Techniques for the interruption of tubal patency for female sterilisation
RHL practical aspects by Mittal S
FIRST CONTACT (PRIMARY CARE) LEVEL
In India most couples use sterilization as their only method of contraception, after having achieved the desired family size. Thus, health care personnel at primary care level in India usually refer the woman to a hospital to undergo sterilization after delivery. Sometimes sterilization camps are conducted at village level, where health care workers screen the women and an operating team from the referral hospital visits the site and conducts sterilizations on a day care basis. At this level most the important task for primary health care staff is to do proper patient selection prior to surgical procedure so as to minimize the complications. The Ministry of Health and Family Welfare in India has laid down standard eligibility criteria and standards for sterilization (1). The findings of this review are unlikely to have any relevance to care at this level.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
Most tubal sterilizations are performed at this level. The technique employed is influenced by the skill and training of the operator and available infrastructure and facilities. In India, as per standards of sterilization (1), graduate doctors are permitted to carry out sterilization by minilaparotomy using the Pomeroy technique. To perform laparoscopic sterilization, surgeons are required to undergo specialized training. In tubal interruption using laparoscopy, the choice of the occlusion method is again influenced by the availability of suitably trained staff in a particular technique. The evidence from this review has shown electrocoagulation to be a better method than tubal rings. To implement this finding, it would have to be ensured that not only trained staff are available, but there are also suitably equipped facilities with uninterrupted electricity supply. . In experienced trained hands, tubal sterilization is safe and highly effective, regardless of the approach or occlusive method.
AT HOME OR IN THE COMMUNITY
The decision to undergo sterilization must always be taken after careful thinking. In this regard it is important to educate and counsel couples on the pros and cons of sterilization.
- Standards of sterilization. New Delhi, Ministry of Health and Family Welfare. Government of India 1999.
This document should be cited as: Mittal S. Techniques for the interruption of tubal patency for female sterilization: RHL practical aspects (last revised: 21 June 2003). The WHO Reproductive Health Library; Geneva: World Health Organization.