The Quality of Care in Sterilization Camps:
Evidence from Gujarat
DILEEP MAVALANKAR & BHARTI SHARMASterilization is the most popular method of contraception in India. The 1992-93 National Family Health Survey found that of the 36.2 percent of eligible couples using any modem method, most (30.7 per cent) had been sterilized and only 5.5 percent were using temporary methods (IIPS 1995, p. 143). Sterilization is thus six times more common than all the other modem methods combined. Although the Family Welfare Programme has begun to give higher priority to spacing methods than to permanent methods, sterilization is expected to remain the most popular method for the foreseeable future. Unfortunately, the government of India has paid little attention to the quality of sterilization services, and has tended instead to emphasize achieving targeted numbers of cases. A great deal of demographic research has been conducted in India, but few studies have focused on the quality of care in family planning, in particular the quality of sterilization services (see Shariff and Visaria 1991; Verma, Roy, and Saxena 1994).
History of the Camp Approach to Sterilizations
Although sterilization has been an important component of the Family Welfare Programme since the 1960s, the camp approach was not introduced until the Fourth Five-Year Plan (1969-74). Sterilization received a strong push in the early 1970s with mass vasectomy camps. The chief district administrator (called collector or district magistrate in India) of Emakulam District in Kerala successfully brought large numbers of villagers to camps for vasectomies, thus setting an example for other regions in the country (Agarwala and Sinha 1983). This approach spread rapidly, and the prevalence of sterilization rose by two percent per year. Doctors at the camps tried to outdo one another in the number of operations they performed each day, with the result that there were high rates of failure and other complications.
The Emakulam camps were models of organizational efficiency, but their methods were not always duplicated elsewhere. Handling large numbers of cases placed a strain on the camps' organizational capacity, making follow-up difficult. The number of sterilizations fell as problems associated with this hurried approach came to light (Soni 1983). The number of vasectomy cases declined further after 1976, when the government declared a national emergency during which thousands of men were coerced to accept vasectomies. Since 1977 female sterilization has been the most commonly used method (Figure 14.1). Among the 31 percent of couples sterilized as of 1992-93, female sterilization accounted for 27 percent and male sterilization accounted for a mere 4 percent.
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