatpltr has gone viral all
Qverthe world.
TnepurPQSe of myvtsttto
Takhatpur was to look at the
workof a.group of young doc-
tors who had set up a hospital
tn thts remote part of the state
to give decent healthcare to
poor tribals. Around 20% of
thedistrtet's population con-
sists of tribes such as Gond,
Mur1a, Bhutnja, Baiga, Kanar,
Kawar and Halba. Most of
them are PrimItive Trtbal
Groups (P'I'G),whose protec-
tion IS manClateCl by law
because· they are becoming
extinct. Despite this clear
directive, It was young women
trom thtsgroup who became
victims oftheState'starget:ed
aPProach,to POPulationst.abi-
lizattonlast week
Eight years ago,I had '-"1it-
ten a repOrt on my vis!t as a
WaK.e-upcaltlo thecentta1 and
state governments on thepub-
Hehealths1tuatlon, My objec-
tlVeWasto showcase the wQrk
of the gronpofprivatedoetors
Whohad set up tree heaIthca.re
for the tlibals as a contrast to
whatthestate ha.dpro\\1ded, I
wanted to Hst good practices
sUch as this, which I saw
across the country, and hold
SICKSYSTEMW:: ill any lesson be learnt from the mass
sterflization camp that went horribly wrong?
them up as worthy of emnlat-
tngand npscaung. Atthe end
of my first term at the com-
mission, I had also tm'ned my
experiences into a booK.
My experience of Jan
Swastllya Sahyog, the or-
ganization which had set up
the hospital for these PTGs
in a village called GaniyarL
was one of the best. I saw
how thts team of doctors pro-
vided them with carlngand
digntfted treatment, SUbsi-
dizing their medicines and
givlngthem nourtsltment to
enable the medicines to be
effective. I had seen how they
had used locally developed
health innovations to cut
costs _. from water puriflers
to cheaper diagnostic equip-
ment to detect sickle cell
anemia Which is rampant
amongst this population.
The pUblic health set-up
stood in stark contrast.
WhHe going to the Jan
Swasthya Sahyog facmt>'. I
drove through Achanakmaar
National Park. On the way I
sa\\va sign: CHC Block Head-
quartm's,Kota. As was my
practice, I stoppe<I the gov-
ernment vehiCle and went
inside thefac1lity. The build-
ing itself was desolate. No
<Ioctor was in sight. The op-
eration theatre was locked.
Outside, I spotted a young
man in a white lab coat.
"Why is the OT locked?"
"Madam, 1tts for safety .~. to
ensure that no equipment is
stolen."
"Where is the key? o~n it."
He shifted uncomfortably
on his feet. "It is with the
medical officer."
"Call him."
"He is not .here."
I realized then that he
was the only one in this
desolate place.
"Where are the other doc-
tors? What if there is an
emergency?"
Silence.
"Where are the other pa-
tients?'
Silence.
"How many beds?"
"Thirty."
"How many people does this
CHCcover?"
"Two lakh."
"How many specialiSts?"
"None."
All of the above was part
of my report and my book.
Looking back, I can see
that it was at such a centre
that the sterilizations were
carri~dol.tt.Atthattjn1e I saw
all signs()f a pQSs1bledisasteI:
Attheannual Plan cUscussion
wIth the state, which was an
important part of om-work at
the Planning Commission,
these facts were brought to the
attention of the chief minis-
teI:He took cognizance of my
field report and personally
went to see the work of .JSS.I
felt a great sense of fillfIllment
that my work had achieved the
desired result. But with 16
deaths of young women in a
botched-up ease of alleged
medical negl1gence in a deso-
late, lUlusedhospitaI adn1tnis-
tering spuriOUS medicines,
there was obviously no follow-
up - a huge gap between In-
tentiOn and implementation_
Last week, 40c1vilsociety
groups presented the:irchar-
tel' of demands to tlle state
government on the deaths of
young tribal mothers. It
l1eeds to heed that, take on
board good practices, and
transform its dismal publiC
health scenario.
The writer isjorrner metnl.Jel;
Planning Comm.ission
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7.9 Page 69 |
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7.10 Page 70 |
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8 Pages 71-80 |
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8.1 Page 71 |
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8.2 Page 72 |
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STERILISATION
Oops, sorry, we've killed you
16 women dying in a sterilisation camp in Chhattisgarh was no
isolated incident, 15 women die on an average across the
country every month during and after botched-up family
planning operations
By Aditi Tandon
SHOCKING stories of disregard for
human life continue to surface from
Chhattisgarh's Bilaspur, where 16
women recently lost their lives following
a botched-up sterilisation camp at a local
hospital.
Those who survived told investigators
how they woke up during the procedure
to feel unbearable pain and see fallopian
tubes coming out of their abdomen.
Their shared memory of laparoscoplc
tubectomy, a common family planning
practice in India's seven high focus
states with the largest share of
~
Patients recovering at a Bilaspur hospital after
complications following sterillsation operations at
a special camp. Sixteen women who underwent
sterlllsation In the camp died. AFP
population, Is of horror, pain and shocking neglect.
None of these women were told by the operating doctor if they were fit to undertake
the procedure, though it is mandatory under Government of India manuals to inform
acceptors of female sterilisation the status of their health before they agree to a
procedure.
But In testimony after testimony from Bilaspur, survivors have spoken of their urine
and blood samples being taken but no reports being shared.
All they remember is they were hastily herded towards unclean beds where they lay
shoulder to shoulder as someone administered them injections (local anaesthesia).
That the sedation was ineffective is clear from the fact that majority of these women
woke up in pain screaming for relief while the doctor, now arrested, continued the
procedure, finishing 83 tubectomies in five hours.
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8.3 Page 73 |
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POPUlATION STABLISATDN EfFORT OF 6 HIGH FOCUS srATES(2.0n •.S2)
S&ale
No.Gf1llbed __ Tf1t •••••••
_
Bihar
54.4701
3.5
Chhattis(tlt'b 1.25.620
2.8
Jltarkhand 1.22.305
•.. 3.20.168
5.51,966
las•t•••.••• .-, ••.•~•....,1,-. .••tee
«21a1dl for death foUC1\\YlngsterUlsationor within a week of disch5!P
l5tUMlO tor death follC1\\YlngsteriUsation within eight to 30 days of disCharge
\\:MtOOO tor a failed procedUre
\\25.000 tor any complication Within 60 da~ Of dlsd1arge
TIle insurance payout stnce 2010; 'f50.76 «ore
All participants were discharged within minutes of the operation despite the
requirement of overnight post-operative care under the Government of India rules.
They went off with sachets of medicines later found contaminated with rat poison.
Although the Bilaspur deaths remain by far the darkest chapter in the history of
female sterilisations in India, deaths and co.mplications in tubectomy camp settings
are routine.
Every month, around 15 women on an average die on account of botched-up
sterilisations, a permanent method of birth control which forms 37.3 per cent of
India's 48.4 per cent contraception figure.
Records of the Family Planning Division of Ministry of Health reveal that between
2008 and March of 2012, 675 cases of deaths of women post-sterilisation
procedures were accounted for.
Families of these victims were legally compensated under the little-known National
Family Planning Insurance Scheme the ICICI Lombard Bank runs in collaboration
with the Centre. The scheme, effective since November 29, 2005, offers the
following packages - Rs 2 lakh for death following sterilisation in the hospital or
within a week of discharge; Rs 50,000 for death following sterilisation within eight to
30 days of discharge; Rs 30,000 for a failed procedure; and Rs 25,000 for any
complication within 60 days of discharge from the hospital.
By the Health Ministry's admission, payment worth over Rs 50.76 crore was made
between 2010-11 and 2013-14 for 363 deaths and 14,901 surgery failures. During
this period, 15,264 cases of sterilisation deaths, failures and severe complications
were officially recorded and for each case, an average of Rs 33,255 per person was
paid.
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8.4 Page 74 |
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Needless to say, the maximum burden of complications was reported from the six
very high focus states which practice female sterilisations with impunity to meet the
national Total Fertility Rate (average number of children per woman) target of 2.1.
These states are Bihar, Uttar Pradesh, Madhya Pradesh, Rajasthan, Jharkhand and
Chhattisgarh.
Women survivors of Chhattisgarh sterilisations recently said they went for surgeries
because they had no other option and wanted to control their families. All of them
admitted to having been motivated by Accredited Social Health Activists whom the
Centre pays incentives to encourage couples to opt for birth control methods.
A Community Health Centre doctor in the state when asked if targets were
prescribed acknowledged the trend, saying, "I personally have a target of around
800 sterilisations a year. One can never achieve more than 60 per cent. Non-
achievers are pUblicly humiliated by government functionaries while achievers are
publicly rewarded."
Dr RK Gupta, under whose watch 16 out of 83 acceptors of tubectomies died in
Bilaspur, was last year rewarded by Chhattisgarh Chief Minister Raman Singh for
completing 50,000 tubectomies.
Sterillsation camp at Kaparfora govt middle school, Araria, Bihar: 53 women
operated in two hours; pregnant Dalit miscarries; many suffer physical harm
Bundi camp, Rajasthan: 88 pc women not told of permanence of procedure; only
3 of 11 mandated pre-operative tests done; mother of three dies
Odisha: Researchers document cases where women in labour are forced to agree to
tubal ligation after they deliver the second child at a health facility
Shanti Mahanand dies of excessive bleeding after sterilisation at Bargarh, Odisha.
Vein cut in haste to operate
In UP, 79 women aged 15 to 19 sterilised against GO! manuals which allow
procedures only on women above 25 years.
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8.5 Page 75 |
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Setting targets, missing
aim
THE Government of India may have
abandoned the targeted approach to
family planning in 1996 in deference
to international conventions like the
CEDAWwhich it signed, but it
continued to promote incentives for
sterilisations, boosting it as a
preferred mode of birth control in
India.
Since 1981, the government has
been implementing a centrally-
sponsored scheme to compensate
acceptors of sterilisation for loss of
wages for the day on which he or she
attends the medical facility for
undergoing the procedure.
Wages under the scheme have been frequently revised, and the last revision
took place on September 7, 2007 when the compensation for male sterilisation
(vasectomy) in a government facility was raised from Rs 1,000 to Rs 1,500 per
person and for female sterilisation (tubectomy) from Rs 800 to 1,000.
Similar procedures in private settings attract more incentives - Rs 1,500 each
for vasectomy and tubectomy.
The reason for increasing numbers of sterilisations in private camp settings is
also hidden in the Centre's own data on incentives for sterilisations.
When conducted in public facilities, the majority incentive goes to the acceptor
of sterilisation but when conducted in a private facility, it goes to the facility
and the motivator.
So, of the Rs 1,000 compensation for female sterilisation in a government
hospital, the acceptor gets Rs 600 as against Rs 150 for the motivator; Rs 100
for drugs and dressing; Rs 75 for the surgeon; Rs 15 each for the nurse and
operation theatre technician; Rs 10 for refreshments and Rs 10 for camp
management.
In the private facility, however, the acceptor of sterilisation gets no money. Of
the promised Rs 1,500 per surgery, Rs 1,350 goes to the facility and the
remaining to the motivator.
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8.6 Page 76 |
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All women's groups agree with the need to do away with incentives for
sterilisations which they say are as good as target setting. Health Minister JP
Nadda, however insists, "The Centre does not set any targets for sterilisations.
Family planning is a voluntary, consent-based movement."
The Centre has for the purpose of monitoring population growth categorised
states into three, depending on their Total Fertility Rates (TFRs) or the average
number of children per woman.
There are six very high focus states with TFR of more than or equal to 3; high
focus states with TFR more than 2.1 and less than 3 and non high focus states
with less than or equal to 2.1 TFR.
Evidence shows sterilisation camps for females are mostly organised in very
high focus and high focus states which are constantly under pressure to deliver
the TFR targets. Incidentally, it was also in these very states that the most
significant dip in population growth rates was recorded as per 2011 Census.
Health Ministry insiders acknowledge that India's goal of reaching TFR of 2.1 by
2015 depends mainly on the performance of very high focus and high focus
states which, in turn, resort to mass female sterilisations in camps to push
targets.
SAMA, a women's group working on reproductive rights, has now called for a
blanket ban on camp sterilisations. Imrana Qadeer, a women's right activist,
says, "According to the Registrar General of India, the very high focus states
will take 25 years to reach the TFR of 2.1 if the family planning programme is
implemented in its mandated voluntary form. You can see why these states are
pushing for the camp approach."
The Health Ministry's own compilations reveal that the very high focus states
wait for central family planning funds to land in the fag end of the year so
these can be used to sterilise women in camps and meet the yearly sterilisation
targets which almost all states set.
Brinda Karat of CPM says camp sterilisation of women in private settings is the
worst form of human rights violation. "What you need is a 24 by 7 public
health service where women wishing for permanent birth control can access
sterilisation when they want. Why should there be camps?" she asks.
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8.7 Page 77 |
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• Chhattisgarh, a very high focus state, has a TFR of 2.8 and sterilises on
an average 344 women every day. Bihar, with the highest TFR of 3.7 in
India, sterilises on an average 1,492 women a day; Madhya Pradesh
with a TFR of 3.2 resorts to 1,512 female sterilisations daily on an
average. Rajasthan with a TFR of 3.1 sterilises on an average 840
women a day and UP with 3.5 TFR conducts an average of 877
tubectomies a day.
• The latest data available with the Centre for 2011-2012 reveals a
whopping 49,06,430 sterilisations being conducted in a single year
across India. Of these, 47.3 lakh (over 95 pc) involved tubectomies as
against 1.75 lakh vasectomies on men.
Huge unmet need for family planning
POPULATION experts feel the focus
of the Centre is grossly misplaced.
Though India had in 1952 become
the first country to launch a
national programme emphasising
family planning, it has not achieved
much in terms of results. By 2050,
it is projected to surpass China's
population and by 2026, it would be
home to 1.4 billion people as
against 1.21 billion today.
Contrast these challenges with
S;:Ci~gb~tween two childbirths in India Is less
than three years in 61 pc of all births. File photo
access to contraception and one traces a huge gap. Contraceptive use among
married women aged 15 to 49 years is just 56.3 per cent. Though the wanted
fertility rate across India, as revealed by the National Family Health Survey-3,
is 1.9, the actual national Total Fertility Rate is 2.1.
Clearly, there is a huge unmet need for family planning. "Yes the need is 22
per cent as per the District Level Health Survey of 2008," admit Health Ministry
officials. They add that spacing between two childbirths in India is less than the
recommended three years in 61 per cent of all births. That explains female
sterilisations as the easy option to attain population stabilisation goals.
"It is not just easy, it is financially rewarding with little or no accountability for
operating doctors, who treat women as cattle. In none of these sterilisation
camps are doctors ever equipped with gloves, disinfectants, equipment or
clean linen to ensure safe procedures," says Devika Biswas, the Araria-based
activist currently pursuing in the Supreme Court a petition that documents the
horrors of India's female sterilisation camps and calls for strict directions to
states which treat women as tools to meet TFR targets.
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8.8 Page 78 |
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In January 2012, a single surgeon performed sterilisations on 54 women in a
government school in Kaparfora of Bihar's Araria district. Spending less than
two minutes per surgery, he left the women writhing in pain with most of them
finding themselves in a pool of blood. The case led to a petition in the Supreme
Court, which is seeking directions to states to follow Government of India's
sterillsation gUidelines. The final arguments are due on December 2.
The gUidelines had come into force following another SC judgment in 2005
which called for protection of women's dignity during sterilisations.
"We have documented a series of violations of gUidelines which say that not
more than 30 surgeries can be held in a day; no camp will be held in schools;
18 people must form the team at each sterilisation camp and every state must
maintain a record of women's consent forms complete with their age, number
of children and health condition," says Biswas.
States are also supposed to ensure that each sterilised woman is given a
certificate of the procedure as proof of surgery. "In 80 per cent cases, women
are not given a certificate of sterilisation. So, deaths or complications are never
recorded," says activist Ramakant Rai, whose petition in the Apex Court had
forced the Health Ministry to lay down Male and Female Sterilisation Guidelines
and Manuals.
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8.9 Page 79 |
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THE
HINDU
-----------_._---------_._-- ._------_.-_._--_.---
Opinion» Comment
Published: November 26, 2014 00:54 1ST I Updated: November 26, 2014 12:36 1ST
Public health, private tragedy
While the Chhattisgarh Health Department is solely responsible for the tragedy, the incident raises several questions regarding India's family"""''''
planning programme.
In Chhattisgarh, people continue tofoIl prey to systematic medicoI incongruities, according to narratives of victims at a workshop
held recently in Raipur
The death of at least 15 women during a tubectomy operation in Chhattisgarh has sent shock waves across the
country. The State government claimed in a report that the deaths occurred as the medicines given to the women
were laced with rat poison. But this was no isolated incident. As was recently narrated by victims at a workshop held
in the State capital Raipur, people in the State continue to fall prey to systematic medical incongruities.
Two women from Abhanpur Block, Sharda and Ramkali (names changed), spoke about the hysterectomy operations
they were made to undergo. They narrated how the doctors in one of the private hospitals in Raipur prescribed that
their uterus be removed in order to relieve stomach pain.
Sharda was made to pay an extra Rs. 20,000 despite using the Rashtriya Swasthya Bima Yojna (RSBY)card, which
offers cashless hospitalisation for up to Rs. 30,000. "We had to sell land to arrange for the money," she said. More
than 20 women in her village had undergone hysterectomies.
When the issue of forced hysterectomies to make insurance claims came to the fore earlier in 2012, it was found that
nearly 7,000 women had got their uterus removed under the RSBYover a period of 30 months.
Chhattisgarh Health Minister Amar Agarwal had promised "stringent steps" against the guilty in 2013 and much like
this time, an inquiry was ordered by the State Health Department. After the report came out, the licences of seven
doctors were suspended. The doctors went to the High Court and acquired a stay order. Meanwhile, the government
constituted a 'high-level' inquiry that went on to exonerate the doctors. The High Court then ruled in favour of the
doctors and they went back to their jobs. The women were not paid any compensation. "Now, we routinely take
injections from the village quack to reduce pain, while the doctors have gone unpunished," Ramkali said in the
workshop.
Who is responsible?
While the Chhattisgarh Health Department is solely responsible for the tragedy, the incident raises several questions
regarding India's family planning programme. Every State is given a target to boost women's sterilisation. The
pressure to sterilise women rises towards the end of the year and the Health Department starts checking the number
of tubectomies performed.
So, the District's Chief Medical officer calls up the Block Medical Officers for "targets" who in turn question the
Auxiliary Nurse and Midwives (ANM) and the ANM pulls up the mitanins (volunteer community health workers). The
KMC/Pg72
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8.10 Page 80 |
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mitanins. who get a few hundred rupees for performing the operations, encourage the women to visit the camp set up
in their area on a particular day.
As the "targets" increase, the guidelines set up by the Ministry of Health and the Supreme Court are flouted. "In this
case, for example, we do not know why more than 80 women were getting operated, when the Supreme Court
permitted 30 operations in one clinic," said Sulakshana Nandi of Jan Swasthya Abhiyan (JSA), the Indian circle of
the People's Health Movement. "We are also unable to understand why the operation was conducted in a makeshift
temporary camp when it has to be performed in a public health facility," she said.
Moreover, health activists across Chhattisgarh said that operations go wrong often and the women develop new
ailments after tubectomy as antibiotics are randomly used flouting norms. The cases come to light only when deaths
occur such as in the recent episode.
The gender bias involved in the implementation of such schemes cannot be ignored either, especially when the family
planning programme is almost entirely focussed on women. Both in Community Health Centres (CHCs) and in district
hospitals, the rate of women's sterilisation or Laparoscopic Tubectomy (LTT) is alarmingly higher than Vasectomy
(VT).
This year, between April and November 21, in Raigarh district alone, 1,070 LTTs were conducted in CHCs,whereas in
the same period, only one VT was performed in the same district. In Bilaspur, the ratio is 1039:23. In JaI\\igir, there
were no VTs against 1091 LTTs. The data underscore similar stories across the State, except in the tribal districts of
the south.
The project to provide health insurance using taxpayer's money was started by the Central government in 2008.
While it was meant for the people Below Poverty Line (BPL), in many States such as Chhattisgarh, it was introduced
for people Above Poverty Line (APL). The scheme has hugely benefitted the private health sector.
Let us sample a testimony from the insurance awareness programme in Raipur. One of the participants, a Gond tribal
from Pandariya, broke down while sharing how a private hospital in Raipur refused to treat her husband under RSBY
and made her pay Rs. 2-4 lakh. After 10 days of hospitalisation and the death of her husband, the hospital asked for
an additional Rs. 23,000 to release the body. She could pay only Rs. 10,000 and the hospital deducted Rs. 13,000
from her card and released the body. These are not exceptions but have become the norm.
The public-funded insurance scheme has made the private sector aware that there is no point in keeping the money
unutilised in the health cards of beneficiaries. A report by the Public Health Resource Network, a voluntary network
of public health professionals, has found that private hospitals "cherry pick" RSBY/MSBYpackages that are profitable
while refusing to treat patients with general illnesses such as jaundice, malaria, in Chhattisgarh. "Private clinics are
only interested in performing operations," says a health department official. So, hysterectomies are often advised.
Poorly staffed
Thus, while the private health sector is growing rapidly, there is a severe lack of trained medical staff. The problem is
particularly acute in Chhattisgarh where public education is also in a shambles resulting in a huge proliferation of
private training centres for paramedics and support staff. Students trained in anaesthesia from such centres can be
found participating in the performance of complicated surgeries in hospitals.
Moreover, the ratio of doctors in the cities compared to district towns is skewed. Reports put out by the Heath
Department show that while the public facilities have more "medical officers" than those sanctioned in the big cities,
the rural or semi-rural areas have hardly any and specialists are even fewer. Moreover, "private hospitals do not
operate in the far-flung remote corners" says a JSA study. In fact, many of the government's ambitious public-private
partnership over the last few years collapsed as the private sector refused to go to remote villages.
The process of buying and distributing medicines is complicated as well, and there have been times when the entire
State was left more or less without any essential drug supply in 2012 and 2013. There are many testimonies to
establish the occurrence of acute malnourishment, malaria, tuberculosis and dysentery-related deaths in Chhattisgarh
and how data related to these are fudged by the State's Health Department. But narrating them will call for a separate
story altogether.
suvojit .bagch i@thehindu.co.in
Keywords: Chhattis~arh, tubectomv, hysterectomy, health schemes
Printable version I Dee 18, 2014 10:27:40 AM I http://www.thehindu.com/opinionjop-edjpublic-health-private-
tragedy j article6633520 .ece
©The Hindu
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REUTfRS
This copy is for your personal. non-commercial use only_ i0 order
tatior>-rerH]
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Indian sterilization targets remain in all but
name, critics say
Tue, Nov 25 2014
By Jatindra Dash
BARUAN, India (Reuters) -India officially abandoned targets for
its mass sterilization program in the 1990s, accepting they had
put undue pressure on people to undergo surgery and failed to
curb population growth sufficiently.
Twentyyears on and targets remain in all but name, say
doctors, healthcare workers and family planning experts,
meaning that, although below peak numbers, more than four
million people underwent surgery in 2013-14.
In recent years, the vast majority have been women.
The risks the campaign poses were highlighted this month
when more than a dozen women died after having a tubectomy at two sterilization "camps" in the state of
Chhattisgarh.
Ongoing investigations point to contaminated drugs given to the women as a possible cause of death, but a dirty
operating room and operations performed in a matter of minutes raised new questions about the program's
efficacy and safety.
"Targets may have been removed, but the target mindset remains ," said Poonam Muttreja, executive director of
the Population Foundation of India NGO.
Wary of a ballooning popUlation, India launched a family planning program to slow population growth in the
1950s.
H, the campaign went into overdrive, some seven million men had vasectomies between April 1976 and January
1977, according to the Centre for Health and Social Justice in New Delhi.
Today, tubectomies on women are by far the most common form of birth control in India, and India's fertility rate,
or the average number of children a woman has in her lifetime, has fallen from 3.6 in 1991 to 2.4 in 2012.
But it has failed to reach the desired "replacement" level of 2.1, and India, with a population of around 1.2 billion,
is set to overtake China as the world's largest nation by around 2028, according to the United Nations.
PI. a recent sterilization "camp" in the eastern state of Odisha, operations went on apace, seemingly impervious
to negative publicity after the deaths next door in Chhattisgarh.
A doctor and five assistants from a nearby hospital worked flat out, performing 13 tubectomies in about an hour
at the facility in Baruan village.
Mer her surgery, 35-year-old patient Renubala Ojha was gUided outside by a health worker who settled her onto
a dirty rug to recover. Nearby, empty water bottles, used tobacco pouches and piles of cow dung littered the
ground.
TARGETS OR "UNMET NEEDS"?
Sabitri Sethi, the health worker, said her supervisor had instructed her to bring at least two women to the camp.
Some 80 percent of Odisha's family planning budget under the National Health Mission was set aside for
sterilization activity this year, including holding camps and paying compensation, a state health official familiar
with the plan said.
He added that Odisha, which accounts for some 3.4 percent of India's population, is prepared to carry out
sterilizations on as manyas 20,000 men and 160,000 women this year.
The Health Ministry is adamant such numbers are not targets, and that state budget figures for the national
program are expressions of "un met need" for such services.
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Critics say the distinction is misleading, because any objective puts pressure on healthcare workers and lands
too many women in "camps"where dozens are operated on in a few hours.
"I have done 90 surgeries in a day," one doctor at the Chhattisgarh Institute of Medical Sciences admitted. "If I had
said no, the government would have sacked me."
Officials in New Delhi add that, in addition to ditching targets, the government has promoted alternative options,
including condoms and intrauterine contraceptives, to reduce the number of people having surgery.
Sterilizations dropped from well over five million in 2010-11 to over four million in 2013-14.
Critics counter that a payments-driven system continues to push more people to choose sterilization over other
options.
Mthe Odisha clinic, Ojha received 600 rupees ($9.70) after her surgery, a significant sum in a country where
hundreds of millions of people live on less than $2 a day.
Sethi, the healthcare worker, said she would also receive money for each woman she brought, but she did not
say how much.
The Odisha state government pays 75 rupees ($1.20) to doctors for each surgery, 25 rupees to the anesthetist,
15 to the staff nurse and attendant, and 10 to other staff.
POOR PUNISHED?
Ad\\lOcates ofa shift away from sterilization say the system penalizes the poor.
"The poor are being seen as irres ponsible breeders ... who need to be permanently dealt with," said .Abhijit Das,
director of the Centre for Health and Social Justice.
Without better education for health workers and a more readily available selection of contraceptive choices,
women will keep going to potentially dangerous camps, Das added.
And entrenched social attitudes will likely remain.
Many men think vasectomies threaten their virility, placing the burden on women. Of couples in India who use
modern contraception, two percent of men were sterilized compared to 74 percent of women, U.N. data Show.
(Additional reporting by Aditya Kalra in Bilaspur and Krista Mahr in New Delhi; Writing by Krista Mahr; Editing by
Mike Collett-White)
cD) Thomson Reuters 2014 . .All riphts reserved, Users may download and print extracts of contentfrom this
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9.3 Page 83 |
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Indian sterilization targets remain in all but name, critics say
Although below peak numht'rs, more than four million people underwent surgt'ry in 2013-14
Baruan: India officially abandoned targets for its mass sterilisation
programme in the 1990s, accepting they had put undue pressure on
people to undergo surgery and failed to curb population growth
sufficiently.
20 years on and targets remain in all but name, say doctors,
healthcare workers and family planning experts, meaning that,
although below peak numbers, more than four million people
underwent surgery in 2013-14.
The risks the campaign poses were highlighted this month
when more than a dozen women died after having a
tubectomy at two sterilisation 'camps' in the state of
Chhattisgarh. Photo: Mint
The risks the campaign poses were highlighted this month when
more than a dozen women died after having a tubectomy at two
sterilisation "camps" in the state ofChhattisgarh.
Ongoing investigations point to contaminated drugs given to the
women as a possible cause of death. buta dirty operating room and
operations performed in a matter of minutes raised new questions
about the programme's efficacy and safety.
"Targets may have been removed, but the target mindset remains ," said Poonam Muttreja, executive director of the PopUlation Foundation
of India NGO.
As the campaign went into overdrive, some seven million men had vasectomies between April 1976 and January 1977, according to the
Centre for Health and Social Justice in New Delhi.
Today, tubectomies on women are byfar the most common form of birth control in India, and India's fertility rate, or the average number of
children a woman has in her lifetime, has fallen from 3.6 in 1991 to 2.4 in 2012.
But it has failed to reach the desired "replacement" leval of2.1. and India, with a population of around 1.2 billion, is setto overtake China as
the world's largest nation by around 2028, according to the United Nations.
M a recent sterilisation "camp" in the eastern state of Odisha, operations went on apace. seemingly impervious to negative publicity after
the deaths next door in Chhattisgarh.
A doctor and five assistants from a nearby hospital worked flat out, performing 13 tubectomies in about an hour at the facility in Baruan
village.
After her surgery, 35-year-old patient Renubala Ojha was guided outside by a health worker who settled her onto a dirty rug to recover.
Nearby, empty water bottles, used tobacco pouches and piles of cow dung littered the ground.
Some 80% of Odisha's family planning bUdget under the National Health Mission was set aside for sterilisalion activity this year, including
holding camps and paying compensation, a state health official familiar with the plan said.
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He added that Odisha, which accounts for some 3.4% of India's population, is prepared to carry out sterilisations on as many as 20,000
men and 160,000 women this year.
The health ministry is adamant such numbers are not targets, and that state budget figures for the national program me are expressions of
"unmet need" for such services.
Critics say the distinction is misleading, because anyobjectille puts pressure on healthcare workers and lands too manywomen in
"camps" where dozens are operated on in a few hours.
"I halle done 90 surgeries in a day," one doctor at the Chhattisgarh Institute of Medical Sciences admitted. "If I had said no, the gOllernment
would halle sacked me."
Officials in New Delhi add that, in addition to ditching targets, the gOllernment has promoted alternatille options, including condoms and
intrauterine contraceptilles, to reduce the number of people having surgery.
The Odisha state gOllernment pays '75 to doctors for each surgery, '25 rupees to the anesthetist, '15 to the staff nurse and attendant, and
'10 to other staff.
"The poor are being seen as irresponsible breeders ... who need to be permanenUydealt with," said Abhijlt Das, director of the Centre for
Health and Social Justice.
Without better education for health· workers and a more readily available selection of contraceptille choices, women will keep going to
potentially dangerous camps, Das added.
Many men think vasectomies threaten their virility, placing the burden on women. Of couples in India who use modern contraception, 2% of
men were sterilised compared to 74% of women, UN data show. Reuters
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INDIA
TODAY in
Mass camps that horrify, doctors who hurt, medicines that
poison and a state that targets women. The Chhattisgarh
tragedy spills wide open the sordid underbelly of public health
across India
Nemichand Jain Hospital looks like a haunted house. A few kilo metres out of Bilaspur town in
Chhattisgarh, a grassy road curves into the cavernous, defunct hospital. Unused rooms smell of mould.
Empty syringes, test tubes and medicine cartons lie around. Touch them and lizards scurry out. A huge
spider swings above a box that reads, 'sterile surgical gloves'. At a glance, and a week after 83 women
were made to lie down together to have their fallopian tubes cut in a 'mass camp', there's nothing sterile
about this place.
Survivors of the mass steriis8tion C8fT'll rac~r8te
in Chhattisgarh's Bilespur
at the elMS hosp •• '
The women are supposed to be numbers: part of the 150,000 'target' Chhattisgarh set for sterilisation
before April 2015. But from statistics, they have turned into stories-15 lives snuffed out and 122
critically ill-sending a shock wave throughout the nation and the world. And it has opened a can of
worms: of spurious drugs and unscrupulous nexus, incentives and rewards, coercion and evasion,
medical ethics and existing laws, callousness and indifference. As investigation expands, the nation is left
to swallow a bitter pill: the truth about the sordid and sadistic underbelly of public healthcare- not just in
Chhattisgarh but across the country.
FEAST OF PAIN
Sadar Bazaar in the heart of Bilaspur is a labyrinth of by-lanes. One such, dotted with sonography outlets, leads up to the Chhattisgarh Institute of Medical Sciences.
Beyond the urinestenched passages, children run around with toys, blissfully unaware that their mothers are fighting for life somewhere here. Bilasa Bai from Bhadi
village cradles sister Hira Bai's child, full of remorse at allowing her to go to the camp. Janki Dassi of Ajab Nagar, admitted with searing pain in her stomach, is still
in ICU. Her sister, Manmati Bai, is stiff with anger. In a nearby hall, women lie on metal beds lined up against the walls, all between age 22 and 29 and each with two
to three children clambering for attention. Weak, reed-thin and exhausted, they are the survivors. Rendered unconscious by anaesthesia, none of them remembers
anything aboutthe surgery done on them on November 8-10. They just remember waking up to pain.
They are lucky they don't remember. The 53 women, who went through sterilisation at a similar camp in January 2012 in Araria, Bihar, did not even get
anaesthesia. The doctor had finished his job in two hours flat, at night under torchlight, without stopping to wash his hands, carting off the bleeding women on straw
paddy outside in the fields. He had even operated on a pregnant woman, Jitni Devi, telling her, "You will never be pregnant again." Days later, she had miscarried.
Despite the uproar, 103 women had been similarly sterilised in February 2013, at a ligation camp in Manikchak in Maida, West Bengal. Barely conscious, they, too,
were kept out in the open. "Both were done with explicit permission of the state on poor, Dalit and Scheduled Caste women, in clear violation of government
guidelines and basic human rights," says Kerry McBroom, head of Reproductive Rights Initiative at Human Rights Law Network, Delhi, which lodged a PIL in
Supreme Court to improve conditions at sterilisation clinics.
"It's medical homicide," says Dr Binayak Sen, public health physician and human rights activist. "The operations are done in places where physical infrastructure is
abysmal and services minimal." Yet the camps happen with striking regularity: for 15,264 failed sterilisations the Centre has had to cough up a compensation of Rs
51 crore between 2010 and 2013, previous U'nion health minister Harsh Vardhan admitted in Parliament in July this year. With 37 per cent married women ligated,
against 1 per cent men, India has the world's third-highest female sterilisation rate, after the Dominican Republic and Puerto Rico, say s the UN. An astonishing 3.8
million women ended their reproductive cycles, and sometimes their lives, on surgical tables and in extreme neglect in 2013-14: more than 500,000 in
Ma1larashtra, 400,000 in Bihar, 300,000 each in Andhra Pradesh and Karnataka. Yet India has not reached its dream population equation of 2.1 children born to a
woman.
ELUSIVE EVIDENCE
On November 16, the gates of Nemichand Hospital are unlocked. Police cars stream in with retired district judge Anita Jha, the
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one-person judicial committee, to investigate the case. "The panel will investigate whether standard protocol was followed, the
circumstances leading up to it, if medicines were of standard quality ," she says. But somebody has already broken into the sealed
operation theatre and removed vital evidence of drugs and documents.
Through the broken windows at the back, one can see a bare room, with stacked-up hospital mattresses. In the backyard, the
grass is charred black in places. One can see burnt, twisted remains of medicine strips, syringes and bottles. Someone has
destroyed evidence with casual arrogance right inside the premises. "We will fix accountability ," Jha says, promising to submit
her report within three months.
She is yet to conclude a 2011 alleged 'fake' encounter case of a tribal girl. A tumult of finger-pointing and raw nerves has gripped
Chhattisgarh. "We didn't even know they were holding a camp here," says Fariha Alam Siddiqui, SDM of Bilaspur. Dr R.K.
Bhange, the now-suspended chief medical officer of Chhattisgarh, says he too had no information about the camp. The
sterilisation surgeon, Dr R.K. Gupta, suspended and arrested, blames spurious medicines.
Suspended block medical officer Pramod Tiwari points a finger at the pressure of fulfilling a stiff 'target' of 40 sterilisations a
day. Women's organisations have demanded the resignation of Health Minister Amar Agrawal, in whose constituency the
incident took place, on "moral grounds". The Chief Minister, Raman Singh, has retorted, "Operations are done by doctors, not
ministers. II
•MOOUI CALlEOMEAND
ASKED METO DO THE
BESTWECAN. RESIGNING
IS NOTTHEWAYOUT,IT
JUST LEADS TO SYSTEM
FAIWRE. WE HAVE TO
CHANGE THE SYSTEM.
RAMAN SINGH
Chief Minister.Chhattlsph
It's not just operations. A report from the Central Drugs Laboratory, Kolkata, has now confirmed contaminated medicines. That
makes the hunt for evidence more of a puzzle. A range of medicines from suppliers across India were used in the surgery:
antibiotic Ciprocin by Mahawar Pharma of Raipur, painkiller Ibrufen by Technical Pharma of Haridwar in Uttar Pradesh, local
anaesthetic injection Lignocaine by Regain Laboratories of Hisar, Haryana, nerve agents Atropine and Diazepam by N andini
Medical Labs of Indore, painkiller Fortwin injection by Magna Laboratories of Gujarat, absorbent cotton wool by Hampton
Industries of Raipur and skin lotion Zielone by G Pharma of Indore.
•ONE SURGEON, ONE
LAPAROSCOPE. 10
Many of these drugs and companies have a controversial history: in 2011, Lignocaine caused loss of eyesight at a mass cataract
camp in Balod, Chhattisgarh. Fake drug operators from Indore to dawa mandis of Uttar Pradesh have been in the news. Gujarat
CASES,THATSTHE
SUPREME COURT RULE.
lists Regain as a top offender for not meeting standards. Traces of zinc phosphide, a component of rat poison, have been found at HERE. ONE SURGEON
Mahawar, apart from burnt up drugs. How did such drugs and suppliers get into Chhattisgarh government's procurement system WITH ONE LAPARASCOPE
headed by Chhattisgarh Medical Services Corporation Limited? The Indian Medical Association demands answers. Drug
DID83CASES.THATS
companies claim they are being made a scapegoat. Any problem with medicines would have led to many more tragic incidents in MEDICAL HOMICIDE.
the state. The problem, to them, was at the camps, not in medicines.
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BINAYAKSEN
Publie heIIlh physlclan and
You can't enter Apollo Hospital in Bilaspur. Nightclub bouncers, garbed in black, with rippling muscles and shaven head, guard the gates. Here the critically ill
women on life-support systems are under observation. Several have died: Rekha Nirmalkar, Nem Bai, Ranjita, Phool Bai, Chandra Bai, Shiv Kumari, Chaiti Bai.
Their post-mortem reports reveal septicaemia, from acute bloodstream infection, and hypovolemic shock, from critical blood loss: all symptoms of surgical
infection.
Dr R.K. Gupta is an award-winning surgeon, for his feat of completing over 50,000 sterilisation surgeries, up to 300 in a day. How did he do it? Preliminary fact-
finding reports reveal that at Nemichand, he conducted one tubectomy every two minutes in a three-hour sterilisation drive, along with only one junior doctor,
without a single break for washing hands or getting a snack. As for hygiene, he apparently dipped his knife in spirit after an operation and then reused it for 10
more. Allegations did the rounds that his tools were rusty (or dirty), that he did not wear gloves, that he made the junior doctor do the surgeries and that he slapped
a woman when she screamed in pain because the anaesthesia did not work. He denied everything. And for all his efforts, the doctor earned Rs 6,225 that day
(although the government rates for doctors is Rs 200-250 per case).
"It's no less than a medical disaster," says Dr M.C. Misra, director of All India InStitute of Medical Sciences (AIIMS), Delhi. "I have never witnessed emergency care
for ligation on this scale, with so many patients in toxic shock and kidney failure, needing ionotropic support to stabilise blood and oxygen supply." It's not ligation
per se that killed them or made them ill, he explains, but the impossibility of doing so many procedures in such short time, keeping in mind dignity, care and
standard operating procedures. That's what the team of seven doctors from AIIMS, headed by anaesthetist Dr Anjan Trikha, which visited Chhattisgarh, has come
back with. "There was obviously some poison in the system, either from the drugs or from infection," Misra adds.
INTIMATE FRIENDS
Across villages, the mithanins (intimate friend in local parlance) or health workers-a system the nation adopted from Chhattisgarh-have gone underground. With
the state and its doctors locking homs, fear stalks the women who provide real community care in obscure corners of the state. "Mithanins are the women a village
trusts," says Dr Sen, who is credited for his role in integrating them in the state's public healthcare system. "They monitor health services, ensure children's
nourishment and education, implement government schemes and act as a feedback mechanism for the administration, often in the face of male resentment."
A mass camp means Rs 150 for each woman a mithanin can motivate to go to: a woman goes to a camp, often in the face of family resistance, because a mit~/Pg
79
convinces her to put an end to endless pregnancies. And the Rs 600 that the state doles out (although it's supposed to be Rs 1,400) as 'incentive', helps. What will
happen to that earned trust? Amsena, just 20 km from Bilaspur town, has just 409 families. But two young mothers of the village have died and another is critically
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With all the other women, Bedan Bai had also taken her youngest granddaughter, Rekha, 22. like her sister before her, it was time for Rekha to go through
sterilisation. But Rekha has not come back home. Bedan Bai now sits with Rekha's two-year-old daughter, Kirti, her face crossed and furrowed with deep wrinkles.
She needs a few answers. But is anyone listening?
URL for this article :
hl1p:lAndialoday.inloday.in/sloryislerilisation-aiims-biias
pur-chhaltisgarh-big-Sloryl1/404072.hbnl
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9.8 Page 88 |
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TI~IIt~SNATION
Report: Contamination, filthyop
theatres killed sten1ized women
Rupali Mukherjee &
SUmitraDebroy ITNN
l\\'ltnnbai: Two weeks after
the botched-Up sterilization
surgeries tbatled to 13deaths
in BilasPur, Chhattisgarh, an
inquiry report has pointed to
signs of infection· ill the vic-
tims, which may have spread
due to the conditions in the
fUthy operation theatre, from
contaminated. surgical equip-
ment and use of adUlterated
andsub-standardmedicines.
TIle report submitted to
the Union health ministry on
Tuesday makes the shocking
reveJationthat fanilly plan·
ning guidelines were violat·
ed.ltsays the deaths of seven
sterlized women coUld be at·
tributed to the presence ofin·
fection in their bodies. Ex-
perts say this coUldhave been
acquired at the hospital or
ca.usedby toxic medicines.
The postmortem report of
the seven revealed "septic
shock", which was caused
due to bacterial or fungal in-
fection, along with other com-
MEDICAL M_U? The 'filthY' operation theatre where the sternlzation
was carried (L) ltthe 'unaccredited' Bilaspur hospital
plications such as adUlterated
medicines, doctors explain.
TIle report, a copy of which is
in possession of the TOI,
makes a shocking revelation:
Nemi Chand Trust, the hospi·
tal where the sterilization
camp was held, is not even ac·
credited.
Atleast85 womenwereop-
erated upon in Bilaspur as
part of a family plann.ing
camp,withmanysubsequent·
ly complaining of pain and fe-
ver. According to the report,
upto 83 surgeries were per-
formed within a span of four
hours. This is in violation of
national. guidelines clearly
stating that a surgeon can per-
form only 30 sterilization sur·
geries on any given day using
three laprascopes.
Dr K K Aggarwal, incom-
ing general secretary of Indi-
an Medical Association, said,
"TIle report points to a system
failu.re in the healthcare sys-
tem,right from where the opo
erationswokplace, the doctor
who operated, and the medi-
cines dispensed to the women
who died."
He said the guidelines for
a sterilization camp should.
have been follOWed".Not only
the doctor. but the person re-
sponsible for procurement of
medicines as well as drug
manufacturers should be
hauled and punished."
Elaborating on the viola-
tions. doctors point outtbata
single laparoscope useq mUl-
tiple tinles without adequate
SWrilization inside a contami-
nated operation thea~
could be at the root of the sev-
en deaths.
Statements of hospital
staffers revealed that there
were two laparoscopes at
their disposal Of which only
one was repeatedly used.
Gynaecologist N.ikhil 08-
tarinsistedthat merecontam-
ination could not have killed
the women. Heexplained that
peritonitis was an inflamma·
tion of the abdomen lining
caused mainly by bacterial or
fungal infection.
"Sepsis is a slow killer and
always takes a few days to be-
comedeadI}(It isra.talbutdoes
not kill immediatelg"he said.
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9.9 Page 89 |
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Cydepump in 56 sterilizations
Odisha Doc
Says It's Fairly
Safe, Routine
Procedure
AsholLPradhan
@timesgroup.com
Bhubaneswar: A cycle
pump was used to dllate the
cervix of womenduringster-
ilization surgeries at a camp
in Angul district on Friday.
The Odisha government
took serious note of the mat-
ter and ordered a probe
on Saturday.
The district medical au-
thorities and the surgeon on
duty at the goVernment-run
Banarpal community health
centre, however, defended
the procedure as "routine"
in such operations in most
government health facllities
in the state.
This comes close on the
Probe Ordered Into Shocker
•. Angul sub-collector P K Das has been asked to look into the
matter and submit a report on his inquiry within seven days. Health
secretary Arti Ahuja has promised thatstringent action will be taken
against whoever is found guilty
heels of 13women dying af-
ter botched sterilization sur-
geries at a government camp
in Chhattisgarh.
Dr Mahesh Chandra
Rout, who operated on the
women, said: "Cycle pumps
are routinely used in many
other parts of the state in the
absence of costly medical
equipment. There is no rea-
son to make a bigfussabout it
as it has been proved fairly
safe, and an affordable alter-
native." He claimed he had
petformed 60.000 steril1za-
tion SlJrgeriesso far and had
received awards from chief
ntinister Naveen Patnaik in
2012and 2013for conducting
the highest nmnber of such
operations in a year.
Health secretary Arti
Ahuja said the government
had asked the Angul district
COllectOl~Sachin Ramachan-
dra Jadhav. to conduct an in-
quiry. "Stringent action will
be taken against whoeVeris
found gUilty,"she said.
Jadhay said Angul sub-
collector P KDas had been
asked to look into the matter
and SUbmita report within
seven days.
Sources said a cycle
pump was used during the
surgeries petformed on 56
women as a substitute to car-
bon dioxide insufflators,
which are used to pump air
into the abdomen in mln1-
mally invasive (laparoscop-
ic) surgeries to create space
so that microscopes and sur-
gicalinstruments may enter-
Chief district medical of-
ficer of Angul, Bidyadhar
Sahoo, who coordinated the
camp. supported the sur-
geon. "There was no compl1-
cation reported in any of the
women. Compromises like
this are a must in gov~rn-
ment set-ups.Itcarries no ex-
tra risk for the women," Sa-
hoosaid.
Gynaecolog1sts said the
use of a cyclepump coUldbe
lifethreatening. "The air can
cause bubbles to form in the
veins, which may even cause
death. Petroleum-based lU-
bricants from·the pump can
enter the bodYand cause se- .
vere complications," said
R K Purohit, a gyanecologlst
based in Bargarhtowll.
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9.10 Page 90 |
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Failure tofQIIQ.protocolled~
sterilisatioll deaths, say NGOs
NEW DELHI: Members of four
NGOsthat visited the epicen·
tre of last month's fatal steri·
lisationdriveat BUaspur in
Chhatt1$garh have blamed the
sh()ck~ fail~retofol1ow safe-
surgery protocols for the death
of 16young women.
They saids.PUPous medicines
~d po$t7sm-geryinfections could
beprimereason.sforthecasttalties.
A join team from Population
Foundation of India, Parivar
Seva Sanstha. Family Planning
Association of India and
CommonHealth w'ent to one of
the sites Where a free laparo-
scopic tubectomy camp was held.
"This tragedy was waiting to
happen. IdeallY. not more than
30 surgeries are permitted in a
day but more than 80 surgeries
were performed in that camp.
Infrastructure at the hospital
was in a mess," said Poonam
Muttreja,tl1eexecutivedirectorof
POpulation Foundation of India.
The team demanded an inde.
pendenti:n.qUiryinto the incident
to punish the guilty as well as
verifYreports that infection·pre- infection compared with tubecto-
vention protocolsweren't folloW'ed. mies. At present, only 3% sterili-
"We can't rule out infection sation drives are male-centric."
because of the speed and.atmos-
TheNGOs said such campaigns
phere in which these surgeries were fraught with danger because
were carri~)out.Evenif a drug only ~14.42 crore have been spent
had rat~.~tsion, the.amQunt so far 011them:from a countrywide
found in a Single 500mgtablet is budget of =t396.97 croreforfemale
not enough tolon a person," said sterilisation in 2013-14.
Dr Alok Banerjee, thetechni~a1
Theteaffi said 39,23.945women
advisor to Parivar SevElSanstha. were sterJ1ised so far this fiscal
To avoid reruns of such trag-
"Coercion and incentives
emes, hesugg~sted a vigorous haven'tworkedgl~
campaignfor h1a1esterilisatio~. should take p women
"Family planning surgeries for get fixed day fac ty on a regular
men involve far less chances of basis," Muttreja said.
.
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10 Pages 91-100 |
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|
10.1 Page 91 |
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NGOs say infection killed
women, not spurious drugs
EXPRESS NEWS SERVICE
of the critical cases showed raised levels
NEW DELHI, DECEMBER I
of procaldtonin that suggests septicaemia
or infection in the blood. Postmortem of
A FAcr-FINDING team from four the first seven deaths at the Chhattisgarh
NGOs has debunked the spurious drugs Institute of Medical Sciences and the Dis-
theory on the Chhanisgarh sterilisation trl(itHospit.I'had eviden¢¢ofperit~~:~~,~
tsrecovering,
tl~::.'
after the surgeries in
Apollo hospital, ap,dpost-
In the report, Robbed
mortem of at least sevenSTERIUSATION DEATHS of Choice (indDignity: In-
victims have found evi-
dianWomen Dead afte:r
dence of septicaemia, indicating infection. Mass Sterilisation, postmortem details
Alleging a ~~coverup that began from were not included. Countering the theol)'
the second or third day", the team has of zinc phosphide mixed in the antibiotics
called for an independent probe. The re- administered to the patients, Dr. Alok
port has been prepared by a team from Banerjee, from Parivar Seva Sanstban,
PopUlation Foundation of India, Family said, '~ecordin,g tofaremic and toxicol-
Planning Association of India, Parivar ogy experts, the amount of zinc phosphide
Seva Sansthan and Commtln Health.
required to be lethal for women is 4.5 gros,
According to Poonam Muttreja, exec- which is much higher than what could pos-
utive director of PFI, "We ftmnd tbatsome sibly have been consumed bythe women."
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I..>Qll,H.....D...•.t.•.f I:
fake moos, behind
16 C'garh deaths
Himan$bLDhawan
@timesgroup,com
Ne.~lJU: An independent
report· has indicated that
septicemia '--' that is infec-
tionduril1~or after the mass
sterilization surgeries -
andnfjt just spurious· rIledi-
cines could be behind· the
deaths of· the 16 women in
the Bilaspur masS steriliza-
tiOhbotch up.
Demanding an independ-
ent inquiry in to the Chhattis-
garh disaster, the team found
that 85% of the budget for
family planning in Chhattis-
garh was spent on inCentives
and compensatiQnfor women
whneonlYl.~%W"as.~penton
equipmel1t, ttallsP()rt, aware-
ness campaign and s"ttiffex-
pensesatl~ 1.15 %in spacing
methods like oralpUlsand
condoms. The team included
members from Population
Foundation of India, Family·
PIanning AssoCiation of .In-
dia, Parivar Seva Sansthan
andCOlnmon Health.
The team found that some
of the critical cases admitted
at Ap()llo Hospital showed
raised levels of pro- calcito-
nin that suggests septicae-
mia. Post-mortem examin~
ations of the first seven
deaths attheChhattisgarhIn-
stitute of Medical Sciences
and the District Hospital had
evidence of peritonitis and
sf}ptifoci in tlle lungs and kid-
neys, also suggesting'septi-
caemia.
"These indicate deaths by
infection during or after the
operation, and not just from
spurious medicines as is be-
ing made out to be the case.
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10.3 Page 93 |
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Business Standal·d
Home Markets Companies Opinion Politics Technology Specials
BSHeadlines NewsN'o'tI' Economy Finance Current Affairs International Management Beyond
Social activists urge central govt to remove
incentives for sterilization process
New Delhi, Dec 02 (ANI): A group of non-government organisations (NGO) urged central government to
remove incentives for sterilization process after more than a dozen women died at a camp in Chhattisgarh last
month. They visited government-run family planning camp in Bilaspur, where 83 women were sterilized, and
made their recommendations to health minister JP Nadda. Chief of NGO, Population Foundation of India,
Poonam Muttreja asked government not to set up camps but to provide the services on regular basis to
women. Muttreja also asked the government to provide more choices to women as it was done in the
neighbouring countries. An investigation is now underway into why the drugs were bought locally when there
was enough stock of the medicine with the state's central procurement agency.
http://www.business-standard.com/video-ga
Ilery/genera I/socia I-activists-u rge-ce ntra I-govt -to-remove-
i ncentives-for-steri Iizatio n-process-14436. htm
|
|
10.4 Page 94 |
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Independent probe demanded in
Chhattisgarh sterilisation deaths
Last Updated: Monday, December 1,2014·2142
New Delhi: A fact-finding team working on public health Monday called for an independent inquiry
commission to probe into the Bilaspur sterilisation camp disaster and ascertain facts regarding the deaths
of women.
Along with the inquiry, the team also urged the state government to immediately make public the post-
mortem examination reports and the laboratory reports on drug analysis.
The recommendations are among the many which have been made by the team from Population
Foundation ofIndia, Family Planning Association ofIndia, Parivar Seva Sansthan and Common Health in
the report titled, "Robbed of Choice and Dignity: Indian Women Dead after Mass Sterilisation". The
report was released here.
Speaking at the report launch, Poonam Muttreja, executive director, Population Foundation of India, said
the fanlily planning programme in India has yet to conform to the principles agreed to at the International
Conference on Population and Development, especially in terms of doing away with targets and
incentives.
"What happened in Bilaspur is happening across the country. Women are not only dying in camps, but
also after they come out of the camps. Between 2009 and 2012, 707 women died ...The government knows
that they died and knows about the unhygienic conditions at such camps," Muttreja said.
While listing the recommendations made for Chhattisgarh and the country by the team that interviewed
doctors and support staff involved in the camp as well as the women who had been sterilised, and family
members of those women who died, she said compensation packages can only be given to the women
going through family planning.
"Right now, the women who motivate, the doctor and all the other health workers get incentives ...So it is
a collective financial monetary interest to do many more than prescribed (sterilisations) and endangering a
woman's life," she said.
"We request the health minister (J.P. Nadda) to ensure that not only incentives are removed, but also the
asymmetry of information. Thereby, compromised informed choice can be taken care of," she said.
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10.5 Page 95 |
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The team recommended that spacing methods like oral pills and condoms should be promoted and new
methods be added; all officials must be oriented on sterilisation procedures and quality assurance; the
drug procurement be strengthened; and vacant posts of doctors be filled and more doctors be trained in
the state.
The team found that some of the critical patients admitted at the Apollo Hospital showed raised levels of
procalcitonin, suggesting septicaemia.
"Post-mortems of the first seven deaths at the Chhattisgarh Institute of Medical Sciences and a hospital
had evidence of peritonitis and septi foci in lungs and kidneys, suggesting septicaemia. These indicate
deaths by infection during or after the operation, and not just from spurious medicines a<; is being made
out to be the case," it said in a statement.
It said, according to forensic medicine and toxicolob'Yexperts, the amount of zinc phosphide required to
be lethal for women is 4.5 gm, which is much higher than what could possibly have been consumed by
the women in 500 mg of Ciprofloxacin.
Published on: nee 2 2014 2:49AM CIIHA'ITISGARH STERlLISATION DEATHS
Experts say drug theory a sham, hint at
cover-up
Tribune News Service
New Delhi, December 1
Nearly a month after 16 women died following botched up
sterilisations in Chhattisgarh's Bilaspur, the state government's
theory that poisoning was the principal cause of death has come
under sharp criticism.
Top experts under the banner of Population Foundation of India,
which recently conducted an investigation into India's worst female
sterilisation camp tragedy, found the state was unduly pushing drug
poisoning as the reason for deaths.
Deaths due to infection
An adult woman needs to consume
4,5 gm zinc phosphide to die, say
experts. Chhattisgarh victims
should have taken 9 antibiotic
capsules for the drug poisoning
theory to hold, but each took just
one capsule, they said
Experts say infection is the real
cause of deaths. "The fact that
women started to die within 48
hours of the procedure is enough to
show that poison wasn't the main
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|
10.6 Page 96 |
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"Infection is the real cause. The fact that women started to die
within 48 hours of the procedure is enough to show that poison
wasn't the main cause. There's an attempt at cover up things
because the state doesn't want to admit to gross lapses at the
operation theatre where women were operated upon," says Alok
Banerjee, who drafted India's quality control manuals for
sterilisations in 2006 following a Supreme Court order.
cause. There is an attempt at cover
up things because the state doesn't
want to admit to gross lapses at the
operation theatre where women
were operated upon," says Alok
Banerjee, who drafted India's
quality control manuals for
sterilisations in 2006 following a
SC order
Forensic and toxicology experts point out why the drug poisoning theory seems a sham. An adult woman
should have consumed 4.5 mg poisonous zinc phoshide to have died. Chhattisgarh Government has been
maintaining that Ciprofloxacin 500 mg antibiotic capsule given to women contained rat poison - zinc
phosphide - and that this was proved by the death of a rat which was administered the same capsule in a
state lab.
Toxicology experts however ask - can a 500 mg Ciprofloxacin capsule contain 4.5 gm zinc phosphide?
"Even if you assume the entire Ciprofloxacin capsule administered to victims was zinc phosphide, a
woman needed to have had 9 capsules to die. But victims took just one," says Soma Sharma of PFI.
Public health experts say the state has instructed its health staff to lie to anyone arriving in Chhattisgarh
for an independent probe into sterilization deaths between November 8 and 10 at Nemi Chand Hospital in
BIlaspur.
"Alldocs informed us that among women who died there were signs of a drug poisoning. However at
Apollo, where 23 women are still in critical care, few cases showed raised levels of pro calcitonin,
suggesting septicemia, a life threatening bacterial infection. Also women's blood pressure could not be
traced when they arrived at the hospital post the procedure. That also indicates infection putting the onus
on the state," Poonam Muttreja Executive Director, PFI said, demanding all medical reports of victims be
made public.
The fact finding team found that the doctor in question didn't change gloves while conducting
tubectomies on 83 women in 90 minutes spending a minute on each. The OT had cobwebs and termite
infestation and the surgeon had one laparoscope for surgeries. It takes 20 minutes to sterilize one
laparoscope.
http://www.tribuneindia.com/news/nat
up/13264.html
ionl experts-say-d rug-theory-a-sha m-h int -at-cover-
|
|
10.7 Page 97 |
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Bllaspurvi
stripped of di
By Neetu ChMId"'~
In New Deihl
SEPTlCAEMlJ\\. and not just spurious
drt.1gswbichcaused the death of16 women
who underwent sterDisation at a camp In
BUaspur In Chhatt1sg'arh last month.
This has been est.abl1shed by a taet-ftndlng
team from tour pUblic health otganlsatlons.
The team (rom PoPulation Foundationotfndla.
Famll.y Planning Association of India. Parlvar
Seva sansthan. and Common Health made its
l'ef)cn-I'tobbedofChoice and Dignity: Indian
WOnten Dead after Mass sterilisat1on-public
on Mond~ exposing setiouslapses at thester-
i1lsation dnve that went horriblY wrong.
The team SI.Il'V\\lYl!tdhe !l8IJlP aitea, Inlierviewed Experts say septicaemia was the ~or
doc~ors arlc:lIlUPport stalf involved In the servlee reason for deaths of the women.
de1lVetY and the womenwtlo bad
been aterlused,and. the ttunlly
members oft:ll.OrNl who had died.
The team lbundthat IIQmeof the
cases admitted at the
oSlSltal showed ralsed
trcicalcitonln that sug-
gests septicaemia.
"PosIilTlOrtem examlnllttom of
the nrst seven deaths at the
Chhatt~Tn8titute
ofMe<lit'a1
Sciences arlc:lthe DIstrict HoBrJl-
l,llJlBw. btehill muehhlgbertban
What eould pD!lSIbJ.lhtave been
eQm1.ll'l1edby the WOO!I!nin 500
mg af Ciprofloxacin. This also
strengthens the arll\\lment
that it was not the medicines
alone that Cl'l\\llled the'e
deathll, "lIhe said. It WIllI eartler
said that the women died due
to spurious drug&.
The fact..lI.ncIlngpanel has also
about the pOlll!lblll eause of
death,"
assistant
saisdeeDrero.oKrYalpagneaneraA]pteof
FamiJ.ltPl.annlng Association of
India. The reports state that
hygienic meaBUl'l!llwere compro-
mised durt/:Ig the surgeries. "we
found that one or the staff
changed their hand gloves In
between the procedures. The
same Injection needle and
tal bad e'Vldence of peritonitis
and septic fool In the ll.U:Ip and
kldneyS, alllQ suggestlngseptt-
~
These lnttiCate deatb8 by
gorattertheopet'-
j~ ti'ou18Purwus
made out to
case," SlIId am Mut-
trela, executive dlreetor ofFopu-
lat10n Foundation of India (:PF1).
':Aceon:llngtoforenslemedidJ:le
tU'g'l!dthe
rnment to syringe. and the suture needle
Immedla
e public the were used for an the eases. They
reports 0
ortem,
were not sterlllaed andnew
labora~orY results of
needles were not used
drug atlalysls and of
lhe
for eath of the eases,
the s~ate eommit-
report-·
The laparoseope
tee set up to probe
the tragedy.
"we found that
Robbed of (hoice
dnd Olgnity: Indian
an.er the proeedurt'
on eaeh woman
was eleaned by
that the families
Women Dead after
dlpplng Into a big
of the deceased
Mass SteriiiSdtkm·-
trBY contalnlng
and toxleolog~ experts, to had not been
become lethal forwomen amount g1Venthe hospital
of zlne phoaphlde requlred ill 4.5 records, nor told
expo~ed5eriou~
lapsl'''' ill tile slcrHl·
satlon 11,-lve
warm water and
betadlne. and by
cleanln&' with a dry
gauze piece before using In the
next l'.a&e .. OnJ.ltOM laparOllCope
was use d, while the Ministry of
Hllaitb and Famlly WeUllreguide-
Ulle$ prescribe three for a maxi-
mum of 30 patients." said panel
membllrSona SbBnna.
The camp W38 organlsed at a
non-functional health faelllt)'1
compromising the basic standBm
of efllanlineSS and care during
and atter the proeoourt'. All the
WOnuln were _t In the hospital
for 30 minutes to one l10ur atI;er
thl! procedure and were .el'lt
home with their motivators orrel-
atives after a payment of Rs 600
as eompensatlon money, as per
the MOHFW eon1pel1Satlon
scheme. The post-procedure
cheek-up was not done by any
doctor or nurse. the report foUnd.
The panel has said that the
practice of eOllvlnclng WOnuln
for sretilisatioll agsinst mone·
tary compenlllltion is also a vio-
lation of human rlgbts. "None of
the women were told about the
procedure, what was to be
done. What the potential side·
etrt'cts could be. and what to do
alter tllt' procedure. "A womall
said. Ba/allll. nahi gaga lek/n
ja/3e school lee dakhlte ke liye
/ONII jama karle he/n ... uspar
dastalehat kaTte heilL val.,e iii
hO(Jrt kuch (We were not. t.old
anything But It seemed Uke
ranns that one signs for admill·
sian in schools ... )," saId Solla
Sharma.
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10.8 Page 98 |
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m"ilOnline
PUBLISHED: 12:59 GMT, 2 December 20141 UPDATED: 13:00 GMT, 2 December 2014
India probe uncovers shared needles, poor hygiene after
sterilisation deaths
By AFP
An independent investigation into the death of 13 women in India after mass sterilisation surgeries found
the doctor and his staff used the same needles for all the procedures and never changed their gloves.
The women died after being paid to have the surgery at a state-run camp in Chhattisgarh state last
month. Dozens of others ended up in hospital in an incident which sparked widespread criticism of India's
family planning programme.
Authorities have blamed the deaths on the drugs given to the women after the operations, which they said
contained a chemical commonly found in rat poison.
An Indian nurse tends to a patient who suffered from complications after mass sterilisation surgeries that left 13 people dead ©Sanjay
Kanojia (AFP/File)
But an investigation by a team from four public health organisations found that the doctor and his staff
operated on the 83 women in unhygienic conditions and that some of them probably died of infection.
"None of the staff changed their hand gloves in between the procedures. The same injection needle and
syringe, and the suture needle were used for all the cases," the team's report revealed.
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|
10.9 Page 99 |
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"Neither were those sterilised nor new needles taken for each case," said the report seen by AFP.
The women suffered vomiting and a dramatic fall in blood pressure after undergoing laparoscopic
sterilisation, a process in which the fallopian tubes are tied.
Sterilisation is one of the most popular methods of family planning in India, and many state governments
organise mass camps where mainly poor and rural women are paid 1,400 rupees ($23) to undergo the
procedure.
Although the surgery is voluntary, rights groups say the target-driven nature of the programme has led to
women being coerced into being sterilised -- often in horrific conditions.
The women were forced to lie on mattresses on the floor after the operations, which were conducted in
just 90 minutes.
"A total of 83 women were ... operated in about one and a half hours, approximately one to one and a half
minutes per surgery," the report said.
They were swiftly sent home and never received any post-operative care, it added.
The doctor who performed the operations has denied any wrongdoing and claimed he was being made a
scapegoat following his arrest over the deaths.
The government has said initial tests on antibiotics given to the women showed they were toxic, and
police have arrested the local drug factory owner and his son.
Although tainted drugs could have caused the deaths, interviews with the doctor who conducted post-
mortem examinations on the first seven women "suggested sepsis leading to septicaemia" was to blame,
the report said.
A public health expert said authorities should take note of the terrible conditions at the camp, rather than
focusing only on the drugs.
Poonam Muttreja, director of Population Foundation of India, said authorities had also completely
overlooked the way the women were treated.
"At the camp, there was complete disregard for the dignity of women," said Muttreja, whose organisation
took part in the investigation.
"None of the women were told about the procedure, what was to be done, what the side-effects could be,"
she told AFP.
The team inspected the decommissioned hospital on the outskirts of Bilaspur where the surgeries were
performed and two other camps. It interviewed women who fell sick but survived, families of the victims
and doctors and support staff.
The investigation is separate from an ongoing judicial inquiry ordered by the state government. Autopsy
reports and final toxicology results on the suspect drugs have not been made public.
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"
A relative of Janki Bai, wbo died after undergoing a botcbed sterilisation operation in a government-run programme, bolds a family
pbotograpb ©Sanjay Kanojia (AFP/File)
An Indian doctor at tbe Cbbattisgarb Institute of Medical Science bospital in Bilaspur talks witb relatives and a patient wbo suffered
from complications after a undergoing a sterilisation operation in November 2014 ©Sanjay Kanojia (AFP)
|
|
11 Pages 101-110 |
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|
|
11.1 Page 101 |
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India
State-run mass
sttriUsation leads
to death of women
,? What •• __
•• Alo~ •.~mtnt~.id
th'tpAj4lmlnaJy •• ~t·
septit shock ~·have cau~
the deaths
•• PossIble< COf'ltHtinatiOnofmedic:at
equipm"nt
••Vietitl'l$hlld~'" v:omitingand
a .dtaouitticfal.lin()IOod pl'YWiu~
afterthe proc_
••.Podor whopetf«med
surgeries hasbeend~alned
•. Doctorope~on
83 women in five houl'$
Indian relatives of patients wbo suffered from tbe complications tbat killed 13 women in a mass sterilisation programme, take care of
cbildren of affected women at tbe Apollo bospital in Bilaspur, on November 14, 2014 ©Sanjay Kanojia (AFP)
|
|
11.2 Page 102 |
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The Tribune, 03 Dee 2014
Tragedy waiting to happen
Deadly lapsesln·the rush to meet the target
A GREED, a growing population is a menace for a country
nuu'Ching towards 'development: But is m'ganising mass
•.•. .•.•sterilisation camps the only way 10 check lhill menace! Of
the 83 women who UnOOI'\\\\'£mt laparoscopk' tubectomy at asterili·
sation ca.mp in Bilaspur 16 dIed. The way things are. had it not been
for tile magnitude of the loss of lives, it wouldn't have made news.
BilaspUf waswaUing to happen. As usu.al, the Chhattisgarh Govem·
ment tlied to put the blame on the drugsuppUers~evading respon~
sibilit~f for the tragedy, A fe\\vexperts. under the banner of the Pop·
ulaUonEbundation of .India have found infection to be the main
cause of the deaths. indicating gross lapses in following the stan-
<lard procedure at the camp,
Since the middle classesbave moved to pdvate healtheMe
providers. the pOOl' quality of health servicestbemargina1ised
secHons aloeofferedequatesdole,Tbis has resulted in •• recut'-
rence of mass deaths andatUmes a Joss of eyesight due to neg,.
ligence.Expel'ts opine that a :surgery caUs for the sanctity of
the surgica.l pl'ocedures to be followed that,.nclude the in'vio·
table standards of hygiene., disinfection of the instruments,
monitoring and care of women, which a camp approach is
unlikely to ever meet.
Since population grmvth is largely taking place among the Wit·
erate and poor, they are treated as a herd at steriHsationea.mps.
Then. meeting the targets ll.ccentuates this problem, The ebbat-
tisga:l'hgovermnent had set for itself a targetofsterilising I.Slath
wom(tn in the current year (20 14-15), Its Programme Implementa-
tion Plan was discussed in August .and approved by the Centre in
OCtober. 201.4, after which funds were l'eleased. 1be state medical
depw'bll enthad less than five months to Mfdl the target-Efforts
to meeting ta.rgets lead to the use of coercion by the ground staff,
Even the poor do Ilot want man>' children. Solutions should be
sought in a wa~lthat r~st~or~si'aith in thepubUc b~alth system by
protecting the rights of the pOOl'to live with dignity.
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Serious lapses in sterilisation drive exposed
NEW DELHI
An independent investigation into the deaths of 16 women at a Chattlsgarh sterilisation camp in
November found the doctor and his staff used the same needles for all the procedures and never
changed their gloves.
The WOmendied after being paid to have the surgery at the state-run camp, which also left dozens in
hospital and sparked widespread criticism of the family planning programme.
Authorities have blamed the deaths on the drugs given to the women after the operations, which they
said were laced with a chemical commonly found In rat poison.
An investigation by a team from four public health organisatlons found that the doctor and his staff
operated on the 83 women in unhygienic conditions and that some of them probably died of infection.
A join team from Population Foundation of India, Parivar Seva Sanstha, Family Planning Association of
India and Common Health went to one of the sites where a free laparoscopic tubectomy camp was
held.
"None of the staff changed their hand gloves in between the procedures. The same injection needle
and syringe, and the suture needle were used for all the cases," the team's resulting repOlt said.
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Published on DOW7 To Earth (http://www.downtoearth.org.in)
Operation cover-up
Author(s):
Jyotsna Singh [1]
Issue Date:
2014-12-31
Rat poison theory offered by the Chhattisgarh government to explain the sterilisation
deaths is a facade, finds an investigation by Jyotsna Singh. The deaths have
exposed deep flaws in India's approach to family planning
As the news ofthe deaths of women sterilised at a camp at Takhatpur block of
Bilaspur district started to filter in on November 10, officers in Chhattisgarh's health
department pro-actively called all the 83 women present at the camp to hospitals in the
district headquarters. Then, news came that women who had attended other camps
too were feeling unwell. Within hours, the operation to gather all the 137 women who
were sterilised in four camps-one on November 8 at Nemi Chand Jain hospital in Sikri,
Takhatpur, and three on November 10 in Gaurella block-was initiated. (See 'How the
tragedy unfolded').
Once the women's health stabilised, they were sent home with a bag of goodies that
included a shawl, blanket, saree, salt and a kit oftoiletries for their babies. The
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administration began brainstorming the cause of deaths. It sought the list of medicines
given to the women post-surgery in all four camps. Four drugs were common in the Iist-
diazepam, ibuprofen, ciprofloxacin and povidine iodine. Looking at the symptoms of
the affected women, they zeroed in on two drugs, namely ibuprofen and ciprofloxacin.
Of these, ibuprofen tablets were manufactured in 2013 and were in circulation for
some time and, therefore, considered safe.
How the tragedy unfolded
An account of what happened in Takhatpur from
NovemberB onwards
• First camp held at Takhatpur. Eighty-three
'M>men sterilised
• Three camps at Gaurella, Marwahi and Pendra villages. Fifty-four
'M>men sterilised
• R K Gupta, surgeon who operated upon women in Takhatpur,
arrested by police
• Compensation increased toRs 4 lakh for the deceased and Rs
50,000 for survivors
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• Fixed deposit of Rs 2 lakh announced for each child of the
deceased
"We found that ciprofloxacin, on the other hand, was manufactured in October 2014.
This made us suspicious and we tested it," said Ayyaj Fakirbhai Tamboli, mission
director, National Rural Health Mission (NRHM), Chhattisgarh. Preliminary tests of
ciprofloxacin tablets showed they were contaminated by zinc phosphide, commonly
used as a rodent killer. The state government says the labs in Delhi, Nagpur and
Kolkata have confirmed the presence of rat poison but it has not made the reports
public. The owners of Raipur-based Mahawar Pharmaceutical Private Limited and
Bilaspur-based Kavita Pharma were arrested for culpable homicide.
The culprit had been fOUnd.The poison that killed the women had been discovered. Or
so it seemed.
Dularin Patel, 27, of Lokhandi village in Takhatpur was one of the 13 women who died.
"She was fine till Monday afternoon when she visited us. She had taken medicines on
Saturday night and twice on Sunday," says Gorabai, Dularin's mother. "She started
vomiting from 40' clock in the evening. Then, we got a call from her in-laws, who stay
70 km away, that the mitanin (local health worker) has asked her to go to the hospital.
By 3 o'clock on Tuesday morning, she was in Chhattisgarh Institute of Medical
Sciences (CIMS)."
"I fed my daughter black tea and bread toast before she left home. I did not-know that
was going to be her last meal," says Dularin's mother, not being able to contain tears
in her eyes. By early evening on Tuesday, Dularin was declared dead.
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anjeeta Suryavanshi of Nirtu village in Takhatpur
lock died on the night of November 10. Her
usband said he was not given the post-mortem
eport despite asking the doctor. Her one-month-old
hild has no option but to live on powdered milk
Photographs: Jyotsna Singh)Preliminary results of
he post-mortems of the victims have been
ubmitted to the investigating agencies. They have
ot been disclosed to the public but a senior
edical officer who closely monitored the post-
ortems told Down To Earth (DTE) that Dularin had
eveloped septicaemia. "She had inflammation of
he peritoneum, the membrane forming the lining of
he abdominal cavity. There was half-a-litre of thick
ellowish fluid in her lungs and septic foci was found
n all organs," said the source, requesting not to be
amed. "This is a clear-cut case of postoperative
nfection."
DTE has accessed seven post-mortem reports. Five of these are of women who died
on November 11, one of a November 12 victim and one of November 13. All five
reports from the first day showed infection ofthe abdomen. The report from the second
day showed high infection in the body. The report from the third day showed septic
shock.
"This shows the infection kept increasing among women who were sterilised on
November 8. The results show definitively that the women got infection which must
have come through unsterilised instruments," says a forensic expert at Lady Hardinge
Medical College in Delhi.
The administration's beautifully crafted story of contaminated medicines collapses.
The women were prescribed one tablet each of two medicines, twice a day for five
days. One of the medicines was the antibiotic ciprofloxacin, which the administration
claimed was contaminated with rat poison, zinc phosphide.
Zinc phosphide is linked to kidney failure. "We did not get any renal failure in our post-
mortems," informed the source. He said the infected laparoscope must have been the
reason for the deaths.
As the forensic expert in Delhi explains, zinc phosphide poisoning shows up as
ulceration of the gastrointestinal tract. The source confirmed that signs of this were
missing in post-mortems. However, confirmation of poisoning can only be through
viscera report, which is awaited.
The health department's second assertion too falls flat. It said apart from the women
who underwent sterilisation operations, 26 more people fell sick after consuming the
same medicine. Six ofthem died.DTE accessed the post-mortem reports of three of KMC/P 100
the six. "There was no peculiar finding in their post-mortems. These can only be
g
confirmed after the chemical analysis of viscera," said the source.
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Though the officials claim that medicines are the culprit, they refuse to provide the
details, saying the matter is sub judice. The only information they are ready to part with
is that two laboratories have confirmed that the medicines were contaminated with zinc
phosphide. They would not say what was the concentration of the contaminant.
Experts do not believe this theory. "According to standard books, an adult female
needs to consume 4.5 g of zinc phosphide to die," says B L Chaudhary, from the
Department of Forensic Medicine and Toxicology at Lady Hardinge Medical College.
The Chhattisgarh administration claims that 500 mg tablets of the antibiotic were
contaminated. For the sake of argument, even if one assumes that the entire 500 mg
was zinc phosphide, a woman would have to consume nine tablets for the poison to
prove fatal. Most women started to complain from Monday. By this time, they had taken
three to five doses of the antibiotic. This casts doubt on the poisoning argument.
Citing some of these gaps, this reporter asked the officials about an alternative line of
investigation. "This seems quite conclusive to us. We are not looking at any other
theory. The rest, the lab reports and other tests will tell," said Tamboli of NRHM.
The state government has set up a one-member judicial commission to investigate the
deaths. It has to collect testimonies of the survivors. But the commission seems to
have placed the responsibility of reporting grievances on the survivors. People wishing
to give testimony will have to visit the commission's office in Bilaspur city which
remains closed most of the time. "It is impossible to understand how the poor,
uneducated and sick women will travel to this place," says Sulakshana Nandi, Raipur-
based member of Jan Swasthya Abhiyan, the India chapter of People's Health
Movement.
The Bilaspur fiasco has also exposed irregularities in drug procurement. The much-
maligned ciprofloxacin was purchased locally by Chief Medical and Health Officer
(CMHO) R K Bhange. An official in the health department informed DTE that
Chhattisgarh Medical Services Corporation Limited (CGMSCL) has written to at least
one inquiry team, stating that the antibiotic stock was available with the authority on
November 8.
"The CMHO has the discretion to buy medicines or procure from CGMSCL. Following
good practice, he should have chosen the government agency, where the tenders are
invited from companies that have been certified by accredited labs," said the official.
"It was a double whammy for the women. The tragedy happened due to multiple
reasons. Firstly, the operations were conducted in pathetic and absolutely unsafe
conditions, leaving the women medically vulnerable. Then they were fed contaminated
medicines," says T Sundararaman, founding director, Chhattisgarh State Health
Resource Centre and faculty, Jawaharlal Nehru University (JNU), Delhi. "All these
factors should be investigated by an independent team. The state should be held
responsible for bungling on all the fronts."
Things don't change
The manner in which the operations were conducted paints a disturbing picture. It
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resembles a scene straight out of the documentary on sterilisation, Something Like a
War, by Bengaluru-based filmmaker DeepaDhanraj, where a gynaecologist boasts:
This year, I have done more than 2,000 operations. I could do these in school classes,
college rooms and zilaparishad halls. These operations are so easy. [A woman moans
in severe pain in the background.] I thought of this particular method and I took 45
minutes for the first operation ... Now, I can finish this operation in 45 seconds.
This was 1991. Cut to 2014. Like the gynaecologist in the film, R K Gupta, operating
surgeon at Takhatpur, performed surgeries like an assembly line (see 'Evil of
efficiency). He was awarded by the state government on January 26,2014, for a
record 50,000 surgeries in his career.
£viIof eflklency
1tjj>(oo~'ee tI~rd(aflffJ~tiUll'ttl(l1s lOt S(('fMl\\dtJOO if1 J989 (alrl!Jaf€O roo ~h l,:;p¥fISWfJ/r SfenlM'lOO .~
(akefM'.~. ~o sht:7uIbdepresent duriJlJr~ .Ito llil ~ fOf'IIec:roriiJfIiff-.savinBsk'ps art' skqJ~ or
{it'ftorlnlJd by IJl(t!IfIPt'telN st;tf{
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Accounts of healthcare providers at the Takhatpur camp show gross violation of the
2006 guidelines, Standards for Female and Male Sterilisation (see 'Flouting of norms
on November 8'). Even basic medical ethics went for a toss. According to the
accounts, women started coming to the camp from 10.30 am. Their blood and urine
tests were conducted by junior doctors. It was only at around 3.15 pm that R K Gupta
came and he was gone by 5.00 pm after operating 83 women, giving less than one-
and-a-half minutes to each woman. The same syringe and suture needle were used for
all the women. The staff did not even change their gloves. The hospital floor was just
mopped, on which the operated women lay down in the absence of beds. "This is a
sure-shot recipe for fatal infection. The women could have acquired infection at any
stage," says Subha Sri, member, Common Health, a non-profit working on maternal
and neonatal health.
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• Event at the camps
• 1. 83 women sterilised
,
; 2. One doctor sterilised them all
)
.8. Operation theatre was cleaned with a mop
) Guidelines of 2006
; 1. Only 30 persons to be sterlised in one camp
f
~3. Prescribed standards would take an average of 5-6 minutes per
case
; 8. The operation theatre should be fumigated thoroughly by burning
formaldehyde tablets and liquid ammonia 48 hours before the
surgery
Fatal planning
India has alVL6Ysleaned heavily on sterilisation, neglecting other methods of birth
control
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Ithough
contraceptive pills are advertised on house walls in Lokhandi village, few women are
aware of these options
On being asked if she knows about spacing methods like intra uterine device (IUD) or
contraceptive pills, Takhatpur survivor Rina Patel answered in the negative. She also
said that no one counselled her at the camp about side effects and post-operation
precautions after sterilisation. (See 'Sterilisation overdrive'.)
Overemphasis on sterilisation has its roots in the policy followed
by India since 1952 when it became the first nation to adopt an
119,104
womensterilistld in 1.142camps
in dmattisgam in 2013-14
official family planning programme. A United Nations Advisory
Mission visited India in 1965 and persuaded the government to
fix targets for widespread use of IUDs. The next year, the
government set up a department of family planning within the
850/0
~13.09croce) oftfN!
state'sexpmdiwlll on
family planning (fl!i09
CCO'l"9w)as on tubKtomy
health ministry. While IUDs did not become popular, India
embarked on a target-driven, camp-based approach. Incentives
in the form of money and goods like transistors were offered to
sterilisation candidates.
The first camp was organised in 1970 in Ernakulam, Kerala, for
vasectomies. Other parts of the country followed and in 1970-71,
1%
nearly 1.3 million vasectomies took place in India. During
Emergency, scores of men were coerced into vasectomy.
~14 lakh}was spent 00
spacing I'Mthods
Addressing the joint conference of the Association of Physicians
in India in January 1976, then prime minister Indira Gandhi said,
"We must now act decisively and bring down the birth
rate ...Some personal rights have to be held in abeyance for the human rights ofthe
nation." Nearly 6.5 million men were sterilised by the end of 1977.
Gandhi had to pay.a price after 1,774 sterilisation-related deaths and her party lost the
elections after the Emergency. "The lesson learnt was: don't touch the men. And then,
the focus shifted to women," says Mohan Rao, professor of public health, at JawaharlalKMC/pg 104
Nehru University in Delhi.
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The department of family planning was also renamed department of family welfare to
make it sound more agreeable. Following a spurt in female sterilisations and
irregularities in operations, the ministry issued guidelines for sterilisation. By the late
1990s the expenditure on family planning overtook the health budget (see 'Skewed
Investment'). "It is a lopsided priority," says Rao. "Better health will help control birth
rates, too. Healthier people, especially children, will mean low infant mortality rate,
encouraging people to reproduce less."
The National Population Policy of 2000 discouraged targets. But in reality it is targets
that hold sway. The target for Takhatpur block, which has 39 sub-centres, for 2014-15
was 2,121 sterilisations, including 1,800 women, explains Poonam Muttreja, executive
director of the national non-profit, Population Foundation of India, that recently released
a fact-finding report on the Bilaspur deaths. It was further divided among local health
workers, so the average target for female sterilisation per worker was 46.
Ske•• d investment
Annual government expenditure on family planning has
overtaken the total health budget since Independence
-
ExpmdIWre 001family IlhMlllt
_
tmaJllealUl~lWn!
=
a",2,5•6•<:.
fl,OJOOt
a,8ZOCI
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I
I
,.19SHO
1961-6S lt68r14 1975-lIO 1'OO-fJS 1985-'JO
III
IV
V
VI
\\I'll
fi¥,~,.,r
'failS
1991-W Im~
\\l1U
IX
I
By the time each state's budget is decided under National Rural Health Mission
(NRHM) and the money reaches the block, half the year is lost. As a result, most of the
camps are crammed into a narrow period of October to February. The camp approach
is being questioned after the Bilaspur tragedy in the new guidelines on sterilisations to
be released in 2015.
Incentives continue to be the norm. A letter by NRHM issued in October says that family
planning is crucial to meet Millennium Development Goals. Citing the Family Planning
2020 document, it explains that the recently computed global goals also underline the
importance of sterilisation in family planning. It, thus, revised compensation for
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12.3 Page 113 |
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sterilisation-from Rs 600 to Rs 1,400 for each sterilisation candidate, and from Rs 75
to Rs 150 for the surgeon. The budget for each sterilisation was doubled from Rs
1,000 to Rs 2,000. The revision made tubectomy a lucrative option for surgeons, luring
them into the number game.
The role of foreign agencies
International agencies too have played a role in shaping India's policy. In 1952,
international agency Ford Foundation gave $9 million to India for family planning. When
Indira Gandhi spoke of national rights over personal rights, she was under instructions
from the World Bank to bring down India's population growth if the country wanted food
for its hungry.
From 2007-2012, India's family planning was primarily funded by USAID, World Bank
and Department for International Development of the UK government. They contributed
$1 billion. The funding came under attack in 2012, after sterilised women of a camp in
Bihar's Araria district complained to the police of irregularities. At present, family
planning is funded only by the Indian Government.
But international agencies continue to influence policies of the developing world. In
November this year, pharma major Pfizer and non-profits Bill & Melinda Gates
Foundation (BMGF) and Children's Investment Fund Foundation announced expansion
plans for injectable contraceptive, Sayana Press. This is part of BMGF's $1 billion
project on population control. Sayana Press is made of the same chemical as Depo
Provera, medroxyprogesterone acetate. Depo Provera has been criticised for adverse
health impacts. "Side-effects of Depo Provera include heavy bleeding, amenorrhoea,
depression, weight gain, breast tenderness, bone thinning, liver damage and cancers,"
says Subha Sri of Common Health.
BMGF is sponsoring trials in Africa to see if it is practical for women to inject
themselves. "This makes it scarier. If self-administered, the hazards include increased
chances of HIV transmission," says Sri. Though India has not yet been mentioned by
Sayana Press's promoters, it is a matter of time before the discussions begin, experts
think.
Analysts believe the reasons for international agencies' interest in developing
countries' populations are much deeper. "Population policies shift the blame for
poverty, climate change and food crises on to the poor and suggest that existing
development models which benefit corporate capital and which are intensifying poverty
and inequality don't need to be changed," says Kalpana Wilson, who teaches at the
Gender Institute, London School of Economics.
Time for a change
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on of Dularin, who died after sterilisation, still
hinks that his mother is at his maternal
randmother's house and will return in a few
aysSince the the tragedy in Chhattisgarh,
octors, policy-makers and public health experts
have been trying to find ways to avoid a repeat. A
eam of doctors from AIIMS in Delhi went to
Bilaspur to help the doctors there provide the best
reatment to the ailing women. Teams of non-
overnmental organisations too went on fact-
Inding missions. The state government has set-up
judicial inquiry, as well as a health department
probe while police investigates the case. While
the probe reports are yet to be released, public
health experts and other concerned people have
uggested some short-term and long-term
olutions.
sking for the operations to be shifted from
amps to proper health facilities, Brinda Karat,
ormer member of Parliament and a prominent
voice on women's issues, said, "The choice of whether to reproduce, method of birth-
control and time should rest with the individual. Sterilisation as an individual's choice
has to be provided in a proper health facility through the year."
Consensus among the experts is that in the long-term India needs a thorough review
and overhauling of its family planning programme. An overwhelming demand is to stop
using monetary incentives to attract people to unsafe family planning practices. Target-
based sterilisation must end. Instead of camps, family planning programmes should be
available as part of regular healthcare services. It has to be ensured that women alone
are not targeted for sterlisation and a basket of contraceptive methods is made
available to families. They demand that the women in Bilaspur be provided justice and
their healthcare needs be met. They also suggest that government doctors be trained
to carry out such surgeries safely. In the light ofthe alleged role of contaminated
medicine, experts suggest that drug procurement policies should also be reviewed.
It is being pointed out that the rate of population growth in India has now decreased
and the anxiety for speedy population control must stop. According to census of India,
the decadal population growth from 2001-11 came down to 17.6 per cent. It remained
above 21 per cent for the preceeding five decades.
"There is a concept called population momentum. It means that population is growing
because of a large number of people in the reproductive age group. So, even if they
have two to three children only, population growth will be high. We can't do anything
about it," Rao says. Around 60 per cent of the population growth today is due to
population momentum, 20 per cent due to unmet demand offamily planning services
and 20 per cent is due to unwanted reproduction, according to a Planning Commission
report. Still, India continues to spend a large part of its population control budget on
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sterilisation (see 'India's lopsided approach').
n .. -d. d. I d··.' I·... This iterates the need to give up the camp approach to
la S OPSI e .family planning. "The goalpost of the family planning
approach
debate has shifted. Now women themselves seek family
planning services. They do not want more than two-three
Tubectomy takes the
children. We have to see to it that their demand is met,"
lion's share
. 85% says T Sundararaman, founding director, Chhattisgarh
t.·~e~le State Health Research Centre. Integrating family planning
s en !Satlon with the rest of the public system would remove the need
for incentives to meet targets. "We do not need separate
camps. The government can fix one day a week when a
laparoscopic surgeon would be present for sterilisation,"
he says.
t.45%.
Spacing method
source: poputation Foundation at India
The main challenge is shortage of trained surgeons.
"Bilaspur has two surgeons in the district hospital who are
trained in laparoscopy. These surgeons perform other
surgeries too. How can we start a weekly service?" asks
S K Nanda, superintendent, Bilaspur District Hospital. To
this, Sundararaman suggests training more doctors.
Birth-control break-Up Alok Banerjee, member of technical committee on family
0.6% Other
65.7% planning of Government of India, says that
modern methods female minilaptubectomy should be encouraged. "It is a simple
steril:isation and inexpensive procedure. While laparoscopy requires
high competency, this can be learnt faster. Also,
equipments for minilaptubectomy cost a few thousand
rupees, while one laparascope costs Rs 10 lakh. Its
success rate is also higher. It is not promoted because
even a trained surgeon would take 10-15 minutes to
perform one surgery. But it is time we cared for meeting
demands and providing safe operations than rushing to
sterilise more people," he says.
6.6. % 10.1% 11.7%
Pill Male
Traditional Jashodhara Dasgupta, convenor of National Alliance for
condom methods Maternal Health and Human Rights, says it is
3.1% IUD
disappointing that India has not been able to provide
2.0% Mate sterilisation
basic human rights to women. A pledge to ensure this
was taken 20 years ago. In 1994, at the UN conference on
population and development held in Cairo, a 20-year
action plan was adopted. This action plan asked countries to consider women's needs
instead of blindly following demographic demands when planning population control
strategies.
Basket of different options for sterilisation also includes male sterilisation which does
not receive any focus. Apart from the fact that women are seen as easy target for
KMC/Pg 108
motivation to sterilise, awareness is also an issue. "Vasectomy is surrounded by many
myths like impotency. Government should create awareness and motivate more men
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to opt for it," says Sri.
A report by a fact-finding mission says that the tragedy in Chhattisgarh was waiting to
happen. In 1974, Karan Singh, the then health minister had declared: "development is
the best contraceptive". This was ignored at that time. The time has now come to
understand this basic concept.
Alok Banerjee,a member ofthe technical committee
that is redrafting the 2006 guidelines on family
planning, spoke to Down To Eat1h about the impactor
the deaths. Excerpts
What challenges does India face in family planning?
! There is non-adherence to national standards and gUidelines. The camp sites
! are
d properly, patients are not screened by surgeons and many other
: \\4
. Quatityofdrugs, their procurement. storage and supply
~i are also compromised.
r. the new re\\4sed gUidelines were to be released on Nowmber 18-
would be released in 2015. According to the proposed guidelines,
re to be trained for sterUisation at MBSS lew/. More emphasis is to be
spacing methods. Having a counsellor at district hospitals and community
health centres would be made mandatory.
visit force a rethink on any suggestions you were planning to
committee?
e to itthatstrong emphasis is placed on phasing outthe camps. Also,l
e
n minilaptubectomy.
successfully implement the position of counsellor in public health
ensure proper follow-up care. then long acting hormonal methods
ei
s, implants and vaginal rings can be introduced. In any case,
spacing methods haw to be widely promoted.
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Survivors of Bilaspur sterilisation tragedy face
locked gate at inquiry panel office
Aarefa Johm;
Dt'c 2,2014' 05:30 am
In the three weeks after botched sterilisations killed 13 women in Bilaspur district, the Chhattisgarh government
has sacked the surgeon responsible for the tubectomies, ensured the arrest of the drug manufacturers who
supplied medicines infested with rat poison, and appointed a judicial commission to investigate the case.
But activists in the district are not sure if the victims and survivors of the tragedy will see justice all the way
through.
The one-member inquiry commission, they say, has made no real efforts to collect the testimonies of the
survivors since it was appointed on November 14. Anita Jha, the retired district and sessions judge in charge of
the inquiry, has so far made just one field visit. She also does not sit in the office where she is supposed to
conduct the inquiry, say activists.
The aim of the judicial commission is to investigate the circumstances that led to the deaths and whether the
doctors and camp organisers followed due protocol for the tubectom.ies. On November 17, three days after the
commission was appointed, Jha visitedthe hospital in Pendari village where a sterilisation camp led to 12 of the
13 deaths.
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Any individual or organisation wishing to record a testimonial is expected to me an affidavit and submit it at the
commission's office in Bilaspur city.
"The commission has published notices in Hindi in the local newspapers to inform the public about the
procedure for filing the affidavit, but how do they expect illiterate people in villages to access this information?"
said a field worker from Bilaspur district, speaking to Scroll.in on condition of anonymity.
Besides the 13 deaths, the botched surgeries in at least four different family planning camps left more than 130
women seriously ill. All of them come from poverty-stricken families who opted for the tubectomies largely for
the monetary compensation they were given. "Despite this, the commission expects these villagers to bear the
cost ofthe stamp papers for the affidavits and travel to the city to submit them," said the field worker.
To top this, Jha is not to be found at the inquiry commission's office, say activists. The office - whose address
. has been published in the newspaper notifications as the place where affidavits are to be submitted - is in
Bilaspur city's New Composite Building, while Jha has been sitting at Ciruit House, a kind of rest house a
kilometre away.
Satyabhama Awasthi, a social worker from the city who visited the commission's office, claims that the gate at
the building's main entrance appears locked all day.
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"When I visited the office, the guard directed me to a different gate for entry, but the main gate under the
actual signboard of the commission remains locked," said Awasthi. "Anyone coming to file an affidavit would
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Inside the office, it is Jha's secretary Nirmal Tigga, an additional collector by rank, who sits to accept people's
submissions. December 8 is the last day for filing affidavits, but Awasthi says not a single one has been
submitted so far.
While the outcome of the Jha commission is awaited, the history of judicial commissions across India - and in
Chhattisgarh in particular - has left many sceptical.
In 2011, soon after scores of houses were artackcdand torched in the villages of Tadmetla, Morpalli and
Timmapuram in Dantewada - allegedly by security forces - a judicial commission was appointed to look into
the matter. More than three years down the line, the commission's inquiry is still incomplete. "In the case of
Tadmetla, the local superintendent of police was initially transferred out of the area for the sake of a fair probe,
but the same officer is now back and has been given a higher post," said Sudha Bharadwaj, a human rights
lawyer based in Bilaspur.
Similarly, a commission set up to probe the killing of eight villagers in Edesmeta, Bijapur district, in May 2013
has also not submitted its report yet.
Anita Jha, who is now in charge of investigating the Bilaspur sterilisation deaths, has her own previous record to
answer for. In 2012, she was put in charge ofa cCHnrnission to probe the alleged fake encounter of Meena
Khalkho, a 16-year-old tribal girl from Sarguja district.
"Because the Jha commission was appointed, a magisterial inquiry that would have looked into the Meena
Khalko case was cancelled," said Bharadwaj. "But till today, the commission has not submitted its report."
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Latest New"
Retd District and Session Jud&e AKita Jilatoillvestil3fe the case
Commission to submit l'eportin three month.s
Statf' Government hasconstituted single-member probe commission to investigate the case ofsterilization surgery camps
held at Sankri (Pendari), Gaurela, Pendra and!\\lanva.ii area of Bilaspur distt"id inChhattisgarh, where 13 women die-dandse'Veral
fell critically ill after undergoing surgery. Considering the case on aserious note, Chief ).1i.ni.sterDr Raman Singh annQunced an
ti."1biased andtransparent judicial probe 1."1the case yesterday. Takingimmediare action on hisannouncement, General
Administration Department (GAD I issued notification onyesterday evening from Mantralaya (Mahanadi Bhavan) regarding
formation of theCommissioo.
As per the notification, single-member probecommission has been constitlJte~ and RetdDistrict and Session Judge Anita
Jhahasbeen entrUSted\\vith the responsibitirj' of investigation. Commission \\villsubmit its report to State Government within three
months from the date onwhich this notification was published. It has .been stated in the notificationthatsterilization surgery
camps were organized at Sankri(pendari) of BilaspurdistrictOfi November S, 3ndat Gaurela,Pendra and l\\ianvahi on November
to.After undergoing surgery at these camps, many \\vomen complained ofdeterioratinghea1t:h. 13 of these wome:ndied and many
other are in critical conditionutldergoing .treatment in various hospitals of Bi1.aspurdistrict StateGov-ernment is of the opinion that
judicialpmbe isnecessaty in this case ofpublic importance. Commission \\"\\111investigatioothe case on fo!io,ving pointsofpublic
importance ;. 1) Was the standard protocol followed in these camps?2) What circumstances led to this incident? 3) Were the
me<licines usedint1:lesecmlps were of standard quality 4) .\\\\'hoare the·ones accountable for.thisincident? 5) What measures C$
be taken to avoid recurrence ofsuChincidences:6) Suggestions regardingGenOOr Equality in Family Welfare Programmes of
state.7) Probing on I:hepoints, which Commission considers to be of publiclmpo!tince. State Govtmmenthasformed this
Commission f-or special.probe ofpUblic importance, by exercising its powetscooferred undfrSecnon-3 ofJudicial Commission
Act (60 of 1952). Commission may take help fromanyorganizatio!l't~xpert wlli1einvestigating Qntechrtical subjects/points.
numberl668/SwarajyaiSana