COMPULSORY STERILIZATION IN INDIA

Warwick, Donald P.

COMPULSORY STERILIZATION IN INDIA DONALD P. WARWICK The resort to coercion raises civil and moral issues For over twenty years India has been the world's proving ground for public birth control...

...One of the best is Robert E. Elder's Development Administration in a North Indian State: the Family Planning Program in Uttar Pradesh...
...Given persuasive evidence that reduced infant mortality and improved maternal health facilitate a drop in fertility, such cutbacks would seem both morally and practically dubious...
...Editorial comment to date on the Indian proposals shows a curious double standard...
...incentives to acceptors and bounties to finders...
...2) non-coercive methods have been tried and have failed...
...For many millions of Indians the idea of having only two or three children simply does not make sense...
...It is by no means evident that the recent proposals address India's most basie population problem, nor that voluntary measures, including development programs, have been given a fair chance, nor that the program would work on its own terms or be administered equitably...
...and (4) program implementation would be equitable across all castes and classes, and would produce more good than harm...
...Mahmood Mamdani's small study The Myth of Population Control gives eloquent testimony to the rationality of large families for Indian villagers...
...The resolutions of the World Population Conference at Bucharest, to which India was a signatory, explicitly state that national population policies should be formulated and implemented "without violating, and with due promotion of, universally accepted standards of human rights...
...It is hard to imagine how a government which cannot manage simple vital statistics will be able to determine the age of couples and the number of their children and then organize an effective enforcement mechanism...
...No UN document, however, states the conditions (if any) under which the right to procreate may have to be sacrificed for the common good...
...Both West Bengal and Punjab are drafting similar legislation...
...In a country already shot through with resignation, indifference and dejection, a further dose of oppression seems particularly ill timed...
...integrated health and family planning services...
...In one sense the Family Planning Programme has already tried everything short of compulsion voluntary clinics, public exhortation, mobile units, incentives, and mass vasectomy camps...
...human rights...
...The few reliable studies done on the government's existing family planning program provide little basis for optimism...
...But there was also compelling evidence that public officials used pressure and intimidation with this group to fill their quotas...
...Significantly, the government has not applied in the development field the drastic measures it proposes for population...
...To the extent that coercive measures divert attention and resources from that objective, they would be misplaced...
...He felt that development was, of course, important, but that what Indians needed even more was a new leader to walk the length of the land preaching hope and change...
...3) compulsion can reasonably be expected to produce the desired reduction in fertility...
...Some would turn the argument around...
...Even measured against these standards, which strong human rights advocates would consider too loose, the Indian proposals do not fare very well...
...Since then it has lurched from one family planning strategy to the next: massive promotion of the intra uterine device...
...Two ethical approaches should be scuttled from the outset...
...Beyond the rampant rumors which are inevitable in such a program and which cropped up in earlier vasectomy campaigns, poor people may understandably find it hard to distinguish Monday's coercive horrors from Tuesday's voluntary services in the same clinic...
...One reason was undoubtedly the greater attractiveness of financial incentives to the poor...
...Few would deny that under existing conditions rapidly increasing numbers severely strain the country's ability to provide food, clothing, shelter, education and other services to its people...
...Nations able to produce such a managerial feat are usually in the middle to upper reaches of development, possessing social conditions which themselves lead to reduced fertility...
...This and other studies point up the pivotal role of program workers...
...To achieve results and to counteract builtin employee resistance, the government will probably assign quotas to each worker...
...Also morally significant is the sex distribution of the living children...
...India's resort to coercion sharply raises the question of government rights vs...
...Such remarks may seem visionary and characteristically Indian, but coming from someone who has tried the route of gadgetry they deserve to be heeded...
...Has India really given non-coercive measures a fair chance...
...India has a very poor record in promoting rural development, land and income distribution, reduced infant mortality, and other forms of material welfare...
...The moral issues posed by these initiatives are doubly important because of India's size and fishbowl status in the world communtiy...
...And where they are available clinic administration is often so insensitive and incompetent that potential users stay away...
...We must certainly sympathize with India's dilemmas in matching resources and services to people...
...Even in India there are vast differences in infant mortality across states and between urban and rural areas: And what about forced sterilization in regions lacking voluntary family planning services...
...People are being told that there is no hope, that the government cannot promise a Better life for themselves and their children, and that, indeed, the begetting of children one of the few areas of accomplishment for the poor is a prime source of despair...
...Is population growth a real threat to India's welfare...
...The reasons are legion: high infant mortality, which means that only one of three may survive...
...After a cautious start in the 1950s, when technology was scant and political reticence abundant, the government moved into high gear around 1965...
...Other moral questions also arise...
...Someone has said that any government which can mount a gargantuan apparatus of compulsion probably does not need it...
...Price Minister Indira Gandhi speaks bluntly of "other strong steps which may not be liked by all...
...Earlier it cut off most government assistance, from jobs to housing, schools and medical benefits, for federal employees and Delhi residents with more than two children...
...It has not launched a large scale, radical land reform effort, a crash program to increase agricultural productivity for the poorest, or dramatic action to break the grip of the landowners...
...Its "population problem," therefore, might be summarized as: growing numbers if governmental ineffectiveness...
...and, in the early 1970s, huge sterilization "festivals" leading to tens of thousands of vasectomies and tubectomies...
...Not onty, will the . upper and middle classes be in a better position to pay bribes and pull strings to save their reproductive apparatus, but they will be better armed through education and experience to take evasive action against the sterilization squad...
...Will a coercive program succeed if it is implemented...
...This argument begs the question of what exactly constitutes the country's population "problem," and also negates the possibility of universal and inviolable human rights...
...By this logic the greatest problem, and thus the prime target for concerted action, should be poverty, not fertility...
...Elder's study provides Vivid documentation of this descent upon the, weak...
...In view of the horrors that compulsory sterilization might create for hunter and hunted alike, the prognosis for employee motivation is abysmal...
...Faced with a current population of over 600 million and the prospect of hitting one billion by 1990, India has now decided to take more strenuous steps...
...To the extent that people have children because they are poor, which seems to be the case, the "population problem" lies in social injustice and the other causes of poverty...
...A second easy escape, on the other hand, is to invoke human rights principles, but fail to relate them to the difficulties posed by rapid population growth...
...cultural preferences for a surviving son...
...condom distribution schemes...
...If implemented, these will be the world's first known across the board compulsory sterilization programs...
...When they do not believe in what they are doing, or are placed under pressure to meet quotas of acceptors, their ingenuity at evasion and falsification knows no bounds...
...In Indian culture it would be a double penalty to sterilize a parent when all children were of the same sex, especially if...
...But those situations have been few in India...
...In April it raised the minimum age of marriage from 15 to 18 for women and from 18 to 21 for men...
...Yet in the judgment of its political leaders this is precisely the dilemma facing India...
...Is it fair, for instance, to apply coercion across the board without regards ior prevailing conditions of health and mortality...
...What will happen if the government does try to enforce, compulsory sterilization...
...Using a variety of research techniques, Elder patiently and objectively documents the mismanagement arid corruption, as well as the negative attitudes of villagers, seen in the Uttar Pradesh case...
...The first is the position that, because India's population problem is so grave and its success with voluntary programs so dismal, the government is fully justified in taking any action necessary to bring down fertility...
...The state of Maharahstra, which includes populous Bombay, has passed a bill making sterilization mandatory for one partner when couples have three or more children...
...Male descendants remain important not only to prove virility, but also for their central role in the Hindu burial ceremony for the father...
...India, by contrast, does not have even an adequate system of birth and death registration in its poorest areas...
...Nothing seems to have had much of an effect on the birth rate...
...Where development programs or the "green revolution" have produced tangible results, and where villagers find that improved conditions reduce the need for children, fertility often does drop...
...having someone to take care of parents in their old age, and so on...
...The results have been meager...
...Under a broader set of ethical criteria coercion might be justified if all of the following conditions were met: (1) population growth could be shown to present a clear danger to the common good...
...Further, the introduction of coercion might well contaminate voluntary family planning efforts...
...In essence, the government is saying that its "problem" is the irresponsible breeding habits of the poor, rather than its own failure to offer people a better life...
...In recent months coercive population control measures proposed by state governments have ricocheted off Draconian edicts from New Delhi...
...A former top official in the Indian family planning program told me not long ago that in his view the solution to the country's population program was ultimately cultural a new set of sym bols, a new moral vision...
...To date these questions have been shunted aside in the frenzied raee for tough legislation...
...Those who refuse face stiff fines and prison terms of up to six months...
...The shift to coercion'may entail other costs as well...
...In short, on the basis of past performance there is every reason to expect that the implementation of compulsory programs will be far from equitable...
...Gandhi has said: "Some personal rights have to be kept in abeyance for the human rights of the nation the right to live and the right to progress...
...Yet even now basic family planning services are not available to large segments of the population, particularly in rural areas...
...Such selective application of sterilization not only creates grave, injustices for the individuals affected, but could have quasi-genocidal" implications for the scheduled cases...
...If earlier sterilization campaigns are any indication, the scalpel will fall disproportionately on the weakest members of society the untouchables, the poor and the illiterate...
...Surely equity demands that couples be given the opportunity for contraception before, one partner is marched off for sterilization...
...For example, although the scheduled castes (formerly untouchables) made up only 29 percent of Uttar Pradesh, they accounted for 49 percent of the "voluntary" vasectomies...
...posters, broadcasts, puppet shows and other informational campaigns...
...At the very least, one could argue that the government should take no more forceful actions against the symptom of high fertility than it does against its underlying social causes...
...Strong arm methods may be effective in stifling political opposition, but they stand little chance of bringing down the birth rate...
...To single out the first component for coercive action without taking equally drastic steps to improve the second seems a classic case of blaming the victim...
...The federal government has given its tacit approval to these measures, and has taken less drastic steps on its own...
...there were no son...
...Few governments in history have had to face such overwhelming demands at the same time that internal conditions and the world market have severely constrained the possibilities for action...
...But even this desperate situation does not, on its face, morally justify a compulsory population control program...
...Writers who are quick to cite United Nations declarations in condemning violations of political freedom in Chile and elsewhere seem quite content to overlook the same declarations when it comes to population control in India...
...Still, both advocates and critics of coercion would probably agree on one point: the main reason for the limited success of family planning is not the lack of service facilities but the absence of motivation...
...Yet such programs might ultimately have a greater impact on fertility than the direct attacks outlined in recent legislation...
...While the birth rate is falling slowly, after twenty-four years of government programs no more than 17 percent of couples in the reproductive ages use contraceptive devices...
...Frustrated by the obstacles encountered in the higher strata, field workers will turn to less protected terrain...
...The health centers, already seriously understaffed and simply non existent in some areas, would then have to curtail maternal and child health care, tuberculosis control, immunizations and other forms of preventive medicine...
...Should the government later decide to abandon compulsion, it may find it difficult to dispel resident demons from the premises...
...It would be a considerable exaggeration to say that voluntary family planning has been tried and has failed...
...To execute a large scale compulsory sterilization program the government will have to divert, medical personnel and funds from'existing health and family planning services...
...Perhaps this what Shakesepare meant when he wrote: "The miserable have no other medicine but only hope...
...donald p. Warwick is a Fellow of the Harvard Institute for International Development and director of the Project on Cultural Values and Population Policy at the Institute of Society, Ethics and the Life Sciences, Hastings, New York...
...If the government moves ahead with these programs and a much bigger if manages to lower the birth rate, other large nations, such as Pakistan and Indonesia, may be tempted to follow its lead...
...COMPULSORY STERILIZATION IN INDIA DONALD P. WARWICK The resort to coercion raises civil and moral issues For over twenty years India has been the world's proving ground for public birth control programs...
...Even if one allows the need for compulsion, it seems egregiously unfair to apply the same standard in areas where more than half of the children die as in those where most will live...
...En ticed by the lure of per capita rewards, or intimidated by the threat of losing their jobs7 the workers will naturally seek the path of least resistance...
...the need for more children to work the land or to supplement the family income with employment elsewhere...
...As a rule of thumb, if a government cannot organize itself for activities widely perceived to be in the people's interest, it is unlikely to do so for programs that are roundly detested...
...But the reasons include not only mounting demands from a burgeoning population, but also the government's notorious failure in achieving national development...
...The major non-coercive method which has not been seriously tried is a fundamental attack on the conditions of life now favoring high fertility, in other words, national development...
...It thus seems crucial at this time to examine the ethics of compulsory population control...
...The ultimate tragedy of the Indian proposals is not that they are an exercise in futility, but that they are a gesture of despair...

Vol. 103 • September 1976 • No. 19


 
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