Does this count as "single payer"?

WHEN her baby died soon after delivery, Gulbahor Zavidova, 28, a poor farmer’s wife, longed to be pregnant again. After months of trying she and her husband visited a doctor who told her she could never have another child because she had been sterilised.

The procedure had been performed immediately after she gave birth, by doctors who did not ask her consent. On learning she could not bear children, her husband left her.

“Not a day passes without me crying,” she said. “I was outraged when I found out what they had done. How could they do such a horrible thing without asking me?”

According to human rights groups, tens of thousands of young women like Zavidova have been sterilised without their consent in the authoritarian former Soviet state of Uzbekistan.

Uzbek sources say the measure was ordered by Islam Karimov, the president, who has ruled with an iron fist for 20 years. The policy is aimed at keeping down the country’s poor population — with 28m people, it is Central Asia’s most densely populated state.

Activists say mass sterilisation began in 2003, but was eased after two years following an outcry. It is said to have restarted in February this year, when the health ministry ordered doctors to recommend sterilisation as an “effective contraceptive”. Critics claim every doctor was told to persuade “at least two women” a month to have the procedure. Doctors who failed faced reprisals and fines.

“We estimate that since February, about 5,000 women have been sterilised without consent,” said a local human rights campaigner who fears detention if she is named.

In many cases, doctors opt for delivery by caesarean section and then perform a sterilisation without telling the woman. Widespread rumours of the practice have resulted in women opting for home births to avoid the risk.

Doctors visited Hidojat Muminova, a 26-year-old cotton picker, at home several months ago. They told the mother of two she should visit a local hospital for a check-up, at which she was diagnosed with a potentially fatal cyst in her fallopian tubes.

“They scared me into believing I needed an urgent operation,” she said. “I was surprised as I’d never had any pain but I was worried and agreed to the surgery. When it was over they told me they’d performed a sterilisation. I could not stop crying. They tricked me and treated me like an animal.”

Another victim, Mahmuda Usupova, 30, said doctors had sterilised her after she gave birth to her third child by caesarean several months ago. She learnt she could no longer have children during a visit to her gynaecologist.

Uzbek authorities deny that sterilisations are carried out without consent, but a report by the United Nations Committee Against Torture reported a “large number” of cases three years ago. According to the UN, Uzbekistan’s fertility rate has fallen from 4.4 babies per woman to 2.5 since Karimov came to power.

Under the 72-year-old Karimov, Uzbekistan has become highly repressive. Opponents have been jailed, tortured and killed. Two critics of the regime, who were accused of being Islamic militants, were scalded to death after boiling water was poured over them.

Hundreds of civilians died when the police and army fired indiscriminately into a large crowd of protesters in Andijan in 2005. The Sunday Times has been denied entry to Uzbekistan ever since because its coverage is considered “unfriendly”.

The sterilisation programme has been relaunched despite efforts by Karimov’s two daughters to improve the lives of Uzbek women and children. Lola, 31, the president’s younger daughter, is a Unesco ambassador and head of a children’s charity.

Her sister Gulnara, 38, who was recently appointed ambassador to Spain, supports a number of charities. Known as “the princess of Uzbeks”, she is a Harvard graduate, martial arts expert and jewellery designer.

Under the name GooGoosha — apparently her father’s pet name for her — she has released pop videos. Her parties in Moscow, where she lived until recently, attracted members of the elite.

The women’s health days advertised on her website provide free access to medical specialists from Israel for women suffering “diseases related to reproductive functions”.

The Uzbek embassy in Moscow insisted that all sterilisations were carried out at the patient’s request and after the woman’s husband had been told of the consequences.