Incentivised Sterilisation in India


Women lie recovering from anaesthesia in an open-sided corridor after their sterilisation operations in a 'Sterilisation Camp' in Buhana Rajasthan, August 2011

When  I first saw this story reported in the Indian press with a headline something like ” Get sterilised and win a car!” I initially thought it was a joke but soon after I was on my way to Rajasthan with my good friend Andrew Buncombe of the Independent to cover the story for real.

India’s population is colossal, still growing and UN estimates predict that by 2050 it will have overtaken China to reach 1.5 billion from its current 1.2 billion. Experts warn this will present immense challenges and further intensify pressures on already scarce resources. The country’s efforts at tackling the problem have had mixed and sometimes deeply contentious results. The most infamous of these involved Sanjay Gandhi, son of the then prime minister Indira Gandhi who during the State of Emergency  in the 1970’s imposed forced sterilisation on countless men and women. Despite the outcry against this policy, sterilisation remains the preferred and often only form of contraception especially in the poorer rural areas.

While paying people directly to undergo the operations is illegal the Ministry of Health has side-stepped the issue by compensating participants for “loss of earnings”. Men receive 1,100 rupees (£15) while women receive 600. Additionally anyone who brings willing patients to the camps are dubbed “motivators” and receive 200 rupees. Other methods of contraception are little known and in some communities still not socially acceptable. Low status and lack of education among women compounds the problem.

One couple I photographed at the camp was Devinder and Rekha Kumar . After the birth of their second child they realised they could not afford more children with the steeply rising prices of basic commodities. The fact that they would receive cash plus the chance to win a brand new car among other items sealed their decision to go ahead with the sterilisation. In fact, even though officials explained it was clearly not necessary for him to undergo the operation now that his wife had, Mr Kumar insisted he would return to have the operation later too saying “I have the right to have it done and to collect the money”. This highlights a major objection to incentivised sterilisation by concerned NGO’s – that the approaches are coercive and target the poor and disadvantaged.

Devinder Kumar supports his wife Rekha after her sterilisation operation in Buhana, Jhunjhunu district, Rajasthan

While camps making people aware of family planning and offering free sterilisation are nothing new in Jhunjhunu the incentivisation is. Sitaram Sharma the Chief Medical Officer of Jhunjhunu said there is a statewide target to sterilise 1% of the population (21,000 this year) and when considering the slump in participants during monsoon months (from July to September) they came up with the incentivisation tactic to try to encourage take-up during this time.  Sharma says they are doing nothing wrong and that the prizes have all been donated by a local university.  Read Andrew Buncombe’s full article here.



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