Opinion: Sterilisation deaths and why Tamil Nadu should worry

There are three important areas where things could go wrong, when a patient wants to be wheeled in for sterilisation. First, it could be due to the care providers, and their inexperience. Or even if they are experienced, a certain amount of negligence could come into play on some days. For example, in their hurry to prepare a patient for surgery, certain protocols may have been overlooked. 

Secondly, the institutions’ may not have had an opportunity to upgrade their equipment. It is mandated that periodic audits of theatres and their operation-worthiness be carried out; additionally, surgical and other equipment have to be scrutinised at regular intervals, and old one have to be discarded or scrapped. However, often, hospitals are forced to makedo with whatever equipment is available, and doctors try their best. One of the causes of sterilisation deaths is from bleeding. Sometimes, when a junior doctor is performing the surgery, the cautery machines may not be available or if present, could be very old. In such a situation, a surgeon may be forced to knot the bleeds. These will loosen in time, and blood could ooze out resulting in death of the patient. Observation of bleeding time and clotting time is a key area in surgery and if one overlooks the standard operating procedure, then fatal errors could occur. 

 The third factor is to do with the patients,who, have to follow the guideline parameters prior to surgery. These include one’s weight, nutritional level at that point of time, conditions such as diabetes or respiratory ailments. For example, most patients ignore advice on haemoglobin levels, saying they have always lived with the condition. They do not treat hyper tension as a physical condition needing correction. Many patients come to Public Health Centres (PHC), dragging their children, and plead with government staff for sterilisation, saying they have no money to feed more children. In my opinion, permanent sterilisation is not the way forward for the state. This is because the state has reached a Total Fertility Rate (TFR) of 1. 7 %. What this figure indicates is that a married woman with productive years ahead of her, will give birth to less than two children, which is a very low demographic reproduction rate. Tamil Nadu is not like Bihar or UP, where the population growth is high. There are concerns among many that in fifteen, twenty years, babies will not have the kind of relatives that one currently has— like uncles and cousins, since the tendency is to have a single child. In urban areas, the younger generation is more focused on career and many young women are not keen on having a child, claiming they ‘don’t want to burden the earth’ further. 

A way forward, if one wants to avoid sterilisation deaths and also keep demographic profile higher, would be for the state to go for the spacing method in a big way. This is an ideal solution, since parents are often known to change their minds after many years. We should advocate oral or injectable contraceptives. In both methods, the hormonal levels of patients need to be carefully evaluated before prescribing the same. Intra Uterine Devices (IUD) is another popular method of birth control. By far the most effective birth control tool in the state is the condom. It was particularly effective in creating an awareness on HIVAIDS. In districts such as Krishnagiri, we used to keep a box of condoms everyday outside the PHCs. By evening, the box would be almost empty. We resorted to this method in order to overcome the reluctance among men to ask for condoms openly. Some even felt it was a social stigma. However, the effect of such subtle encouragement was far-reaching. Let’s put down the scalpel and keep the numbers growing.