The good doctor

Ilias Ali of Assam quotes from holy texts to persuade husbands to accept sterilisation without the fear of stigma and allays concerns about their sexual health, one snip at a time. Rahul Karmakar reports.

health and fitness Updated: Apr 16, 2012 20:13 IST
Rahul Karmakar
Rahul Karmakar
Hindustan Times

For almost a decade, Ilias Ali, 56, had made it his mission to underscore how India had got her population control strategy wrong by targeting female, not male, reproductive health. He travelled all over Assam — by foot, bicycle, motorcycle, bullock cart and country boat — to help spread the word. Birth control wasn’t against Islam, Hinduism or Christianity, he said.

And the results showed. Between January 2009 and December 2011, Ali, a professor of surgery at the Gauhati Medical College, and his team motivated more than 33,000 men to get sterilised. Almost 43% of them were Muslims.

Thanks to Ali’s efforts, Assam achieved 15-19% of its target sterilisations during this period, compared to the nationwide average of 5.5% . Understandably, the New Delhi-based National Institute of Health and Family Welfare asked other states, including sensitive states such as Uttar Pradesh, to tread Ali’s path.

India could have topped the world in birth control; it had been the first country to adopt family planning in 1952. But the focus was all wrong. “While obstetrics and gynaecology developed as a distinct faculty for female reproductive health, we forgot males have sex-related issues too,” said Ali. “Consequently, males showed no interest in family planning programmes while dumping the responsibility on women.”

Ali, Assam’s nodal officer for the No Scalpel Vasectomy (NSV) programme, knew what he was talking about. Trained by Li Shunqiang, the Chinese surgeon who invented no-scalpel vasectomy in 1974, he realised the real issue was not about technology, but about custom and faith. He spent hours answering hesitant questions on family planning and reassured men that sterilisation had no quarrel with sexual prowess. The medical procedure, in fact, got over quicker. Ten minutes were all it took the good doctor to sterilise a man.

It wasn’t smooth sailing from the start though. Clerics issued a fatwa against him banning his entry into mosques. Hindu leaders barred him from entering the namghar, the ubiquitous Vaishnav prayer hall in every Assamese locality. A church in a western Assam village turned away some Christians he had sterilised. Until, of course, the religious leaders found his pro-sterilisation arguments were from the very holy books they used to quote from, to strike the fear of the devil called Birth Control.

At government-backed NSV camps, Ali proceeded to tell his audience a few home truths. “Do you know our holy books don’t want us to have more children than the earth can sustain?” he asked. “Islam is the only religion to evolve family planning since the days of Prophet Mohammed. It allows azol (coitus interruptus or ejaculation of semen outside the vagina) if women have no objection,” he said.

But he didn’t confront the clerics. “Rather, I convince them I’m not on an unholy mission. I tell them why India needs a leaner but qualitative population to be a world leader. I cite examples of Islamic countries such as Iran where birth control is a huge success,” he said. Ali also espoused contraception methods other than NSV or tubectomy for women. He campaigned against bigamy, particularly in remote sandbars inhabited by migrant Muslims. And he argued why human beings need to yield more space to plants and animals for a better earth to live on. He also justified each exercise with a quote from the holy texts — Faa-in khiftum alla ta-dilu fawahidatun (Marry only one if you fear you cannot do justice to the others) or Eka brikhya, dasha putra (One tree equals 10 sons).

Forced male sterilisation during the Emergency had made the topic taboo. In 2000, the central government formulated a policy to popularise it again. Assam, wary of demographic changes vis-a-vis migration from Bangladesh and Nepal, gave NSV the go-ahead in 1993. Success came in 2007-08 with 19 people turning up for the Sonapur camp, 30 km east of Guwahati. The turnout encouraged the government to set targets; it had also found the man for the job — Ilias Ali.

Ali realised he had to be unconventional to popularise sterilisation, especially among superstitious and cleric-controlled non-indigenous Muslims. “I explain how NSV involves making a small single hole in the scrotum and blocking two sperm-carrying tubes,” he said. “It’s a painless exercise.”

Ali’s approach has earned him global acclaim. Islamic countries from Africa have invited him to start similar programmes. But back home, he said he had been braving threats from certain quarters. “Every time I go out to conduct an NSV camp, my family fears I could be killed. But I trust the people,” he said. “I know they realise that there isn’t any angel to save the earth from a population explosion unless we do it on our own.”

First Published: Feb 22, 2012 22:43 IST