India should eliminate "coercive female sterilization practices" as it moves to expand contraceptive services, human rights watchdogs said Thursday.
As GlobalPost reported in 2010, obsession with the Millennium Development targets pushed India back to incentive-based family planning, something the country first visited in the 1970s — where dangerous sterilization operations for women are too often presented as the first, and sometimes only, option for birth control. Moreover, the country is outsourcing the work to private clinics — a move that has raised concerns about poor and illiterate women of rural India being pressured or fooled into going under the knife without fully understanding the risks, consequences and alternatives.
The Indian government announced on July 11, 2012, at the London Summit for Family Planning that it has brought about “a paradigm shift” in its approach and will emphasize promotion and provision of contraceptives for birth spacing, according to a press release issued Thursday by Human Rights Watch, the Coalition Against Two Child Norm and Coercive Population Policiesand CommonHealth Coalition for Maternal-Neonatal Health and Safe Abortions.
The Indian government announced that its new strategy focuses on “making contraceptives available at the doorstep through 860,000 community health workers,” providing services for inserting intrauterine devices (IUDs) on fixed days in public health facilities, and improving post-natal services for IUDs, especially in those public health facilities that have large numbers of women coming to give birth, according to the human rights organizations.
But activists remain worried that the government's target-based approach will continue to encourage a "coercive environment" that encourages women to undergo sterilization procedures without knowing their risks or implications.
Since 1996, India has officially had a “target-free” approach to family planning-- meaning that the government has stopped setting centralized targets. But state-level authorities and district health officials still assign targets for health workers for every contraceptive method, including female sterilization, according to Human Rights Watch.
Of greater concern, authorities threaten health workers with salary cuts or dismissals if they miss those targets, especially for female sterilization, the rights watchdog said. The result is that some women undergo sterilization without knowing the risks, or even that the process is irreversible.
“Health workers who miss sterilization targets because they give proper counseling and accurate information about contraception risk losing their jobs in many parts of the country,” the press release quoted Aruna Kashyap, women’s rights researcher at Human Rights Watch, as saying. “The Indian government should work with civil society to ensure that mechanisms to monitor progress in contraceptive use emphasize quality and respect for reproductive rights.”
In June, more than 50 health workers interviewed by Human Rights Watch said that district and sub-district authorities assigned individual yearly targets for contraceptives, with a heavy focus on female sterilization, according to the press release. Almost all of them said that their supervisors or other officials threatened them with adverse consequences if they did not achieve their targets.
Among other consequences, they threatened to cut or withhold the workers' salaries, give them negative performance assessments, and even to suspend or dismiss them from their jobs, Human Rights Watch said.