By Ila Ananya
Here are two stories about governments who look at human beings and see “population”.
Story#1. The only way a woman from the Baiga community in Chhattisgarh can undergo sterilisation is if she is given government “permission” to do so. For this, first she has to approach the Block Development Officer. The officer is expected to explain to her what sterilisation would entail, and then give her a No Objection Certificate. The certificate is all that is required to “allow” her to be sterilised at a hospital after this. You can imagine how easy this must be. Rajni Soren of the Human Rights Law Network says that for the last 39 years, officers have refused to give these No Objection Certificates to women belonging to Particularly Vulnerable Tribal Groups (PVTGs). Instead, families spend months running around writing frantic letters to no avail.
The reason? People like the Baigas, belonging to PVTGs have very poor access to contraception and healthcare, and a bizarre law controls what governments are generally more than ready to give the poor: sterilisation.
In 1979, the undivided Madhya Pradesh government passed an order that denies people belonging to PVTGs any access to sterilisation without permission. It was started to save them from forced mass sterilisation drives because their population was so low. Apparently, this was the quick-fix for communities with high mortality rates (that continue today) because healthcare services never reached them. But as Ranichand, a Baiga woman from Chhattisgarh told The Indian Express with a heavy dose of irony, “We live inside the Achanakmar Tiger Reserve where they want to preserve tigers. They treat us like them, too.”
Story # 2. This one was in the news earlier in April 2017. Assam’s state government has drafted a proposed population policy that bars people who have more than two children from holding government jobs and contesting in panchayat and other local elections. The terrible move will have obvious implications if it is passed. It will affect a large number of families from different communities and the poor, specifically denying them their right to hold jobs and take part in democratic processes.
What’s common between Chhattisgarh’s Baiga families and now Assamese families potentially, is the government deciding how many children they ought to have while simultaneously providing terrible maternal and child healthcare. Forced mass sterilisation in the way that it has been conducted is just one horrific way in which women are denied their rights. But in Chhattisgarh, the government has done the same by stopping PVTG women from making active choices about their bodies — in this case, to undergo sterilisation.
Now, along with the Jan Swasthya Sahayog and the Jan Swasthya Abhiyan, 10 Baiga families have filed a petition in the Chhattisgarh High Court demanding that the 1979 order be scrapped. Soren, their lawyer, says they have all run around with letters to sub-divisional officers for No Objection Certificates, but got no response. Sulakshana Nandi of the Jan Swasthya Abhiyan, says, “The feeling is unanimous that they want their right to decide how many children they want to have.”
Most of the Baiga families living in Achanakmar Tiger Reserve have eight to 15 children they can’t provide for and a tragic story about a child who died. Nandi says that a study that the Public Health Resource Network (PHRN) and other organisations are currently undertaking among Baigas in Chhattisgarh and Sabars in Jharkhand (also PVTGs) has found that among 505 married women (248 in Chhattisgarh and 257 in Jharkhand), 59 per cent of women (62 percent in Chhattisgarh and 57 percent in Jharkhand) had a lower number of living children than the number of pregnancies.
In both Assam and Chhattisgarh, it seems like following problematic old orders and drafting terrible population policies is only a simple diversion from actually putting in the effort to improve contraceptive availability and healthcare.
For many years now, as Nandi says, women have taken to travelling to small hospitals in neighbouring Madhya Pradesh to be sterilised under fake names (Baiga women find it harder to do this because they have distinctive tattoos). If their community is discovered, they are turned away. In 2011, the 1979 order became an issue between the Madhya Pradesh and Chhattisgarh governments for this reason. Back then, as Supriya Sharma had written, men from small hospitals in neighbouring Madhya Pradesh (that had set targets for sterilisation) had come to Chhattisgarh, selling the idea of hysterectomies to Baiga families. But the bigger problem is that if women do get pregnant, they are forced to undergo unsafe and painful abortions from local healers.
A 2012 study by PHRN and State Health Resource Centre (SHRC), Chhattisgarh, aimed to understand how much access PVTGs had to health and nutrition services and resources. They found that of the 1,200 households of Baiga, Pahari Korwa, and Kamar communities that were surveyed, only 32 per cent of the families had received Rashtriya Swasthya Bima Yojna cards (insurance programme for those below the poverty line). Only 4 per cent had even used these cards. In only 6 per cent of the families, had women got financial incentives under the Janani Suraksha Yojna, which aims to reduce maternal mortality by promoting institutional delivery. In 2016, Assam had followed Madhya Pradesh and Chhattisgarh at a close second in infant mortality rate, but this question obviously never came up in its discussions on drafting the new population policy.
Since neither women nor men belonging to PVTGs were allowed to be sterilised, surely it should have crossed the government’s mind to make other contraceptives available? Nandi says, “An auxiliary nurse midwife in Chhattisgarh we spoke to during our study said that she had not received any supply of Mala-D in the last one-and-a-half years, that the supply of condoms was very less, and that she had no training to insert an Intra-Uterine Device (IUD).” Obviously, the government didn’t think it was important to provide these women with the “basket of contraceptives” that it so aggressively promotes.
It’s true that it is important to lift the prohibition on sterilisation. But it is also true that as Nandi says, “PVTGs still live under vulnerable conditions. The government needs to strategise on improving their access to health.” It also reminds us of what Ranichand had told The Indian Express, “It is always the woman who gets affected the most. The toll is on our bodies.”