Deaths from contraceptive sterilization in bangladesh: rates, causes, and prevention

This report summarizes the second of 2 epidemiologic investigations of deaths attributable to sterilization in Bangladesh. All deaths resulting from sterilizations performed nationwide between September 16, 1980, and April 15, 1981, were investigated and analyzed. Nineteen deaths from tubal sterilization were attributed to 153,032 sterilization operations (both tubal sterilization and vasectomy), for an overall death-to-case rate of 12.4 deaths per 100,000 operations. This rate is lower than that (21.3) for operations performed in Dacca and Rajshahi Divisions from January 1, 1979, to March 31, 1980, although this difference is not statistically significant. Anesthesia overdosage, tetanus, and hemorrhage were the leading causes of death. Improvements in anesthesia management, surgical asepsis, and postoperative monitoring of vital signs should make sterilization operations even safer. Although tubal sterilizations performed in Bangladesh cost some lives, they avert far more maternal deaths. The net health impact is strongly favorable: For every 100,00 tubal sterilizations performed, approximately 100 deaths are prevented.