The Madhya Pradesh government on Friday withdrew an order warning male multi-purpose health workers that they could lose their jobs or their salaries if they failed to convince at least one man each to get sterilised, PTI reported. News reports about the circular had led to a controversy earlier in the day.
State Health Minister Tulsi Silawat told PTI: “I have just now nullified the NHM’s [National Health Mission’s] order with immediate effect. The language in it was not proper...Things should be done after proper reasoning.”
He also said, according to NDTV: “No one will be forced to be sterilised. No one is losing jobs and we are just spreading awareness. I will not let anything which can hurt you happen.”
In the original order, the state’s National Health Mission had asked high-level district officials and chief medical and health officers to make a list of male workers with “zero work output” and enforce the “no work no pay” principle if they fail to register at least one case each in 2019-’20. The mission cited the National Family Health Survey-4 report, noting only 0.5% male participation in the programme.
The state government’s circular, issued on February 11, warned that proposals in support of compulsory retirement of the male health workers would be sent through the district collectors if the situation did not improve. The circular said the proposals would be sent to NHM headquarters in Bhopal after which they would be sent to the health directorate for action, The Indian Express reported. The notification added that all male multi-purpose health workers should mobilise at least five to 10 “willing beneficiaries” when camps are conducted in districts.
“We are not saying you use coercive methods,” NHM Deputy Director Pragya Tiwari said earlier. “We want them to strength advocacy. There are many who want to limit their family size but lack awareness. It’s their job. If you can’t motivate even one person in one full year it shows your work output. What’s the use of spending taxpayers’ money on salary?’’ She added that there was negligible participation among men in the state’s family planning programme.
The state has witnessed a progressive decline in the number of male sterilisation cases over the last five years. In the 2019-’20 period, the number was 3,397 – as on February 20, 2020 – compared to 3.34 lakh women. In the 2015-’16 period, 9,957 vasectomies were done in Madhya Pradesh. In the three following years, the numbers were 7,270, 3,719, and 2,925.
The NHM deputy director pointed out that there was no monitoring of the male multi-purpose health workers unlike auxiliary nurse midwives. Tiwari, who took charge of the state’s family planning programme in October last year, said she began its strict monitoring after taking over, and that those who do well are rewarded under the “carrot and stick approach”.
The state’s health officials claimed the decline in male and female sterilisation numbers began in 2015-’16 after a judgement was passed against a coercive approach and the state administration eliminated the concept of “targets”.
Indore’s Chief Medical and Health Officer Dr Praveen Jadia said: “It’s for the first time that such a circular has been issued by the government. Indore’s total target was 22,500 and nearly 19,500 sterilisations have been done but the district is not likely to meet the vasectomy target of 2,250.”