The forgotten roots of India's mass sterilization program

In 1951, a prominent, urbane demographer named R.A. Gopalaswami set out across rural India on an expedition that, he hoped, would change a country described by The New York Times as a "pitiful giant." Gopalaswami, a man with an exceptional grasp of both mathematics and language, was attempting India's first post-independence census.

The numbers he produced were staggering. India had 356 million souls -- one-seventh of the world's population. Nearly 3 million boys and more than 6 million girls had married before age 14. He calculated India's population would grow by 500,000 every year, and the country would need to import millions of tons of grain to meet demand. To break the cycle, Gopalaswami urged a practice no country had tried before: mass sterilization.

"It is nearly as certain as any prediction can be that India's population will rise to 520 million by 1981," he said, according to a 1954 Washington Post article, adding that any plan to get more food wouldn't be enough. How, he asked, would India feed all these people? Better to sterilize anyone with three children or more.

Gopalaswami's report produced the policy shift that this week brought tragedy: The deaths of 13 young women at a free mass-sterilization camp in the district of Bilaspur in Chhattisgarh state. In all, 60 women became sick following the procedure. Thirty women remain in critical condition, The Washington Post's Annie Gowen reported.

The exact cause of the deaths have not been decided.

Late Wednesday, the doctor who performed the sterilizations, R.K. Gupta, was arrested and charged with attempted culpable homicide and negligence. Authorities accused him of failing to sterilize surgical instruments used in the sterilizations. The doctor has professed innocence. "They went back to their villages and went to the village quacks, who gave them antibiotics," he told The New York Times. The vomiting and pain were "all a reaction to these medicines," he said.

On Friday, it was announced that authorities had arrested the director of a drug-making firm that supplied the clinic. And on Saturday, an Indian health official said a preliminary finding suggests a poisonous chemical compound, zinc phosphate, got mixed with the drugs.

Even if the doctor is exonerated of any wrongdoing, the tragedy has exposed what some critics call "horrible" conditions under which sterilization doctors work.

Gupta, who performed 83 surgeries in six hours -- meaning he had spent minutes on each patient -- said he was only trying to meet the demands of sterilization quotas mandated by local authorities. "It was not my fault," he told an Indian television channel. "The administration pressured me to meet targets." Indeed, the government praised him in January for performing 50,000 laparoscopic tubectomies, and he's under pressure to complete 15,000 sterilizations, USA Today reported.

The case has also raised disturbing questions about sterilization as policy. While China's one-child policy to temper population growth achieved worldwide notoriety, India's own system, despite its controversy and complexity, is not as familiar. Where did the idea of mass sterilization come from? And has it worked?

The answer lies in the Malthusian politics that pervaded India following the release of Gopalaswami's report, heightened by the fact that the demographer's projections turned out to be understatements: In 1981, India's population wasn't 520 million. It was 683 million. The number of Indians passed the 520 million mark sometime in the late 1960s. Estimates of population growth spiked to 10 million additional people per year. The current population is roughly 1.3 billion.

What happened, in part, was that India learned how to keep people alive. That was illustrated in 1961 by journalist Rowland Evans, who described an old man he found in a tiny village outside Calcutta. The man had broken teeth and gray stubble, and he commented on how his life -- and lives in the village -- had changed.

"When I was a boy," the man told Evans, "they took away 40 to 50 bodies after a cholera epidemic. It happened every five or 10 years. Now they come and vaccinate our children. I have lived here almost 70 years. The biggest change in my time has been health. We've learned how to keep from dying."

"What is needed is a method which is simple, safe, cheap, effective, acceptable culturally," the director of the Indian Institute for Population Studies said at the time. "Only one method meets most of the requirements: sterilization." Added M.C. Chagla, a former ambassador to the United States: "Until we develop an oral contraceptive that works and that we can afford, we must encourage sterilization. . .. It must be voluntary, but it must be encouraged."

But then the voluntary aspect was dropped from the equation. Politicians went from advocating giving transistor radios to men who submitted to vasectomies to a policy of compulsory sterilization in 1976 -- a year when "police literally dragged people in from the fields to the vasectomy table," one medical officer told The New York Times. In all, more than 6 million people were sterilized that year, the Times reported, giving rise to violent protests. The backlash meant measures to slow population growth stalled for decades.

Today, programs are voluntary but include incentives. Women in most Indian states can make 1,400 rupees -- $23 -- if they opt for sterilization. That can be almost a month's income in rural India. "The payment is a form of coercion, especially when you are dealing with marginalized communities," Kerry McBroom, director of New Delhi's Reproductive Rights Initiative, told the Guardian.

Local residents, too, are suspicious of the monetized sterilizations. "We suspect [my daughter-in-law is] already dead," Gauri Bai, 54, told The Washington Post after the 27-year-old woman fell sick following the procedure. "We thought the government is running the program for the benefit of the poor, but they have cheated us. We want the guilty to be punished. They have destroyed my family. Who will take care of these little children?"