When family planning becomes coercion and public health turns into institutional neglect.

Munish_Kumar_Gaur_ , Advocate & former Bureaucrat_

The disturbing reports emerging from Dhar, Madhya Pradesh, where dozens of women predominantly from Adivasi communities were subjected to mass sterilisation under appalling conditions, have reopened a dark chapter in India’s public health administration. Images and testimonies describing women lying on bare floors in open spaces, still under the lingering effects of anaesthesia minutes after surgery, are not merely visuals of mismanagement; they are evidence of a grave constitutional failure.

At the heart of this incident lies a fundamental question: why are tribal women repeatedly found at the receiving end of such medical excesses, and where was the promised healthcare system when it mattered most ? The reported scale and speed of the procedures, allegedly completed in just a few minutes each , stand in direct contradiction to established medical norms and legal safeguards. Sterilisation, a permanent and life-altering procedure, cannot be reduced to a mechanical exercise of numbers without stripping women of dignity, autonomy, and safety.

The Supreme Court of India has, in clear and unambiguous terms, held that reproductive health forms an integral part of the right to life under Article 21 of the Constitution. Following earlier sterilisation-related tragedies in the country, the Court mandated strict adherence to quality assurance norms as voluntary and informed consent in a language understood by the patient, safe limits on the number of surgeries per doctor per day, proper anaesthesia management, post-operative monitoring, availability of beds, medicines, and emergency referral facilities. These directions were not advisory in nature; they were binding safeguards designed to prevent precisely the kind of incident now reported from Dhar.

In parallel, the Government of India’s National Health Mission and the Ministry of Health’s Family Planning Quality Assurance Manuals clearly state that sterilisation services must be patient-centric, non-coercive, and delivered only through adequately equipped Primary or Community Health Centres. The emphasis is on choice, counselling, spacing methods, and continuity of care not mass camps driven by informal targets or administrative pressure. When hundreds of procedures are reportedly compressed into a single day at a peripheral health facility, it signals a systemic disregard for these norms.

The disproportionate presence of Adivasi women in such camps is neither accidental nor incidental. Tribal populations often live in remote regions with fragile healthcare infrastructure, limited access to contraceptive choices, and heavy dependence on state-run outreach programmes. In such contexts, sterilisation camps become the most visible and sometimes the only interface between the state and reproductive healthcare. Economic vulnerability, low health literacy, and unequal power dynamics mean that “consent” can easily slide into compliance. What is presented as choice may, in reality, be shaped by inducement, lack of alternatives, or subtle coercion.

Equally alarming is the failure of the medical facility itself. A Community Health Centre is expected to be a space of care, recovery, and dignity. Women recovering from surgery and anaesthesia lying on the ground in open areas is not a minor procedural lapse, it is a complete breakdown of healthcare delivery. It points to the absence of recovery wards, beds, monitoring staff, and emergency preparedness. Such conditions would be unacceptable anywhere; that they are tolerated for poor and tribal women raises uncomfortable questions about equality before law and equal access to healthcare.

The Dhar episode must therefore be viewed not as an isolated administrative error, but as a warning sign. It exposes how constitutional guarantees, Supreme Court directions, and national health policies can collapse on the ground when accountability weakens. Family planning cannot be pursued at the cost of bodily autonomy and human dignity. Adivasi women are not demographic variables to be managed; they are citizens entitled to the same standards of care as anyone else.

Unless responsibility is fixed beyond the lowest functionaries, informed consent is rigorously enforced, and healthcare infrastructure in tribal areas is strengthened in substance rather than on paper, such incidents will continue to recur. The real tragedy is not only the violation that has already occurred, but the normalisation of indignity under the guise of public welfare. A constitutional democracy cannot afford to look away.