TWO NOTES FROM INDIA
Sinha, Arun
ALTHOUGH THE WINDS of compulsory sterilization are blowing over many parts of the country, in Bihar State this extreme measure has been advised against for the present. The major reason is...
...These may be stray cases, but they indicate that in certain circumstances the doctor-motivator combine can develop vested interests that defeat the objectives of a rational and humane family planning program...
...Doctors who fail to achieve the target of sterilization operations set for their areas will suffer in the matter of promotions and increments...
...With the lowering of the cash incentive to 15 rupees, the number of sterilizations dropped to 30,000 in 1973-74 and to 32,000 in 1974-75...
...He discoursed eloquently and at length on the functioning of the organs of the human body, the marvelous precision of nature in the working of the liver, the heart, the lungs, and the kidneys...
...Urea, the endproduct of protein breakdown, accumulates in the blood more rapidly and concentratedly than the rate at which the kidneys can eliminate it...
...asks a deputy director in the department of family planning...
...Scientific research was certainly concerned with solving problems confronting man...
...The state government claims to have sterilized about 1.5 million people in the decade 1966-76...
...The reason why tubectomy is becoming more popular in the tribal (adivasi) belt is quite simple: women get 50 rupees, men only 20 rupees...
...Carbon dioxide is exhaled and water discharged through urine...
...In 1972-73, when the news of the higher cash incentives (60 rupees plus clothes) had been widely publicized, the family planning centers were crowded with the poor and the old...
...The class dispersed in silence...
...others will have to produce a sterilization certificate to get a ration card...
...A comprehensive scientific approach would have to start by considering, in detail, the causes of kidney disorders...
...and since people do not come forward voluntarily, there is no alternative to compulsion...
...A case in point is the supply department's decision to issue ration cards only to families with three children or less...
...11 Irrelevant Education rilE FOLLOWING EPISODE took place in a postgraduate classroom of a university in southern India...
...There is acceptance of family planning among the educated people in the rich rural families...
...He explained the significance of bio-engineering...
...Since kidney damage in most victims of thi...
...The doctor has an even greater interest in the number of sterilization operations performed...
...Research cannot afford to be blind to the concrete problems before us...
...The major reason is that medical facilities in the rural areas of Bihar are very meager...
...Normally, explained the student, oxygen taken in by the lungs reacts with carbohydrates to (continued on page 112) 95 produce carbon dioxide and water and to liberate heat that keeps up body warmth...
...The teacher agreed, slowly, that what the student had said was the simple incontestable truth...
...The readiness to use compulsion has resulted in a number of regrettable incidents...
...As scientists, we should proceed from there to look for the most effective solution to the problem...
...The newly-wed daughter of a harijan (untouchable) was sterilized...
...The principal reason for kidney ailments among the majority of victims is carbohydrate malnutrition, resulting from gravely insufficient calorie-intake through energy-giving foods...
...In family planning too it has started mounting pressure on the state government to resort to tougher measures than hitherto...
...What else do you expect in a target-oriented program...
...It has been alleged that in some villages of the Vaishal District, groups of older persons, particularly agricultural laborers, were put into jeeps and taken for sterilization...
...Bombay Economic and Political Weekly q 112...
...We cannot enforce compulsory sterilization," says a deputy director of family planning, "unless the poor are guaranteed that their two or three children will have a normal life expectancy...
...However, if carbohydrates are not present in sufficient quantity, oxygen reacts with protein to produce the necessary warmth —this time, producing carbon dioxide, water, and urea...
...A number of actual occurrences of kidney disorder would have to be studied to determine the most widespread reason for kidney malfunctioning or failure...
...The 260,000 sterilizations in that year is a record unbroken to this day...
...Though smallpox has been nearly eradicated, such epidemics as polio, malaria, and kalazar still haunt several areas...
...The kidneys are thus impaired, unable properly to regulate acidity and its concentration in living cells, and many kinds of poisoning by waste products result...
...Thus, according to an official evaluation released in mid-April, the sterilization drive was "never so satisfactory" as in the years 1971-72 and 1972-73 "when higher cash incentives were given to the acceptors of vasectomy and tubectomy...
...Bio-engineering, he explained, was that pioneering branch of science which sought to emulate nature's delicate precision...
...Some time ago a complaint had reached the Secretariat that a young man had been sterilized at the insistence of his cousins who did not want him to bear children who would have a share in their joint property...
...Research in bio-engineering had already yielded many inspiring breakthroughs—such as the construction of artificial kidneys from synthetic materials...
...The link, however, needed to be probed further...
...The infant mortality rate in Bihar is 140 per 1,000...
...What a great privilege it was, explained the teacher, to be able to participate in the exploration of this branch of science, to reconstruct and reproduce the efficiency of these intricate mechanisms...
...The doctors seem to be convinced that their careers are at stake...
...There have been many reports recently about the "success" of family planning...
...Also, we should provide sufficient nutrition to both the children and the mothers in the poor families...
...disease in our country is produced by carbohydrate malnutrition, concluded the student, obviously the primary task is not to provide them with artificial kidneys hut to remove carbohydrate malnutrition: in other words, to remove the utter poverty and destitution of the large majority of our people...
...While the urban middle class has definitely been in the forefront of family planning all through these years, according to officials, "there has been a growing awareness in the countryside too...
...But what about the rural poor...
...Finally, he asked whether there were any questions...
...To take the concrete example quoted by the teacher, the question of spare parts for the human body, such as the artificial kidney...
...The question of priorities in research, he began, was vitally linked with the question of scientific challenge as posed by the learned lecturer to the class...
...So, before thinking of using compulsion "we will have to take responsibility of protecting children at least up to the age of five from fatal diseases...
...The bureaucracy is wont to explain failures in terms of inadequacy of power...
...The motivator, who may be the mukhiya or high-caste village-leader, has his eyes on the 10 rupees that he is offered for each sterilization case...
...A young student rose to his feet...
...The achievement of 165,000 sterilizations in 1975-76 can be explained in terms of the fear generated among the family planning officials, including doctors, and enhancement of the incentives to acceptors and motivators by 5 rupees each...
...And causes of kidney disorder among the poor are quite different from the causes of kidney disorder among the rich...
...And so he went on...
...In West Champaran, according to the minister of mines, Narsingh Baitha, an 80-year-old man was lured to the operating table for hydrocele and was vasectomized...
...The fact is, the sttdent stated, that in our country most cases of kidney disorder are to be found among the poor...
...This is so because the poor cannot afford even plain gruel containing sufficient starch that would provide adequate carbohydrates...
...This is to be expected, for the very rationale of cash incentives is to lure the poor...
...Among them, it is admitted, "cash incentive has certainly played its role...
...In the classroom a reader in chemical engineering was delivering a lecture on bio-engineering...
...Indeed, research is worthless if it does not grasp and confront these problems in their totality...
...He pointed out its potential for research by the young men present who were approaching the end of their academic life and may be considering scientific research as a career...
Vol. 24 • January 1977 • No. 1
