The horrifying deaths of at least fourteen women after undergoing surgery at sterilisation camps in Chhattisgarh highlight the ongoing violence of global population control policies which the British government is at the forefront of promoting. Far from giving poor women in the global South much-needed access to safe contraception which they can control, these policies dehumanize them as ‘excessively reproductive’ and set ‘targets’ which make atrocities like those of Chhattisgarh possible. And while these policies are rooted in deeply imperialist, racist and patriarchal ideas they are now implemented in the name of women’s reproductive rights and ‘choices’.
Two years ago, on World Population Day, July 11 2012, the British government and the Bill and Melinda Gates Foundation, which has been instrumental in influencing Britain to take the lead on population issues, hosted the London Family Planning Summit. Along with USAID, UNFPA and other international organisations, they announced a $2.6 billion family planning strategy to get 120m more girls and women in the poorest countries to use ‘voluntary family planning’ by 2020. A few months later Britain’s Development Secretary Justine Greening announced ‘determined UK action on family planning’, including the increased distribution of contraceptive implants.
Despite its insistence that it opposes coercion, it had already been revealed that Department for International Development(DfID) aid was helping fund forcible sterilisations in Madhya Pradesh and Bihar in which, as at the Chhattisgarh sterilisation camps, poor women, many of them Dalits, died after being lied to about the operation, threatened with loss of ration cards or access to government welfare schemes, bribed with small amounts of cash or food, or, as with this latest case, forcibly taken to camps. They were then operated on under appallingly unsafe conditions, to meet targets set by the government.
Sterilisation of women has long been the main method used in India’s population control policies. During the Emergency men were forcibly taken to similar camps for vasectomies, but this generated massive opposition contributing to the historic electoral defeat of the Congress party in 1977. Research conducted in 2005-06 suggested that around 37% of married women had undergone sterilisation. Doctors, private health centres and NGOs are paid ‘incentives’ for every woman sterilized. Officially recorded deaths caused by sterilisation between 2003 and 2012 translate into 12 deaths a month on average, and actual figures may be much higher. In 2012 a Human Rights Watch Report warned that without a change of policy on sterilisation, the commitments made by the Indian government at the London Family Planning summit would lead to further abuses and increased pressure on health workers to meet targets.
This has been further confirmed by a recently revealed letter dated October 10, 2014 from the National Rural Health Mission, under the aegis of the Union Ministry of Health and Family Welfare, which cites the Family Planning 2020 commitment made by India at the Summit, and states that to meet the new goals an increase in sterilizations is essential, especially for 11 ‘high focus’ states, ruling out the importance of other possible methods of contraception. The letter ordered an increase in the payment given to all those involved in carrying out sterilisation in these states. (Jyotsna Singh, ‘Official document exposes government’s intent to incentivise sterilisation’, http://www.downtoearth.org.in).
Britain’s support for the mass sterilisations of poor and marginalised women which characterize India’s population policy is covert – but many of the contraceptives which DfID and its corporate partners more openly promote also deny women control and put their lives in danger. Feminists in the global South and feminists of colour in North America and Britain have campaigned for years against unethical testing of new drugs, and the dumping of unsafe injectable and implantable contraceptives, like Depo-Provera - which is being coercively administered to Ethiopian migrant women in Israel - Net-En, and Norplant. In Europe and North America, Black, indigenous and minority women, women in prison, and women with disabilities have been particularly targeted for these interventions.
The Gates Foundation has been repeatedly criticized for its close relationship with pharmaceutical giants, and its role in financing drug trials and vaccine programmes which were found to be unethical and unsafe. These include a clinical trial of the HPV vaccines against cervical cancer in India in 2009, falsely claimed to be a ‘post-licensure observational study’, for which 23,000 girls aged 9-15 from impoverished communities were selected and requirements for parental consent were bypassed. The trial was suspended following the deaths of seven adivasi girls aged between 9 and 15. A government enquiry found that the process of obtaining consent amounted to ‘covert inducement and indirect coercion’, and expressed concerns over a ‘hidden agenda’ to push the expensive vaccinations manufactured by Glaxo Smith Kline and Merck Sharp and Dohme into India’s Universal Immunisation Programme. A Supreme Court investigation is ongoing.
DfID’s current initiative with Merck involves promoting the long-lasting implant Implanon to ‘14.5 million of the poorest women’ by 2015’. Implanon was discontinued in the UK in 2010 because trained medical personnel were finding it too difficult to insert, and there were fears about its safety. As well as debilitating side-effects, the implant was reported as ‘disappearing’ inside women’s bodies. Merck has introduced a new version Nexplanon, which is detectable by X-ray, but have been allowed to continue to sell their existing stocks of Implanon. This is the drug which is being promoted in DfID and UNFPA programmes in the ‘poorest’ countries, despite these countries’ huge deficit of trained health personnel. In fact, in Ethiopia, one of the target countries, mass insertions of Implanon are part of ‘task shifting’ where hastily trained health extension workers are being made to take on the roles of trained doctors and nurses.
Like earlier versions dating back to Malthus, current approaches to population are based on shifting responsibility for poverty away from capital and onto the poor themselves. Population growth in the global South is being linked to climate change, shifting attention from the role of carbon emissions in the North, and is held responsible for the escalating food crises generated by land grabbing by transnational corporations and foreign governments. Meanwhile ‘young populations’ are being demonized as dangerous and the ‘youth bulge’ theory of security threats developed by the CIA during the Cold War is being redeployed as population growth is being linked to terrorism, and used to justify further US imperialist interventions.
While population control is argued to be linked to declining maternal mortality and improved child survival rates, this cannot be achieved without a change in the dominant economic model which could make substantial investment in health provision possible. But current population discourse insists that the World Bank and IMF-imposed neoliberal policies in which health provision, along with education, sanitation and other essential public services, has been decimated since the 1980s, can remain in place. Tellingly, erstwhile Development Secretary Andrew Mitchell described population policies as ‘excellent value for money’ citing the example of Tanzania which he claims would ‘need 131,000 fewer teachers by 2035 if fertility declines - saving millions of pounds in the long run’.
Today’s population control is also part of a broader strategy of global capital in which women’s labour is extended and intensified, with responsibility for household survival increasingly feminised, and more and more women incorporated into global value chains dominated by transnational corporations. It is this, not concerns about women’s rights and choices, which underpins the policies like those of DfID and the Gates Foundation which deny women in the global South real control over their bodies. Increasingly, women are demanding ‘reproductive justice’, which involves exposing this neoliberal strategy and confronting structures of power and inequality, as the only way of preventing more deaths like those in Chhattisgarh.