Camp of Wrongs

December 13, 2014

A fact finding report on sterilisation deaths in Bilaspur

by  Sama Resource Group for Women and Health, Jan Swasthya Abhiyan, and National Alliance for Maternal Health and Human Rights

Download (PDF, 12.11MB)

Here is an excerpt –

V. Recommendations

“The woman’s right to make reproductive choices is also a dimension of personal liberty as understood under Article 21 of the Constitution of India. It is important to recognize that reproductive choices can be exercised to procreate as well as to abstain from procreating. The crucial consideration is that the woman’s right to privacy, dignity, bodily integrity should be respected. This means that there should be no restriction whatsoever on the exercise of reproductive choices such as a woman’s right to refuse participation in sexual activity or alternatively to insistence on use of contraceptive methods. Furthermore, women are also free to choose birth control methods such as undergoing sterilization procedures..” Suchita Srivastava v. Chandigarh Administration, AIR 2010 SC 235.

At the Bilaspur / Chhattisgarh Level:

o All necessary steps must be taken for continued follow up with all the surviving women who had undergone the sterilisations in the four camps to ensure access to health care, and to address any complications that the women may be experiencing.

o Ensure provision of compensation and access to indemnity schemes to all families / children of women who died following the sterilisations and those who experienced morbidities.

o Make public the reports of the forensic tests and tests of viscera analysis; reports conducted on the drug samples, including the estimated quantity of zinc phosphide found (if at all).

o Make public, in the case of the camp in Bilaspur, the following information:
How many trained doctors were available at the camp?
What was the infrastructure available at the camp for maintaining asepsis, and what were the procedures used to do so?

o Provide Certificates of sterilisation and all other documentation they are entitled to for all the women and to the families of women who died, as evidence of the surgeries that they have undergone,as mandated by the government’s guidelines.

o Ensure that the abandoned Nemichand hospital that was the location of the current camp as well as previous camps, is not used any further for this purpose.

At the Policy Level

Women and Men’s sexual and reproductive rights should be well articulated in all policies. Women’s right to dignity, privacy and bodily integrity has to be respected, and women’s right to make an informed decision regarding her sexual and reproductive health, including contraception must not be compromised at any cost.

o The family planning programme in India needs a thorough review and over-hauling, towards centre-staging these rights. Thus, the contrary but prevalent policy perspective and push to “control population” needs be urgently changed.

o Discontinue immediately incentives and disincentives or ‘camp approach’ towards this ‘population control’, typically equated with control of fertility of women – particularly poor and marginalised women.

o Do away with the continued emphasis on female sterilisation in the name of reproductive rights and reproductive health.

o All target based sterilisations must be stopped. The targets in any form – official or unofficial – should be completely eliminated from policy and programmeas well as in practice.

o Abolish all coercive population policies, the two child norm being implemented across different government departments and schemes.

o Review all existing guidelines, SOPs on contraception services, sterilisation through consultative processes.

Strengthen Access to Safe and Quality Contraceptive Services

o Provide routine contraception services through an improved public health care system offering safer contraceptive methods such as condoms, oral pills and encourage male responsibility. Sterilisation should only be offered as one of the options among other safe, non hazardous, non invasive, methods of contraception, regardless of marital status, age, gender identity, etc.

o Strengthen public health care institutions – make them functional by improving infrastructure, availability of doctors and other health personnel, counselling, medicines, etc.

o Strengthen capacities of human resources at all levels of the health system, to ensure provision of comprehensive information, adequate response to the needs of persons wanting to access contraceptive services.

o Ensure ethical processes such as informed consent, provision of medical documents, consent formats to all those accessing services.

o Promote male responsibility in contraception through health and sexuality education and provision of information and services through adequately trained male health workers in addition to ASHA/Mitanin.

Strengthen implementation of SOPs, Quality Assurance

o Implement and strictly monitor guidelines and standards for sterilisation services.

o Ensure the functioning of the Quality Assurance Committees (QAC). The regular monitoring must ensure that such acts of negligence are not repeated and the underlying deficits are addressed effectively.

o Review systematically the evidence from implementation of sterilisations across different states to assess issues in programme design and implementation.

Ensure Thorough and Systematic Enquiry

o The Judicial enquiry which has been set up by the State government must speak with the women who had gone for sterilisations, as well the families of the women who lost their lives. In addition, the commission must procure and study all relevant documents – registration,  discharge summaries, consent forms, postmortem reports of the women who died. All the reports should be available on the public domain.

o Ensure that the Terms of Reference of the Judicial Enquiry Commission is comprehensive and incorporates critical aspects that emerge from the tragic events in Bilaspur. The terms should also clearly state the scope, objectives, purpose and detail the areas and aspects of this important Enquiry

o Expand the Commission to include other experts so that the Enquiry Commission is enabled to carry out a thorough and indepth enquiry declaring conflict of interest.

o An independent and comprehensive epidemiologically-sound investigation into this incident should be carried out. A thorough, impartial and unimpeded investigation with a team of experts (following their declaring of absence of conflict of interest) from different backgrounds -including social sciences, medicine, pharmacology, epidemiology, etc. to be conducted.

o Accountability and culpability need to be clearly fixed for the deaths of otherwise healthy women following a medical procedure. That would be one of the first steps towards ensuring that mistakes and lapses are not repeated and such tragedies do not recur.

o Negligence and contributory negligence may be fixed on all parties involved, including those providing contaminated surgical equipment, medicines, etc. State is vicariously liable and ought to pay higher compensations for the lives lost and also to those who are sick. On the basis of the findings, responsibility must be fixed in terms of criminal negligence not only on the medical team, which performed the operations, but also in identifying other officials who sanctioned and were involved in managing this particular camp.

The tragedy in Chhattisgarh was waiting to happen. These avoidable deaths and complications not only reflect the malaise of the public health system but are also an emphatic and sad reminder of the State’s preoccupation with population control and targets. These 13 lives lost and the experiences of complications are symbols of the apathy and violations of basic human rights. The

No Comments »

Leave a comment