Press Release on Chhattisgarh Sterilization Deaths
NOV 2014
Health Activists and
women’s rights activists held a Press Conference on 19th November to
draw attention to the range of issues raised by the recent tragic and completely
avoidable deaths of more than a dozen women and the critical condition of many
more following their laparoscopic sterilization
in Bilaspur, Chhattisgarh.The manner in which the surgeries were performed, in
complete violation of all standard operating procedures,and subsequent events amount
to grave violation of some very basic health rights of the affected women. In addition, they point to the callous and
biased attitudes towards poor women that persist among health functionaries and
policy makers, and the tenacious hold of the “targets” approach in the family
planning programme despite statements to the contrary.
The said sterilizations were performed
at acamp held on 8 November 2014 in Takhatpur Block of Bilaspur District. The camp had been organized by the State Department
of Health under the National Family Planning Programme to perform laparoscopic
tubectomies, and was conducted in the premises of a non-functioning and
abandoned private hospital. Surgery should not be performed in a hospital that
is abandoned and that does not have basic facilities. These operations are not
urgent and are elective. There is no need to perform them in unsafe areas,
abandoned hospitals or in make shift hospitals as is happening through the
camps.
83 women -predominantly
Dalit, tribal, and OBCs- were subject to sterilization within a short span of 5
hours. It needs to be pointed out that the sterilization procedures flouted two
sets of Supreme Court Orders (Ramakant Rai Vs Govt. of India, 2005 and
Devika Biswas Vs Govt. of India, 2012). These orders instruct that a maximum of
30 operations only can be conducted in a day,and only in government facilities with
2 separate laparoscopes; one doctor cannot perform more than 10 sterilizations
in a day. Notwithstanding such orders, we see that in Bilaspur a single
surgeon performed about three times the permissible number of surgeries (83) in
less than 5 hours in a private hospital which has reportedly remained
closed for 15 years. In
The state government
has announced several measures – monetary compensation and support to the
affected families for care of the children of the dead women; suspension of several
officials, and appointment of an enquiry commission. The High Court has also taken suo moto
cognizance of the tragedy. There are
also statements that the doctor is not to be blamed and that the problem lay
with contaminated medicines that were given to the women. As health activists who have been repeatedly
calling attention to the deep-rooted problems afflicting the health system in
the country and advocating several remedial steps, we believe that these
measures are not adequate and do not touch the systemic and policy factors that
lead to such incidents. We feel that
these are attempts to obfuscate the actual causes of death and the reasons leading
to the incident. A series of issues
need to be addressed in the immediate to medium to long term.
In the short term, a
thorough, impartial and unimpeded investigation and medical audit must be done
immediately, by a competent team of medical and public health professionals, into
the causes of the deaths and the illness of the women who underwent the
sterilization. Accountability and culpability need to be clearly fixed for the deaths
of otherwise healthy women following a medical procedure. That would be one of the first steps towards
ensuring that mistakes and lapses are not repeated and such tragedies do not
recur.Even 10 days later, such an investigation has not been announced by the
state.
It is pertinent to
remember that the failures in implementing guidelines and standards, and other
kinds of violations in the sterilization component of the family planning programme
have been repeatedly raised by civil society groups over the last decade or so,
and are the subject matter of several petitions in the Supreme Court, such as
the two referred to above. Given that a
lot of documentation already exists from several parts of the country, it is
the need of the hour to compile all these evidences to learn the lessons and also
ascertain why its implementation is so shoddy and poor.
In the medium to long
term, severalpolicy matters and systemic issues need to be addressed.Among
these are: (i) to do away with the continued emphasis of the Family Welfare
Programmes on female sterilization in the name of reproductive rights and
reproductive health. It is seen that
despite all the talk and concerns expressed by the state and international
agencies for women’s health and maternal health,at the ground level the action
is centred on such sterilizations and institutional deliveries only for
reducing maternal mortality. The state
still focuses on such permanent methods of contraception rather than provide safe temporary methods for
spacing and increasing access to safe contraceptives. In addition to this,the
two-child norm significantly contributes to the pressures for
sterilisation. Such ‘Camps’
(euphemistically called ‘fixed day static’ camps) are routinely organised in
many States in the country in an irresponsible manner. Health providers in many
parts of India confess that they are under pressure to fulfil unwritten targets
coming from the top.
(ii) to improve the
dismal condition of the government health institutions, make them functional by
improving availability of doctors and
other health personnel and medicines.
Why is it that despite years of planning and allocating money for health
system improvements, under reproductive and child health, under the NRHM, and
despite years of so-called technical assistance for improving health system
management, there are no improvements at the ground level? There is no substitute for increasing
material, human and financial resources to strengthen the primary health
institutions across the country.
This terrible incident
should be taken as a wake-up call.This incident must be declared an emergency,
and we demand that:
1. An independent and comprehensive
epidemiologically-sound investigation into this incident should be carried out.
On the basis of the findings,
responsibility must be fixed in terms of criminal negligence not only on the
medical team which performed the operations, but also in identifying other
officials who sanctioned and were involved in managing this particular camp.
2. Negligence and contributory negligence
may be fixed on all parties involved, including those providing contaminated
surgical equipment, medicines, etc. State is vicariously liable and ought to
pay higher compensations for the lives lost and also to those who are sick.
3. Further deaths and damage arising of
poor quality of health care system, lack of compliance with SOPs, inefficient
oversight system for quality control of healthcare delivery at the grassroots,
and medical negligence should be entirely eliminated.The govt should must be
held Sterilization operations only in well fully equipped government hospitals and sterilized places,
not abandoned hospitals that are shut, or in makeshift places, where
sanitation and cleanliness is compromised and there is a high likelihood of
women undergoing a procedure in acquiring infections.
The
‘camp method’ with incentives and targets of sterilization should be stopped
with immediate effect. Instead, sterilization should be
offered as one of the options among other safe, non hazardous, non invasive,
long acting methods of contraception. It
should be provided as one of the services through an improved basic primary
health care system.
5. The
family planning programme needs a thorough re-analysis and overhauling, that centre-stages
the reproductive and health rights of women. Emphasis should be placed on male responsibility
for family planning, and use of condoms and vasectomy without coercion which
involves far lesser health risks.
Jan Swasthya Abhiyan
Sama Resource Group for
Women and Health
National Alliance for
Maternal Health and Human Rights
Medico Friend Circle
All India Democratic
Women’s Association
National Federation of
Indian Women
Muslim Women’s Forum
Coalition against 2
Child Norm
Healthwatch Forum UP
Initiative for Health
& Equity in Society
Diverse Women for
Diversity
Human Rights Law
Network
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