Condemn “Assembly Line” Sterilizations

January 3rd, 2015

News media focused in November on deaths in India after women had surgery at a sterilization “camp”. Authorities suspect that the surgeon caused more than a dozen deaths, so he is in prison.

More people are added to the population of India each year than to any other country. India has family planning programs, but abuses occur. This epidemic of deaths may have occurred because of disregard for established standards.

Indian gynecologist Pravin Mehta holds the world’s record for the number of tubal ligations that one doctor has done—over a quarter million. He told me how he could do 300 surgeries in one day; Henry Ford would have been amazed!

I didn’t realize how crude Mehta’s process was until I saw a movie of him working in a surgery camp. Operations were performed in a tent, and conditions were very primitive.

Nevertheless, Dr. Mehta’s safety record was remarkable. He offered a reward for anyone who reported a problem, including pregnancy, after his surgery, but gave out very few rewards. Indeed, I believe that his complication rate was lower than surgeons doing tubal ligations under modern conditions.

Were all these surgeries truly voluntary? During the era when Dr. Mehta worked—1970s and 1980s—India had aggressive sterilization programs for both men and women. Acceptors were given a small stipend if they agreed to the surgery. Recently the stipend for a person getting sterilized was equivalent to less than $10—a small sum by our standards but more than a villager might see in a month.

Reports of the recent sterilization tragedy frequently mention that women wanted to limit their family size, but that they were not given information about temporary methods of family planning. Even if women knew about temporary methods, they were not available.

Many problems were found after these Indian surgeries that killed many young mothers. The operating room was not clean, the staff were untrained, the medicine was contaminated. The same syringe and needle were used to inject local anesthesia for many women. Even worse were systemic problems: almost all of the funding was used for administration and too little paid for actual health care, there was little counseling or informed consent, no access to temporary contraceptive methods, and providers were pressured by numerical targets.

Two Americans are making a documentary about sterilization. Quartz published quotes from some of the Indian women they interviewed; here is the link: http://qz.com/299712/these-are-the-voices-you-did-not-hear-after-the-chhattisgarh-sterilization-tragedy/. One of the women, Archana, said:

“I was 19 when I got married and I have 3 kids. I don’t have much income, that’s why I got sterilized. When our income is limited what’s the use of having so many kids? ASHAs [Accredited Social Health Activists] came to visit me and told me about sterilization. When I got sterilized I went with my sister-in-law to the hospital and was given Rs600 in compensation. My husband and my mother-in-law were supportive. It took me about a month to recover fully. After a week I had to cook for my kids and take care of the house. I would have liked an entire month to recover, but we didn’t have anyone else to do the work. I chose this method because I had so many kids, and I didn’t know of other methods of contraception at that time. Now I’ve learned about more temporary methods. Copper T is not available here, you have to go to the cities, but you can get pills and condoms here.”

Please remember that conditions and standards in developing countries are different from what we know. Nevertheless, people must be respected and well informed about their health care.

Can family planning programs provide services to millions of people and yet assure that care is truly voluntary? Delegates at the International Conference on Population and Development 20 years ago felt that it is best if family planning were a part of comprehensive reproductive health programs. Since then our population has grown by 1,600 million people, with consequent increasing problems. Much of this growth is in developing countries, but remember that it is we in the rich countries who cause the worst impact because of our consumption!

Some of the family planning workers have real concern for the people they serve. After this tragedy one ASHA (health activist), Mitanin, is quoted as saying: “with what face we will tell people to go for sterilization?  Now, even if they come to us for it, we will hesitate.”

A new program, FP2020, is working to provide quality family planning services while respecting reproductive justice. More about FP2020 soon.

© Richard Grossman MD, 2014

Woman after sterilsation surgery in Bilaspur

Contribute to these Organizations

November 24th, 2014

thanksgiving_cornucopia

This image from: http://www.foodclipart.com/

Contribute to these Organizations—11-2014

The most common question I get from readers of this column is about what organizations are worthy to receive our donations. I will respond with my opinions.

As you can imagine, some nonprofit organizations are more fiscally responsible than others. I suggest checking with Guidestar or Charity Navigator if you would like objective information about an organization’s financial integrity. Some good organizations are too small to be listed, unfortunately.

I only know of two national environmental organizations that have significant population programs. My favorite is the Center for Biological Diversity. It has recognized that we are in the midst of the sixth massive extinction of species; the last one resulted from a huge meteor and wiped out the dinosaurs. The growing number of people is causing species to go extinct at a rate 1000 times normal. The Center is not afraid to face reality, and they have a sense of humor, too. Have you seen their Endangered Species Condoms?

The Sierra Club has a person dedicated to the issue of population, and soon will have a second. Consistent with other Sierra Club programs, they advocate for renewable energy, reducing resource consumption and empowerment of women and girls. In addition they sponsor youth advocacy trainings and work to increase funding for international family planning.

Dave Gardner is a friend who grew up in Colorado Springs. He worked in Texas for a long time making videos for PBS. When he returned to Colorado he barely recognized his hometown, it had grown so much. He has used his terrific sense of humor and moviemaking talent to good purpose with a full-length video “Growthbusters”. Perhaps his funniest videos feature Endangered Species condoms, or his irreverent “Phone call to the Pope”—both available on YouTube.

When is the best time to reach people with messages about population? It’s certainly not when they are old like me or even in the middle of building a family. It is best that school age children know about the world that they will inherit. Population Connection’s age-appropriate curricula reach 3 million students each year in the USA. In addition, this organization keeps our Congress up to date about population issues, and keeps track of the voting record of our representatives in Washington. Is this organization’s name unfamiliar? Perhaps you will recognize ZPG (zero population growth), its former title. It first made headlines back in the 1970s.

The two most prominent of our country’s population activists are at opposite ends of the USA. Paul Ehrlich is in California at Stanford University and Bill Ryerson’s office is in Vermont—but he is seldom home. In March of this year I attended a meeting these two men organized to look at the next steps in the population movement. It was a little discouraging because we didn’t come up with a unified plan—but these two giants are working hard to help make the world more sustainable.

Ehrlich started the modern population movement in 1968 with his book “The Population Bomb”. It is difficult to remember that, in addition to his concern about human population, he is an outstanding biologist. He and his wife, Anne, have authored three dozen books and almost a thousand scientific papers.

The Ehrlichs realized that science alone is not sufficient to influence the hearts and minds of people. Recently they started the “Millennium Alliance for Humanity and the Biosphere”—MAHB. This online international network has individuals and nodes all over the world, but has yet to gain much traction. At this time MAHB is looking for people to help it grow. I am delighted that my monthly columns are available through MAHB by RSS feed.

Ryerson’s organization is the Population Media Center. Although only 16 years old, it is making a difference in over a dozen countries, including the USA. My column from July focused on East Los High, an excellent online video series helping mainly Hispanic teens to make wise life decisions. Ryerson uses a model that has been proven to work. In many places people are addicted to “soap operas”. PMC designs characters as role models to reflect local values, while emphasizing empowerment of women, AIDS avoidance and the advantages of small families.

Don’t forget Durango Nature Studies. Although not focused on population issues, it gets kids outside so they learn to love our environment, and will be more likely to be advocates to protect it in the future.

Several organizations are working to make families healthier and smaller. We can help with our contributions.

© Richard Grossman MD, 2014

Distrust Amendment 67

October 12th, 2014

Image NO67 largerThis essay needs some explanation to people who live outside of Colorado. Colorado has been chosen to be a lightning rod for the antiabortion people. This year is the third time they have proposed an amendment to the state’s constitution that would give “personhood” to a fetus–even to a fertilized ovum!
Although this article may not be relevant to people who live outside of Colorado, if we are not careful the “personhood” movement may spread across states–and across countries.
If you live in Colorado, be certain to vote against Amendment 67. If you live elsewhere, please wish us good luck!

Some people are trying to take political advantage of a tragic accident. In 2012 a drunk driver turned left in front of woman who was driving home from a prenatal visit. The two vehicles collided and the woman’s airbag exploded. She survived, but her fetus was killed by the impact.
The intoxicated man had had multiple prior tickets for drunk driving. By Colorado law at that time, drunk driving was only a misdemeanor unless it resulted in the injury or death of a person. This added insult to injury since the infant was not a person, and thus the drunkard got off with a light sentence.
Fortunately the law has been changed. In June of this year the Governor Hickenlooper signed into law: “The civil remedy for unlawful termination of pregnancy act.” The purpose of the law is “to provide an appropriate civil remedy to a woman who suffers an unlawful termination of her pregnancy….” This makes Amendment 67 unnecessary.
Importantly, this new law stresses that the law cannot be construed to confer “any rights… upon a human being at any time prior to birth”. Furthermore, it provides that no woman or healthcare worker can be prosecuted for an injury to her pregnancy caused by any action or inaction.
What is this all about? Amendment 67 is the third attempt of people who are against abortion to establish that a fetus—even an embryo and most ridiculously, a fertilized egg—is a legal “person”. This “personhood” would give it the same protection of law as a walking, talking individual.
It would seem that the ultimate goal of this legal maneuvering is to limit or to outlaw all abortions. But if this is so, why aren’t the people who are pushing “personhood” honest and just propose an amendment that would outlaw all abortions? Why are they sneaky and going this devious legal route? The people of Colorado have already passed a law to protect a fetus from “unlawful termination”. This amendment would increase governmental probing into and control of our personal lives. Reproduction should remain private!
I can only guess at the deceitful thinking that is motivating this amendment. It is likely that antiabortion forces are exploiting the drunk-driving tragedy mentioned above.
The writers of this proposed amendment should disclose three important facts to make it more truthful. Amendment 67 is totally unnecessary because there already is a law to cover this. Furthermore, the proposed amendment has been worded so that it could be interpreted to outlaw all abortions. Even worse, it could be construed to prevent the use of some of the most effective methods of birth control.
IUDs are now recognized to be significantly more effective than hormonal contraceptive methods such as “the pill”. Medical science has found that IUDs do not cause an abortion. Many of the people who are against abortion are also against contraception, and ignore the scientific evidence and would try to outlaw IUDs.
If this amendment were to become law, women who had a miscarriage would be vulnerable to investigation by law enforcement authorities. Furthermore, desperate women who tried to self-abort could be guilty of murder.
An evangelical professor and historian, Randall Balmer, writes about the hypocrisy of the Religious Right’s movement against abortion in his book “Thy Kingdom Come—an Evangelical’s Lament”. He describes what he calls the “abortion myth”, that the RR has always been against abortion. Indeed, some of the leaders of the movement were initially in favor of abortion when it became legal in our country, in 1973. Instead, he claims, when too many evangelicals were leaving their spouses abortion became a political football. Balmer writes that in the late 1970s there was a conference call among evangelical leaders to discuss strategy. They realized that they had the makings of a broad political movement but needed a cause. “A voice said ‘How about abortion’. And that is how abortion was cobbled into the agenda of the Religious Right.”
Even if you are against most abortions, sometimes abortion is necessary to save a woman’s life, and almost everyone feels that legal abortion should be available to survivors of rape and incest.
There have been two prior attempts (in 2008 and 2010) in Colorado to establish legal “personhood” for a fetus by amending our constitution. In each case over 70% of voters cast their ballots against those amendments. Please vote in this election, and please recognize that Amendment 67 is not needed. Indeed, the amendment is a devious attempt to control women.
© Richard Grossman MD, 2014

Creative Commons Attribution 3.0 United States
This work is licensed under a Creative Commons Attribution 3.0 United States.