Too big not to fail

"I gained consciousness around 12 or 1 in the night," Devanti Devi told a reporter for RT, a Russian news channel. "I was bleeding heavily and came home without being given any medicine." Devi's account is only the latest in a slew of emerging stories of forced sterilizations in India, where government leaders have long pushed sterilization as a form of birth control in a country with 1.2 billion people.

In Bihar, the eastern state where Devi lives, about 1 million women a year are sterilized. At a sterilization camp at one local school in January, a government doctor performed the procedure on 80 women in three hours-that's an average of 2 minutes 15 seconds for surgery to cut or tie off a woman's fallopian tubes.

According to a report in the National Catholic Register, untrained staff laid the women from Bihar on school desks and anesthetized them. The doctor worked at night by flashlight and the dim light of a single generator light bulb. The school had no running water and the doctor did not change gloves between procedures. Not surprisingly, many of the women suffered excessive bleeding and infections. One, her pregnancy undiscovered because there were no pre-op screenings, miscarried. Numerous women have died from these sterilizations.

The practice is coming to light because Human Rights Law Network and other groups have filed petitions in India's Supreme Court to halt the sterilization programs. They have provided videotape evidence of the sterilization camps, affidavits from the women's families, and government documents revealing the extent of abuses.

What's also becoming clear from the court filings is that the sterilizations are carried out using Western aid money. A 2010 paper published by the UK's Department for International Development cited the need to fight climate change as one of the reasons to support sterilizations in India. It said reducing population size would cut greenhouse gases.

"It smells of colonial air. Actually, it smells of racism," says Abhijit Das, director of India's Centre for Health and Social Justice. "You say that the poor are the reason for all your greenhouse gases. This is simply unacceptable."

So far there's no clear evidence that U.S. aid was involved-and it shouldn't be. The 1999 Tiahrt Amendment prohibits USAID from funding family planning programs that set quotas, are coercive, or have financial or other incentives. The USAID administrator must report to Congress within 60 days any findings that suggest a Tiahrt violation-and some lawmakers may want to ask questions to be sure that's not happening in India.

There are at least two lessons here for U.S. watchdogs. Fifteen years ago, British Prime Minister Tony Blair set in motion this sort of foreign aid boondoggle when he separated the Department of International Development (DfID) from the foreign ministry. Blair hoped to remove the "taint" of national self-interest from the seeming largesse of overseas aid. But in fact, many countries that need Western aid need Western values thrown in too.

The second lesson comes on the heels of a global recession and worsening economic crisis in Europe. Too little attention has been given the role that corruption has played to reduce state coffers, both in the West and in the rest. Take Kenya, whose Anglo Leasing scandal, now well documented, robbed public coffers of $1 billion-mostly British aid but also some U.S. aid-in a country with an annual GDP of just $31 billion.

As Michela Wrong points out in her masterful book on Anglo Leasing and corruption, It's Our Turn To Eat (HarperCollins, 2009), a big part of the problem was Blair's decoupling DfID from foreign policy. In African and Asian capitals, DfID officers now have more staff, newer SUVs, and bigger houses than their foreign service counterparts. Left unwatched, corruption rules.

By now it should be an old saw, but the more government promises, the harder it is to assess results, to separate success from failure. "If you are responsible for everything, you are responsible for nothing," writes aid critic and New York University economics professor William Easterly. The bigger-sounding the goals-from reducing population in India to ending hunger in Africa-the more questions taxpayers should ask.

Email mbelz@worldmag.com