WASHINGTON, DC, April 27 (C-FAM) The government of Uzbekistan is accused of running a clandestine program to forcibly sterilize women, possibly as a way to meet U.N. goals on maternal mortality. The BBC World Service reports this disturbing trend of compulsory sterilizations and mandatory quotas for doctors.

The news comes despite claims by Uzbekistan’s government that sterilizations may not be performed without informed consent of the patient. However, medical professionals report they are given annual plans telling each doctor the number of women they are expected to provide with contraception and to sterilize.

Medical sources say pressure is particularly strong for rural area doctors in Uzbekistan, where some gynecologists are required to perform up to eight sterilizations per week.

“There is a quota. My quota is four women a month,” a gynecologist from the Uzbek capital told the BBC.

The stories exhibit the ease of crossing the line from informed consent to coercion at the hands of a government known for its human rights abuses and population control agenda.

“On paper, sterilizations should be voluntary, but women don’t really get a choice,” says a senior doctor from a provincial hospital, who wished to remain unnamed. “It’s very easy to manipulate a woman, especially if she is poor. You can say that her health will suffer if she has more children. You can tell her that sterilization is best for her. Or you can just do the operation.”

Women reported not knowing they had been sterilized until facing unexpected complications after pregnancy or later trying – and failing – to get pregnant.

Beyond the controversy of government-enforced sterilization, the real mystery is why the government perpetuates the policy, particularly given how far the country’s fertility rate has fallen. According UNICEF, Uzbekistan’s total fertility rate fell from 6.5 children per woman in 1970 to 2.4 in 2010. Today, the CIA World Factbook estimates a mere 1.86 born children per woman, well below the replacement level of 2.1 children per woman.

In addition to a low fertility rate, the country faces a population decline due to emigration. With a population of about 28 million, Uzbekistan experienced a net loss of 779,200 people in 2010.

Apart from a population control agenda, there might be another theory. Doctors and international human rights activists speculate that sterilization measures are a tactic to lower maternal and infant mortality and boost Uzbekistan’s international ranking in these areas. The U.N. Millennium Development Goals emphasize reducing the maternal mortality ratio by three-quarters by 2015.

“It’s a simple formula – less women give birth, less of them die,” one doctor told the BBC.

“Uzbekistan seems to be obsessed with numbers and international rankings,” says Steve Swerdlow, Central Asia director at Human Rights Watch. “I think it’s typical of dictatorships that need to construct a narrative built on something other than the truth.”

But the diminishing specter of maternal and infant mortality fails to ease the pain of women deprived of the chance to have more children, as BBC reporter Natalie Antelava recounts, “Nigora is among many for whom forced sterilisation is a reality. She had an emergency C-section. A day later she was told she had been sterilized. On the same day, her newborn died. “Nigora is 24 and will never have children.”