India’s Forced Sterilization Practices Under International Human Rights Law
Raji Kevat (story originally found here) consented to a procedure in 2014 that promised her the possibility of spacing the birth of her children. Her sister-in-law suggested it because she had heard that the government was offering the procedure for free. Raji was one among almost 100 women, herded to an old government hospital, where a single doctor with only one set of surgical instruments then began to perform tubal ligations on each of them. Raji was not sure if the local anesthesia was working but felt the terrible pain of the procedure and was then asked to lie down in the corridor, on the floor of the hospital, to recover. She was led to believe that sterilization was the only contraceptive option. This piece explores ongoing harms of state sponsored health programs that force or coerce sterilization in India and how the State’s actions are in violation of international human rights law.
Forced Sterilization in India: The Gandhi Regime
India has a long and traumatic history with the imposition of forced sterilization on both men and women. Much of this approach is attributed to the post-colonial anxiety of a “population problem”. In 1975, during a period of emergency declared by then Indian Prime Minister Indira Gandhi, the government proceeded to impose a massive compulsory sterilization program. Gandhi was equipped with foreign funding and encouragement from the World Bank and others to follow through. Under the excuse of population control for the purposes of development and with methods rooted in eugenics practices, the Gandhi regime enforced millions of sterilizations. Notably, 6.2 million Indian men were forcefully sterilized in just a year, with thousands dying from botched operations.
International Developments on Forced Sterilization
In an interagency statement (p. 2), a number of UN agencies, which support the right to health and sexual and reproductive health and rights (SRHR), noted the dangerous eugenics approach of governments implementing forced sterilization on specific population groups (including people living with HIV, persons with disabilities, indigenous peoples and ethnic minorities, and transgender and intersex persons), who continue to be sterilized without their full, free and informed consent. The 4th World Conference on Women demanded that States, international health agencies and civil society at large focus on a rights-based approach that dismantled coercive population policies. States were required to adopt the principle of ‘voluntary choice’ (p. 3) and fade targeted approaches to practices such as sterilization out.
Against this background, the UN’s International Conference on Population and Development, the work of the Committee on the Elimination of All Forms of Discrimination against Women (CEDAW Committee) and tremendous civil society engagement have laid the foundation for the strong human rights-based approach to SRHR (ARROW, p. 30). Precisely, the CEDAW Committee has observed that State(s) violate article 10 (h) of CEDAW when they fail to provide information and advice on family planning. In its General Recommendation No. 21 on equality in marriage and family relations, the CEDAW Committee underlined in the context of “coercive practices which have serious consequences for women, such as forced … sterilization” that informed decision-making about safe and reliable contraceptive measures depends upon a woman having information about “contraceptive measures and their use, and guaranteed access to sex education and family planning services” [Article 16 (1) (e) para 22]. Coercion and force may be construed in this context, especially when the State rejects or creates insufficiency in securing a variety of choices in terms of access to contraceptives.
The above developments in the SRHR framework are the outcome of the advocacy of human rights feminist groups, who asked that States acknowledge the role of policy and law in reinforcing patriarchal norms (see here, p.25).
The Continuing Peril of Coercion and Insufficient Protection
The Gandhi regime came to an end, but the Indian State continues to run these harmful programs among poor and rural populations. As violative as the Gandhi regime’s actions were, the Indian State has done little to improve or remove imposed sterilization programs, perhaps worsening the impact by now primarily targeting women. Indeed, as has been reported, India carries out 37% of the world’s sterilizations, with 4.6 million women sterilized in 2012 alone. Sterilization camps are held across the country, promoted by state governments and encouraged by an army of health workers, often as the only method of family planning offered.
Human Rights Watch has further reported that in much of the country, “authorities aggressively pursue targets, especially for female sterilization, by threatening health workers with salary cuts or dismissals. As a result, some health workers pressure women to undergo sterilization […]”. Most notably, the Indian State’s programs seem to affect those women with the most socio-economic challenges, and the practice appears to be systematically withholding information about the procedures performed on their bodies under the guise of health camps and other social welfare programs.
Evidently, the Indian State’s programs of forced sterilization violate SRHR and fall short of respecting the rights of those targeted for these forced sterilization programs. During the 40 years that followed the Gandhi regime, women have continued to have very limited agency over reproductive choices and their body. State actions that enforce sterilization have caused tremendous intergenerational harm to the lives of millions all while continuing to erase access, choice, and rights for many.
In 2020, journalists and civil society called for attention and action against the National Health Mission’s February 11 order that “warned Madhya Pradesh health care workers of dire consequences as only 4% of the [sterilization] target had been achieved in the current financial year”. It was reported that although Madhya Pradesh’s male sterilization target was 60,000, only 2,514 men had been sterilized in the entire state at that point. In the neighboring region of Chhattisgarh (the home state of Raji, whose story was mentioned in the beginning of this piece), the government’s sterilization operations had stopped, but since the nationwide lockdown in 2020, the Covid-19 pandemic has aggravated unmet needs for contraceptives. So, the government resumed forced sterilizations with over 250 women sterilized that year.
Perhaps more insidious is the potential use of this procedure for genocide. Article 2 of the 1948 United Nations Convention on the Prevention and Punishment of the Crime of Genocide defines genocide as “any of the following acts committed with intent to destroy, in whole or in part, a national, ethnical, racial or religious group, one of these act/s being – imposing measures intended to prevent births within the group”. China, for example, is currently being accused of committing acts of genocide against the Uyghur ethnic minority, against which plans for a campaign of mass female sterilization have been revealed.
The current party in power in India, the Bharatiya Janata Party (BJP) has defined its governance by remaining largely silent regarding the surge of discrimination and violence against religious, tribal and ethnical minority communities in India. Political leaders within the BJP have openly vilified these communities, which in turn has empowered radical fringe groups to commit atrocities against them. Madhya Pradesh, the region previously mentioned has one of the largest populations of tribal communities making up over 20% of the total state population. 7% of this region’s population belong to religious minority communities.
Outlawing and abolishing coercive or forced sterilization practices must be a priority for India. This must include the prohibition of programs, policies or incentives that insert targets for sterilization procedures into domestic law or incentivizing health workers to (falsely) push sterilization as the only available method for women. The critical concern here is that such systems may be imposed on those communities at risk that are already marginalized by the State’s agenda or the current political regime’s ideology. If the 1970s period under Gandhi has taught us anything, it is that unchecked State power, is capable of using its machinery to identify and target communities with atrocity crimes.
Any opportunity for state-sponsored atrocities to be targeted against vulnerable populations in guise of population control or responding to development indicators needs to be eliminated. Sterilization procedures can be useful as a way of expressing agency and choice for individuals, who want to make that decision in an informed manner. Part of the responsibility of informed consent is to ensure that those opting in for the procedures understand the risks, are offered post procedure care and are aware of any irreversible results.
International human rights law, standards and norms confirm the framework for SRHR as an agenda does not allow governments to decide which fractions of the population have the permission to procreate. The framework, instead, centers a rights-based approach that acknowledges the full dignity of choice.
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