Understanding Family Planning – Poor Medical Care, Forced Sterilization and the Genocide of Tribal Peoples and ‘Backward Castes’

By: Morgan Wilson, PHRGE Fellow at Human Rights Law Network in Delhi, India

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Sterilization patients recuperating on the floor of a meeting room in the Basta Community Health Centre


I recently completed a co-op assignment with the Human Rights Law Network (HRLN) in Delhi, India. I worked with the Women’s Health and Reproductive Rights Initiative (WHRRI) researching maternal and infant deaths and the implementation (or lack thereof) of the Indian Public Health Standards (IPHS) in Odisha state. My travels took me to two villages – one in the Basta region, Balasore District and the other in the Banki region, Cuttack District, where my supervisor and I met with two families impacted by substandard medical care.

These families, and most of the people served by WHRRI, were from the so-called ‘Backward Castes’ (BC), Scheduled Tribes (ST) or Scheduled Castes (SC). In India’s complex caste system, these are ‘protected’ classes, people who through generations of discrimination and isolation have become socio-economically disadvantaged.

At our first meeting, we spoke with the mother and mother-in-law of a woman who died of postpartum hemorrhaging (PPH) after childbirth. In this case, the woman bled out on the delivery table in front of her family as the doctor stood idly by. Although the decedent’s family begged the doctor to administer lifesaving treatment, he refused. The doctor decided instead to chastise the decedent in her final moments of life, making clear that his refusal to administer care was punishment for having a third child as a member of a ST. The impact of his decision is felt not only on the three children the decedent left behind, but on the father who is now a widower, and the mother who was forced to bury her child prematurely.

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Delivery table in the labor room of the Dampara Community Health Centre


Similarly, at our next interview, we listened to a grieving father explain that his daughter’s only child was killed by a disgruntled doctor whose aggressive use of forceps punctured the newborn’s head, resulting in a slow painful death. In this case, the OBGYN insisted that she be paid 500 INR (roughly $7.40) to assist with the birth, even though healthcare is free. When the family explained that they were unable to pay the exorbitant fee, the doctor begrudgingly assisted in the delivery once it was clear the baby was in a difficult position. After the delivery, the doctor told the family “these things happen sometimes” and “there was nothing she could do” to save the child. As I later learned, stories like this are not uncommon in rural areas. Without access to legal aid organizations, many families are left without any recourse to confront negligent doctors.

Adding insult to injury, a tour of the medical facilities in Odisha revealed sterilization wards where BC/ST/SC women, no older than 23, were being sterilized through vigorous and vicious family planning campaigns aimed at decreasing their family sizes. In exchange for being sterilized, men and women are given monetary incentives by national and state governments for their participation in family planning programs. This form of coercion increases the number of people (particularly women) dying from haphazard procedures in healthcare institutions where IPHS are not fully implemented and doctors care more about meeting quotas and receiving awards than they do about helping patients. In this way, the government maintains control of BC/ST/SC people and ensures a smaller tribal population in the future.

Historically, BCs/STs/SCs were effectively excluded from attending medical school, resulting in a large portion of medical staff treating patients of different/lower castes/tribes. When doctors refuse to give care or are negligent in the administration of their duties, caste and tribe discrimination in both the medical and legal fields provide them with relative impunity. Sadly, if a victim or their family is successful in bringing a medical malpractice claim against a negligent doctor, oftentimes the result is that the state pays a pre-set amount of money to the family and the doctor is allowed to continue harming/killing patients. What this means on a basic human level is that BC/ST/SC people are being killed by the very people charged with their care. It comes as no surprise, when villagers explain they are afraid to utilize the free government medical facilities but are too poor to pay for private care, that the question is one of risk – stay home and hope for the best, or go to the government hospital where there is a high likelihood of substandard care and possibly death.

What I have taken away from the visit to Odisha, and my experience with HRLN, in general, is that there is a significant need for attorneys and volunteers to engage in human rights work. Otherwise, the most vulnerable populations will continually be subjected to acts of violence and terrorism. Terrorism has taken on a very specific meaning in the post 9/11 age, but terror manifests itself in a myriad of ways. In the context of women’s health and reproductive rights in India, it is my contention that the forced sterilization of BC/ST/SC) women is, indeed, terrorism. Sanctioned by the national government and implemented through health service providers at the state and local level, mass sterilization becomes a form of genocide. Moreover, it is also an act of terror when doctors refuse to administer care to BC/ST/SC patients, thereby causing death or serious bodily harm.

The work that HRLN does in the field of women’s health and reproductive rights is necessary to ensure delivery of proper medical care, and critical for the livelihood of BC/ST/SC people. For more information about HRLN, please visit: www.hrln.org.

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