Every morning, as I walk down the road where I live, I see a young woman rag picker. She stands in a mountain of garbage, generated by a housing colony of Central government officials, and rescues from it anything that can be recycled. She wears no gloves or protective gear.

Some months ago, I noticed that she now has a young child. He is a cute little boy with dark bright eyes and a mop of curly hair. Most days, the child is deposited on the pavement across the road as the mother sorts through the garbage. Quite often you see him crying inconsolably. He is hungry. Strangers and friends of the mother sometimes drop off food for the child — a packet of biscuits, or a banana. For a short while, the child is distracted and stops yelling. One day when he was particularly inconsolable, I called out to the mother. "Why don't you feed your child?" I asked. "I have," she yelled back, "but I also have to work to be able to feed him tomorrow." I was effectively silenced.

No plan for such children

Millions of Indian children are conceived, born and just grow up, like this little boy of the rag picker. There is no plan for their future. The mother does not know what she will feed him, when she will feed him, whether he will go to school or not, for how long he will stay in school, what clothes he will wear, whether he will have any clothes to wear. And if he falls sick, she doesn't know what she will do? Will her child live or die?

It is a terrible story. But it is real. And in some ways, it exemplifies what some people like to call the "population problem". This young woman works bent double in a pile of garbage for many hours, risking her health. She sleeps in the alcove of an old wall that once formed the perimeter of a Maharaja's palace. She only knows at the end of each day whether there will be enough money to survive tomorrow. So does this woman have rights, reproductive rights, the right to produce a child? Or should someone decide for her what her rights are?

In practice, the only choice they are given is to get sterilised. "Stop having any more babies. That is best for you and for the country", they are told.
For middle class India, it is women like this who are seen as "the problem". They can hardly earn enough to survive, we are told, and yet they have babies. No one bothers to ask why they end up having babies, whether there was a choice, whether a woman sleeping on the street can fend off unwanted attention, and whether as a consequence of an unwanted encounter, she can choose what to do. Can she have a safe abortion? Is there someone who will advise her? Does she know about contraception? Does she have access to affordable health care? Does anyone care?

I think of this woman each time I read or hear about the "population problem". It is now 10 years since the International Conference on Population and Development was held in Cairo where India was a signatory to a document that acknowledged that women had reproductive rights and choice. In other words, they had to be viewed as people who had rights, including the right to choose how and whether they control their fertility. For this, their ability to access health care for themselves and their children was as important as fertility-related health interventions.

Yet, although this has been accepted as policy, in fact there is little by way of rights, or even basic health care that comes the way of millions of poor women like this rag picker.

In practice, the only choice they are given is to get sterilised. "Stop having any more babies. That is best for you and for the country", they are told. As a result, despite the rhetoric, reproductive health still consists of sterilisations, mainly of poor women. Even if women accept tubectomies as the only way out of situations where they cannot control their fertility, the process places them at huge risk. A recent study of the situation in India's most populous state, Uttar Pradesh, by Healthwatch, a network for action and research on women's health, tells many horror stories. For instance, the norm established by the government for the number of tubectomies that should be done in a day in a "camp", that is a temporary facility that is established specifically to perform tubectomies on women, is 20 cases per day per camp. The Healthwatch survey of 11 camps revealed that the average number of operations per camp was closer to 100 per day with doctors taking just three minutes to conduct a tubectomy.

Terrifying tubectomies

Women were lined up, administered anaesthetic and then left to wait until their turn came. Often the anaesthetic would wear out by the time they were placed on the table or rather an operation station designed for the doctor's comfort. The woman would have her head hanging down, her sari petticoat covering her face as the doctor used the laparoscope to get to work on her reproductive tract. The activists could hear women moaning and crying out in pain.

What happens to these women once the operation has been performed is well documented. They have practically no access to health care if complications arise, as they must given the conditions under which these operations are performed.

Reports last year had revealed that bicycle pumps were used in these camps to pump air into the abdomen while conducting laparoscopic tubectomies. Sreelatha Menon's essay in The Unheard Scream: Reproductive Health and Women's Lives in India, published by Zubaan, gives a terrifying account of this method.

Yet, even as we come to the end of 2004, the thinking behind such callous treatment of women, just because they possess the ability to create human life, continues virtually unchanged. Women activists have expressed legitimate concern about the United Progressive Alliance government at the Centre wanting to launch a "sharply targeted population control programme" in the 150 odd "high fertility districts". For the women in these districts who have been the "targets" for decades, life will continue as before. My rag picker should thank her lucky stars that she is not one of them.