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Female sterilization: The world's most common birth control method is irreversible

2022-09-26T11:59:20.477Z


Not condoms or pills, but female sterilization is the most efficient means of birth control for countries like India. In some places, the interventions are carried out as if on an assembly line – sometimes with fatal consequences.


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Almost every third adult Indian woman is spayed

Photo: Rajesh Kumar Singh/AP

25 euros so that you never get pregnant again: This is how much money women in India receive from their government if they have themselves sterilized.

It is intended as compensation for travel expenses and lost wages - but also as an incentive.

India's government has been trying to slow down population growth in this way since the 1970s.

With success: Female sterilization is now the most widely used contraceptive method in the country - and the birth rate has fallen significantly.

Almost 30 percent of Indian women of childbearing age reported being spayed in 2019.

17 percent use other birth control methods;

45 percent stated that they did not use contraception at all or that they did not need it;

eight percent would like to use contraception, but have no access to the appropriate means.

And India is no exception: Worldwide, more women use sterilization than condoms or the pill.

It's the most commonly used birth control method - not least because it's widespread in populous countries like India and China.

According to estimates by the United Nations, more than 200 million women worldwide were sterilized in 2019 alone.

In China, in Puerto Rico, but also in the USA and Canada, the proportion of sterilized women was between 18 and 31 percent,

shows a meta-analysis as part of the World Bank's »Global Burden of Disease« project, which was published in »The Lancet« magazine.

This is mainly because other contraceptive methods are often unavailable or too expensive in these countries.

And that men around the world rarely allow themselves to be sterilized.

Because women often lack freedom of choice and the intervention is encouraged in India, for example, for political reasons, experts take a critical view of it: "For politicians, contraception is primarily a means of controlling population growth," says Mona, a researcher who works as a research assistant works in the Sustainable Development Program of the Observer Research Foundation in Delhi.

For personal reasons, she does not keep a cash on delivery.

In India, the number of children per woman fell from 5.2 to 2.3 between 1971 and 2016 – a positive development from the government's point of view.

Forget politics in the face of this

Mona criticizes the numbers, however, about what sterilization means for many women.

The procedure, in which the fallopian tubes are severed or sclerosed by an operation, can usually not be reversed.

It is also associated with greater medical risks than other methods.

»Contraceptives shouldn't just work.

They must also be safe and practical, and their use must not degrade people,” says the Indian scientist.

Sterilizations like on an assembly line

Because this is not guaranteed, India's state-sponsored sterilization programs are repeatedly criticized.

In addition to the bonus for women, the state also finances most of the clinics where the operation is performed.

According to the researcher, these are often what are known as mass sterilization centers, especially in rural areas.

Again and again there are reports that women are sterilized there like on an assembly line and do not survive the procedure due to the poor medical care.

In 2016, the Indian constitutional court therefore ordered the government to close all sterilization centers.

More than 300 women had died in the facilities within three years.

According to Indian media, such clinics are still in operation.

To date, female sterilization is the most efficient form of birth control for the Indian government.

In addition, as Mona says, "Family planning is a woman's business in India," contraceptive campaigns are almost exclusively aimed at women, and although vasectomies are often rewarded more than female sterilizations, the procedure is not widespread.

There are also historical reasons for this.

During the national state of emergency between 1975 and 1977, millions of men in India were forcibly sterilized within a very short time.

Since then, vasectomies have also been a political taboo.

"Male sterilization is hardly talked about," says Mona, "partly because of the history, but there is also a societal stigma that the procedure damages a man in his masculinity and his 'steadfastness'."

The fact that vasectomies are stigmatized and that contraception is primarily a women's issue can be observed worldwide.

"The popularity of female sterilization is an indicator of poverty and lack of access to good health care," says Laura Briggs, professor of international health care and reproductive policy at the University of Massachusetts Amherst.

"Sterilization is often only the best method of contraception when circumstances make it so."

This also applies to the USA, for example.

More and more people there are affected by poverty and poor medical care.

"If regular doctor's appointments for prescription contraceptives aren't possible, then I'm much more likely to choose a method that only takes one appointment."

Puerto Rico shows how powerful social and historical circumstances are.

The country has had the highest sterilization rate in the world for years.

"Women in Puerto Rico are so familiar with the procedure that they just call it 'La Operaciòn—the surgery,'" says Iris Lopez, professor of Puerto Rican diaspora and sterilization abuse at City College in New York City.

The colonization of the island by the USA played a large part in this.

By the 1970s, one-third of Puerto Rico's women were sterilized under a US-funded program.

From Washington's point of view, the development problems on the Latin American island were mainly due to the high birth rate.

Many of the women affected were not sufficiently informed and considered the operation to be reversible, while others were forced to have the procedure.

Not only the consequences of the sterilization program are still having an effect today.

US pharmaceutical companies tested high doses of progesterone in pills in Puerto Rico in the 1950s.

"Many women got sick at the time and suffered from side effects," says Iris Lopez.

The pill and other modern contraceptive methods therefore had a bad reputation for a long time.

Only since the mid-2000s has the proportion of sterilizations in Puerto Rico been slowly declining.

However, high costs, bureaucracy and a lack of infrastructure still make it difficult for people to access other contraceptives.

For Iris Lopez, another question arises: "In a colonial context where sterilization has been the only method promoted for so long, can we even speak of free choice?"

Boundaries to compulsory sterilization are blurred

"Consent is often a gray area when it comes to female sterilization," says the Indian researcher from the Observer Research Foundation.

In India, poor women from lower castes or with mental disabilities are particularly affected.

"The women are not informed enough to be able to make an informed decision," she says.

In other countries, too, socially disadvantaged women are often affected: the procedure is often carried out after a caesarean birth, when the women are exhausted and can hardly object.

Sometimes the doctors simply sever the fallopian tube while the woman's abdomen is still open.

While forced sterilizations can be ordered by courts in the United States, indigenous women in Canada still report that they are being sterilized against their will, even though the practice violates Canadian law.

One affected woman told a Canadian Parliamentary Inquiry report: 'I had no idea what was being done to me until I went to a fertility clinic to see why I wasn't getting pregnant.

I was then told that my uterus was partially removed.”

However, such abuses do not explain the dominance of female sterilization.

Iris Lopez considers the discussion about possible causes to be polarized - women are either seen as completely free individuals or as victims of their circumstances.

For Lopez, the truth lies somewhere in between: »Women try to make the best decisions for themselves in oppressive circumstances.«

Laura Briggs takes a similar view: as long as states make access to certain contraceptives more difficult and leave people alone with the costs of doctor's appointments, childcare and care work, truly free decisions on contraceptive issues are not possible.

This contribution is part of the Global Society project

Expand areaWhat is the Global Society project?

Under the title »Global Society«, reporters from

Asia, Africa, Latin America and Europe

report on injustices in a globalized world, socio-political challenges and sustainable development.

The reports, analyses, photo series, videos and podcasts appear in a separate section in the foreign section of SPIEGEL.

The project is long-term and is supported by the Bill & Melinda Gates Foundation (BMGF).

A detailed FAQ with questions and answers about the project can be found here.

AreaWhat does the funding look like in concrete terms?open

The Bill & Melinda Gates Foundation (BMGF) has been supporting the project since 2019 for an initial period of three years with a total of around 2.3 million euros - around 760,000 euros per year.

In 2021, the project was extended by almost three and a half years until spring 2025 under the same conditions.

AreaIs the journalistic content independent of the foundation?open

Yes.

The editorial content is created without the influence of the Gates Foundation.

AreaDo other media also have similar projects?open

Yes.

Major European media outlets such as The Guardian and El País have set up similar sections on their news sites with Global Development and Planeta Futuro, respectively, with the support of the Gates Foundation.

Did SPIEGEL already have similar projects? open

In recent years, DER SPIEGEL has already implemented two projects with the European Journalism Center (EJC) and the support of the Bill & Melinda Gates Foundation: the "Expedition ÜberMorgen" on global sustainability goals and the journalistic refugee project "The New Arrivals", within the framework of which several award-winning multimedia reports on the topics of migration and flight have been created.

Expand areaWhere can I find all publications on the Global Society?

The pieces can be found at SPIEGEL on the Global Society topic page.

Transparency Note: Some of the data processed here comes from a meta-analysis for the Global Burden of Disease Project funded by the Bill & Melinda Gates Foundation.

Source: spiegel

All news articles on 2022-09-26

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