New Delhi: Eighty-five percent of India’s family planning budget is used to promote and conduct sterilizations on women, the head of a prominent charity said on Friday, calling for more funds to be channelled towards providing alternative forms of contraception.

Poonam Muttreja, executive director of the Population Foundation of India (PFI), said an analysis of the national family planning programme’s budget for 2013/14 found that Rs340 crore out of a total Rs400 crore was spent on female sterilization.

“There is a total emphasis on sterilization in India. 85% of the expenditure for family planning is on incentives for sterilization, 13.5% is on equipment and salaries, and just 1.5% is on other forms of contraception," said Muttreja.

India’s efforts to rein in population growth have been described as most draconian after China. Birth rates have fallen in recent decades, but population growth is still among the world’s fastest.

The world’s top sterilizer of women, India came under global scrutiny for sterilization drive last November when 15 women died and scores of others were hospitalized after surgery at a sterilisation camp in Chhattisgarh. Investigations found the deaths in Bilaspur district were due to unhygienic conditions, dirty medical instruments and equipment and an overall lack of care for the patients who were poor tribal and low-caste women.

Authorities have since put in place guidelines and are training local health workers on conducting safe and sanitary surgeries, based on findings of a PFI study into the deaths, but incentivised, target-driven sterilization continues.

Doctors, nurses and health workers receive cash incentives for promoting and carrying out sterilizations. Patients are also given compensation—ranging from Rs600 to Rs1,100 for tubectomies and vasectomies respectively.

“The doctor is getting Rs250 per surgery. Why would he bother to do only 10 or 20 surgeries when he can do 80? In the Bilaspur case, this is what happened," Muttreja said. “The doctor did not even change his laparoscope once during the 86 operations. He didn’t change his gloves once. He didn’t have the time."

The doctor denies charges of culpable homicide not amounting to murder and told the Thomson Reuters Foundation that the deaths were caused due to spurious medication supplied by the authorities. The trial is yet to come before the court.

Cutting maternal mortality

With more than four million Indians sterilized every year, the incentive system encourages officials and doctors to cut corners and uneducated women are often given money for surgery without knowing the risks, say activists.

Muttreja said India had to improve access to other forms of contraception, widen the basket of contraceptives on offer and invest in providing better reproductive health services. The government currently offers only five choices to men and women— female sterilization, male sterilization, Intrauterine Contraceptive Devices (IUCD), oral contraceptives, and condoms.

In contrast, other countries in the region such as Nepal, Bhutan, Bangladesh and Indonesia have seven contraceptive methods available which include injectables and implants.

An estimated 32 million Indian women do not have access to any form of modern contraception and providing more choice, together with screening and follow-up, will reduce numbers of unintended pregnancies and help accelerate a fall in maternal mortality rates.

In 2012, 178 women died per 100,000 live births in India, down from 212 in 2007, according to the UN children’s agency. Despite the falling rates, the UN says India has made slow progress on development targets on maternal deaths, assisted births and ante-natal care. “Women do need sterilization as a option of family planning, but we need it conducted properly and under hygienic conditions. The manner in which sterilisation is being done in India currently is unethical," Muttreja said.

“We will see a huge reduction in maternal mortality if we invest in other methods of family planning also." Reuters