Of Sterilisation, Public Health, and Politics: LSPR in conversation with Dr. Y.K. Sandhya (1/2)

Prannv Dhawan speaks with Dr. Y.K. Sandhya in an exclusive interview for LSPR.


Dr. Sandhya and her NGO (Sahyog) have been instrumental in formulating the first-ever Youth Policy of Uttar Pradesh in addition to leading the PIL in Ramakant Rai vs. Union of India that led to strong guidelines to outlaw forced sterilisation and ensure humane conditions in sterilisation camps. Her organisation has also leveraged their fieldwork as evidence to successfully advocate for change in rules under two-child norm policy by highlighting its exclusionary characteristics.

LSPR: Your work has thrown considerable light on the pitiable state of public health infrastructure. Could you please share insights from your fieldwork about the same?

Dr. Sandhya: We (read: Sahyog) have done a series of fact finding missions to find out the situation of health services, especially with regard to maternal health. The tribal dominated villages of Jharkhand were the focal point for these missions.
Based on this ground reporting, it came to light that the budget meant for the childhood plans was not really being used to promote the welfare of children but instead were being used to build stadiums and roads. Later, we raised this as a question with the parliamentary standing committee and to the Ministry of Family Welfare. As a result of these efforts, an increase in the allocation for fund schemes concerning maternal health was made in that particular year, however, it is still a long way to go.

LSPR:  Can you outline Indian Government’s approach towards sterilisation?

Dr. Sandhya: The international conventions on reproductive rights have a human rights approach, in the sense that, they talk about very important principles such as consent. The fact that you should have a range of separate choices in the sphere of family planning and women should be free to decide how many children she wants to have. That is very crucial to inform policies regarding how many children do I have, when do I want them and if I don’t, what are the methods available to me. She should understand that there are A/B/C/D options and the negatives or the risks associated with those options and after understanding that only she decides to choose a particular option. We think that the entire focus should not be on women. Contraception is something that should happen after discussion between the partners. When you present all the methods to the couples, only then a true choice can be made. If you don’t present all of them, women have very little choices and in the way they are forced to choose whatever you offer.
The above problem also has its basis in the ‘lack of supplies’. So due to lack of public resources and comprehensive programs, government is not offering the basket of choices. This violates the international agreements and commitments which come out of a lot of struggle.

LSPR: How does the Ramakant Rai judgment affect the above scenario and what is the status of its implementation?

Dr. Sandhya: The Ramakant Rai judgment, the Supreme Court laid down the conditions which should be followed not only during sterilisation but before it. It is mandatory to ensure whether she had given her consent when the operation was being done and if requisite equipments are available, what methods are to be followed, overall hygiene standards etc. However, what we have seen recently is that none of these were followed because of logistical failures on part of the government.
For instance, in Uttar Pradesh, the fund flow for the financial year is from April 1 to March 31. However, you get your funds towards the end of the year like in December or January. Hence, the money actually comes into the system very late, however, you still have to meet a family planning target under the established target based approach. So what transpires is that camps with a large number of women are organised and mass sterilisation is performed.
Therefore, it is linked with the budgetary flows. This also results in abysmally low standard of care, obviously, if you do sterilisation on such a large scale and do it anywhere like in abandoned primary school buildings or broken community centres, health standards are bound to take a hit.
The recent case of Devika Biswas v. Union of India, where thirteen women died in 2014-15 it was observed that none of the guidelines under Ramakant Rai were followed. The state of compliance of mandatory guidelines is clear from the fact that while you should have two instruments and those instruments need to stay for certain timing in an antiseptic solution and then you move on to the next person during sterilisation. All of those are not there and normally the people who are trained in this procedure are few in number and they don’t stay where you are holding the sterilisation camp. By the time the medical staff reaches, it is late evening. However, the women who are going to be sterilised have to wait there from morning on empty stomach.

LSPR: The situation clearly appears quite grim, do you see some light at the end of the tunnel?

Dr. Sandhya: All being said, there’s still light at the end of the tunnel. In the Devika Biswas orders the court said that the current policy of sterilisation camps has to be completely stopped in three years. The court also ordered for the strict compliance of Ramakant Rai guidelines during the conduct of these camps which to an extent. Currently, the camps are still organised and there are minor violations of these guidelines but majorly the use of dynamic jugaadu services has been discontinued and they are happening in static places like hospitals. However, a lot is yet to be done.

Read the Part II of the Interview, where Dr. Sandhya talks about the Politics of Public Health Policy.



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