Practice of standards in female sterilisation
Tewari, S.; Rathee, S.
Journal of the Indian Medical Association 95(5): 136-137; 141
1997
ISSN/ISBN: 0019-5847 PMID: 9357259 Document Number: 269699
The quality and safety of voluntary surgical contraception in India were evaluated as part of a training of trainers course organized for medical personnel at Haryana Civil Medical Services. A total of 55 physicians, with a mean duration of 9.35 years spent performing female sterilizations, were surveyed regarding their practices related to counseling, informed decision making, asepsis, surgical procedures, operative and postoperative care, and client follow up. Respondents performed an average of 550 minilaparotomy tubectomies and 1250 laparoscopic sterilizations per year. 89.1% of physicians considered client counseling to be the responsibility of auxiliary nurse-midwives or paramedical workers, 85.4% believed the registration clerk should take informed consent, and 94.6% thought the general practitioner should perform the pre-operative evaluation. Only 10.9% of physicians adhered to sterilization eligibility criteria. Maintenance of asepsis was left to operation theater attendants by 91.9%. All physicians practiced ligation and excision. Most patients were discharged 2-4 hours after surgery. Only 9.1% of physicians provided patients with discharge instructions and follow-up was generally handled by community workers. Finally, 20 physicians (36.3%) had experienced a tubectomy-associated death at some point in their career. Peritonitis with septicemia was the cause of death in most of these cases. Overall, these findings indicate an urgent need to improve the safety of female sterilization in India by upgrading physician standards and expanding their responsibilities.