Volume 379, Issue 9835, Page 2415, 30 June 2012
Uzbekistan accused of forced sterilisation campaign
By Ed Holt
Doctors in Uzbekistan have spoken out about the government's alleged attempts to control the population rate by encouraging coercive sterilisations of women. (Alexander Zemlianichenko/AP/Press Association Images)
A nationwide campaign of forced sterilisation is being undertaken in Uzbekistan as the autocratic regime in the poverty-stricken former Soviet state looks to impose population controls and head off potentially enormous socioeconomic problems, it has been claimed.
Victims and doctors have spoken to international media laying bare the extent of a secret sterilisation programme, which they say has been going on for years and which is estimated may have involved tens of thousands of women so far.
Reports in world media cited medical workers, speaking on condition of anonymity, outlining how the state's repressive and highly secretive regime officially sanctioned and encouraged sterilisation as a birth control method more than 2 years ago. Doctors have since been put under pressure to ensure monthly sterilisation quotas are met and ordered to actively persuade women to undergo the procedure.
Some doctors admitted that they tricked women into agreeing to sterilisation, taking advantage of poor public health awareness, caused in part by the attitude of the authorities to providing information, or playing on poor people's fears of the financial burdens of large families. But more chillingly, some also seemed to admit to doing sterilisations without the patient's consent. The main method inferred was tying off fallopian tubes during caesarean sections. Women interviewed in the reports spoke of how they had been sterilised during caesarean births, only discovering months later what had happened to them.
However, the repressive nature of the regime means that the claims are almost impossible to verify independently. The authorities of autocratic president Islam Karimov, who has ruled the central Asian state of 28 million for more than 20 years, have almost complete control over information. The government issued a furious rebuttal of the reports when they emerged earlier this year.
But speaking to The Lancet, the head of one of the few independent non-governmental organisations still functioning in the country, Sukhrobjon Ismoilov, Director of the Expert Working Group, confirmed many of the claims in the media reports.
His organisation undertook a 7-month study of sterilisation practices in 2010, gathering evidence of almost 80 000 sterilisations, although it was impossible to confirm how many had been forced. Since the media reports emerged, his group has begun a new survey, speaking to doctors in many areas. He told The Lancet: “While the government decree on sterilisation says it should be performed based on informed consent…in most cases in practice women are pressurised, tricked, or even threatened into undergoing it.”
“Gynaecologists working in urban areas are regularly sent on missions to rural localities all over Uzbekistan to carry out forced sterilisations in local hospitals and clinics.”
He added that doctors had said that “the procedure is very often performed without the woman's knowledge in instances where she has had surgery for an unrelated condition eg, sclerocystosis, appendicitis, c-section, etc.”
Ismoilov also said that claims that the government had ordered the sterilisations to improve maternal and infant mortality figures to show the country in a good light internationally were partially correct. But fear of widespread social unrest could also be behind the campaign. “There are only two major reasons to do this. The first is demographic control as the government is facing huge social-economic pressure due to fast population growth and the failure of economic reforms. The second is maternal and infant mortality control”, he told The Lancet.
According to data from the UN, Uzbekistan's maternal mortality ratio improved by more than 40% between 1990 and 2008 to 30 deaths per 100 000 livebirths. Its infant mortality rate remains high at 48 deaths per 100 000 livebirths but it too has dropped substantially in the past 20 years.
Since the media reports, rights groups have called for international action. The pressure group Avaaz has demanded US Secretary of State Hillary Clinton address the issue with President Karimov. Ismoilov also said international agencies, such as WHO, which is active in Uzbekistan, should undertake an independent review of the claims. WHO declined to comment when contacted by The Lancet.
However, while many major international organisations, including the WHO and USAID, work in cooperation with the government on various health-care projects, privately, some foreign workers in the health sector have admitted to The Lancet that speaking out in any way against the authorities could have “serious consequences” for their operations.