West Bengal is in the news again for its poor healthcare management. A government hospital in Malda district allegedly conducted mass sterilisation of women in appalling conditions on Wednesday, reported NDTV.

According to the television channel, the Manikchak block hospital, which has 30 beds each for men and women, organized a sterilization camp with two doctors sterilising 103 women on Wednesday. Many women, still under anaesthesia, were left to recuperate in the open compound of the hospital after the procedure.

A hospital is allowed to carry out only 25 sterilisations per day.

A legal notice has been issued to the medical officer of the hospital and a probe has been ordered, said the Malda district magistrate.

The incident would shock medical experts as it is impossible for two doctors to carry out over 100 operations in a day considering various risk factors.

Sterilisation Risks:

There are several potential risks associated with sterilisation, and tubal occlusion (female sterilization) is more complicated and riskier than vasectomy (male sterilization).

Here are possible risks of sterilization, according to a report by Queensland government:

1)      Internal bleeding can occur after the operation and it is more common if the person takes blood thinning drugs. He or she may be asked to return to the operating room in such circumstances.

2)      Infection can occur and this could lead to organ damage.

3)      Complications or even death can happen during and after the operation.

4)      The operation can weaken the heart which could lead to stroke and heart attack.

5)      Infection of lung, chest and other organs could occur. Medical treatment like antibiotics and physiotherapy may be needed in such cases.

6)      Blood clot in the leg could cause swelling and pain.

Besides these general risks, sterilization failure can happen (though it's rare), leading to more health complications, especially in the case of ectopic pregnancy (when fertilization of eggs takes place outside the womb). Pregnancy test must be done immediately if one misses a period after sterilization.

Government Rules and Guidelines for Doctors:

The Government of India and state governments have laid down rules and guidelines for doctors while carrying out sterilization on both men and women.

1)      Doctors should strictly asses the eligibility of the applicant, like age, number of children etc. before carrying out the procedure.

2)      Only married people, who have attained the age of 35, are eligible for such operation.

3)      The procedure can be carried out only with the consent of both partners.

4)      Doctors should explain the nature of the operation to the applicant, preferably to both husband and wife.

5)      Only gynaecologists and surgeons can perform the operation.

6)      Male doctors can perform male sterilization but cannot attend to female patients except under special circumstances.

The Government of India set certain clinical standards for such operations through its Sterilization Manual 1971, but there has been frequent violation of such official directives. The legal regulation of sterilization is ambiguous and is still referred to the provision of Indian Penal Code, 1860.

Facts about Sterilisation in India

In 1976, the government initiated a programme under which citizens were encouraged to get sterilized in exchange for social welfare benefits like land, housing and loans. Thousands of citizens opted to go through the procedure. The program had backlashed as more women got sterilized though the procedure was for men is much and less risky.

India announced a "target-free" approach to family planning two years after the 1994 International Conference on Population and Development. It also announced at the London Summit for Family Planning in 2012 that it would emphasize promotion and provision of contraceptives to control population growth. However, the prevailing target assigned to health workers by authorities in the state and district levels failed to help Indian women.

Several health rights networks have claimed that the targets set for health workers for use of contraception, especially female sterilization, has led to coercive female sterilization.

In several parts of the country, authorities aggressively pursue targets, especially for female sterilization, by threatening health workers with salary cuts or dismissals. As a result, some health workers pressurise women to undergo sterilization without providing sufficient information regarding possible complications, irreversibility, or safer sex practices after the procedure, reported Human Rights Watch. 

"Health workers who miss sterilization targets because they give proper counseling and accurate information about contraception risk losing their jobs in many parts of the country," said Aruna Kashyap, women's rights researcher at Human Rights Watch.

"The Indian government should work with civil society to ensure that mechanisms to monitor progress in contraceptive use emphasize quality and respect for reproductive rights."