The death of fourteen women (8 to 14 according to different news sources) after sterilisation surgeries conducted in a government mass sterilisation camp in Bilaspur has sent shockwaves across the country. The doctor at the camp conducted 85 ligation operations ( that's what sterilisation procedures on women are called) on a single day at a stretch. 55 of the 85 patients took ill soon after. 14 women died within 24 hours of the operations while the others had to be hospitalised.

The doctor was suspended. Health officials were interrogated. It has now surfaced that the antibiotic (Ciprofloxacin) provided to these women was contaminated with rat poison (Zinc phosphide) at the manufacturing unit. Medicine produced by that company has been seized in lakhs from private and government stocks. A one man judicial probe has been initiated which will submit its report within 3 months. Under the pressure of massive public outcry the government is quick to put on a big display of activity on this issue.


Brinda Karat's Reaction: Demanding Resignation of Health Minister

Brinda Karat, leader of the left democrartic movements in India has said, "I believe that the Health Minister has no right to continue his office and therefore we demand that the Health Minister of Chhattisgarh immediately resign and we also demand an end to the target based approach and full compensation to the women who have been victimized by this wrong policy approach. It is shocking and condemnable, when we are claiming to be a country to be developing so fast, today we have a situation where eight women have died in a sterilization camp in Bilaspur in Chhattisgarh. It's an indication and also a commentary on the extreme carelessness of the authorities of that state."


Targeted Approach Criticised

To those of you wondering how an operation theatre can be converted into a production line conducting insane numbers of surgeries per day, blame the race to meet targets imposed by the health ministry and its programmes. The unit at Bilaspur were simply trying to meet their target for that day when they decided to operate on 80 women at once. This target based approach has come under severe criticism in the aftermath of this incidence. Firstly it tends to impose the decision to opt for sterilisation upon the woman. Though our public health programmes speak of "cafeteria choice" of contraceptive measures where women are informed of their choices along with the risks and benefits of each, setting definite targets for one or two out of these options, eg. ligation, often makes it easier to just spoon feed a choice to the woman to fulfill the target.

 Moreover mass camps like these when conducted without a strict eye on safety and protocol can go horribly wrong in a number of ways from infections by  incompletely sterilised OT instruments to allergies from  antibiotics given without skin sensitivity  testing. Negligence in terms of cleanliness, materials, nursing and safety measures lead to more deaths than the procedure itself. The tragedy is that the women who suffer hardly knew what they are getting in to.


Dark History of Sterilisation: Targeting Poor and Women

India has a dark history when it comes to sterilisation. Egged on by tens of millions of dollars from the World Bank, the Swedish International Development Authority and the UN Population Fund, the population control drive began in the seventies. During the emergency it is said that an astonishing 6.2 million Indian men were sterilised in just a year, and two thousand died from botched surgeries. Though the government claims to have installed several safety checks sterilisation camps in India continue to be risky business. More than 700 deaths were reported due to botched surgeries between 2009 and 2012. There were 356 reported cases of complications arising out of the surgeries. The fact that these camps mainly target the poor speaks volumes on the government's disregard for the right to a choice in this matter.

Sterilisations are safer and easier when performed upon men. But the Indian health system has always focused on women, because they are considered easier to convince. India carried out nearly 4 million sterilisations during 2013-2014, according to official figures. Less than 100,000 of these surgeries were done on men.


Need For Systematic Quality Control

The target based approach should of course be abandoned, ensuring that institutions are not under pressure to run production lines instead of operation theatres. Other measures to ensure standards and safety of drugs, fluids, instruments etc used on patients like an effective national drug quality monitoring authority also need to be taken. The health system is intimately dependent on pharmaceuticals and instruments. The need to monitor the quality of health providers almost equals the need to control quality of medicines and instruments. What has happened in Bilaspur is one manifestation of a systematic failure. The disease and not merely its symptom must be addressed