Although many parents who lost children in the disaster are applauding the government's decision to conduct free sterilisation reversals, experts point out that the move reveals a flawed reproductive health policy in India

With the Tamil Nadu government offering free reversals of tubal ligation, also known as tubectomy, to women who lost their children in the tsunami, family planning experts say it's a sign of the Indian government's failure to promote easily reversible contraceptive methods such as the pill, IUDs and condoms.

The procedure -- where surgeons rejoin the reproductive tubes of people who have had vasectomy and tubectomy operations -- will be offered free at all state-run facilities, while those wanting to go to private hospitals will be given Rs 25,000. Government hospitals and health centres across the southern state are being equipped with facilities and qualified surgeons to help people wanting to take advantage of the government's offer.

So far, 189 women have signed up for the microsurgery, known as recanalisation. "In countering the depression of losing a child, this is a very intelligent option," says Dr J Radhakrishnan, district collector of Nagapattinam, a coastal district in Tamil Nadu where the Indian Ocean tsunami of December last year left 6,065 dead, including 1,776 children. Over 2,300 children under the age of 18 died in the state of Tamil Nadu alone.

The government's move has, however, opened up a can of worms, with population experts claiming that, nationwide, more than two-thirds of India's female contraceptive users rely on tubectomies and that women are not given proper counselling on which form of birth control to go in for. Many women are coerced into undergoing permanent sterilisation in order to meet population targets.

Women often opt for tubectomies, as there have been cases of excessive bleeding after IUDs are inserted. There's also the fear that pills have side effects, including chronic fatigue.

"The choice has been very limited for India's women," says Dr Saroj Pachauri, regional director for South and East Asia at the New York-based Population Council.

According to a 2004 report by the directorate of family welfare in Chennai, Tamil Nadu, only 3% of women rely on IUDs; 1% use the pill and 1.5% use condoms. Although the annual targets for tubectomies have been officially abandoned, local governments such as Tamil Nadu's still strive to meet what they call each district's "expected demand" for sterilisation. Official sources point out that between April 1, 2004, and April 1, 2005, doctors in Tamil Nadu performed over 416,000 tubectomies, up from roughly 370,000 in the same period five years earlier.

Social activists are concerned that the high-profile sterilisation reversal programme feeds into broad cultural biases that only validate women if they bear children. "This is about societal pressure on a childless parent. And that's not the right reason to have a child," says Sujatha Natarajan, vice-president of the Family Planning Association of India.

Concerns are also being raised about the fact that the operation does not necessarily guarantee a healthy pregnancy. According to Sheela Rani Chunkath, secretary of the health and family welfare department in Tamil Nadu, many reversals could be doomed because government doctors often cut too much of the fallopian tubes during the original tubectomy in order to forestall legal claims of method failure. One public hospital in Chennai that specialises in the procedure reports that just 47% of its recanalisation patients eventually gave birth again. Many women seeking recanalisation are over 35 years of age.

Source: www.prb.org, July, 2005
www.abc.net, July 2, 2005
www.bbcnews.com, March 1, 2005