Chhattisgarh’s Sterilisation Deaths Have Changed Nothing For Family Planning Burden on Women

Even after a gap of ten years between two government health and family surveys, the burden of sterilisation – with all its risks – on women remains unchanged.

In 2014, eleven women died in a government ‘sterilisation camp’ in Chhattisgarh where 83 women were sterilised in just about six hours.

In the year after that, the government collected data for its massive National Health and Family Survey-4 (NHFS), for 2015 to 2016.

The full data of that survey has just been released, and it shows that the tragic deaths in Chhattisgarh did little to change India’s population and policy choices: Female sterilisation is still the most used mode of contraception in India.

In the last session of parliament, three parliamentarians asked the health ministry “whether the number of women opting for sterilisations is falling in the country.”

The MPs were also concerned about whether women were being compensated when their sterilisations failed.

The next question was vague: “Whether the Government has noticed any serious flaws in the population control policy.”

To this last question, the government replied, “No.” The government said there were no problems with the National Population Policy because it was “comprehensive and holistic.” And thus the question “does not arise,” if the government has taken any corrective measures for problems in India’s population control policy.

Yet, there is a problem: The entire burden of population control in India has been borne, and continues to be borne by women. And this is especially the case with sterilisation.

The data has barely changed in ten years

This has remained true over ten years, from the last NHFS in 2005-2006, all the way to the most recent survey by the government for 2015-2016.

The most used form of contraception among both men and women in India remains female sterilisation. Female sterilisation remains top of the charts among all the 12 methods of contraception that the NHFS data captures.

In the NHFS-4 survey, female sterilisation is at 35.7%.

In NHFS-3, it was only slightly higher, at 37.3%. In NHFS-2 (1998-1999), this was 34.2% and in NHFS-1 (1992-1993), this was 27.4%.

There is nearly no uptake of male sterilisation. It has, in fact, dropped to a minute figure of 0.3% in the new survey, from a small enough figure of 1%, ten years ago.

After female sterilisation, the next popular option comes with a large distance – condoms for males have remained nearly consistent in their usage, at 5.6% in this new data and 5.2% in the previous round.

All other methods of contraception have been below this.

The NHFS collects data on both modern and traditional methods of contraception. The modern methods it looks at are sterilisation (male and female), contraceptive pills, intra-uterine devices, injectables, condoms (male and female) and the lactational amenorrhea method. The traditional methods it tabulates are rhythm and withdrawal. It also has two general columns for all other traditional and modern methods.

On contraceptive usage, the data has been collected from a large sample of 6,99,686 women and 1,03,411 men.

What does information have to do with sterilisation?

Between 2012 and 2016, the government records 537 sterilisation deaths in India.

The burden of female sterilisation is, of course, a complete reversal from the 1970s when men were put through controversial, forced sterilisation camps.

Sterilisation of men is, in fact, an easier surgery, as the recovery time is sooner and complications are rarer. However, the burden has never been shared.

Full information and consent thus becomes key, especially when the burden of population control, via sterilization, is borne by women.

Yet, according to NHFS-4, there is an inverse relationship between education and sterilisation: The less educated a married woman is, the more likely it is that she adopts female sterilisation. According to NHFS-4, for the three bands of education examined (those with no schooling, those with under five years of schooling, those with five to seven years of schooling), the figures are 42.7%, 44.6% and 41.1% of married women who have chosen female sterilisation.

Women who underwent sterilisation surgery at a government mass sterilisation camp pose for pictures inside a hospital at Bilaspur district in Chhattisgarh November 14, 2014. Credit: Reuters/Anindito Mukherjee

Women who underwent sterilisation surgery at a government mass sterilisation camp inside a hospital at Bilaspur district in Chhattisgarh November 14, 2014. Credit: Reuters/Anindito Mukherjee

In  NHFS-3, these figures were 39.7%, 46.7% and 41.1%.

Apart from the choices that men and women make regarding contraception, how much information do they even have to make these choices? According to the NHFS-4, even that is skewed towards sterilisation.

The method of contraception most known to women, in both urban and rural areas, is female sterilisation.

In urban areas, 96.8% women said they know about female sterilisation. In rural areas, 95.5% women said they know of it.

Men show a higher awareness of the option of male condoms (94.1%) while women show a far lower awareness of this option (79.1%).

And even though the government’s survey asks questions about 12 methods of contraception, both women and men responded that they were aware of only 6.5% and 6.4% of the options.