While on the one hand the government is pushing for a two-child norm, on the other it is forcibly precluding certain Particularly Vulnerable Tribal Groups (PVTGs) in the country from accessing sterilisation services, thus transgressing their right to access contraception. This only goes to show how government policies are arbitrary in nature and violate the fundamental rights of women by trying to secure control over their bodies and their reproductive rights, without providing any safe contraceptive choices.
On December 13, 1979, an order was issued by the Public Health and Family Welfare Department of Madhya Pradesh (then including Chhattisgarh) placing restrictions on the availability of sterilisation services to PVTGs, who were then called ‘Primitive’ Tribal Groups, as infant mortality rates were excruciatingly high and their numbers were dwindling at a fast rate. Attention was directed only towards increasing their birth rate at the cost of ensuring access to livelihood, health and education facilities.
According to the census of 2011, tribals constitute 30.62% of the total population of Chhattisgarh. There are 42 tribal groups including five PVTGs – Abujmadia, Baiga, Kamar, Birhor and Hill Korva. These PVTGs continue to live in dire poverty, with high levels of impoverishment and malnutrition, and limited access to health and nutrition services, which in turn lead to high mortality rates.
The Jan Swasthya Sahyog (JSS), an organisation working in the health sector and running a hospital in rural Chhattisgarh, conducted a study in 2017 on access to sterilisation and contraceptive services to PVTGs. The study was conducted in two villages, Sarasdol and Chapparwa of Mungeli district, which are situated deep inside the Achanakmar Tiger Reserve. A total of 210 households were surveyed and 200 women were interviewed for the study. The predominant tribal community that lives in these two villages are the Baigas. Baigas were identified as PVTGs because of their stagnant population, high morbidity and mortality, extremely low literacy, pre-agriculture level of technology, subsistence-level economy and dependence on forests for their livelihood. Fertility rates are high among the Baiga community; however, their population remains more or less stagnant due to the high mortality rate.
The findings of the JSS study indicate that while the mean number of pregnancies among Baiga women between the age group of 36-45 years was found to be 5.5, the average number of pregnancies for their non Baiga counterparts was 3.5. Out of the 154 Baiga respondents, 150 (97.4%) reported that they have knowledge about female sterilisation, 17(11%) women were knew about vasectomies, 21(13.6%) of condoms, 30 (19.4%) of contraceptive pills and 32 (20.7%) reported awareness about the Intra Uterine Contraceptive Device (IUCD). IUCDs was only utilised by three (1.5%) women and no one was found to be using condoms and/or contraceptive pills.
Out of the 154 Baiga women interviewed, 29 women had spontaneous abortions while 16 had induced abortions, which together constitutes 10% of the total number of women from the Baiga community. Among those who had induced abortions, most (93.7%) were practiced using unsafe methods which include self-medication to terminate pregnancy, massaging the stomach or consuming jadi-buti (an astringent herb) to induce the abortion. Five (31.2%) women had induced abortions multiple times. The reasons for abortions shared by these women regarding were either that they had too many children or their children were too young and to have another child was an added burden.
In addition, 87 (56.4%) women from the Baiga community reported that they wanted to undergo sterilisation, out of which 42 (48.2%) got the operation done and 45 (51.7%) could not get the procedure done. Out of these 45, around 27 (60%) Baiga women could not access sterilisation because of their PVTG status, 9 (19%) used herbs for contraception, 8 (17%) did not opt for sterilisation because their husband had undergone a vasectomy and 1 (2.2%) reported that she could not access sterilisation because she was feeling weak.
Findings of the study showed that awareness and utilisation of contraceptive methods other than female sterilisation was poor among the Baiga respondents. The government’s restriction on the availability of a permanent method such as sterilisation compounded this problem and rendered them vulnerable to unwanted pregnancies and unsafe abortions.
Besides this, there were 35 (17.5%) miscarriages and intra uterine deaths between six to nine months of gestation. The lack of access to safe and quality services has adversely affected women’s health, causing a serious threat to their lives. This vulnerable situation of women in PVTGs seems to have arisen due to the result of the denial to permanent sterilisation without assured availability and awareness of other contraceptive methods.
As mentioned above, 42 Baiga women could access sterilisation at government community healthcare centres (in Kota and Takhatpur), charitable trust facilities and private facilities. However, these women who could access sterilisation at government facilities had undergone the procedure several years ago. It is only for the last three years that the public health centres have been implementing an older government order which had been largely ignored till then, and denying PVTG women their right to choose contraceptive methods.
The study also indicates that many women from the Baiga community who wish to get sterilised have stopped approaching public health facilities now. The mitanins (ASHA workers) who are entrusted with the task of motivating women to undergo safe sterilisation operations at the village level now discourage them from approaching public institutions for the same. Such flagrant discrimination deserves unequivocal condemnation from all quarters.
At present, as per an amendment made to the 1979 order in May 2017, people from the PVTG community are required to seek permission in writing, by making an application to the sub-divisional magistrate, to get a ‘clearance letter’, and only then are allowed to undergo sterilisation. Such amendments that involve the bureaucracy in making choices on individual reproductive health and related decision making curtail the freedom of individuals. The need of the hour is to do away with such a draconian order at the earliest.
In February 2017, ten members from the Baiga community filed a public interest litigation along with other concerned organisations in Chhattisgarh high court, demanding access to sterilisation services for the PVTG community, hoping that court may quash the order and reinstate the reproductive rights of the PVTGs.
Current state policies and practices in Chhattisgarh indicate a clear violation of basic reproductive rights of the Baiga people. The objective of the order to “preserve Baiga community” is arbitrary, unjust, unreasonable and discriminatory. It is ironical that the state thinks the denial of the choice is a means to preserve a community amid substantive poverty and pervasive deprivation.
Ultimately, when it comes to reproductive health, women are the ones who are most impacted by patriarchal state policies which deny them their autonomy. The right to life under the constitution guarantees a life with dignity. However, this notification denies Baiga women their dignity, selfhood, self-determination and choice. Recently, the Supreme Court has held that the right to privacy and is a primordial and fundamental right. Denial of access to sterilisation to Baiga women intrudes on their privacy, infringes on their dignity and portrays the paternalistic attitude of the state.
Sonam Lavtepatil and Harendra Sijwali work at Jan Swasthya Sahyog, an organisation working on health and running a community health programme in rural Chhattisgarh. The authors would like to thank Sarojini Nadimpally from SAMA Resource Group for Women and Health for her guidance and support.