Non-surgical female sterilisation [letter]

The method of non-surgical female sterilization investigated by Hieu and co-workers has great potential in Vietnam and the prospect of a full-time family-planning worker at every commune health station mentioned by Feuerstein in her accompanying commentary is encouraging. However enthusiasm for female sterilization should be carefully tempered. The principle of individual choice in family planning means that services must not be prescriptive and that professionals should avoid being patronizing about the suitability of specific methods. No drugs device or procedure is without side-effects: the decision about which family-planning method to use has to rest with the individual who should be properly informed about the risks and benefits. Sterilization may provide an expedient way of achieving official targets but coercion should be avoided. As in most developing countries the government budget allocated to family planning in Vietnam is inadequate. Now that investigations demonstrating the safety of injectable contraceptives have allayed previous concerns it is to be hoped that research on injectable contraceptives in Vietnam will soon lead to improved health-service delivery. International development agencies should promote the inclusion of injectable contraceptives in the "cafeteria model" aimed at providing a wide range of choice. That may mean advocacy on the agencies part so that injectable contraceptives are licensed in western donor countries. We must avoid the perception that injectable contraceptives have side-effects that make them inappropriate for donor countries but suitable for dumping in the third world. The unique advantages of injectable contraceptives must be emphasized. (full text)