Understanding the role of female sterilisation in Indian family planning through qualitative analysis: perspectives from above and below

Figures & data

Figure 1. Indian family planning: a timeline

Table 1. India & Rajasthan – key family planning facts at a glance

Indicator	Rajasthan	India
Total Population	68 million^a	1.2 billion^a
Total Fertility Rate	2.0^b	2.0^b
Mean age at effective marriage for females	20.5 years^a	21.2 years^a
Total wanted fertility rate	1.6^b	–
Current use of any method of family planning	72.3%^b	66.7%^b
Current use of:
Any modern method of family planning	62.1%^b	56.6%^b
Female sterilisation	42.4%^b	37.9%^b
Male sterilisation	0.3%^b	0.3%^b
IUD/PPIUD	1.4%^b	2.1%^b
Pill	3.1%^b	5.1%^b
Condom	13.7%^b	9.5%^b
Injectables	0.6%^b	0.6%^b

Latest data for Total Wanted Fertility Rate for India was unavailable at the time of publication.

^a Census of India, 2011.²³

^b NFHS 5 (2019-20).

Table 2. Data collection overview

Data type	Respondent type	In-depth interviews	Group discussions
Secondary	ASHAs	20	5
Primary	Key informants	5
Total		25	5

   

Code	Description
Female Sterilisation	Code to any mention of female sterilisation – this could be operation, LS, TT, etc. by ASHA
Contraception Other	Code when ASHA talks about methods of contraception other than female sterilisation (pills, condoms, etc.)
Family Planning	Code when ASHA talks about family planning generally, without referring to specific contraceptive methods (including her views on FP)
Motivation Tactics	Code to any mention of ASHA talking about tactics or strategies she used to motivate women to take up sterilisation
Targets	Code to mention of targets generally by ASHA
Female Sterilisation Targets	Code any mention of targets pertaining to female sterilisation specifically by ASHA
ASHA Soft	Code any mention of ASHASoft (online payment and monitoring system)
Health Worker – other	Code work done by other health workers in the community – if description is of ASHAs relationship with them, code to “relationship with other health workers”
Relationships with other health workers	Code any description of ASHAs relationships with other health workers or staff in health facilities (like doctors)
Challenges	Code ASHA’s views on challenges she faces in her work – double code where appropriate
Attitude of ASHA	Code here when respondent talks about what it means to her to be an ASHA, insights on attitude towards her work
People's Attitude to ASHA	Code description by the ASHA about her perception of people’s attitude towards her
Training	Code any mention of training received by ASHA for her work
Money	Code discussions on incentive payments for her work as well as to acceptors, expenses related to her work, costs of treatment incurred by women
Govt schemes	Code description of government schemes – double code if appropriate
Work – generic	Code description by ASHA of her work broader than female sterilisation

Table

Code	Description
Respondents past experience
female sterilisation	Code respondents’ past work experience related to female sterilisation
FP general	Code respondents’ past work experience related to FP broadly
FP Issues – Current	Code what respondent feels are current issues in Indian family planning
PM Speech - Concerns	Code discussion on concerns stemming from PM’s independence day address regarding population “explosion”
Exploding population	Code discussion on perceptions of population “explosion”, outside of PM’s speech
Female Sterilisation	Code any mention of female sterilisation in India
History
FP generally	Code discussion on history of or historical factors pertaining to family planning overall in India
Sterilisation	Code discussion on history of or historical factors pertaining to sterilisation (male and female) in India
Changes post ICPD	Code any mention of changes that took place in policy and programme after ICPD Cairo
Control coercion restriction	Code any mention of control/coercion/restriction in terms of population growth and reproductive right and health
Rights choices consent	Code discussion on rights, choices, and consent in FP
Vasectomy	Code any mention of vasectomies (including NSVs)
Training	Code discussion on training for vasectomies
Quality of care or services	Code discussion on quality of care or services in FP
Proposed Solution	Code if respondents suggest ideas for moving away from female sterilisation to other contraceptive methods, improving FP broadly
ELAs or Targets	Code any mention of targets or ELAs as well community needs assessment
ASHAs	Code any mention of ASHAs and their work here
Incentives	Code any mention of incentives for acceptors, providers, health workers for female sterilisation
State level variations	Code discussion on state-level variations within India with regard to family planning
Policy level challenges	Code discussion on policy and implementation challenges regarding FP - supply side, infrastructure etc
Policy level successes	Code discussion on policy successes regarding FP

Table

Policy Document	Year
Programme of Action adopted at the International Conference on Population and Development Cairo	1994
National Population Policy	2000
Guidelines on Accredited Social Health Activists (ASHA)	2006
Ramakant Rai v. Union of India, W.P (C) No 209 of 2003	2007
Training Programme on Expected Level of Achievement (Target Fixation) for Family Welfare Programmes	2012
A Strategic Approach to Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH + A) in India	2013
Mission Parivar Vikas	2016
India’s Vision FP2020	2014
Standards & Quality Assurance in Sterilisation Services (Updated)	2014
Devika Biswas v. Union of India & Others, Petition No. 95 of 2012	2016
National Health Policy	2017
PM’s independence day speech	2019
Update on ASHAs	2019
Ministry of Health and Family Welfare Annual Report 2019–20	2019

Office of the Registrar General & Census Commissioner India. Census Data; 2011. [cited 2021 Mar 30]. Available from: https://censusindia.gov.in/2011-common/censusdata2011.html.

 Google Scholar