The tragic deaths of fifteen women as a result of sterilisation procedures in India’s rural Chhattisgarh district have once again drawn the world’s attention to the nation’s struggle with population control. Home to over 1.2 billion people, India’s swelling population is expected to overtake that of China by 2030, reaching a peak that its infrastructure and resources will be unable to support. Yet unsurprisingly this is not a recent phenomenon; a rapidly rising birth rate has seen India’s population grow drastically since its independence in 1947. Therefore, since its earliest years, the Indian government has been forced to consider the controversial concept of ‘population control’.
‘Controversial’ is a mild term to describe the nation’s earliest attempts. During a period of desperate food shortages in the 1970s, which later became known as ‘The Emergency’, Prime Minister Indira Gandhi launched an aggressive mass sterilisation programme, forcing fathers with three or more children to undergo vasectomies. The efforts of the programme, orchestrated by Prime Minister Gandhi’s son Sanjay, primarily focused on poor, lower-caste men living in rural areas, and it is estimated that over 6.2 million men were sterilised against their will in the space of a year. When the public learned of this campaign, there was mass outrage and Mrs Gandhi’s government quickly lost its support and her term came to a rapid close.
In spite of this dark history, sterilisation remains India’s most popular form of birth control, practiced by an estimated 37 per cent of Indian women.  Shockingly, the current sterilisation programme bears a striking resemblance to that of ‘The Emergency’. It retains the element of obligation, as for many there is no viable alternative, and the vast majority of the candidates have the operation as a result of its gender- and socioeconomically-discriminatory policies. Sadly, India’s modern family planning campaign has not yet faced such backlash. However, the prominent deaths of these women have revealed the impracticality of a system that has changed very little over the past 40 years, and it is clear that now is the time for India to reconsider its family planning policy.
The most significant change in the sterilisation policy is that nowadays its efforts are almost entirely focused on poorer rural women. From their perspective, the advantages are clear: it is undeniably the most effective form of contraception, sterilisations performed in government hospitals are free, and the women receive a small incentive fee after the operation. However, the promise of money coerces the desperately poor into having a sterilisation without fully understanding the risks and consequences involved. This has resulted in the majority of operations being performed on some of India’s poorest and most vulnerable women. It has been suggested that this is not a coincidental consequence, with certain rural Indian politicians regarding them as “irresponsible breeders”.
Aside from the intrinsic socioeconomic inequalities present in India’s sterilisation policy, it is also clear that a gender imbalance is present. Women are widely considered to be ‘easier targets’ for persuasion, as Poonam Muttreja, executive director of the Population Foundation of India states, “we can coerce women.” Men are no longer easily convinced by sterilisation, as there is a pervading myth in India that such a procedure would harms a man’s virility, possibly arising from a misunderstanding of the term ‘vasectomy’, which many assume to mean ‘castration’. Unfortunately, the government has done nothing to dispel this myth, and has instead focused its resources on women, despite the fact that the male equivalent involves a much simpler procedure.
Statistically speaking, the system has been arguably successful, as the birth rate in India has fallen to 2.5 children per woman, only slightly higher than the US average of 2.1. However it would be unfair to attribute this drop entirely to the sterilisation programme. Aside from any potential benefits, the tragic deaths at Chhattisgarh and countless others throughout the country have proven that sterilisation is simply an impractical method of birth control in the rural settings where they are most commonly performed. Sterilisation centres have been described as shockingly unsanitary, with women reporting being treated like “cattle”. Conditions are difficult for the government to monitor as they often outsource the work to private clinics, on whom they then impose extreme quotas that encourage healthcare providers to cut corners, leading to surgeons performing up to 80 operations a day (as was the case in Chhattisgarh). This also leads to health workers inventing new ways of coercing women into sterilisation to meet targets, including one particularly shocking case of a health centre offering guns in exchange for operations.
For the sake of equality and public health, it is clear that sterilisation is not the answer to India’s population control problems. However, the problem then lies in finding a suitable alternative, particularly one that addresses the gender and socioeconomic discrimination issues. Other forms of contraception have been discouraged in order to promote sterilisation over the last forty years, so it will take time to change attitudes and reduce taboos towards the use of condoms and oral contraceptives. Long-term solutions such as the IUD are not widely available in India, and are often too expensive for those who would opt for an incentive-based sterilisation. There has also been talk of introducing a ‘one-child policy’ similar to that of China’s, but amid fears that it would exacerbate the existing problem of abandonment of female babies caused by the dowry system, it has been abandoned. One positive alternative to previously discouraged methods is the new Sayana Press, a form of injectable hormonal contraceptive that has been trialled in Burkina Faso. The Sayana Press does not require a syringe (which eliminates the risk of re-using needles) and can be administered by any health worker, although there are plans to develop it so that women can do it themselves. Protection lasts for up to three months, and the injection itself only costs around a dollar to produce.
If India is to effectively curb its population growth in a positive way, it must abandon its incentive-based sterilisation programme and instead focus on the education and empowerment of poor women in rural areas. The prejudiced rhetoric must be discarded in favour of a more positive outlook, and instead of imposing government sterilisations on women, they must be encouraged to make an informed choice on family planning. Education has already successfully lowered population levels: in the state of Kerala, which has recently seen a huge rise in literacy rates, the average birth rate has fallen to 1.7 children per woman. This could be possible for the nation as a whole. India’s family planning policy needs reform, before it causes any further tragedies.