Practice of standards in female sterilisation.

During training of trainers (TOT) courses organised for medical personnel of Haryana Civil Medical Services (HCMS) by COE Medical College, Rohtak, 55 doctors involved in female sterilisations were interrogated regarding practices in counselling, informed decision, asepsis, surgical procedure, operative and postoperative care and follow-up of the clients accepting sterilisation as contraception. Counselling was the responsibility of auxiliary nurse cum midwife (ANM) lady health volunteer (LHV)/other paramedical workers as viewed by 89.1% participants whereas 85.4% thought that the registration clerk should take the informed consent. Eligibility criteria were always adhered to by 10.9% participants. Asepsis and sterilisation of instruments, etc, were maintained by operation theatre (OT) attendant or OT nurse as answered by 90.9% doctors. Skin preparation was done by a solution containing cetrimide and chlorhexidine alone by 70.8% doctors. The ligation and excision was the method practised by all. Catgut suture was used by only 43.6% doctors. Twenty-six maternal deaths were reported by 20 participants during their whole career. There were 7 deaths on the table, all with laparoscopic sterilisation. Peritonitis with septicaemia was the major cause of death in majority of cases. To ensure high quality and safety of voluntary surgical contraception, programmes must establish a system to ensure that standards are maintained.