Uptake of family planning methods in health centre not far from Patna-a cause of concern

Article published in “Eastern Cronicles” on 31st October 2013, titled: “Uptake of family planning methods in health centre not far from Patna (Bihar)-a cause of concern”. 
Khagaul Public Health Centre (13 km away from Patna town)  “It talks about lack of basic facilities in Khagaul PHC, including lack of beds for patients, operation theater, OT clothes for patients and staff, running water, etc. Women from the community using IUDs and contraceptive pills are facing complications, as a result of which they are not able to use any spacing methods with full trust on either the method or the service providers in the area”.
This article is just a snapshot of the dismal state of the public health system in India. The link to the article is shared below:

6th Asia and Pacific Population Conference ended with a joyous bang


History was made today at the Asia  Pacific Population Conference as thirty eight member states voted to adopt the attached  declaration. After a week of intense and passionate debate and negotiation the region overwhelmingly voted to adopt, support and promote progressive language on Sexual and reproductive rights, comprehensive sexuality education, the first time it has been mentioned in such a document, and the need to address discrimination, including on the basis of sexual orientation and gender identity.

Russia, Iran and Azerbaijan voted no to the text. A cross regional alliance and partnerships stretching including the Pacific Island states, SE Asia and S Asia stood firm and voted to adopt the text. In a rousing  closing speech Dr Nafis Sadik, former Executive Director of UNFPA commended the critical role of civil society, recalling that civil society collaboration in the ICPD, and this week in the Sixth Asia Pacific Population helped make history, change paradigms and change lives.

Glimpses from the political maneuvers surrounding the 6th Asian and Pacific Population Conference (Bangkok 2013)


It was the first day of the senior officials meeting at the 6th Asian and pacific Population Conference at Bangkok. The day one itself was extremely exciting and full of hot global politics with regards to the issues of sexuality, comprehensive sexual education and gender identities, and other issues.

Countries were clearly divided and battle plans were already ready! Block politics were very clear and evident when the country delegates raised contentions and reservations to certain sections of the outcome document of this monumental meeting. Clearly, letting go of control over women and broadening the horizon of civil rights to protecting diverse sexual identities, saw strong reservations from countries like Russia, Pakistan and Iran in the room. Food security and nutrition emerged as one among the pressing global challenges.

The chair (Mr keshav Desiraju, presiding over the UN conference) played a graceful and key role and in facts set in motion discussions between delegates to negotiate controversial concerns among themselves and come to an agreed consensus, while not dropping the rights language of the outcome document.

Civil society meeting to prepare for the UN ESCAP and rendezvous with delegates  

As the 120 civil society organisations from Asia and Pacific had anticipated in the two day intensive strategic meetings just before the UN ESCAP, strong reservations to language of ‘rights based approach’ were raised by Iran and Russia. Professor Gita Sen joined the ESCAP and boldly spoke the language of rights. She took charge of strengthening the language around rights and proposed alternatively strong language at points when countries opposed to rights based approaches. She said and I quote “recognizing the need to enact and implement policies and programmes on adolescent health, reproductive health and child health that fully respects Human Rights and further recognize the need for countries to learn from each other on approaches towards achieving universally health care including universal health coverage”.

India hooted that Violence Against Women derives centrally from particularly some aspects of culture. India rephrased the Preamble point number 34 of the outcome document (which will be submitted to the 70th session in April to commission of population in New York and General Assembly Special Session on the follow-up to the Programme of Action of the International Conference on Population and Development in 2014) into a stronger language as “recognizing that while also recognizing that violence against women throughout the lifecycle derives essentially from harmful cultural patterns, in particular the effects of certain traditional or customary practices and all acts of extremisms linked to race, language or religion that perpetuate the lower status accorded to women in the family, workplace, the community and society” this was supported by Pakistan, Japan, Philippines, Bhutan, Papua New Guinea, Cambodia) but opposed by Iran and Russia once again!!       

India has managed to incorporate the recommendation that population policies based on incentives and disincentives should be replaced with rights-based policies into the combined civil society statement read out in the UN by the Indian CSO delegation.


Leena Uppal, Coalition Against Two-Child Norm and Coercive Population Policies Image


By Leena Uppal
WHILE THE GOVERNMENT OF INDIA TRIES to project the fact that the country’s family planning programme has shifted from the old female sterilisation centric approach and now offers a basket of contraceptive choices to couples in the reproductive age group, in actual fact nothing much seems to have changed on the ground. This report from Khurda district in Odisha reveals how women in labour are being forced to agree to go in for tubal ligation, after they deliver their second child at a health facility.
“We are required to motivate and bring in couples for sterilisation, and we try our best to do this. We do not persuade those clients who have daughters to consider this option but prefer to focus on those who have already given birth to boys.”
Read more

Submission to CSW on forced/coerced sterilisation and abortion of HIV+ women in Asia

The Women of Asia Pacific Plus (WAP+) has made a submisstion (attached) to the Comission on the Status of Women highlighting coerced sterilisations and abortions and other violations of rights during pregnancy and delivery among women living with HIV in six Asian countries: Bangladesh, Combodia, India, Indonesia, Nepal and Viet Nam.
Citing evidence reported in “Positive and Pregnant: How dare you” (link below) the report highlights in particular coerced sterilisations, coerced abortions, and coerced caesarean section deliveries among pregnant women living with HIV, as well as refusal of care during pregnancy and at delivery.
Positive and Pregnant: How dare you – A study on access to reproductive and maternal health care for women living with HIV in Asia
Leena Uppal
Advocacy Officer
Coalition Against Two-Child Norm and Coercive Population Policies
Please visit our website: 

The Mirage of Choice in Family Planning: Case Study from Odisha


By- Leena Uppal, Advocacy Officer, Centre for Health and Social Justice

The Times of India, on July 11, 2013 carried an advertisement on ‘small families’ and mooted India’s gains in achieving replacement level fertility to about 44%. It also advertised the various contraceptives available in Public Health Centres and with the ASHAs. For many, this advertisement reflected of government’s assumption that parents select their family size in more or less the same way as they choose consumer durables.

Such messaging is unfortunately not telling of the deeply ingrained social inequalities that exist in India. It is hard for the common people to really understand the implications and impact of the strategies that family planning programmes utilize in their repertoire of programmes to promote birth control. In my recent visit to Odisha on 22-26 June, I understood how family planning is reinterpreted by the states and how it is being pushed across to reach the replacement level fertility.

“We have been asked to motivate and bring in clients for sterilisation and we do that, we try not to bring in those clients who have girls, but focus on those who have already given birth to boys, and motivate their mother-in laws to send them across for sterilisation.  They immediately agree as they do not want daughters.” – ASHA, Balugaon Block Khurda

It struck me in my interview with the health officials in Odisha, how important for the programme planners was the reduction in numbers and population growth. They were quick to let me know a mathematical formula to calculate the Expected Level of Achievement (ELA-0.4% of the Mid Year population of the district) which is then applied as target for contraceptive needs of people.

It was striking to see the minutes of monthly meeting held on 12.04.203 during the review of family welfare & maternal and child heath in the district of Khurda, the Chief District Medical Officer has praised blocks like Balugaon, Banpur, Tangi, Haldia, Mendhasal CHC and has expressed deep dissatisfaction against low performing blocks like Janti CHC and had specially warned them to perform well.

The Odisha government celebrated the World Population Day on July 11, 2013, where key districts and Medical Officers were felicitated for best performance in achieving optimal sterilisation targets. Awards were announced for best performing surgeons in minilap operations as well as male sterilization operations as well as best performing NGOs in mobilising sterilisation cases.  

The data shared by the Directorate of Family Welfare, Odisha, reflected that the districts which were awarded best performance in sterilisation performance (2012-13) included Malkangiri (achieved 138.27% sterilisation target), Koraput (achieved 109.08% sterilisation target). These are predominantly tribal districts (with the tribal population of around 50% or more) and Anugul (achieved 106.09% sterilisation target) which has 11.6% of tribal population. It was shocking to know that all these three districts have crossed the stipulated 100% female sterilisation targets set in 2012-13. This was the fact that no award was announced for distribution of other contraceptives like IUCD, or oral pills or condoms does signify the seriousness with which sterilisation is being promoted in the state.

In another meeting, at New Delhi on the eve of world population day organised by coalition against two-child norm and coercive population policies, the in-charge of national family welfare programme of government of India, Dr. Sikdar shared that the family welfare has moved away from a camp based approach to fixed day services for women in CHC, evidences from the field however suggests otherwise and do imply that family planning services rarely addresses the gender barriers or address the special needs of the marginalised communities. The family welfare programme in states continue to limit people’s family planning options to sterilisation in the belief that people cannot be relied on to practice temporary methods effectively.

This trend is especially a matter of concern since in the Family Planning Summit 2012; the international community took an enormous stride towards rectifying the human rights violation faced by women and girls globally and where India committed to providing greater access to modern contraceptives. 


Violence in West Bengal over the panchayat elections

By Leena Uppal
There is an article in the HT (attached) about the violence in West Bengal over the panchayat elections. The article makes a quick reference to the panchayat election process in India and it has highlighted that anyone with more than 2 kids cannot stand as a candidate for panchayat elections, referring to Andhra Pradesh. 
It was ironic for me to read that despite the fact that the report focuses on West Bengal, the writer had made sure to make a reference to the two-child restriction in elections picking it from another state. Also, the report on panchayat election process did not go clear without making a reference to the two-child restriction.  

This rampant reporting of the norm in an un-thoughtful way leaves the readers with no scope of thinking that this restriction has rendered communities in India vulnerable and doubly disadvantaged. 

Almost every day, readers are bombarded by population control rhetoric in the media without any specific mention to the dis-empowering nature of the current population control policies and policy prescriptions.

The Irony of Targets: Sterilisations in Jharkhand


By Priya John

After six of their children survived the crucial first five years, Dabri Paharin (name changed) and her husband were content with their family size. They decided to adopt a permanent method of contraception – Sterilisation. Among Paharias, as in most communities in India, male sterilisation is almost inconceivable. On being asked how and why it was decided that she would go in for the procedure and not her husband she simply declared that it is the only option and that in her community ‘it is just not done’. So once the decision was taken they approached the state’s health department which incentivises both male and female sterilisation. At the health centre, however, the couple was informed that they are not eligible for sterilisation as they are Paharias.

The government of India identifies Paharias as a Particularly Vulnerable Tribal Group (PTG) which is a sub-category within the Scheduled Tribes. They are identified as ‘vulnerable’ because they are understood to be an isolated indigenous group living in very poor socio-economic conditions. In Jharkhand, the government proposes to take special care to preserve these communities as they are perceived to be nearing ‘extinction’ (GoJ 2013). The main strategy to meet this end is to deny permanent methods of contraception regardless of the need of individuals in the community. This is seen as a foolproof way of ensuring steady increase in their population which is presumed to be dwindling.

The problems with this strategy are manifold and fairly obvious. Firstly, this paternalistic treatment of these vulnerable populations is in gross violation of their right to self-determination. The most absurd logic lies at the heart of this government policy-driven demand to reproduce in order to fight extinction. Men and women are not seen as rational thinking beings who could choose not to reproduce after a point or even in some cases ever in their lives. It is indeed ironical that in the name of their preservation they are compelled to continue reproduction even if they do not deem it fit for themselves. Secondly, the burden of this denial falls squarely on the wombs in the community as male sterilisation is literally unheard of in the area. Women are reduced to wombs, mere receptacles for future generations! The government uses these wombs to fulfill the objective of preservation of an entire community. Paharias traditionally believe that large families translate to more resources to support a household and its needs. The pressure to deliver takes a toll on women’s wellbeing. The government’s strategy to increase population by denying sterilisation is then the last straw that breaks the camel’s back. Thirdly, local organisations working in these areas dispute the state’s claim that Paharias are going ‘extinct’. They cite figures generated in the census to show that there has been if anything a steady increase in their populations over the decades – 8800 in 1991, 13500 in 2001 and 16000 in 2011. Finally, this strategy is objectionable owing to how these communities are equated to endangered flora and fauna which need only be planted more or reproduced more in laboratory conditions. If the government concentrated on ensuring proper implementation of its PTG focused programmes and schemes it might be a more befitting approach to addressing the historical marginalisation and continued structural deprivation experienced by these communities.

A bit of statistics to further punctuate the irony of targets set by the government – Female Sterilisation accounts for 66% of the contraceptive use in Jharkhand (NFHS 2005-6). Data from National Family Health Surveys 2 and 3 show a reduction in male sterilisation from 0.8% in 1998-99 to 0.4% in 2005-06. In the year 2011-12, the population stabilisation targets set by the Government of Jharkhand were:

Male Sterilisation


Female Sterilisation


Intrauterine Device (IUD) Insertions


Source: National Rural Health Mission, Record of Proceedings, GoJ 2011 

The above figures together avow that the state actively entrenches patriarchal structures in which male virility trumps female fertility. Promotion of female sterilisation is much higher than that of male sterilisation. This is despite the fact that male sterilisation is far simpler, less time consuming and requires nearly no surgical intervention in comparison to female sterilisation. Here again women’s bodies are conveniently the sites of state intervention which in this case is to stabilise population as opposed to promoting reproduction to preserve a community.

Also, these set of targets highlight that even though there is heavy emphasis on sterilisation, Paharia women are denied access to this method in the name of a larger good. It appears whatever the problem may be – women and their bodies provide ready panaceas!

Fortunately, the Planning Commission of India recently asked the Chhattisgarh government to revoke this archaic order which was passed three decades ago in 1979 (The Hindu, 2012). The Planning Commission has clarified that the orders were ‘misconstrued’ and members of the PTG community in the state seeking sterilisation cannot be denied the facility. One hopes that the Commission would instruct other states with PTG populations to follow suit soon so that women like Dabri Paharin are not compelled to deny their identity to avail the facility under an assumed name.     



Aarti Dhar (2012) Misconstruing order, Chhattisgarh tribals denied sterilisation for three decades, The Hinduhttp://www.thehindu.com/news/national/misconstruing-order-chhattisgarh-tribals-denied-sterilisation-for-three-decades/article4048484.eceaccessed on 7 June 2013

Government of Jharkhand (2013) State of health in Jharkhand – A Retrospect, Department of Health, Medical Education and Family Welfare http://www.jharkhand.gov.in/new_depts/healt/healt_restro.html accessed on 7 June 2013

International Institute for Population Sciences and Macro International (2008) National Family Health Survey – 3, India, 2005-06: Jharkhand. Mumbai: IIPS

National Rural Health Mission (2011) Record of Proceedings – State Programme Implementation Plan, Department of Health, Medical Education and Family Welfare, GoJ.