The death of eight women in botched sterilisation surgeries in Chhattisgarh brings back into focus a long-running, contentious state-run programme that is neither transparent nor clinically safe, nor even greatly beneficial in stabilising India’s population.
Back in the 1970s, the government was so worried about the exponential growth in population that it launched a compulsory sterilisation programme which saw unwilling men hiding in fields and on trees to avoid getting vasectomies.
In many cases, school teachers trying to meet family planning targets pressured fathers of their students to sterilise, before a public outcry drove authorities to abandon these desperate attempts.
That coercive campaign was replaced with a new, free choice policy which emphasised education of women and health care rather than demographic control.
But, in practice, women and men are often coerced, forced or bribed into accepting tubal ligation.
Deaths due to sterilisation are not a new problem in India, where some 4.6 million sterilisations were performed in 2013-14, government figures show. Many die as a result of botched surgeries, while others are left bleeding and in agony.
Government figures show 1,434 sterilisation deaths between 2003 and 2012, with 2009 being the worst year with a maximum of 247 deaths. On an average, 12 deaths occurred every month over the last ten years.
A typical sterilisation camp in villages throws up dire images of surgeries rushed through in unhygienic conditions: Typically, half a dozen tables set next to each other, blood-stained sheets, health staff without protective masks and tools only rinsed with hot water.
Even paying women to undergo sterilisation is a form of coercion in a country blighted by decades of poverty and illiteracy and where the poor still see an extra child as an extra pair of hands. Also, paying a bonus to doctors and officials for every surgery raises as much an ethical question as the prospect of perpetuating coercion.
Excessive focus on sterilisation may actually be contributing to a population boom. The drive to promote sterilisation limit the contraceptive choice, with spacing methods for young couples - pills, intrauterine devices and condoms - getting neglected.
Given that India is a young country, limiting the contraceptive choices of the young maybe slowing down the fall in growth of the population.
Many states also violate the population policy of 2000, which called for a target-free approach to population stabilisation. To meet the goal of population stabilisation, many states such as Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan have fixed targets especially for sterilisation.
In India, population control remains a delicate issue, with politicians being wary of promoting family planning too vigorously, mindful of the lessons of history.
In 1977, then Prime Minister Indira Gandhi was punished by voters for imposing the Emergency. But her worst defeats came in areas where the family planning campaign was robustly implemented by her son, Sanjay.
Our sterilisation programme still remains mired in controversy. Although there may be merit in stabilising the population, it is time to break the awkward silence around a controversial state programme before it becomes a grave human tragedy.