How Sterilization Led to Death in India
Every time we check the news the number of women dying in India from botched sterilizations gets higher.
As of this writing, twelve women have died and dozens more are sick (some on life support) as a result of surgeries performed in a government-run camp in the central Indian district of Bilaspur on women who were paid 600 rupees (approximately $10) to undergo tubal sterilization. One doctor and two assistants performed 83 surgeries in six hours — more than 13 per hour or one ever 4 to 5 minutes. The sick are suffering from hemorrhage (heavy blood loss) or sepsis — an advanced infection that invades the blood stream and attacks vital organs. If not treated quickly and aggressively, death can occur within hours.
I’ve assisted as a nurse in hospitals that perform tubal ligations and here’s how the procedure is supposed to go:
The patient signs an informed consent that indicates she understands the surgery, side effects, potential complications and benefits and agrees to have the sterilization done. She is prepped for surgery and consults with an anesthetist in a well-lighted surgical room where all equipment has been carefully sterilized and all personnel wear sterile gowns, masks and gloves. The patient receives anesthesia — either an epidural, a local anesthesia with sedation or general anesthesia (she goes to sleep). A doctor is in charge of the surgical procedure while an anesthetist is in charge of pain management and monitoring the patient’s vital signs. A surgical technician or nurse is in charge of the equipment and another nurse is responsible for making sure the patient’s needs are met and documentation is done correctly. Once the patient is anesthetized, the surgical site is scrubbed with surgical soap and the surgeon makes an incision right below her naval. A small telescope (called a laparoscope) is inserted into the incision and threaded through the pelvic cavity until the fallopian tubes are in view. Surgical equipment is threaded through the laparoscope and the tubes are either cauterized (burned), cut and tied or clips are placed on the tubes to make it impossible for sperm to reach and fertilize an egg, thus preventing future pregnancies. Then, the surgical equipment is removed, the incision is sutured and bandaged and the patient is observed for several hours to make sure she’s stable. The whole procedure from start to finish can take as long as a couple of hours (including preparation time) to as short as twenty to 30 minutes (for the surgery itself).
An article that appeared in the New York Times describes how these camp-style procedures have been performed in India in recent years:
[a doctor]…claimed to be doing 250 to 300 operations per day. He said the traditional practice was for women to lie on a row of tables, with three health care workers on hand — one preparing the patient, one carrying out the surgery and one stitching up the wound… He said the most common complication was infected wounds. …. A lawsuit brought by human rights advocates against the Indian government in the case asserts that the surgeon operated atop student desks, wore the same gloves throughout and left his patients lying on straw mats on the ground.
Some may wonder why women would agree to undergo sterilization considering the conditions under which surgery would be performed. These women live in areas where other means of family planning, reproductive and maternal healthcare and health education are scarce if available at all. Many of these women have no way to avoid having several back-to-back pregnancies and many live in such impoverished conditions that bringing another child into the world is well beyond their physical, emotional or financial means. Many are desperate for the 600 rupees this surgery provides and others simply didn’t understand what the procedure entails. These women live with very few options, very little power and no idea how the procedure would be performed under safe conditions. They were provided an opportunity and they took it, not understanding that many of them were walking straight towards hemorrhage, sepsis and death.
Much of what’s being written about these deaths centers on women’s human rights, sterilization quotas and the bullying women endured that coerced them to submit to surgeries some didn’t want. There have been government-run sterilization campaigns in India since Indira Ghandi was Prime Minister in the 1970s. Doctors are pressured to meet quotas to sterilize certain numbers of women in specific regions in an effort to control over-population. These women are not made aware of other contraceptive options. While those quotas have supposedly been eliminated as official policy, doctors say they’re still expected to meet sterilization targets. That’s led to renewed discussions about human rights, women’s rights to skilled healthcare. We’re working with Nazdeek, a legal capacity building organization committed to bringing access to social and economic justice to marginalized communities in India. They work in impoverished communities to educate women and their families about their rights to respectful, high-quality maternal healthcare. In light of the stories we’re hearing today about the deaths of Indian mothers, we hope more women learn that their rights, choices and lives have value.