The World’s Population Day is celebrated on July 11 every year. The slogan for 2018 was “ Family Planning is a Human right.”

The current population of our World is 7.7 billion as of August 2019 according to the most recent United Nations estimates elaborated by Worldometers. By 2019, the densely populated country in the world is China(18.41%), followed by India(17.71%), United states of America(4.27 %) ,Indonesia(3.51 %). The lowest populated country is The Vatican city whose population is lesser than 1000 members, followed by Tuvalu, Nauru.

(photo by Rakesh Kalshian in https://www.downtoearth.org.in/)

The rapid increase in population has simultaneously caused a rapid increase in various problems globally ranging from socio-economic differences and leads to various other problems such as malnutrition as equal amounts of nutrition cannot be met to each person of the world in right quantities, lacking healthcare facilities leading to spread of various deadly infectious diseases from one part of the world to another part of the world, poverty, increase in infant and child mortality rates, environmental damages, genetic impairments, ecological imbalances, depletion and decrease of natural resources on the planet, water deficits, deforestation, depletion of fossil fuels, low life expectancy, elevated crime rates for survivorship, less personal freedom and more restrictive laws.

(photo by William Graham in http://www.freshvista.com/)

To overcome all such above-mentioned considerable problems, there are various scientific ways, methods, and schemes to restrict overpopulation.

One of such methods is Sterilization Operations.

Sanjay Gandhi, son of the late Prime Minister of India Indira Gandhi, implemented a forced sterilization program between 1975 and 1977. Officially, men with two children or more had to submit to sterilization, but there was a greater focus on sterilizing women than sterilizing men. Some unmarried young men and political opponents may also have been sterilized. This program is still remembered and criticized in India and is blamed for creating a public aversion to family planning, which hampered government programs for decades.

STERILIZING OPERATIONS

Sterilization in humans is a process of birth control method which makes a person infertile or childless anymore. It is a part of Family Planning.

Sterilization can be performed in both males and females which are intended to be permanent and usually irreversible. It includes Surgical and Non — surgical methods.

The sterilization processes are widely classified as under:

i) Surgical sterilization

ii) Non — Surgical sterilization

a) Voluntary sterilization

b) Promoted sterilization

i)SURGICAL STERILIZATION: There are different methods of Surgical Sterilization for both males and females.

For females,

  • Tubal Ligation is a process of birth control, where the Fallopian tubes are removed or permanently blocked. This process is a permanent process where the passage of sperm is thus objected and fertilization of the ovum is prevented. The reversal of the process is very rare.
  • Hysterectomy is a process where the uterus is removed permanently preventing in bearing a child anymore and other diseases such as cervical cancer

For males,

  • Vasoligation is a process of permanent contraception, where the male vas deferens are sealed or cut and tied together, thereby blocking the sperm passing through the urethra, preventing the fertilization of ovum and sperm, in return preventing the implantation of an embryo.
  • Castration is a process of male contraception where the testicles, the male gonads are removed. The Castration process involves Chemical castration by the use of pharmaceutical drugs and Surgical castration by surgically removing the testicles.
(photo from Shutterstock)

Transluminal Sterilization: Lumen is the hollow space inside a tubular structure. Transluminal sterilization is a process of insertion of an inert substance into the lumen, preventing the passage of reproductive substances i.e, ovum or sperm.

The Essure procedure is a female sterilization method, where Polyethylene terephthalate fiber is inserted into each of the Fallopian tubules, thus inducing fibrosis and blockage. In April 2018, the FDA restricted the sale and use of Essure. On July 20, 2018, Bayer announced the halt of sales in the US by the end of 2018.

(Photo from Shutterstock)

ii) NON — SURGICAL STERILIZATION: Non — Surgical Sterilization includes Voluntary sterilization and Promoted sterilization. It is a kind of birth control in both males and females.

The main reasons for voluntary sterilization include:

Lifestyle: The increase in personal freedom and giving the decision of bearing a child to women influences in opting between having children or not. Traditionally, not bearing a child is seen as a defect in the reproductive capacities of anyone between the partners. Voluntary Childless is one who opts not to bear a child, though both the partners can reproduce.

Financial situations: The career objectives and economic incentives remain the major reasons for women to be childless. Few women of low socio-economic conditions, feel having a child would be a burden economically and financially to lead their lives. So, in many countries across the world started medicaids for newborns until they reach a particular age where they reach a capacity of earning by themselves and also to the parents are given suitable amounts for sterilization processes under various schemes.

National examples: United States of America.

Promoted Sterilization :

Compulsory Sterilization — In observance of densely populated states, many countries opted for Compulsory Sterilization with a norm of giving chance to conceive up to 2 children.

National examples — India, China, Japan, Singapore.

Pharmacologically, to date, no oral medication could make a person completely sterile. But there are perceptions that there would be few such medications shortly.

Reversal of Tubular Ligation: Although Tubular Ligation is one of the permanent processes of birth sterilization, recent studies by CREST, stated that around 18.5% out of 1000 persons had reversed in sterilization and ended up in becoming pregnant.

Negligence while performing the process:

It is a well-known fact no process guarantees 100% surety. The processes might fail sometimes due to various reasons. This failure is not always because of the gross negligence of the medical officer. A doctor is held liable if the process of sterilization is not done with due care and the proof of negligence is shown and the patient was assured of complete sterilization which would result in no childbirth that could occur by that person. The doctor is not liable if the proof of negligence could not be admitted in a court of law.

There were a considerable number of cases of Medical negligence by Medical officers or the doctor performing the sterilization operation and one of the landmark cases was

State of Haryana v. Smt. Santra

(photo by Advocate Chikirsha Mohanty in https://lawrato.com/)

The brief facts of the case and judgment are mentioned hereunder:

State of Haryana v. Smt. Santra :

Date of judgment: 24/04/2000

Bench: S.S. Ahmad, D.P. Wadhwa

Brief facts: Smt.Santra, the respondent was a poor laborer and a mother of 7 children. She had undergone a sterilization operation at The General Hospital, Gurgaon under a scheme of Sterilization established by the then state government on 04/02/1988. She was issued a certificate that mentioned that the operation was complete and successful and assured that she would not conceive any child in the future. But, she conceived and gave birth to a female child. In the beginning, when she contacted the Medical Officer and other doctors at General Hospital, she was informed that she was not pregnant. But later after 2 months, when the pregnancy was evident, doctors told that her operation was unsuccessful as her right Fallopian tube was operated but the left one is left untouched and hence she was conceived and gave birth to the female child.

The victim of negligence filed a suit for recovery of 2 lakhs as damages for medical negligence which decreed a sum of Rs.54,000 with a rate of 12% per annum from the date of institution of suit till the payment of the decreed amount.

Two appeals, each filed by the State of Haryana and Smt. Santra was dismissed in the court of District Judge, Gurgaon, by a common judgment dated 10/05/1999.

2nd appeal filed by the State of Haryana was summarily dismissed by Punjab and Haryana High Court dated 03/08/1999.

In these circumstances, the present special leave petition has been filed in court.

The main issue of the case: The main issue, in this case, is whether the Medical officer and the doctors amount to Medical Negligence or not and whether the state is vicariously liable if it is medical negligence.

Medical Negligence: It was laid down that when a doctor is consulted by a patient, the former, namely, the doctor owes to his patient certain duties which are

a)Duty of care in deciding whether to undertake the case.

b)Duty of care in deciding what treatment to give.

c)Duty of care in the administration of that treatment.

A breach of any of the above duties may give a cause of action for negligence and the patient on that basis recover the damages from his doctor.

The Government had taken up family planning as an important program for the implementation of which it had created mass awakening about sterilization operation, the doctor along with the state must be held liable and responsible in damages if the sterilization operation performed by him is a failure on account of his negligence, which is directly responsible for the birth of another female child in the family, causing the additional burden to the family economically.

The judgment of the case: The theory of Sovereign immunity was rejected. As mentioned above, Smt.Santra, a poor lady raising 7 children already was under a monetary burden. The unwanted, unintended girl child born to her has created an additional burden for her on account of the negligence of the doctor who performed the sterilization operation upon her. Therefore, she is entitled to full damages from the State government to enable her to bring up the child until she attains puberty.

Having regard to the above facts, we find no merit in this appeal which is dismissed but without any order as to costs

ENDNOTE :

Cecil Rhodes quoted that “Man begets, but the land does not beget.” So everyone needs to take reasonable care on protecting the environment by controlling the overpopulation following various birth control methods and making the right use of the schemes presented by the Governments. Any failure resulting from medical negligence should be liable by the doctor and state as a whole. Hence, being healthy by each results in a healthy and controlled society.

Adolf Hitler quoted that “ Our object must be to bring our territory into harmony with the numbers of our population.”

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