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| 11 Women Die After Botched Government Sterilizations in India | 11 Women Die After Botched Government Sterilizations in India |
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| NEW DELHI — Twelve women have died and dozens more were sickened after surgical sterilizations at a government-run camp in India, where women are often paid to undergo the procedures in an effort to control population growth, health officials said on Tuesday. | |
| The women were paid 600 rupees apiece, or almost $10, said Dr. Amar Singh Thakur, joint director of health services in the central Indian district of Bilaspur. One surgeon performed surgery on 83 women in the space of six hours on Saturday — meaning he could have spent only a few minutes on each patient, Dr. Thakur said. | The women were paid 600 rupees apiece, or almost $10, said Dr. Amar Singh Thakur, joint director of health services in the central Indian district of Bilaspur. One surgeon performed surgery on 83 women in the space of six hours on Saturday — meaning he could have spent only a few minutes on each patient, Dr. Thakur said. |
| The women began to fall ill around five hours after being discharged, Dr. Thakur said, experiencing giddiness, vomiting and low blood pressure. Sixty-seven women are being treated for septic shock in hospitals, and four are in serious condition and on ventilators, he said. | |
| State officials said evidence pointed to negligence on the part of the surgeon, Dr. R. K. Gupta. Amar Agrawal, the health minister in the state of Chhattisgarh, where the sterilizations took place, said Dr. Gupta had not sterilized his surgical instruments. | State officials said evidence pointed to negligence on the part of the surgeon, Dr. R. K. Gupta. Amar Agrawal, the health minister in the state of Chhattisgarh, where the sterilizations took place, said Dr. Gupta had not sterilized his surgical instruments. |
| Dr. Gupta denied any culpability in a telephone interview, saying the women were well when they left the hospital. | Dr. Gupta denied any culpability in a telephone interview, saying the women were well when they left the hospital. |
| “They went back to their villages and went to the village quacks, who gave them antibiotics,” he said. The vomiting and abdominal pain, he said, “are all a reaction to these medicines.” | “They went back to their villages and went to the village quacks, who gave them antibiotics,” he said. The vomiting and abdominal pain, he said, “are all a reaction to these medicines.” |
| Dr. Gupta confirmed that he had performed 83 sterilizations in six hours with two assistants. He said he had performed 50,000 sterilizations in his career. | Dr. Gupta confirmed that he had performed 83 sterilizations in six hours with two assistants. He said he had performed 50,000 sterilizations in his career. |
| Mr. Agrawal said the authorities had filed a criminal complaint against Dr. Gupta. | |
| India has a tumultuous history with sterilization, dating to the 1970s, when a ruthless, coercive campaign was carried out under Indira Gandhi. Though the country recoiled at those measures, in recent years many state-level policy makers have favored a tough approach to population control, and have begun introducing incentives, often financial, to discourage families from having more than two children. | India has a tumultuous history with sterilization, dating to the 1970s, when a ruthless, coercive campaign was carried out under Indira Gandhi. Though the country recoiled at those measures, in recent years many state-level policy makers have favored a tough approach to population control, and have begun introducing incentives, often financial, to discourage families from having more than two children. |
| Fertility rates in India have been in decline for decades, to about 2.5 children per woman now from six in the 1950s. Mass sterilizations are frequently performed, and human rights activists have long complained that they are done hastily and under dangerously unsanitary conditions. The Bilaspur deaths are the largest loss of life during a sterilization drive in recent history. | Fertility rates in India have been in decline for decades, to about 2.5 children per woman now from six in the 1950s. Mass sterilizations are frequently performed, and human rights activists have long complained that they are done hastily and under dangerously unsanitary conditions. The Bilaspur deaths are the largest loss of life during a sterilization drive in recent history. |
| Reeta Netam and Madhulata Yadav, two patients who spoke by telephone from the hospital, said a village health worker had gone door to door inviting women to have the surgery, and then reclaimed one-third of each woman’s compensation as a fee for transportation. | Reeta Netam and Madhulata Yadav, two patients who spoke by telephone from the hospital, said a village health worker had gone door to door inviting women to have the surgery, and then reclaimed one-third of each woman’s compensation as a fee for transportation. |
| Ms. Netam, 23, and Ms. Yadav, 26, each have several children, and they said they had willingly agreed to the procedure. But both suggested that the money had been an inducement. Ms. Netam said her husband earned 100 rupees a day as a farmhand. | Ms. Netam, 23, and Ms. Yadav, 26, each have several children, and they said they had willingly agreed to the procedure. But both suggested that the money had been an inducement. Ms. Netam said her husband earned 100 rupees a day as a farmhand. |
| In a news release, Raman Singh, the leader of the state, said sterilization was a national program, carried out under the auspices of the Ministry of Health and Family Welfare. “There should not be any laxity in such an important program,” he said. | In a news release, Raman Singh, the leader of the state, said sterilization was a national program, carried out under the auspices of the Ministry of Health and Family Welfare. “There should not be any laxity in such an important program,” he said. |
| Conducting the surgery safely is time-consuming, since it takes 25 to 30 minutes to sterilize and prepare the laparoscope used in the operation, said Dr. Raman Kataria, who works with Jan Swasthya Sahyog, a nongovernmental organization that carries out sterilizations in the Bilaspur district. Under those constraints, he said, it would be unsafe to try to conduct more than two, or possibly three, per hour. | Conducting the surgery safely is time-consuming, since it takes 25 to 30 minutes to sterilize and prepare the laparoscope used in the operation, said Dr. Raman Kataria, who works with Jan Swasthya Sahyog, a nongovernmental organization that carries out sterilizations in the Bilaspur district. Under those constraints, he said, it would be unsafe to try to conduct more than two, or possibly three, per hour. |
| “This incident is a reflection of a very bad, poor system, of a nonexistent and nonaccountable public health system, where such tragedies are waiting to happen,” Dr. Kataria said. He said that there were regular reports of one or two deaths after health fairs, as the events are also called, but that this was the worst he could remember. | “This incident is a reflection of a very bad, poor system, of a nonexistent and nonaccountable public health system, where such tragedies are waiting to happen,” Dr. Kataria said. He said that there were regular reports of one or two deaths after health fairs, as the events are also called, but that this was the worst he could remember. |
| India carries out roughly 37 percent of the world’s female sterilizations, according to a 2011 report by the United Nations. The percentage for China was around 28. | India carries out roughly 37 percent of the world’s female sterilizations, according to a 2011 report by the United Nations. The percentage for China was around 28. |
| For decades, state governments were given targets for sterilizations and developed a “camp approach,” in which surgeons performed dozens of them in the course of a few hours, said Dr. Abhijit Das, director of the New Delhi-based Center for Health and Social Justice. | For decades, state governments were given targets for sterilizations and developed a “camp approach,” in which surgeons performed dozens of them in the course of a few hours, said Dr. Abhijit Das, director of the New Delhi-based Center for Health and Social Justice. |
| Those methods were challenged in the mid-1990s, when India endorsed the conclusions of a United Nations conference on population that called for abandoning contraceptive targets, improving educational programs and offering voluntary contraceptive choices. Safety standards were introduced, recommending that a surgeon perform no more than 30 procedures a day. | Those methods were challenged in the mid-1990s, when India endorsed the conclusions of a United Nations conference on population that called for abandoning contraceptive targets, improving educational programs and offering voluntary contraceptive choices. Safety standards were introduced, recommending that a surgeon perform no more than 30 procedures a day. |
| But high-pressure campaigns are still used in states with high fertility rates, like Chhattisgarh and Madhya Pradesh, said Dr. Das, who recalled meeting a surgeon in Madhya Pradesh who claimed to be doing 250 to 300 operations per day. He said the traditional practice was for women to lie on a row of tables, with three health care workers on hand — one preparing the patient, one carrying out the surgery and one stitching up the wound. | But high-pressure campaigns are still used in states with high fertility rates, like Chhattisgarh and Madhya Pradesh, said Dr. Das, who recalled meeting a surgeon in Madhya Pradesh who claimed to be doing 250 to 300 operations per day. He said the traditional practice was for women to lie on a row of tables, with three health care workers on hand — one preparing the patient, one carrying out the surgery and one stitching up the wound. |
| He said the most common complication was infected wounds. | He said the most common complication was infected wounds. |
| The practice drew attention in 2012, when a surgeon in the northern state of Bihar performed sterilizations on 53 women over the course of two hours, leaving three women bleeding profusely and prompting a miscarriage in one. A lawsuit brought by human rights advocates against the Indian government in the case asserted that the surgeon operated atop student desks, wore the same gloves throughout and left his patients lying on straw mats on the ground. | |
| Chhattisgarh is one of the poorest states in India, with a population of more than 25 million. A decade ago, the state introduced a law requiring local elected officials to have two or fewer children. | Chhattisgarh is one of the poorest states in India, with a population of more than 25 million. A decade ago, the state introduced a law requiring local elected officials to have two or fewer children. |