Monday, November 17, 2014

Choice or Coercion?

Once again 14 women have lost their lives after undergoing tubectomy at a sterilization camp in Chhattisgarh.  Deaths due to sterilization are not new phenomena in India, neither are incidents like the one which has taken place in the Chhattisgarh sterilization camp.  In 2013-14, more than four million sterilization operations were performed, according to a report by the government. More shocking is the fact that between  2009 and 2012, the government paid compensation for 568 deaths resulting from sterilization, the health ministry said in an answer to a parliamentary question.

The fundamental question is why do we need to organize sterilization camps where women are herded in and mass procedures conducted often under not so ideal conditions? Why have we failed to provide services to women that are easily accessible and affordable? Even today a woman cannot walk into a primary health centre and ask for a tubectomy. She is often not even provided with a regular supply of pills or condoms. The basket of choices is so limited - condoms, pills, intra- uterine devices and tubectomy. The NFHS 3 data shows that the contraceptive prevalence rate for the various methods is as follows. Total percentage of users of modern contraceptives 48% out of which 76.9% use female sterilization, 2.06% use male sterilization, 3.5% use intra uterine devices, 6.3% use pills and 10.7% use condoms. The data thus indicates an overwhelming preference for female sterilization.

Service providers as well as women find tubectomy to be a more convenient option due to issues involving hurdles in obtaining, using and monitoring of the side effects of the spacing methods. The preferred choice is to have children in quick succession and go for a permanent method. However, early  and closely spaced pregnancies have bad health consequences  for women  and also for population stabilization as generations get replaced at shorter intervals.

The fact that 20% of births in India are unwanted shows how desperate the need is to increase access to contraceptive services to men and women. A study conducted by Population First showed that even when men are willing to go for sterilization, the service is not made available to them in the PHC. A laparoscopy specialist is called only if there is sufficient case load! Thus, it is the case loads which determine the availability of service and not the requirement of the individual even if he is the lone seeker of service.  And men are not willing to be herded to camps when it is so much easier for service providers and the families to coerce cajole and lure the woman to the camp with incentives.

There are also a number of patriarchal values which discourage a man from going in for a vasectomy. It is often said that men should have the option of siring a child in case of the death of his wife and in the event of a second marriage or if he wishes to get into a relationship with another women.  Women oppose the procedure because they fear that if the Non Scalpel Vasectomy (NSV) procedure fails and they get pregnant they would lose everything. NSV requires abstinence or intercourse with the use of condom for a period of three months  and a test to check the sperm count after three months to ensure that the sterilization has been successful. Yet, this follow-up is not carried out rigorously leading at times to the women getting pregnant. In such an eventuality, her fidelity is doubted and she often faces social stigma and domestic violence.

There can be no better indicator of the failure of health care system than the health camps and sterilization camps which are seen as a quick fix for our inability to provide quality contraceptive and other health services on a regular basis at an affordable price to women and men.

Add to this, the pressure of looming targets. Though in principle we have adapted a target free approach in 1995 targets continue to haunt the service providers and governments and camps are organized to achieve the targets. It is imminent that India’s promise at the July 2012 FP2020 Global Summit to increase access to 200 million couples and adolescents will reinforce the pressures of targets further more in the coming years.

Census data shows that India's population growth rate has been steadily declining over the last few decades and stands at 1.6%.  The total Fertility Rate or the average family size has come down from 2.7 to 2.5 between 2001 and 2011. More importantly, 12 out of 29 States and 5 out of 7 Union territories have achieved replacement level fertility i.e two children per family. Then, where is the population spurt taking place? In remote rural and tribal areas, in economically backward districts and states and finally where gender indices have remained stagnant.

Research had again and again shown the importance of girls' education for stopping child marriages and teen pregnancies as well as for promoting maternal and child health. More importantly, research shows that education helps women exercise their contraceptive and sexual and reproductive health choices.

Contraceptive behavior thus is not just determined by the knowledge of the contraceptive methods, but is influenced by easy access to affordable services, ability of women to take decisions regarding their sexual and reproductive health and efficient follow-up care.

The inherent bias in the Family Planning programs which lays the whole burden on the women, who lack the decision making power makes them easy targets for target driven sterilization programs. There is a need to promote more male participation.

  Population programs are seen as the sole responsibility of the government, particularly the health department. There is a greater need to pursue sustainable health interventions, which look at woman's health in totality - her nutrition, sexual and reproductive health, and contraceptive needs. Yet, a woman comes under the radar of the health system only when she gets pregnant or when there is a pressure to meet sterilization targets. While overall social and economic development has tremendous impact on contraceptive behaviours, there is a lot that can be done to reach out to vulnerable women.

A 2012 report by Human Rights Watch urged the government to set up an independent grievance redress system to allow people to report coercion and poor quality services at sterilization centers. But, despite the recommendations to the government, the issue persists with woman having hardly any choice or recourse to justice.

It is time we ask the government to undertake an impartial inquiry into the tragedy and ensure that those responsible for it are punished as per the law.

Please sign the petition demanding an impartial inquiry into the incidence and strongest action against all those responsible for it. CLICK HERE

Tuesday, November 4, 2014

It all started with a kiss.....

The ‘Kiss of Love Campaign’ sabotaged by the police, has in a way worked in favour of the protesters. The whole campaign began on social media after a coffee shop in north Kerala’s Kozhikode, city was vandalised last week by a group of people who criticized the public display of affection (PDA) by some couples there. The campaign fizzled out even before students could use a public place to mark their protest against moral policing in Kochi, Kerala. The Kerala high court refused to intervene and police had denied permission for the event, and had said they would only intervene if it created a law and order problem.
However, the police rounded up the 50-odd activists who were planning to march towards Marine Drive, the venue of the event, to protest against moral policing.

Expressing her views, Seema Sood, Director, Events and PR, Leo Burnett, added, “This was an amazing campaign. Moral policing should not be done for people expressing their love. We are a democratic nation, where freedom of action, speech should be allowed and accepted. PDA should be allowed in society. We are a land of the Kamasutra, and no one should be stopped from expressing love and warmth.”

India is growing at a rapid pace. Exposure to the outside world is changing mindsets. Along with that, behavioral changes are also taking place. Today’s GEN X is more open, more aware and a lot more vocal about their likes and dislikes. The have access to social media to protest.

“The youth of today is very different. Their exposure is different. The way they express affection is different. We cannot put a ban on PDA. The youth is exposed to different forms of media. In today’s changing world scenario, we cannot have gender roles and expect a particular behaviour from one gender group. We cannot tell girls not to go to pubs, not to go out late in the night. As gender roles are blending, the more conservative groups see this as a threat. The campaign is a defiance from the youth, as a way of saying that we also have a voice and want to be heard,” adds Dr. A . L. Sharada, Director, Population First.

However, there is always a flip side to every story. When there are winds of change blowing, there will always be different schools of thoughts that will be against the change. The open display of affection, the protests against moral policing is being viewed as a threat by groups people and government officials averse to change.

On one hand, we want to call ourselves modern and open minded, but don’t want to give up on our so called India culture. Says Tina Mehta, Brand Consultant, Lightbox, “Culture is living, breathing thing. People blame things on our Indian culture, saying this is not identified with our Indian culture and values. However, culture is very dynamic. The fact that a group of youth is expressing themselves is a big indication of change.”

She further adds, ” However, we need to realize that mindsets and perceptions will not change overnight. India as a country is opening up, but it will take a while for overall acceptance. With reference to the campaign , I’d say, well, good, well done.The right community of people have been touched by reaching out to , that is the youth, via a Facebook campaign. The main thing is not how long it will take to change things, but the fact that the campaign created awareness is a big step.”

Protesting against moral policing is not new or unheard thing in India. Earlier campaigns like Pink Chaddi, protested against moral policing and the Slut Walk, called for an end to rape culture.

Trying to bury an issue under the guise of law, will not end the problem. The issues that mater to the youth have to be given a platform to be expressed. Says Sharada, “The government officials should have handled the protesters with more maturity.Things do not bode well for a country that tries to quieten the voice of the youth". Adds Mehta, “ The good thing about the campaign was that media was able to pick it up. Had it not received media attention, it would have been one of the many incidents that happened in some part of India. The objective of the campaign, which was to protest against moral policing, was achieved.”
Parallel to the police’s reaction to the campaign, Sood adds, “On the same note, archaic laws which are anti-women should be banned. The police should invest all their energies in catching criminals in India and not people who spread love and happiness. “

So are things looking bleak for the youth of today, who are being exposed to the world via social, electronic and web media. Well ,as of now it looks like the more liberal they want to get, the bigger is the backlash from people who want to cling on to more conservative mindsets.

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