November 15, 2014; Reuters

Tests reveal that the antibiotics linked to the deaths of more than a dozen women are likely to have contained a chemical compound commonly used in rat poison, reports Reuters. The women underwent sterilization at a government-approved mass sterilization camp in Chhattisgarh, one of India’s poorest states.

Preliminary tests of the ciprocin antibiotic tablets used were found to contain zinc phosphide, according to Siddhartha Pardeshi, the chief administrator for the district where the deaths occurred. The antibiotics were handed out at the mass sterilization held a week ago in the impoverished state in Central India. At least 15 women who attended the camp have died.

An earlier report from Reuters describes a visit from Indian police to Mahawar Pharmaceuticals, the source of the drugs. The owners, Sumit and Rajesh Mahawar, locked the doors from the inside, and a few hours later, “witnesses reported smoke rising from medicines burning behind the building.”

Weak quality control standards for generic drugs manufactured in India is a serious problem, and not only within India. The Food & Drug Administration (FDA) has taken action against Indian manufactured drugs in the U.S. due to concerns about safety.

Earlier reports of the deaths had pointed the finger at the surgeon and the cleanliness of the so-called “sterilization camp.” The surgeon, R.P. Gupta, operated on 83 women in a single day, according to the Indian business newspaper, Mint. “They can’t blame me for murder,” says Gupta, who has done more than 50,000 sterilization procedures since 1987. “What happened is beyond our imagination. We didn’t even know anything was wrong until one patient suddenly died.”

Another doctor, K.K. Sao, had a similar experience on the same day at a separate sterilization clinic in Chhattisgarh. That incident left one woman dead, while 17 others are still in critical condition. Those women received the same batch of antibiotics and painkillers as Gupta’s patients, said Sao, who said he’s done more than 70,000 such procedures in his career. “The patients who got medicine from the same batch are either in the hospital or dead.”

The real story, though, is not these deaths but the high prevalence of female sterilization in India. Mass sterilization operations, as the term “sterilization camp” suggests, are routinely performed in India’s poor rural regions. India falls third after the Dominican Republic and Puerto Rico for the rate per head of female sterilization. In 2007, India increased incentives for women to undergo sterilization. The government’s efforts focused on underdeveloped, impoverished states, such as Chhattisgarh.

The Hindustan Times reports that sterilization deaths mostly occur due to the rigorous pursuit of “targets” assigned to health workers by state- and district-level health officials. Many grassroots-level health workers have gone on record that they are assigned annual targets with special focus on female sterilization. Superiors even coerce them with threats of reduced salary, suspensions, and dismissals.

Data from discussion of the issue in the Indian Parliament show that 1,434 deaths owing to sterilization occurred between 2003 and 2012, with 2009 being the worst year, with a maximum of 247 deaths.

The sterilization deaths should sound an alarm about the lack of birth control choices for women in India, says Poonam Muttreja, executive director of the Population Foundation of India, a New Delhi think tank. “It is inexplicable that this is the only option available to most women,” she adds.

“I have been to so many of these camps where the women are lying on the floor post the procedures; there are no arrangements for housing or even for an emergency situation. In some instances, they have been brought from neighboring districts,” said Vandana Prasad of the Public Health Resource Network (PHRN), an independent body that monitors health policies of the government.

And commenting on the wider issue of health facilities for the poor in India, Prasad adds, “There is a genuine need for good quality medical services, especially for poor people who are unable to struggle for their rights. Solid investment in the health sector is the need of the hour.”

“NGOs are providing services at low cost for poor people with no support from the government.” She gives as one example Jan Swasthya Sahyog in Chhattisgarh, a nonprofit support group of health workers working to develop affordable and effective health programs in the tribal and rural areas of Chhattisgarh state.—John Godfrey

KEYWORDS: sterilization, sterilization camps, sterilization in India, population control, nonprofits, non-governmental organizations, NGOs, poisoned antibiotics, poisoned ciprocin, rat poison in medication, Chhattisgarh, Indian drugs, Indian pharmaceuticals, female sterilization, women’s rights, health workers in India, reproductive rights, birth control

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