India: 18 yrs post-Cairo's ICPD, sterilisation re-imposed on impoverished women & illiterate tribals Print E-mail


 Magazine | March 12, 2012

Madhya Pradesh: Family Planning, Execution

By Anuradha Raman 

Sitakumari, 38, Kol tribal, Satna. Faced with the threat of having her name struck off the BPL list, she underwent tubectomy on February 15. Had seven daughters, and a son, who died. Wants tubes opened to enable her to conceive again. Needs at least `20,000 for reversal of tubectomy. She is hoping she will have a son. (Narendra Bisht)

Faced with the threat of having her name struck off the BPL list, she underwent tubectomy on February 15. Had seven daughters, and a son, who died. Wants tubes opened to enable her to conceive again. Needs at least `20,000 for reversal of tubectomy. She is hoping she will have a son.

Women and impoverished, illiterate tribals fall prey to Madhya Pradesh’s overweening family planning zeal

Birth Control

  • 1951 Family planning as a policy is launched in independent India
  • 1978 Rechristened Family Welfare after the emergency
  • 2000 National Population Policy aims at stable population by 2045
  • 2010 Madhya Pradesh launches targeted family planning
  • NPP says sterilisation should be last resort in family planning.

***

When Shyam Lal* walked into a primary health centre at Rewa, a dusty little town in Madhya Pradesh which makes news only when the region’s hit by malnutrition or infant deaths, it was to ask the doctor there to treat him for fever. Instead, he found himself being taken to a room and poked with a lot of needles. At some point, the 16-year-old lost consciousness. “I was later told I had been sterilised, after which the doctor and his attendant dumped me on the road and I had to walk back home,” recounts Shyam Lal, still stricken by the experience.

That was on February 16. The enormity of the situation still hasn’t sunk in for Shyam Lal. He now wears a distinction he could well have done without—of being the youngest “unmarried male” to be sterilised in BJP-ruled Madhya Pradesh. He might be 16, but his age has been recorded as 25 on the medical form at the primary health centre where he was sterilised. He has not been paid any compensation.

Shyam Lal, 16, Kol tribal, Rewa Forcibly sterilised on February 16. Was told that he was being treated for fever. Abandoned by the doctor in an unconscious state, had to walk back home after spending the night out in the fields. Has not been compensated for being sterilised by the district officials at Rewa (Narendra Bisht)

A bewildered Shyam Lal is back at hospital, having developed abdominal pain after the ‘procedure’. He’s at the Sanjay Gandhi Memorial Hospital, and surely unaware of the irony that it bears the name of the man who gained notoriety for running the famous nasbandi (sterilisation) campaign during the Emergency years of 1975-77.

Constructed in 2001, the hospital is perhaps an apt postscript to that aborted chapter on population control. Clean, huge and spacious, its premises bustling with people, the in-patient wards are packed to capacity. When we walk into ward B-1, where Shyam Lal is supposed to be admitted, he is not on his bed. Other patients in the room, mainly from the town, seem suspicious of him. “He got beaten up for teasing a girl,” says one. Another lets his sentence hang in mid-air, “You know these tribals....”

A daily-wage labourer, Shyam Lal belongs to the impoverished Kol tribal community. He and other poor and illiterate tribals like him seem to have become unwitting victims of chief minister Shivraj Singh Chauhan’s ambitious zeal to accomplish 7,00,000 sterilisations by March 31. An open admirer of “Sanjay Gandhi’s vision back in the ’70s”, the CM believes there can be no economic growth without serious population control. Hence, his devotion to what he sees as “a noble cause”. Ask him about cases such as Shyam Lal’s and he dismisses them as aberrations, and denies that family planning in the state is a targeted exercise (see interview). Yet, there is far too much evidence on the ground to suggest that simple, illiterate tribal folk are being forced, coaxed and lured to add to the numbers of sterilised people. Other communities, including the minorities, who are usually at the receiving end of the Hindu right’s snide remarks, are not being as aggressively targeted. Outlook’s travels through Satna and Rewa threw up enough instances to show that tribals are being sterilised for as little as Rs 600 and a six-yard saree.

   Shyam Lal, 16, Kol tribal, Rewa Forcibly sterilised on February 16. Was told that he was being treated for fever. Abandoned by the doctor in an unconscious state, had to walk back home after spending the night out in the fields. Has not been compensated for being sterilised by the district officials at Rewa (Narendra Bisht)

 

When we checked the monthly health bulletin on the MP government website, 3,72,230 people had been sterilised, more than half the CM’s target. Of these only 23,316 are males. Since the women are an easier target, there are 10 times more tubectomies than vasectomies.

However, unlike other states, where family planning is an informed choice, the officials in Madhya Pradesh are making the choice for people. And they have set their sights on the more vulnerable sections of society, the poor and illiterate tribals, as well as women. Dependent on the BPL/Antyodya cards, which entitle a family to 25 kg of foodgrain every month, it’s crutches like these that the state administration threatens to withdraw should the tribals not fall in line with its objectives. With no fixed jobs and living on the periphery of the ‘civilised’ world, the poor tribals have no choice but to follow the state’s diktat.

It’s a moot question, though, whether it’s the tribals who need population control. In a state that has close to 20.3 per cent tribal population as per the 2001 census, tribes like the Korkus, belonging to the most backward district of Khandwa, have actually registered low decadal growth—they have grown by 19.3 per cent in the last 10 years, below the state average of 24 per cent. Which means their population has actually declined in this period. Other tribes, like the Kols, Saharias, Mawasis, Kairwars, Gonds and Baigas, have not registered any rapid growth in their population either. There is no logic, therefore, to the zeal with which they are specially being targeted.

Population experts also aver that if the state tackles its infant mortality rate (measured in number of deaths per 1,000 live births of infants less than a year old), the fertility rate too would come down. Orissa has already shown the way—the state has similar social indicators, but its efforts to arrest the rates of infant deaths have worked, with the number of deaths now at 21 per 1,000 live births. MP, on the other hand, continues to have India’s highest infant mortality rate, according to Sample Registration Survey of 2010-2011. Put in cold figures, 67 out of 1,000 infants die at birth here and 89 out of 1,000 infants do not survive beyond age five. Both these figures are worse among tribals, which means they should have the freedom to have more children. “It’s their insurance against deaths,” explains Sachin Jain of Bhopal-based NGO Vikas Samvad. And death is a recurring motif in their lives. If it isn’t infant mortality, then disease takes a toll; even measles can be fatal at times, and with medical care being out of bounds, life’s at a premium.

Lalita, age 35, Kol tribal, Rewa Got sterilised on January 25 when her anganwadi worker informed her that her name would be struck off the BPL list. She has been promised a BPL card; hasn t got one yet. She has also been promised a cooker, television and fridge. There is no power in her home and she walks half a kilometre to fetch water for her family (Narendra Bisht)

But they are being left with no choice. The local administration is using both threat (of withdrawing BPL privileges) and incentive (providing Antyodaya cards, ration cards, even houses; Rs 600 and a six-yard saree for women) to lure them into sterilisation. It’s an elaborately tiered system that flows from the chief minister, down to the principal secretary, chief secretary, collector, the sdms, patwaris to the direct point of contact—the anganwadi worker (see box). The anganwadi worker, a woman, is instructed to bring in 10 people for sterilisation. For her effort, she’s paid Rs 600 for every woman she can get to undergo sterilisation and Rs 1,100 for men. However, should she fail to fulfil her requirement, there’s a threat hanging over her head too. As we found out after a conversation with our cab driver, Sunil Soni. His mot-her, an anganwadi worker in Satna, stands to lose her job if she does not follow the quota system. “So, I help her out occasionally,” he confesses. Only to add hastily, “But I don’t coerce them.” Lalit, a daily-wager in the Majganwa block in Satna, offered to go for a vasectomy to save a part of his anganwadi worker wife Asha’s Rs 1,250 salary. The Kol couple has three children; Asha got herself sterilised last year. “This year, it was a choice of seeing the breadwinner face a salary cut of 15 days as per the collector’s orders, or getting myself sterilised.” Needless to say, he opted for the latter.

In some instances, the lowest-ranked officer of the state, namely the tehsildar or the revenue official, has shot off ‘instructions’ to a family, which of course read more like threats. He is, after all, under threat from the sub-divisional magistrate who, in turn, feels the heat from the district collector. A typical missive reads thus: “Your family is in the BPL list. We have been told that even after three children you have not adopted any family planning methods. You have also been dissuading others from taking to family planning. Hence, it has been decided to remove your name from the BPL list. Kindly respond.”

Being illiterate, the tribals wouldn’t even know what is being threatened. They get the ‘sarkari’ letter read by others, panic and run to the nearest doctor to get sterilised. Which is what Sunita did. On the outskirts of Dabhoura in Rewa, the mother of 12 children proudly displays the sari that she got as a gift for her efforts; the Rs 600 has long been spent. Just two months before the sterilisation, she had delivered a baby boy in a hospital. The institutional delivery too had been motivated by a reward of Rs 1,100, of which Rs 300 is a bribe to local doctors.

Sudesh, 27, Kol tribal, Rewa Lost his parents when young. Mentally unstable and unmarried, he was asked to come and clean his upper-caste neighbour’s house. Was lured with the promise of drugs and sterilised. Picture is of his uncle and aunt. He is the first victim to have lodged an official complaint with the police (Narendra Bisht)

Rewa, the district to which Sunita belongs, has met its target. Which is why she is also part of the post-sterilisation lottery. She has a little slip with a number on it. If the number wins, she gets a refrigerator. It’s another matter what she will do with it—there’s no electricity, water comes from a pump half a kilometre away. The target has been met in the tribal-dominated Khandwa district too; the area has seen 13,000 sterilisations. The Korkus here were promised Antyodaya cards, rations and houses. The paltry cash and saris came easily, the house turned out to be just an illusion. The district heads of Gwalior and Vidisha had expressed their inability to meet the targets. Satna is 2,000 short of the 22,000 target. When we reach a family planning camp in the area, held usually between 2 and 5 pm, we find chief medical officer D.N. Gautam munching grapes and oranges. “I don’t think we’ll be able to reach our target,” he tells us. It is 3 pm, and only one woman has walked in, assisted by an anganwadi worker. She appears to have come in voluntarily, and waits for the surgeon to come from Satna town. Gautam says there’s no point in sterilising women with many children. “It is not our policy to do so. Besides, what will I get?” A merit certificate and Rs 50,000 for meeting targets, we tell him. “Is that really a huge sum, an incentive to force people to sterilise?” he counters. When we remind him of a few cases where it has been so, he replies, “maybe there are a few cases here and there. But we are very alert to such instances”.

Meanwhile, as reports of forced sterilisations seem to mount, CM Chauhan has decided to crack the whip and ask his officials to instruct field staff to exercise caution. It’s a twisted reality if the most unspoilt people of the state have to become dummies for target practice.

(*Some names have been changed.)

***

Target practice in MP

  • Anganwadi: Healthcare facilities are set targets by district officials. Each ‘Asha’ worker has to bring in ten cases for sterilisation. Reward: Rs 600 for each woman lured into tubectomies; Rs 1,100 for each man.
  • Patwari: The local revenue official, empowered to bring in couples, threatens to strike them off the Below Poverty Line (BPL) list if they don't comply. Dangles pattas (land) and awaas (homes) to those who do.
  • SDMs: The sub-divisional magistrates set the anganwadi targets, but very little of what they demand is on paper. Most times, they just instruct juniors to comply.
  • Collector: The ‘mukhia’ of the district, usually an IAS officer, is answerable to the chief secretary. The principal secretary, who is above him, is answerable to the chief minister.

By Anuradha Raman in Satna and Rewa Photographs by Narendra Bisht