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Direct Link to Full 62-Page ICRW 2014 Report:

http://www.icrw.org/sites/default/files/publications/QoC%20Bihar%20Report%20FINAL_0.pdf

India – Very Dirty Facilities Imperil Bihar's Sterilised Women

Most facilities even lack the very basic, minimum necessary equipment, drugs and supplies for sterilisation, a study found

Saumya Tewari | April 27, 2015

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Bihar polls

These were the results of an audit of public healthcare facilities offering surgical sterilisation procedures in the eastern state of Bihar, which boasts India’s highest fertility rate of 3.5 children per mother—against the all-India average of 2.4—and struggles to contain its population.

The audit is part of a five-district study conducted by the International Center for Research on Women (ICRW), based in Washington D.C. Apart from the “unsanitary environment”, the study said: “Most facilities even lack the very basic, minimum necessary equipment, drugs and supplies for sterilisation, with some lacking simple essentials, such as scissors and narrow forceps.”

The fallout: Fever, bleeding, pus and other problems

The state of healthcare facilities was worst in the largest hospitals at the main district towns. More than half of women suffered sepsis, or infections, from their sterilisation wounds. The problems included fever, bleeding, pus and problems with sutures.

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Source: ICRW

 The objective of the ICRW study was to provide evidence on the gaps in family planning services for women as well as efforts needed to improve the quality of such services in Bihar.

These are some of the conclusions of the ICRW study:

graph1
Source: National Family Health Survey

High risk of simple sterilisation

In an incident that led to much soul-searching in India last year, 16 women lost their lives in Chhattisgarh to failed sterilisation procedures.

This was not an aberration, as IndiaSpend reported.

Our analysis of national health data revealed 200 deaths ever year between 2009 and 2011.

A preliminary inquiry into the Chattisgarh deaths revealed that the first camp held on November 8, 2014, carried out 137 operations, ignoring government orders restricting sterilisation operations per day to 30, India’s Minister for Health and Family Welfare, Jagat Prakash Nadda said in a statement to the Lok Sabha.

Nadda also said the operation theatre was not working, and adulterated medicine was given to the women who died.

However, larger questions emerged after the incidents regarding better practices at health centres. The ICRW report from Bihar indicates that while there have been some improvements over the years in physical infrastructure, such as electricity and water, other problems were widespread and severe. 

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http://www.icrw.org/publications/quality-care-provision-female-sterilization-and-iud-services

Quality of Care in Provision of Female Sterilization & IUD Services - An assessment study of Bihar

Pranita Achyut, Priya Nanda, Nizamuddin Khan and Ravi Verma - 2014

In many communities around the world, women continue to lack access to quality family planning services that provide the information, counseling and care necessary for them to make sound decisions about their fertility. And the caliber of care they receive has been shown to have a direct correlation with women’s contraceptive use. Often, in settings where the quality of family planning services is substandard, contraceptive use among women tends to be low or fragmented. High quality family planning services that recognize their dignity and respects choice and privacy, are rarely considered a matter of rights for women.

This is true for many communities in India as well. As such, leaders have responded by carrying out major transformations to the country’s family planning program over the last few decades that have, in part, demonstrated a commitment to providing high-quality, comprehensive health services. However, gaps in quality of care remain.

To assess what these gaps are, as well as patients’ satisfaction with sterilization and IUD insertion, two of the most common reproductive health services, ICRW conducted an analysis and audit In Bihar, India, home to 103 million people, where there is a high unmet need for modern contraceptives.

The report describes where the gaps are within facilities, including a lack of qualified staff, few safe spaces for women to discuss questions or concerns about their reproductive health, missing necessary post-operative drugs, and the report details patients' satisfaction with these services. The report also contains a host of recommendations that could be implemented immediately to ensure family planning services are performed in a safe, sanitary environment where women’s rights and entitlement to quality, comprehensive health care are respected.