Sumati Devi knew before she arrived at the grimy government clinic in northern India that she would be paid to be sterilized. She didn’t know that she would lie on an operating table with bloody sheets, that the scalpel used on her would be stained with rust, or that she was supposed to get counseling on other birth control methods before consenting to have her fallopian tubes cut and tied. The main reason Devi agreed was that the $10 she received—about a week’s wages for a poor family—would help feed her three children. “I did it out of desperation,” says Devi, 25, as she lies on the concrete floor recuperating at the clinic in Bihar state. “We need the money. Health officials came to our home. They told us it would be best.”
India carries out about 37 percent of the world’s female sterilizations. Quotas set by state governments and financial incentives for doctors contributed to 4.6 million women being sterilized last year, many for cash and in the unsanitary conditions Devi encountered. Vasectomies accounted for just 4 percent of all sterilizations. “Women are the easiest prey, whether it’s government officials or their husbands asking them to undergo the operation,” says Kerry McBroom of New Delhi-based Human Rights Law Network, which provided the lawyer for an ongoing court case against the government that was filed last year. The lawsuit documents the brutal practices at sterilization camps, where large numbers of women are gathered to have the procedure, and calls on the Supreme Court to issue guidelines to prevent abuse.
Only about half of Indian couples of child-bearing age practice modern birth control methods, United Nations data show. The government doesn’t pursue the costly option of teaching often-illiterate women how to use contraceptives. One in five babies born worldwide is Indian, straining supplies of land, food, and water. “A fast-growing population affects everything: the economy, the environment, quality of life,” says Vishwanath Koliwad, secretary general of the Family Planning Association of India, an advocacy group.