In an investigation of the sterilisation camp deaths in Chhattisgarh, the Population Foundation of India (PFI) found that the state government spent about 20 times the amount incentivising women to get the procedure as they spent on the procedure itself – and women were only paid between 600 and 1400 rupees each (£7-15) to get sterilised. But because of the 2014 tragedy, the national government “did wake up to the fact that there is abysmal quality of care in these facilities”, says PFI director of programmes Sonal Sharma. She says the Indian government accepted PFI’s recommendation that the ‘camp’ approach to sterilisation be banned.

The government has shifted the focus instead to ‘fixed day’ services, meaning that women must come to particular facilities on particular days of the week if they want to be sterilised – which allows better monitoring and regulation of operating room conditions. But in some places, the more limited hours are proving inadequate to service demand for the procedure. At the Mungeli district level hospital about 50km from Bilaspur, for example, a surgeon now comes in to do the procedure two days each week. But that only adds up to about 20 surgeries – which, says the district’s chief medical officer Mukhya Chikitsa, isn’t enough for all the women who want it.

If sterilisation remains in such high demand even among women in Chhattisgarh despite its now-tainted history there, many women must still see it as their best option.

But the procedure remains controversial – and not only because of preventable deaths like those in Bilaspur.

Imperfect answer

Even when performed correctly and in hygienic circumstances, tubal ligation remains more risky and invasive than vasectomy. Even so, in the majority of countries, female sterilisation is more popular than male sterilisation.