Photo courtesy The Social Architects

[Editors note: Please read Above the Law: Violations of Women’s Reproductive Rights in Northern Sri Lanka by The Social Architects, which expands on this initial report and address the points made in the comments as well as in other web fora, including mainstream media which picked up on this article.]

Recently, women in three Kilinochchi villages were subjected to coercive population control.

This incident occurred on August 31, 2013 – at the Veravil government divisional hospital in Kilinochchi.  The affected women reside in Valaipaddu, Veravil and Keranchi[1] ; all three are coastal villages.

September 13 - map

On August 30, the hospital staff and volunteers attached to Veravil divisional hospital informed community members residing in the three villages that any woman with a child under the age of five should come to the hospital the following day to weigh their children and to receive a vaccination.

On August 31, over twenty nurses and midwives who had come to Veravil divisional hospital from Killinochchi went door-to-door in those three villages and asked all the mothers to come to the Veravil divisional hospital. In Valaipaddu, two ambulances were used to transport mothers to the hospital that day.

A forty-three-year-old woman told TSA members “the volunteer came to my house in the evening and asked me to come to the hospital with the “clinic card” to weigh my child who is under 5 years. When I told her that my daughter is in good health she said that the research team is coming from Kilinochchi district hospital and they know better. I thought it will be good to consult a specialist who is coming all the way from Killinochchi.  Little did I know what they were up to.”

Upon arrival at the hospital, the doctors and nurses used coercive language and manipulated medical information to convince the women to take Progestogen-only subdermal implants (POSDIs), a long-term hormonal birth control inserted under the skin of a woman’s upper arm.

The medical professionals said that they were going to give the women some contraceptives and inquired about the types of contraception the women already used. Many women had said that they take oral contraceptive pills. The health professionals informed the women that the contraceptive they had with them was better than pills as it would prevent pregnancy long-term without side effects including weight loss.

Initially, all the mothers were opposed to the idea of accepting this new contraceptive. The nurses clearly explained to the women that, if they chose not to receive contraception, then they may not be able to receive any other treatment at the hospital in the future.

Another female teacher told TSA “there were a lot of people at this small hospital. There were only seventeen beds and the outpatient department could hold less than fifty people. They weighed my daughter and they recorded her weight on the card, but they didn’t return the card. I waited for two hours and I was anxious about my other daughter at home. They were speaking to the women for a long time and they were sending the women to the doctors inside after spending a lot of time trying to convince them of something. I saw women walking out of the doctor’s room with a big bandage. I got a bit worried. I got up and asked the nurse to give me my clinic card and they asked me to wait for a while. I waited for thirty minutes and then asked again. They got annoyed with me and asked me to come next. When I sat in front of them they asked me about my age and my reproductive health practices. They asked about my family planning practices. I told them that I use natural methods using my cycles. They laughed at me and said that I should not be getting pregnant at the age of forty-three. If I get pregnant I will give birth to a “deformed” child and I refuted that. I also told them that even though I delivered my two other children by “C” section I could have one more child. If I get pregnant that is God’s wish. I fought with them and the nurse sent me to her supervisor. I told her the same thing and this person was ruder than the previous one and I got a bit scared. I then told her that I should ask permission from my husband to undergo this procedure even though I didn’t understand anything they were saying. They told me that I won’t have children for five years.  They also told me that I will not have any side effects and that this is the best contraceptive method. I reiterated that I should get permission from my husband otherwise he will leave me. They told me to leave without the clinic card and come back with my husband’s permission. I refused and I told them that I can state in writing that I don’t want to get anything and that I would like to continue with the same methods I was using since my marriage. I wrote and signed a piece of paper and left with my daughter.

I didn’t see the doctor who was usually at the hospital. The previous evening he had come to our school and asked for big pots and pans, stating that lot of doctors are coming from Killinochchi to do some research. I don’t think he was aware of what was going on in his hospital”

After speaking with the medical professionals at the hospital, the mothers then said that without any information about this procedure, they needed to get permission from their husbands to receive the contraception. The nurses and other medical staff present responded that, if the women didn’t do what was being asked of them now, then their husbands would be brought to the hospital so that the procedure could also be performed on them. After hearing this, a lot of the women were compelled to accept.

September 12 - medical card for TSA piece

When the women went back home, and informed their husbands, the men didn’t take it lightly. (For example, a woman told TSA, upon returning home, her husband accused her of wanting to get the procedure done so that she could have an extramarital affair).

According to Veravil divisional hospital staff/volunteers, staff members got a call from Dr. Karthikeyan, Director of Health Services at Kilinochchi district hospital, the previous night. They were told that people would be coming from Colombo on August 31 to do research. Hospital staff had also been told they would need to cook for eighty people. The day this coerced contraception took place, hospital staff told TSA that most of them were preparing food and that the senior staff left for the hospital at 2PM. Since this is a very rural and economically marginalized area, it was even difficult to obtain enough utensils to cook for eighty people. People also noticed that a doctor attached to the hospital was supervising the cooking rather than attending to what was happening in the hospital. While the local hospital staff cooked, doctors and nurses from Kilinochchi administered the POSDI at the hospital. When the Veravil hospital staff had gone to their hospital all they witnessed was chaos. They saw something being injected in the arms of these women.

A thirty-six-year-old woman who underwent this procedure told TSA “my youngest child is eight-months-old and my older child is three-years-old. The health volunteers asked me to come with the clinic card to weigh my children. They also said specialists are coming from Killinochchi district hospital. I was excited to see big doctors who are knowledgeable. I went to the hospital and they weighed my children, but then they made us wait. When my turn came they spoke to me about the pros of not having any more children and told me that I am better off with only two children. I was of two minds and they sent me to the doctor. The doctor spoke to me nicely and told me that rich and educated people in Sri Lanka and America use this method. This way my two children will be better. How can I argue with such educated people? I hesitantly went ahead. But a few days later, I developed this pain and I went to the hospital. They treated me but I wanted to see the doctor who did this to me, but he wasn’t there. And the other doctor told me that he doesn’t know anything about this. The other doctor told me that I will be okay, but now I am not okay. How can these educated people do this to us? I wish they gave me time to think about this. They forced us to make a decision on the spot. I couldn’t speak to my husband or anyone that I knew.  These doctors are not nice people. They cheated me.”

Another twenty-eight-year-old mother of two children from Valaipaddu said they all gathered at the pre-school. She said, “All of us with children under the age of five were asked to assemble here with a clinic card. About thirty nurses, midwives, other health officials and a few doctors who had come from the Ministry of Health (MoH) in Kilinochchi district had come. They spoke to us about family planning and asked us to come to the hospital. Many of us went with them in their vehicle or ambulances and we were taken to Veravil hospital. They injected something on our upper arm. I trusted these doctors. We have never seen this many doctors. How can we say no to such educated people? This must be good for us and that is why they have done this to us. The only concern I have is that they should have told us what they were going to do the previous day when they asked us to come. They were a little dishonest with us.”

When TSA spoke to both medical professionals and others attached to Veravil hospital they didn’t have a clue of what Progestogen-only subdermal implants (POSDIs) actually were. They didn’t know anything about the side effects either. In addition, the women were given a card by those who administered the procedure. Yet the card was only in English.[2]

This coercive population control project violates myriad fundamental rights, reproductive rights, and basic notions of human dignity. After government health workers used false pretenses to gather the women at the hospital, the doctors and nurses failed to provide the women with information on the full spectrum of contraceptive choices. In violation of the women’s right to bodily autonomy, right to information, and right to reproductive autonomy, the doctors and nurses provided false and misleading information about the side effects and after-insertion care. In reality, side effects include hypertension, weight gain, irregular periods, hormonal imbalance, and venous thrombosis (clotting of blood vessels). The medical professionals failed to tell the women that the injectable can be removed at any time. Moreover, the information card the pharmaceutical company provides is in English; the women did not have access to information about this drug in Tamil. Furthermore, the section on the card labeled ‘For further information, please contact:’ is followed by a blank.

Women have a right to understand the benefits and potential side effects of all available contraceptive options that they may require at different stages of their lives. They have the right to accept or deny any form of contraception at any time. Removing the implant requires a medical intervention (unlike pills), therefore reducing the woman’s control over her reproductive self-determination. Contraceptive counseling with an emphasis on free choice is especially important in conflict zones where women already have fewer options, inadequate information, and limited access to primary health services including contraception. Misleading women into hospital visits, presenting false medical information, and the failure to ensure a woman’s right to make an informed, meaningful choice amounts to coercion and force – clear violations of women’s autonomy, well-being, dignity and bodily integrity.

Coerced medical procedures constitute cruel, inhuman, and degrading treatment under international law.

What if a woman had reacted adversely to this procedure? Why did a district hospital director personally visit this very small hospital on a Saturday morning?

Why did Sri Lankan government employees hide conceal their real agenda? Why would this have happened in a predominantly Catholic community on the Kilinochchi-Mannar border? Why did government employees call people in under the pretext of weighing their children?

In post-war Sri Lanka, doesn’t a woman have a right to know the truth about what is going to be done to her body? Don’t women have the right to make an informed choice about their reproductive health?

TSA will continue to monitor this disturbing story.

[1] 230 families live in Valaipaddu and 136 live in Veravil. 450 families reside in Keranchi.

[2] The medical card is attached.

  • HR Defender

    How come No one comment one this ????????

    Anything do with LTTE you will see 100 of comments … This clearly show the polarisation of people from south.

  • C Elaine Wick

    This is very serious and should be looked into asap! Those women need help!! Please help them……..
    Such things should never happen to anybody. These innocent women have been through hell during war times and dishonest deceitful people are making their lives harder. Shame on the dpt of health services.

  • kaushi

    Thank you for the expose. it is shocking.

    What are the steps that can be taken? i think Sri Lanka Medical Council should erase the names of these doctors from their medical registry. The women should also be able to do FR petitions. Please do update this with further news.

  • justitia

    In the sixties,the most popular method of birth prevention was by the insertion of an Intra Uterine Contraceptive Device – known as the LOOP into the uterus of women who had had their periods within the previous 14 days – a simple offce procedure.
    The loop is left in for five years,then replaced by another. No side effects .except for bleeding in one in a thousand women,when it was pulled out,and another inserted after a month. There is normal menstruation after insertion.
    In this instance,the pharmaceutical company had ‘persuaded’ doctors to obtain women for a trial of the contraceptive insertion,most probably.
    The procedure described appears to have been unethical.

    • Swordchild

      In the 60s- says it all… No person should have to be forced to have a procedure against their will- especially when something like contraception could be against their personal and religious inclination- Absolutely appalled. I don’t really know where to start- either the emotional manipulation, the threats from people who call themselves healthcare professionals, the misrepresentation of facts. The subtle eugenics at play here. I’ll be surprised if they dont do force abortions next for ‘population control’!

  • Anne

    Population Research Institute:

    “Our Mission:

    Debunk the myth of overpopulation, which cheapens human life and paves the way for abusive population control programs

    Expose the relentless promotion of abortion, abortifacient contraception, and chemical and surgical sterilization in misleadingly labeled “population stabilization,” “family planning,” and “reproductive health” programs.

    Defund these programs by exposing the coercion, deception, and racism inherent in them.

    Emphasize that people are the most valuable resource on the planet, the one resource we cannot do without.

    Encourage programs to help the poor become agents of their own development.”

  • georgethebushpig

    This is completely another level of madness! Can the names of the “Drs” be published please?

    On another note, pardon my ignorance but are these contraceptives medically approved, or are they being tested, like what was done in the Philippines in the 1970 – 80s?

  • DJ

    It is upsetting to me that this type of injustice continues to occur more and more, especially with the marginalization of the women in this less populated community . Unfortunately these women did not have a voice, and the medical practitioners, midwives,and nurses took advantage, performing the medical procedure, (POSDIS), manipulated these innocent women who are at disadvantage due to their lack of understanding and access to the information behind the subject matter(POSDIS). These women have been deceived, and manipulated into thinking false information, in addition to having fear instilled in them through intimidation. In a first world country, govt officials, feminist group activists, the victims, would propose that legal action is taken for such claims, however in this third world country who do these women now turn to? Women should have the right to be well informed, and say ‘No” if they so choose. Some of us in the world are entering an age where I am happy to say animals are no longer always being experimented with. I cannot stand for women being treated so poorly. As women we must stay united and protest ANTI- Oppression for this humanistic/social Injustice .I do not feel these women should have to negotiate control over their own bodies. It is time for autonomy,why should one be intimated into having their reproductive systems altered, because they fear if not their husbands will suffer the procedure. Who gives these medical practitioners the right to prescribe these women thier fate with such force, cruelty, and inhumanness?

  • Mr. Who

    Progestogen-only Sub-dermal Implants is a well known contraceptive method. One could search the term online for details. But I find it fascinating that the hospital staff didn’t know what it was.

    Also, who are behind these forced administrations?

  • sickanditred

    reminds me of a story I read long timeago during Indra Ghandi’s time of indian police taking thousands of beggers and forcing them to undergo some procedure to make them unreproductive. I wonder where the order for this came from? Is this the new way to control the Tamil population growth?

  • FranklyDisgusted

    This is appalling!
    The world is just watching idly by while the rights and voices of these women are drowned out.
    The politicians strategically planning this systematic genocide are criminals. One a smaller scale than the oppressive government, it actually makes you wonder how the consciences of the doctors and nurses are able to stand victimizing these innocent women. What is humanity coming to??

    • Joyfully

      The “world” is not “just watching idly”.

      The “world” doesn’t even know it is happening.

      The “world” just learned of this incident and I personally learned of it when it popped up on my Facebook page through a Catholic blog site.

      Share this link on every social media you can to raise awareness because the large corporate media sources will not be bothered with a small village on the coast of Sri Lanka. Share also because there are people in powerful governments that will only give aid to countries if they perform these atrocities.

  • Shiva Ramakrishnan

    This is very serious and another Tamil Ethnic cleansing attempt by certain chauvinist Sinhala Budhist State Terrorists forcibly occupying Vanni region under the guise of democracy.

  • puniselva

    eh? coercive? THIS is FORCEFUL population control

    • puniselva

      Sorry, I meant to say FORCED, not FORCEFUL

  • Helping Hands

    Please inform the Ladies to go to the police accompanied by a lawyer and lodge complaint against the doctors, nurses and all others involved. Get them to write or meet the President/ secretary of the Bar Association – Tel. 2447134/ 2331697/2387477 Fax- 2448090 they will give the best advise. Tell them to send a petition to the Human Right Commission of Sri Lanka No: 165, Kynsey Road, Borella Colombo 08 IMMEDIATELY. There IS HELP only they need to reach out for it.

    • Joyfully

      Now that information is helpful. Thank you.

  • puniselva

    Material incentives to the armed forces to have more children and forceful population control on people who are denied even aid from NGOs, including the UN:

    ”Conflict-affected areas remain highly militarised, which has made progress towards achieving durable solutions more difficult. The military has become an important economic player and a key competitor of local people including returnees in the areas of agriculture, fishing, trade, and tourism. It has also been involved in areas that would normally come under civilian administration. It continues to occupy private land, thereby impeding IDPs’ return. The government has failed to make durable solutions a priority, and humanitarian organisations have faced funding shortages and restrictions on programming and access” – Sri Lanka: A hidden displacement crisis, *Internal Displacement Monitoring Centre, 31 October 2012,$file/srilanka-overview-oct2012.pdf

    ”The military leadership continued to control the approval of humanitarian projects in the north through its membership in the Presidential Task Force for Resettlement, Development and Security in the Northern Province (PTF). The PTF places particular restrictions on the provision of mental health care and psycho-social activities. Because of government restrictions, no comprehensive assessment has been conducted in conflict-affected areas, and there is no comprehensive data on the needs of the most vulnerable groups. No IDP profiling has been done since 2007. The government, UNHCR and the UN Office for Project Services launched a survey of protracted IDPs in 2011, but the project was abandoned in December 2012 due to obstacles placed on it by the PTF” – Global Overview 2012: People internally displaced by conflict and violence, Internal Displacement Monitoring Centre, 29 April 2013,$file/global-overview-2012.pdf

  • puniselva
  • puniselva

    Readers will benefit by reading about some facts – more facts are needed to the women in the North under the army control:

  • Maneka

    This reminds me so much of what Israel did to Ethiopian women. This is the arrogance of power, where one can dupe uneducated women, and without their knowledge or consent, decide they should not produce children.
    Perhaps this was done under Israeli advice, like many other negative incidents in this country.

    All this, while their own are supposed to have as many as they like.

  • Future Human Rights Lawyer

    This is absolutely disgusting! The Tamil population is forced into population control, not only is this stupid but it is appalling as well. These women do not know what they are getting themselves into until it is done! Sri Lankan Government: congratulations, you have done another thing to help with your ethnic cleansing of the Tamil people-_- Oh and I don’t understand how this is population control if Sinhalese families are being told to have 5-6 children! WTF!!! These women need justice, and they need it now! The Sri Lankan Government needs to be brought down, war crime investigations need to be places, and the Tamils need to have their own land separated into a state called Tamil Eelam, this is the only way that Tamil people will be able to live their life as human beings!

  • srivanamoth

    This is eugenics of the type practiced by Dr. Mengele during the Nazi regime! The UNHCR should be alerted to this gross abuse of human rights pertaining to Tamil women and that too on the eve of the local election!

  • Suresh

    This is SICK! Surely, this has to be exposed both in the country and around trhe world!

  • kaushi

    To my letter to the SL Medical Council inquiring if they knew about it and if so, had taken any steps on it – I received this answer:

    “The Sri Lanka Medical Council being a statutory body acts on complaints
    received by it in the form of an affidavit accompanied by a letter.

    You may send in a complaint in the manner mentioned above, to enable
    the SLMC to intiate action”. Does anyone know if a complaint has been made?

  • Lalith K

    Since the information in this report has been shown to be problematic shouldn’t Groundviews put a note about it at the end? This is the story:

    How about some integrity and honesty?