Women sterilised in eastern India risk infections and other complications due to dirty conditions and a shortage of doctors and supplies, a report said on Monday just months after 15 women died following surgery.
The International Center for Research on Women (ICRW), which reviewed the quality of female sterilisation services in India's third most populous state, Bihar, said there were still major problems despite some infrastructure improvements.
The world's top steriliser of women
India, the world's top steriliser of women, came under global scrutiny last November when 15 women died and scores of others were hospitalised after sterilisation surgery in neighboring Chhattisgarh state.
Read: India police detain sterilisation surgeon after 13 women die
The case prompted agencies such as the United Nations Population Fund to reiterate the need for surgical contraception to be administered in safe and sanitary conditions.
Ravi Verma, head of ICRW's Asia regional office, said the evidence generated by their research highlighted the fact that services for women undergoing sterilisation were still poor.
Denied of the dignity and respect
"The plight of poor women denied of the dignity and respect they deserve, coupled with the high risk of exposure to infections and post-surgery complications, are clearly highlighted by our research," Verma said in a statement.
The ICRW said the report was conducted with the Bihar government, but the state's health minister said he was unaware of the study and refuted its findings.
Read: How doctors in India scam sick patients
"We never came across any report of risks of infection and other such complications during sterilisation operations in government hospitals," Health Minister Ramdhani Singh told the Thomson Reuters Foundation.
Reining in population growth
India's mass-sterilisation programme and efforts to rein in population growth have been described as the most draconian after China. India's birth rates have fallen in recent decades, but its population growth is still among the world's fastest.
With more than four million Indians sterilised every year, almost all women, a quota system encourages officials and doctors to cut corners and uneducated women are often given money for surgery without knowing the risks, say activists.
Read: Indian women die after mass sterilisation
Bihar has over 100 million people yet contraceptive use is low compared to other states and sterilisation mostly chosen.
The study was based on interviews with around 800 doctors, nurses and patients in nearly 80 public and private hospitals.
Recovering on mats on the floor
Only one tenth of primary health centers provided all women with a bed after surgery, leaving most to recover on mats on the floor, and in nearly one out of three, hospital waste was found scattered around, compounding the risk of sickness.
Most facilities lacked basic, minimum equipment, drugs and supplies for sterilisation, and some lacked essentials such as scissors, gloves and cotton swabs.
Researchers reported "troubling shortages" of doctors and nurses at some facilities and only a third had family planning counselors so most women left without counseling or advice.
"Safe, sanitary conditions are absolutely non-negotiable and can be achieved with very little or no heavy additional costs but will surely yield long-term dividends," Pranita Achyut, the report's lead researcher, said in a statement.
Mystery illness in Indian children may be caused by litchi fruit
Indian officials to track toilet use
India's struggle with faulty drugs exposed