Female sterilization in India.

Although India was 1 of the 1st countries to include voluntary sterilization in its national family planning program results to date have been disappointing. Some notable successes have been achieved such as the 1971-72 Gujarat State campaign when 211933 vasectomies were performed but poverty ignorance lack of trained personnel antiquated cultural attitudes and political conflicts have hampered the program. This paper analyzes the 23152 female sterilizations performed at the King Edward Memorial Hospital and the Nowrosjee Wadia Maternity Hospital in Bombay from 1975-79. The backbone of the program has been postpartum sterilization through a miniincision. Various techniques and modes of anesthesia have been employed in different centers and accurate figures on morbidity mortality and failure rates are difficult to ascertain. 2 deaths occurred in 8989 postpartum sterilizations at the 2 hospitals 1 from total spinal effect and 1 from cortical vein thrombosis. Vaginal tubectomy through the anterior pouch and later the posterior colpotomy approach have been popular in Western India. The Family Planning Association of India widely employed the colpotomy approach in the early 1970s in small clinics and camps. The required instruments are few and inexpensive and low spinal general or local anesthesia can be used. The procedure can be done with pregnancy termination. The main disadvantage is sepsis followed at times by secondary hemorrhage. The method fell into disfavor because of fatalities. The Family Planning Association of India reported 12 deaths in 29000 cases. The vaginal approach should be employed only by a gynecologist trained in vaginal surgery. 2400 vaginal sterilizations have been performed at the King Edward and Nowrosjee Wadia hospitals only 85 of them in 1979. Laparoscopic sterilization came into use soon after gynecologic endoscopy was introduced into India in 1970. Teams of trained personnel from the King Edward and Nowrosjee Wadia hospitals have performed 9938 laparoscopic sterilizations without a fatality. The most significant difference in laparoscopic sterilizations performed in camp settings is the use of air for the pneumoperitoneum. Only trained personnel capable of dealing with emergencies should work in camps because of the possibility of serious complications. A trained anesthesiologist and equipment and drugs for emergencies should always be available. Minilaparotomy has a promising place in Indias family planning program because it is easily performed under local anesthesia and can be taken to the villages. Only 283 minilaparotomies have been done at the 2 teaching hospitals mainly because of the large number of puerperal sterilizations.