The recent deaths of at least 15 women at a sterilisation camp in Bilaspur district, Chhattisgarh, once again highlight India's horrifying approach to family planning. While Harsh Vardhan no longer holds the health portfolio, it would remain a cause for grave concern if the government's approach is in line with the statements he made during his time in office.
IN JUNE THIS YEAR, less than a month after taking office, the union health minister Harsh Vardhan declared in an interview to the Deccan Chronicle that “population stabilisation” was high on his agenda. In another interview around two months later to the same paper, Vardhan elaborated on his plans: he intends to revive a controversial draft bill from 1992, which would disqualify anyone with more than two children from membership to parliament or legislative assemblies.
Vardhan’s statements received little attention, and were not discussed in the media. But the government’s moves will merit scrutiny, since the statements suggest that the health minister is ignorant of the globally established fact that coercive population-control measures not only violate human rights but are simply not effective in curbing population growth.
Since family planning and population control fall under the concurrent list of the Indian constitution, both the central government as well as respective state governments have the power to frame laws and policies on these subjects. But while several states have enacted laws on population control in the past three decades, governments in power at the centre have by and large been wary of dealing with the issue since Indira Gandhi’s defeat in the 1977 general elections. That loss, the Congress’s first ever fall from central power, was widely seen as an electoral backlash against Gandhi’s authoritarian actions during the Emergency, prominent among which was the programme of forced vasectomies.
The previous NDA government had, in fact, considered pushing the 1992 draft bill through, with the support of several of its chief ministers. But the coalition fell out of power before it made any significant progress, and the UPA government—particularly the left parties in the coalition—was less enthusiastic, steering clear of introducing any legislation on the subject. With the NDA back in power now, and the issue having resurfaced with Vardhan’s statements, it is worth examining the often vexed questions of family planning and population control against their historical context in India.
The debate on how policymakers should treat the question of population control is broadly split along two lines. In a 1995 essay, titled “Population Policy: Authoritarianism versus Cooperation,” the economist Amartya Sen described these two contrasting approaches in terms of an eighteenth-century dispute between the French mathematician Nicolas de Condorcet, and the English scholar Thomas Malthus. Both felt that population growth was a grave problem; but while Condorcet believed it could be addressed through the “progress of reason,” and by increasing people’s freedom to make decisions, Malthus had no such faith in humankind, believing that populations would tend to grow unless reduced by “preventive checks” such as abstinence, or “positive checks,” such as war, disease and other catastrophes. Sen noted that this scepticism about people’s “ability to make sensible decisions about fertility … led Malthus to oppose the public relief of poverty” as he believed that it encouraged population growth.
In India, the best known measures of population control—and proposals such as the 1992 draft bill—have stemmed from a Malthusian understanding of the problem. Prominent among these was the adoption, through the 1990s and the 2000s, of a two-child norm for panchayat members, which remains in force in Andhra Pradesh, Gujarat, Maharashtra, Odisha and Rajasthan. The implementation of this norm is seen as a way for the government to set an example for people to follow. In some states, the norm also applies to government employees—that is, a person with more than two children can never get a government job, or stand for panchayat elections.
In some of these states—and others, such as Uttar Pradesh and Bihar—family-planning programmes also include the promotion of tubectomy, or female sterilisation, often through mass camps. These are not forced in the manner of the programmes under Indira Gandhi; but as Sen explains in his essay, they often entail forms of indirect coercion, such as offering incentives that the poor find difficult to resist, obtaining uninformed consent for the procedure or conducting insufficient counselling on other temporary forms of contraception, such as condoms and birth control pills.
Though many states—such as Rajasthan—which have a two-child norm for panchayat members also have extensive sterilisation programmes, no study has yet mapped the precise ways in which high-level family-planning intentions translate into and influence the direction of on-ground programmes such as sterilisation camps. But since both are based on a similar neo-Malthusian approach to population control, India’s past record in executing these programmes is very relevant to their immediate future.
While Indira Gandhi’s programme in the 1970s focused on vasectomies, family planning has since shifted overwhelmingly towards female sterilisation. The District Level Household and Facility Survey conducted in 2007–08 revealed a stark statistic that indicated the extent of emphasis on female sterilisation in the country: over 35 percent of married women in the 15–49 age bracket had undergone sterilisation, as against around 1 percent of men in the same age bracket—even though the procedure for men is non-invasive, while for women it carries risks of failure, complication and even death.
According to Mohan Rao, a professor at the Jawaharlal Nehru University and an expert on India’s population policies, this shift occurred because, during the Emergency, “there were political repercussions of large scale coercive male sterilisations for the ruling party.” In his book on family planning in India, Rao quotes from the post-Emergency draft five-year plan (for the years 1978—1983), which stated that “coercion and pressure was witnessed in some parts of the country during the period of internal Emergency in connection with the implementation of the Family Welfare programme.” The draft proposed the establishment of a working group on population dynamics to study the demographic situation and make recommendations. In 1980, the working group noted, without any evidence, that “women are best votaries of the programme” and recommended that the programme “for the immediate future be increasingly centred around women.”
In 2012, an activist named Devika Biswas filed a public interest litigation in the Supreme Court seeking action against the governments of Rajasthan, Madhya Pradesh, Bihar and several other states for failing to follow statutory guidelines for sterilisation programmes. As part of her case, Biswas presented research by the NGO Centre for Health and Social Justice from several Indian states in the last five years, detailing nightmarish scenarios that unfolded as the states attempted to meet sterilisation targets. These, the PIL said, were in violation of laws on screening, counselling and treating women during sterilisation.
The research described filthy “camps” in Rajasthan (the first state to adopt the two-child norm, in 1992) where sterilisation surgeries were conducted on women at a breakneck pace to meet targets set by the state. One doctor sterilised 72 women in one day at Kolayat Hospital in Bikaner district on 23 May 2012, despite a prescribed regulatory limit of 30. According to research from the state’s Bundi district, 88 percent of women were not informed about the likelihood of failure, complications and side effects after sterilisation; 42 percent of the women were not told that sterilisation is permanent. Overall, around 60 percent of women were unaware that sterilisation surgery can cause complications and, in some cases, death.
In the same petition, Biswas also claimed that the determination to meet sterilisation targets had led the government of Bihar to outsource the job to NGOs. According to the petition, in January 2012, 53 poor women were operated upon by one doctor at Kaparfora Government Middle School in the state’s Araria district at night under torchlight within two hours. The doctor did not wash hands, change gloves, or wear a surgical gown and cap during the surgeries, and NGO workers placed the women on straw paddy. When the camp concluded, three women were left with heavy bleeding.
Treating these cases as representative of the government’s implementation of sterilisation programmes, the PIL, which is currently being heard, seeks compensation for women in Bihar who have suffered injuries, and asks the court to instruct the government to abideby the law in conducting sterilisations.
Regardless of the court’s decision in Biswas’s PIL, it would be apt for the health ministry to investigate the gross violation of rights that women allegedly face at these horrifying camps. Such camps represent an extreme outcome of Malthusian principles; the revival of the proposal for a two-child norm for MLAs and MPs would simply be an additional coercive measure along these lines.
Harsh Vardhan’s statements also fail to acknowledge that coercive measures are not effective at controlling population. Amartya Sen made this point in another essay—from 1994—on population titled “Population: Delusion and Reality,” writing that across the world, “conditions of economic security and affluence, wider availability of contraceptive methods, expansion of education (particularly female education), and lower mortality rates” have been found to reduce population growth. “Malthus’s fear that economic and social development could only encourage people to have more children has certainly proved to be radically wrong,” Sen wrote, “and so have all the painful policy implications drawn from it.”
India’s experience has empirically borne out this position. The National Health Family Survey conducted in 2005–06 recorded an average fertility rate of 1.9 for every woman with ten or more years of education, and an average of 3.6 for women who did not receive an education.
Adopting a two-child norm, even if limited to panchayat members, would also violate India’s international commitments on the issue: at the International Conference on Population and Development 1994 in Cairo, India signed on along with 178 other countries to expressly reject the use of incentives, targets and norms in family planning. The governments agreed to respect reproductive rights and gender equality while providing universal access to family planning, sexual and reproductive health services as a population stabilisation measure.
This culminated in the landmark National Population Policy of 2000, under the Vajpayee government, which asserted the centrality of human development, gender equality, and better reproductive health among other factors, in attempts to stabilise population. This progressive, forward-looking policy stated that “stabilising population is not merely a question of making reproductive health services accessible and affordable, but also of increasing the coverage and outreach of primary and secondary education, extending basic amenities like sanitation, safe drinking water and housing, empowering women with enhanced access of education and employment.”
The health minister’s stated intentions are inconsistent with this view, and with India’s commitments in Cairo. His proposal is in its early stages yet, and may dissipate before it can be placed before the cabinet. But in the event that it does progress, and eventually become law, it will signal a deeply regressive move, far more suited to an authoritarian state than a democratic one.