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              Lab: India's Deadly Post-sterilization Drugs Tainted

   by Anjana Pasricha

   And Indian laboratory has confirmed that drugs used as part of mass
   sterilizations at a government-run health camp, which killed at least
   13 women and made dozens ill, were tainted.

   Indian Health Minister of Chattisgarh state, Amar Agrawal, says the
   antibiotic, ciprocin, which was handed out to dozens of women who
   underwent sterilization surgeries two weeks ago, contained zinc
   phosphide, a chemical commonly used in rat poison.

   The women started vomiting and complaining of severe pain after taking
   the medicine at home. In the following days, at least 13 died and many
   fell seriously ill. The tragedy has raised questions about the practice
   of conducting mass sterilizations at health camps.

   While Indian pharmaceutical companies export billions of dollars' worth
   of medicine annually, the tainted ciprocin had been manufactured by
   Mahawar Pharmaceuticals, a locally-owned company in the central Indian
   state of Chattisgarh, one of the country's poorest. Mahawar had been
   sanctioned for making substandard drugs in 2012 and was forced to
   suspend production for three months. It was recently shuttered and its
   promoters have been arrested.

   Indian Pharmaceutical Association Secretary General D.G. Shah says the
   tragedy underscores the need for much tighter regulation of these small
   firms, which, he warns, sometimes do not adhere to "GMT," shorthand for
   good manufacturing practices.

   "They supply to one district or at the most one state or three, four
   states. They are not national players, and they are governed by the
   state drug commissioner," he said. "Though on paper they say everybody
   is complying, they do not comply. As reported in this case, in spite of
   poor GMT standards, the state drug commissioner had not taken adequate
   action for closure of this unit. The only positive side we see is that
   it might act as a wake up call."

   The tragedy has also turned attention to the practice of mass
   sterilizations carried out at government-run camps, where women are
   offered a cash incentive of about $10 to undergo tubectomies. There
   have also been allegations that substandard drugs such as those
   produced by Mahawar make their way into the state government health
   facilities in exchange for kickbacks.

   Backbone of population control
   In the world's second most populous country of 1.25 billion people,
   sterilizations continue to be the backbone of population control,
   although the government denies there is any coercion.

   But some advocacy groups say patients aren't given adequate information
   about alternate methods of contraception by state health workers, who
   are often under pressure to line up women to undergo tubectomies. The
   groups have also pointed to the unsanitary conditions in which the
   surgeries are carried out. The Chattisgarh sterilizations, for example,
   were done in an unused, private hospital by a doctor who raced through
   83 tubectomies in about five hours -- about four minutes per patient.

   "These camps, they never adhere to those guidelines," said Nibedita
   Phukan of the New Delhi-based Center for Health and Social Justice. "We
   have seen lot of camps -- Rajasthan, Bihar, Madhya Pradesh, UP. If you
   go through the guidelines, you cannot operate on any women after 4
   o'clock and [not more than 35 women]. Everything has been violated in
   the mass sterilization camps."

   Recent statistics indicate roughly 4.5 million women were sterilized in
   India in the year ending in March 2013, but the latest tragedy will
   likely put the government under pressure to reassess population-control
   methods.
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   [1]http://www.voanews.com/content/india-sterilization-drug-ciprocin-tai
   nted/2532423.html

References

   1. http://www.voanews.com/content/india-sterilization-drug-ciprocin-tainted/2532423.html