Misritha Arvapally
The recent mass sterilisation drive in Dhar district of Madhya Pradesh has again revealed the enduring continuities between the family-planning tradition of India and the long history of forced population control in this country. Almost 180 Adivasi women, their children, and other family members were called to a camp in the Bagh Community Health Centre early in the morning, where at least 175 of them were allegedly to be sterilized. Reportedly, even the most elementary amenities like mattresses, seats and drinking water were in shortage in the camp. The women were then made to lie on the ground itself after the procedures, and many of them were seen clearly struggling in excessive heat with young children. There was also a government hospital supervisor who reported that a private doctor contracted to attend the camp was performing one sterilization every two minutes. This is raising some disturbing questions around medical negligence, the absence of informed consent, and the continued dismissal of the bodily integrity of women by the state.
To fully understand this incident, it must be situated within the historical context of sterilisation policies in India. In 1975, during the Emergency period (1975-1977), the then-government headed by Indira Gandhi had the most aggressive population control policies that impacted the marginalised communities. Sanjay Gandhi was convinced that Indian poverty could be solved by compulsory sterilisation and that economic development would be faster due to the decrease in population growth. To make this belief workable, the Chief Ministers of all states in India were placed under sterilisation quota that had to be achieved, including coercion, both direct and indirect.
It is the lower classes that bore the brunt of these policies, especially Dalits and Adivasis. The police often rounded up people from poor communities, arrested them, and forced them to undergo sterilisation procedures. The magnitude of this campaign was unprecedented. As science journalist Mara Hvistendahl wrote in 2013, the sterilisation figures recorded in 1976 were nearly 15 times higher than those of Nazi sterilisation programmes, underscoring the severity of the Indian experience.
Even though men were the main targets in the Emergency, the permanent forms of birth control have remained the major approach to family planning in India even today. The whole burden of sterilisation has now been shifted to women, about 93 percent, according to the latest government figures. This is a gendered transformation which did not happen by chance but was a calculated reconfiguration of the population control measures after the political backlash against male sterilisation.
Women and the Marginalised as Targets: An Intersectional Analysis
Since the late 1970s, in India, the sterilisation burden came to rest squarely on women. Although the focus of the Emergency was on men, concerns relating to male fertility, masculinity, and productivity, many of which continue to persist today, instigated an increasing preference for female sterilisation. Women were regarded as more appropriate candidates not just due to deeply rooted ideas that the fertility of men should be maintained, but also because women were considered less likely to protest and resist. This change signified highly gendered violence. This was even though vasectomies are medically easier, safer and have a faster recovery time compared to tubectomies. However, women had more invasive operations, often with lower compensation or no compensation at all. Officially, several hundred individuals lost their lives due to this sterilisation drive, which is indicative of the fatal nature of coercive, target-oriented policies.
During the post-emergency era, population control plans have been reconstituted in the language of maternal health and reproductive choice. Programmes such as Janani Suraksha Yojana present sterilisation as part of women’s healthcare and voluntary choice. Nevertheless, such framing tends to conceal the ground realities. The major recipients of these schemes remain poor women living below the poverty line in villages and urban slums, with most of them being members of the marginalised communities and having no access to private healthcare. What is being presented as “choice” is often influenced by financial insecurity, lack of choice, and coercion by health officials.
Poor women are targeted on the basis that they bear more children than the rich. Nonetheless, this argument is inseparable from India’s long history of eugenic approaches to population control in which the reproductive patterns of marginalised groups are framed as threats to national development and social order. In this regard, sterilisation is the means to enhance the “quality” of the population by curbing births among the poor. Empowering women to make responsible choices about family planning is one thing, and forcing citizens to get sterilised without their consent is another.
The continued reliance on mass female sterilisation carried out through inferior-quality services and shaped by coercion reflects a family planning programme that devalues women’s lives, particularly those of poor women, who are often framed as irresponsible reproducers. Despite the government being adamant in its claim that India is a nation of demand driven and target free approach, the sheer magnitude of female sterilisation can be interpreted to mean that there is no real choice. Women are not often aware of other contraceptive methods and other reproductive services, such as abortion, which is often conditional on acceptance of sterilisation.
Dalit and Adivasi women are even more targeted when the concept of intersectionality is considered. These women are not only marginalised due to gender but also caste, tribal identity, classification, and geographical location. Women of tribal and Dalit origin are regularly deprived of good education, health, and basic rights. This structural marginalization makes them especially susceptible to those forms of population control, which are sanctioned by the state, the sterilisation of which is implicitly viewed as the technique of controlling the reproductive capacities of the marginalized groups.
The absence of informed consent is emphasized by empirical data. According to the data from the National Family Health Survey, one in every three women who underwent sterilisation was not informed about the permanent nature of the operation, and two out of three women did not learn about the potential side effects of the operation. These injustices are multiplied by the discrimination against Dalit women in the medical facilities of Dalit women. They are usually given poor services in the rural or underequipped hospitals and are at many times degraded by the health workers, such as denying them of touching or take proper care of them. Being encouraged by the state to achieve sterilisation targets, the health workers take advantage of illiteracy and lack of awareness amongst the Dalit women. Consent forms are routinely signed without being read or understood, making their consent meaningless.
Coercion Despite Constitutional Recognition
Incentives and disincentives serve to further enhance coercion. Medical officers and frontline healthcare workers still get performance-based rewards based on sterilization statistics, even after targets were formally abandoned. For example, in the year 2012, the Madhya Pradesh Chief Minister set a goal of 750K sterilizations and offered incentives like automobiles and electronics to women who agreed to get sterilized as well as to doctors and other motivators. In Rajasthan, lotteries for cars and motorcycles were held for women who had undergone sterilization. The Odisha government gave cash rewards to service providers in the areas having the greatest sterilization rates for World Population Day in 2013. In areas like Chhattisgarh, state implementation plans still set sterilization goals, with the goals being disproportionately higher for women.
When considered collectively, the Dhar sterilization incident and the development of India’s population control system show a troubling continuity rather than an end. The price of long-term contraception has never been equally shared, even if medical professionals agree that male sterilization is safer and less invasive. Rather, it has been relentlessly imposed on women, particularly Dalit and Adivasi women, whose bodies have become intersections of state power, gender, caste, and class. Devika Biswas, a health rights activist, filed a lawsuit in 2016, which was a significant turning point in the legal system. The Supreme Court of India categorically acknowledged in Devika Biswas v. Union of India that sterilization practices directed at marginalized and rural women are a violation of Article 21, constituting breach of right to health and bodily integrity.
Conclusion
However, structural change has not resulted from this legal recognition. States still heavily rely on female sterilisation, with India performing more than 30% of all sterilisation operations worldwide annually. The state continues to control and discipline women’s fertility in the name of development by taking advantage of poverty, illiteracy, and the systematic lack of informed consent. This turns reproduction from a matter of personal choice into a tool of governance where women’s reproductive capacities are subservient to population targets and economic objectives. India’s population control system will remain more of a control effort than a public health one until family planning policy is firmly grounded in informed consent, bodily autonomy, and equal access to healthcare. Events like Dhar are not anomalies in this context, but rather, they are predictable results of a governmental framework that views women’s bodies as tools of governance rather than as bearers of dignity. The claims of equality, liberty, and autonomy in the constitution cannot be reconciled with a development paradigm based on compulsion. The real test of progress is not whether the state respects women, especially Dalit and Adivasi women, as independent beings with the freedom to determine whether, when, and how to reproduce; anything less amounts to a betrayal of both women’s rights and the constitutional vision itself.
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Misritha Arvapally is an incoming 3rd-year BBA LLB student at Jindal Global Law School
