torsdag 13 november 2014

The sterilization catastrophe in Chhattisgarh

72 readers until April 12, 2015.

Translation of a blog in Swedish

I was asked to say something about the catastrophe in the state of Chhattisgarh, India, where at least 13 women died after a doctor with two assistants did 83 sterilization operations in 5 hours. The operation is done by keyhole surgery and resection of the fallopian tubes. The operation itself does not take many minutes, but in Sweden, the staff’s preparations and taking care of the patient after the operation takes a quite long time.

Sterilization campaigns in India has bad reputation since the compulsory sterilizations in the 70:s. I thought they had more or less disappeared. Today, women are lured to sterilize themselves by the offer of a small amount of money.

Health campaigns in India are performed as camps. It means that a team with equipment arrives and settles down in some available building. Here the team works with “assembly line” during one or a few weeks. Then they move to the next place.

When I search on the web I find several facts about the sterilization campaign in Chhattisgarh. Also in other camps women have been hit by complications, and some have died – this seems more to be a rule than an exception.

The forms for the operations can be questioned. The hygiene is generally bad in the camps. The patients are routinely treated with a broad spectrum antibiotic (ciprofloxacin) and painkiller (ibuprofen). It is suspected that the medicines are polluted. What is not discussed is whether multi resistant microbes are spreading between the patients because of lack of hygiene routines. In Chhattisgarh, a deserted and empty hospital, with matrasses on the floor, was used. It is said that the equipment was rusty and not properly sterilized. What is it like in the other camps?

The motives for the sterilization campaign can be questioned. Today, 2.5 living children per woman are born in India. Some of these children, specially girls, dies before they reach fertile age. There are too few women, all men cannot marry. On the other hand, people live longer. Those who learnt their Hans Rosling know that the population pyramid is changing form to a rhomb, with narrow foot and wide waste. Those who cause the population increase are the middle aged and the old ones – as in most parts of the world.

That the campaign is directed towards women instead of men can be questioned. To divide the spermatic duct through a little cut in front of the scrotum is much easier, cheaper and connected with much fewer complications compared to go into the abdomen of the woman. The patriarchal society probably plays a big role here. The potency is extremely important, and is often mentally connected with fertility. A sterilization would be a threat to the man’s identity. The woman has a secondary position in most of the world – the Nordic countries, together with the tuareg people and some other ethnic groups, should be regarded as “green islands” when it comes to gender equality. All the same, sterilization for men has not been possible for more than around 30 years in Sweden.   

The motives and the ethics for doctors to take part in this kind of campaigns can be questioned. Dr Gupta was awarded by the Health Minister when he had done 50,000 sterilizations. How much did he get per piece? Is it ethical to perform such operations on disputable grounds (see below)? 

That women expose themselves to sterilization can be questioned. Women in India marry early. At 25, she has at least one son, important for old age, and she is offered sterilization. If something happens to the son, or if she becomes a widow and wants to remarry, she cannot get more children. At the same time, this is about poor and low educated women. Their knowledge about different family planning methods is low, and they give priority to food instead of contraceptive pills and condoms. There might well be a pressure on her from the husband and the mother in law to get the extra 170 Euro (1 400 rupies), the “fee” for the sterilization.     

India's sterilisation scandal  The Lancet online 16.12.2014

India Today 13.11.2014
The Indian Express 13.11.2014
The Indian Express 2 13.11.2014
F.India 13.11.2014
N.DTV 13.11.2014
India Today 13.11.2014
Times of India 13.11.2014
Times of India 1 12.11.2014
Times of India 2 12.11.2014
Times of India 3 12.11.2014

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