• sterilisation
• India
• service delivery

Despite being the first country to launch a family planning (FP) programme, India is currently the world’s second most populous country and will soon surpass China to become the most populated country in the world.1 2 To stabilise its population, India needs to achieve a norm of two children per couple.1 As a step towards this goal, India has expanded the range of contraceptives included in its national FP basket in order to allow couples to choose the method best suited to their needs. Despite the availability of various methods, female sterilisation is the most common method adopted by couples,3 regardless of the fact that sterilisation is promoted as an irreversible procedure.4 The success rate of reversal procedures is variable (42% to 69% pregnancy rate according to a recent systematic review) and reversal surgery is costly and is available only at a few public health facilities in India.4 5

Two decades ago, the government of India adopted a ‘target-free’ approach to its family planning programme. However, the day-to-day reality of the Indian healthcare system is in stark contrast to the government’s claims.1 6 7 Annual Program Implementation Plans (PIPs) prepared by each administrative block, district, and state of India include fixed, predetermined numerical targets of prospective contraceptive users to be added …