Female Sterilization in India

April Issue: Global Edition

With a population of approximately 1.2 billion people, India is the second-most populated country in the world; however, with such a dense population also comes the struggle to aid and maintain a country with 1.2 billion people. To combat this, Indian prime minister, Indira Gandhi launched the world’s first national planning program in the mid-1970’s, and eventually a mass campaign to sterilize men. More than six million men underwent vasectomies in a single year, but the campaign was quickly abandoned after public outroar. Since then the family planning program has traditionally focused on women because of the popular argument that male sterilization impact a man’s virility. Today, female sterilization is estimated to be the method of birth control in over 30% of households in India. Pendleton Trainer ’18 sadly voices, “Indian women, unfortunately, have to make the choice between spending money and their right to their bodies.” In addition, this method can lead to serious health complications or death. However, despite these risky complications, this method of birth control has been met by both harsh criticism and acceptance.

According to studies, Indian women who opted for permanent birth control say they choose the method because of economic reasons, and to live their lives to the fullest. This could mean taking on things with the confidence that they won’t become pregnant, taking on jobs to contribute income to their families, having a sense of autonomy, being subjected to gender-based violence, and to have an overall fuller and richer life. According to John Townsend, Director of Reproductive Health at the Population Council in Washington, D.C, “It’s important that the man and woman are given the opportunity to be fully informed and that they give their consent, which, in most places, for permanent contraception, should be written. It shouldn’t be a complicated, seven-page form that essentially is only preventing the providers from any lawsuits. [Those seeking the procedure] should be completely informed about the risk and have opportunities to talk to a counselor. They should have a space that is clean and indicative of respect for the patient. They should be given high-quality medicines and techniques that are modern, accepted and part of professional protocols.”  

However, since so much controversy surrounds the procedure, those concerned tend to wonder why this method is so popular among Indian women. In countries where people have their children early, their desired family size is reached earlier than it would in country where people have their children in their mid- to late-20’s. In order to stay at that family size for the rest of their lives, women would have to use some form of contraception for around 20 to 25 years. With permanent contraception, they don’t have to spend money every one to three months for injectable contraceptives, or every three to five years for an implant; without unplanned pregnancies, Indian women believe they can have the lives they want. Maya Powell ’18 states, “Now that I know permanent contraception popularity is linked to early ages in childbirth, I understand why women look for something more permanent to prevent having more kids. Even though it would cost less money and limit trips to store, women should think about the risks before they sterilize.” However, the government is bringing intrauterine contraceptive devices (IUCD) to light in order to abolish the idea that a one-time method is more desirable.

This year, the government of Prime Minister Narendra Modi took a major step toward modernizing the system by introducing injectable contraceptives in government facilities – free of charge. For a long time now, new birth control options have been advocated by international organizations, including the United States Agency for International Development, and the Bill and Melinda Gates Foundation. These organizations argue that Indian women need methods to delay or space out pregnancies because they are oftentimes worn out, anemic, and at higher risk of death due to having beared children so young. Surprising to some, the groups with the most opposition to newer methods of birth control have come from some women’s activist groups; they distrust the safety of the methods, while believing profit-hungry Western pharmaceutical companies are pushing them. These groups have continued to oppose them, despite the increasing evidence of the safety of injectable contraception, and their widespread use in South Asia. “I thought it was incumbent on the government to provide it as a choice,” said C. K. Mishra, Additional Secretary in the Ministry of Health and Family Welfare, of the contraceptive Depot-medroxyprogesterone acetate (DMPA). However, the method will be introduced gingerly, limited to select district hospitals and medical colleges at first with implanted contraceptives may follow.