January 28, 2012
In the beginning of January, a group of 53 women underwent surgical sterilisation in the village of Kaparfora in the Indian state of Bihar.
While there is a Primary Health Care centre in the vicinity, they were treated in a State-run middle school. The case is an example of unethical medical conduct, a violation of reproductive rights, and frauduleus practices in health care.
The group, comprising mostly of poor, illiterate women from Araria district, had assembled in anticipation of a sterilisation camp to be conducted by the NGO Jai Ambe Welfare Society, which had been contracted by the government to run such a camp. All women were operated on by one surgeon, who took only a few hours to conduct the tubectomies. According to the newspaper The Hindu, which brought the story, “the women were called in, operated upon on rough, unvarnished school benches and their fallopian tubes sealed at breakneck speed.” Three women started bleeding profusely and had to be brought to the nearest Primary Health Care Centre. Further trouble broke out when the camp organisers refused to pay the mandatory amount (Rs.600 fixed by the Bihar government) to the women for undergoing sterilisation.
The Hindu report
“When the police, led by the District Superintendent, reached the spot next morning, they found the ‘Operating Theatre’ in utter mess, with the room a diffuse tapestry of spent needles, syringes and some medicines past their expiry date.” There was no surgeon present, nor another doctor. Only a few medical students were on site to supervise the patients. There was no evidence of any clinical assessment, pre- or post-operative care or decent waste disposal procedures during the entire run of this camp. “There was nobody to look after us once the surgery was completed … we were lain on the veranda as if we were dead people,” said Rambha Devi, one of the women who started bleeding after her operation.
The surgeon admitted he had performed 53 surgeries on a Saturday evening. Asked whether proper regulations were followed during the duration of the surgeries, Dr. Choudhary said: “I am not aware of all that [Health Ministry rules and regulations] … all I know, sir, that I was requested by the NGO [Jai Ambe] to come for a birth control camp at Kaparfora.”
The Hindu spoke to some doctors from the Federation of Obstetrics and Gynaecologists Societies of India (FOGSI), who said that it was “not humanly possible” to perform so many tubectomies without a specialised team or standard medical infrastructure. “I have performed a maximum of three Minilap operations in an hour in a superior medical ambience. So, such figures [53 in six hours] are simply unbelievable”, said Dr. P.K. Shah, Secretary-General of FOGSI.
During a raid of the NGO’s office, various frauduleus practices were discovered. CDs showing promotional photos of women who had undergone sterilisation were found, in which the same women were used under different names several times over, in order to prove that a ‘successful birth control programme’ had been conducted by the NGO.
According to The Hindu, the State’s all-round lack of capacity in the health sector, including family planning is at the root of the problem. The average number of children a woman in Bihar will bear in her lifetime (total fertility rate) is 3.9 — the highest in India. In the district of Araria the total fertilate rate is as high as 4.6. In comparison, the national average is 2.6. There is a high unmet need for family planning.
An NGO receives Rs.1500 for every successful tubectomy and vasectomy operation performed. As a result of this incentive: “bogus or botched up, on-the-hoof operations can be passed off as successful tubectomies, and the money to be made is considerable,” The Hindu wrote. A Civil Surgeon said the Jai Ambe trust had been operating in the region for more than four years and had carried out more than 4000 sterilisations in the district of Araria alone.
IFHHRO’s Asian Region Focal Point has contacted FOGSI, asking them to endorse a statement in support of good quality and ethical practices in sterilisation.
Source: The Hindu, 23 January 2012