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India's Population Programme
As sterilisation scandals abound, a consensus is emerging for a shift away from sterilisation towards a larger "basket" of contraceptive choices and concomitant improvements in service delivery. That such a shift needs to take place is clear, but precisely how it is to come about, and who gets to determine what is in the basket of choices are questions that deserve greater attention. The neo-Malthusian resurgence, combined with the technical fixation on contraception, favours certain methods over others, but health and safety concerns related to these methods are typically downplayed or suppressed.
Betsy Hartmann was a Fulbright-Nehru Distinguished Chair in New Delhi from January to May 2015, affiliated to the Centre of Social Medicine and Community Health, Jawaharlal Nehru University, and Sama Resource Group for Women and Health, during which time she conducted research on Indian population policy.
In November 2014, India was rocked by yet another sterilisation scandal that made international headlines. Thirteen women died after being sterilised in a camp in Bilaspur District, Chhattisgarh. Fact-finding missions by women’s health and human rights organisations revealed appalling conditions at the camp (Population Foundation of India et al 2014; Sama Resource Group for Women and Health et al 2014). The Chhattisgarh tragedy is the tip of a much larger iceberg. India still relies overwhelmingly on female sterilisation in its family planning programme, and states are essentially given free rein to impose sterilisation targets—now euphemistically called Expected Levels of Achievement. Quality of care for all methods is abysmal, with family planning providers receiving minimal training, and no supervision.
Periodically, winds of change sweep through at the policy level. In 1996, the government officially adopted a target-free approach, reflecting the shift from population control towards reproductive health at the 1994 International Conference on Population and Development (ICPD) in Cairo. In 2000, it launched a new National Population Policy (NPP) based on free and informed consent, critical of coercion. Yet, rhetoric has not translated into action.
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