New York Times
By ELLEN BARRY and SUHASINI RAJ
NOV. 11, 2014
NEW DELHI — Eight women have died and dozens more are hospitalized after surgical sterilizations at a government-run “health camp” in India, where women and health workers are often compensated for sterilizations in an effort to control population growth, health officials said on Tuesday.
The women were paid 600 rupees, or almost $10, apiece for undergoing the procedure at the camp, said Amar Singh Thakur, joint director of health services in the central Indian district of Bilaspur. One surgeon performed surgery on 83 women in the space of six hours Saturday — meaning he could have spent only a few minutes on each patient, Dr. Thakur said.
The women began to fall ill around five hours after being discharged, Dr. Thakur said, and complained of giddiness, vomiting and low blood pressure, all symptoms of toxic shock. Sixty-eight women are being treated in area hospitals, and four are in serious condition and on ventilators, he said.
All the patients were poor women, between 20 and 35 years old, and already the mothers of two or three children, according to Dr. Ramanesh Murthy, the medical superintendent of the Chhattishgarh Institute of Medical Sciences.
India has a tumultuous history with sterilization, dating to the 1970s, when a ruthless coercive campaign was carried out under Indira Gandhi. Though the country recoiled at those measures, in recent years many state-level policy makers favored a tough approach to population control and began introducing incentives — often financial — to discourage families from having more than two children.
Mass sterilizations are frequently performed in India, and human rights activists have long complained that they are done hastily and under dangerously unsanitary conditions. A 2013 inquiry into post-surgical deaths in the southern state of Tamil Nadu found a death rate of one in every 1,000 women who underwent surgical sterilization.
The Bilaspur deaths, however, mark the largest loss of life during a sterilization drive in recent history.
Officials in the state of Chhattisgarh, where Bilaspur is located, suspended four senior officials in its health department and filed a criminal report against R.K. Gupta, the doctor who performed the surgeries. In a press release, Rahman Singh, leader of the state, said sterilization was a national program, carried out under the auspices of the Ministry of Health and Family Welfare.
“There should not be any laxity in such an important program,” he said.
Conducting such surgeries safely is time-consuming, since it takes 25 to 30 minutes to sterilize and prepare the laproscope ahead of each one, said Raman Kataria, a doctor with Jan Swasthya Sahyog, a nongovernmental organization that carries out sterilizations in the Bilaspur district. Under those constraints, he said, it would be unsafe to try to conduct more than two, or possibly three, per hour.
“This incident is a reflection of a very bad, poor system, of a nonexistent and nonaccountable public health system, where such tragedies are waiting to happen,” Dr. Kataria said. He said there were regularly reports of one or two deaths after health fairs, as the events are also called, but this was the worst incident he could remember.
“This is nothing but coldblooded murder,” he said.
India carries out roughly 37 percent of the world’s female sterilizations, according to a 2011 report by the United Nations. The percentage for China was around 28.
For decades, state governments were given specific targets for sterilizations and developed a “camp approach,” in which surgeons perform dozens of sterilizations in the course of a few hours, said Abhijit Das, director of the New Delhi-based Center for Health and Social Justice.
Those methods were challenged in the mid-1990s, when India endorsed the conclusions of a United Nations conference on population, which called for abandoning contraceptive targets, improving educational programs and offering women voluntary contraceptive choices. Safety standards were introduced, recommending that a surgeon perform no more than 30 procedures a day.
But high-pressure campaigns are still used in states with high fertility rates like Chhattisgarh and Madhya Pradesh, said Mr. Das, who recalled meeting a surgeon in Madhya Pradesh who claimed to be doing 250 to 300 operations per day. He said the traditional practice was for women to lie on a row of tables, with three health care workers on hand — one preparing the patient, one carrying out the surgery and one stitching up the wound.
He said the most common complication was wound infection.
The practice drew attention in 2012 when a surgeon in the northern state of Bihar performed sterilizations on 53 women over the course of two hours, leaving three women bleeding profusely and prompting a miscarriage in one. A lawsuit brought by human rights advocates against the Indian government asserts that the surgeon operated atop student desks, wore the same gloves throughout and left his patients, still under general anesthesia, lying on straw mats on the ground, to awaken later, bloody and in pain.
Chhattisgarh, where the latest deaths occurred, is one of the poorest states in India, with a population of more than 25 million. The poverty rate is 49 percent, and literacy and health indicators are poor, according to the United Nations Development Program. A decade ago, the state introduced a law requiring local elected officials to have two or fewer children.