Female sterilization in India: A comparison of static and mobile services delivery

Sterilization is the most popular method of contraception in India. As the demand for sterilization services remains very high with a large unmet need, the country has continued with the camp mode (mobile clinic) to reach the people in under-served and under-reached areas. However, the camp approach throws out challenges in terms of quality in service (MoHFW, 2008). The 2005-06 National Family Health Survey found that female sterilization with a prevalence of 37% accounts for 66 % of all contraceptive use (IIPS & Macro International, 2007). 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 research has been conducted in India, but few studies have focused on the quality of care in family planning, particularly, the quality of sterilization services (Shariff and Visaria 1991; Verma et., al., 1994). The paper compares the types of service delivery for female sterilization in India by their socio-economic characteristics and by the awareness of alternative contraceptive methods. Data: For the present study data from the third round of the District level Household Survey-III, conducted in the year 2007-08, has been used. The District Level Household and Facility Survey is one of the largest ever demographic and health surveys carried out in India, with a sample of about seven lakh households covering all districts of the country. The Ministry of Health and Family Welfare (MoHFW),Government of India, initiated District Level Household and Facility Survey (DLHS) in 1997 to provide district level estimates on health indicators to assist policy makers and program administrators in decentralized planning, monitoring and evaluation. DLHS-III is designed to provide estimates on maternal and child health, family planning and other reproductive health services. In this survey, 1,156,932 ever married women in the age group 15-49 were interviewed. The ever-married women’s questionnaire contained information on women’s characteristics, maternal care, immunization and childcare, contraception and fertility preferences, reproductive health including knowledge about HIV/AIDS. According to the data, out of 1,156,932 ever married women aged 15-49 interviewed in India, 35.8 percent women opted for female sterilization. Methodology: In India, there are two broad categories of delivery of sterilization services namely, public and private. It is imperative here to mention that we have considered only the public facilities for this study because in India the share of public service delivery is manifold compared to private service delivery