Uzbekistan: “Three Children Is Enough for You”

This week the BBC Radio program Crossing Continents released a powerful new report uncovering Uzbekistan’s secret government program of forced sterilization. This report may have far reaching implications for European Union/USA/United Nations relations with the Uzbek government going forward; relations which had recently warmed as western officials lifted sanctions against Uzbekistan in exchange for using the country’s strategic location to get supplies to troops in Afghanistan.

Journalist Natalia Antelava, a long-time BBC correspondent who covered Uzbekistan’s Andijan massacre in 2005, documents an official government policy, Ruling 1098, mandating that women should be sterilized after giving birth to two or three children. In the piece, she looks at reports of directives to doctors from the Health Ministry to perform the procedure on women without their knowledge or consent when they have visited the hospital for a completely unrelated procedure or after childbirth. It is common for medical workers to go door-to-door convincing women—often by lying about the health risks of future pregnancy—to undergo surgical sterilization. However, whether they are truly convinced or not, there is no choice.

Despite putting themselves in extreme danger of retaliation, a few brave doctors and victims shared their stories with Antelava. One activist even smuggled audio recordings of victims’ stories across the Uzbek/Kazakh border to Antelava after the journalist was refused entry to Uzbekistan. In Kazakhstan, Antelava found Uzbek families forced to leave their home country in order to have more children.

As Antelava reports, suspicion of widespread forced sterilization in Uzbekistan was first reported in 2005 when a pathologist working at a morgue received more than 200 uteruses of young women who had undergone unnecessary hysterectomies. She went public with the findings, was fired, and then jailed on trumped-up charges. In 2007, the United Nations Committee Against Torture raised the allegations of forced sterilization in Uzbekistan, and for a few years it seemed that the practice greatly decreased. Only recently was it discovered to be current state policy, begun again in 2009.

Recent surveys of medical workers shared with Antelava for this report revealed that approximately 80,000 women were sterilized over seven months during 2010. An obstetrician told Antelava that each doctor is given a mandatory quota of sterilizations to complete. Hers was approximately four per month in a big city, but the policy is much more strictly enforced in rural areas where quotas may be as high as eight per week, resulting in 900-1000 sterilizations per province per month.  The policy does not require men to be sterilized. The same obstetrician also told Antelava that it is the doctors themselves who are punished if they provide care to pregnant women over the age of 35 or if they care for pregnant women who have allowed less than three years between pregnancies, the required spacing between births.

While some women may undergo the operation voluntarily, a large number are either forced to have the procedure or never told that they have been sterilized.  In the traditional Uzbek society, as in many societies around the world, being sterilized carries a massive stigma.  That, in addition to paranoia and fear of the government makes many unwilling and too afraid to speak. However, every woman that BBC talked to at the Kazakh/Uzbek border in a two-week period knew someone who had been sterilized.

Women’s stories differ.  One woman, a teacher, said she was coerced to accept sterilization after her school's headmaster threatened to fire her if she did not comply. Another woman was told that she had to have the operation because she is HIV positive and was not allowed to have children. A third woman went to a doctor to find out why she had been unable to become pregnant after her first child and discovered that she had been sterilized without her knowledge. When she asked the doctor why, she was told that "that's the law in Uzbekistan."  Many women report having health problems following sterilization, suggesting that perhaps not only were the procedures unwanted, but they may also have been botched.

In an interview for the report, Steve Swerdlow, a Central Asia Researcher at Human Rights Watch, hypothesized that despite not having a census in Uzbekistan since 1989, the country’s obsession with birth statistics and population control is typical of an authoritarian regime trying to maintain its control. Like other countries that have recently undergone revolution during the Arab Spring uprisings, the unemployment rate for young men in Uzbekistan is very high. Perhaps by keeping the number of births low, the Uzbek regime is attempting to avoid upheaval. Sterilization may be seen by the government as a way to keep infant and maternal mortality figures low, so that Uzbekistan looks better in the global standings.

The government replied to BBC’s request for comment saying that this allegation of widespread forced sterilization has “nothing to do with reality and is an attempt of a purposeful slander.” Instead, the government respondent suggested that Uzbekistan could be a "model of maternal and infant health for countries around the world.”

For more information about the fight against forced sterilization around the world, visit www.stoptortureinhealthcare.org.