Medical Eligibility Criteria for Female Sterilization

	All women can have female sterilization. No medical conditions prevent a woman from using female sterilization. This checklist asks the client about known medical conditions that may limit when, where, or how the female sterilization procedure should be performed. Ask the client the questions below. If she answers “no” to all of the questions, then the female sterilization procedure can be performed in a routine setting without delay. If she answers “yes” to a question, follow the instructions, which recommend caution, delay, or special arrangements. In the checklist below: Caution means the procedure can be performed in a routine setting but with extra preparation and precautions, depending on the condition. Delay means postpone female sterilization. These conditions must be treated and resolved before female sterilization can be performed. Help the client choose another method to use until the procedure can be performed. Special means special arrangements should be made to perform the procedure in a setting with an experienced surgeon and staff, equipment to provide general anesthesia, and other backup medical support. For these conditions, the capacity to decide on the most appropriate procedure and anesthesia regimen also is needed. Help the client choose another method to use until the procedure can be performed.
	1. Do you have or have you ever had any female conditions or problems, such as infection or cancer? If so, what problems? NO YES If she has any of the following, use caution: Previous abdominal or pelvic surgery Past pelvic inflammatory disease since last pregnancy Uterine fibroids Breast cancer If she has any of the following, delay female sterilization: Related to pregnancy Current pregnancy 7–42 days postpartum Postpartum after a pregnancy with severe pre-eclampsia or eclampsia Serious postpartum or postabortion complications (such as infection, hemorrhage, or trauma) except uterine rupture or perforation (special; see below) Hematometra (a large collection of blood in the uterus) Unrelated to pregnancy Unexplained vaginal bleeding that suggests an underlying medical condition Purulent cervicitis, chlamydia, or gonorrhea Pelvic inflammatory disease Pelvic cancers (treatment may make her sterile in any case) Malignant trophoblast disease If she has any of the following, make special arrangements: Fixed uterus due to previous surgery or infection Endometriosis Hernia (abdominal wall or umbilical) Postpartum or postabortion uterine rupture or perforation
	2. Do you have any heart problems, stroke, high blood pressure, diabetes, or complications of diabetes? If so, what? NO YES If she has any of the following, use caution: Controlled high blood pressure Mild high blood pressure (140/90 to 159/99 mm Hg) Past stroke or heart disease without complications Diabetes without damage to arteries, vision, kidneys, or nervous system If she has any of the following, delay female sterilization: Heart disease due to blocked or narrowed arteries Blood clots in deep veins of legs or lungs If she has any of the following, make special arrangements: Several conditions together that increase chances of heart disease or stroke, such as older age, smoking, high blood pressure, or diabetes Moderately high or severely high blood pressure (160/100 mm Hg or higher) Diabetes for more than 20 years or damage to arteries, vision, kidneys, or nervous system caused by diabetes Complicated valvular heart disease
	3. Do you have any lingering, long-term diseases or any other conditions? If so, what? NO YES If she has any of the following, use caution: Moderate iron-deficiency anemia (hemoglobin 7–10 g/dl) Severe lack of nutrition (Is she extremely thin?) Sickle cell disease Inherited anemia (thalassemia) Diaphragmatic hernia Epilepsy Hypothyroidism Mild cirrhosis of the liver, liver tumors, or schistosomiasis with liver fibrosis Kidney disease Obesity (Is she extremely overweight?) Elective abdominal surgery at time sterilization is desired Depression Young age Uncomplicated lupus with negative antiphospholipid antibodies If she has any of the following, delay female sterilization: Gallbladder disease with symptoms Active viral hepatitis Severe iron-deficiency anemia (hemoglobin less than 7 g/dl) Lung disease (bronchitis or pneumonia) Systemic infection or significant gastroenteritis Abdominal skin infection Undergoing abdominal surgery for emergency or infection, or major surgery with prolonged immobilization If she has any of the following, make special arrangements: Severe cirrhosis of the liver Hyperthyroidism Coagulation disorders (blood does not clot) Chronic lung disease (asthma, bronchitis, emphysema, lung infection) Pelvic tuberculosis HIV with advanced or severe clinical disease (see Female Sterilization for Women With HIV, below) Lupus with positive (or unknown) antiphospholipid antibodies, with severe thrombocytopenia, or on immunosuppressive treatment

Female Sterilization for Women Living With HIV
Women who are living with HIV or are on antiretroviral (ARV) therapy can safely undergo female sterilization. Special arrangements are needed to perform female sterilization on a woman with advanced or severe clinical disease. The procedure may need to be delayed if she has an HIV-related illness. Urge these women to use condoms in addition to female sterilization. Used consistently and correctly, condoms help prevent transmission of HIV and other STIs. No one should be coerced or pressured into having female sterilization, and that includes women with HIV.

Female Sterilization for Women Living With HIV

Women who are living with HIV or are on antiretroviral (ARV) therapy can safely undergo female sterilization. Special arrangements are needed to perform female sterilization on a woman with advanced or severe clinical disease. The procedure may need to be delayed if she has an HIV-related illness.
Urge these women to use condoms in addition to female sterilization. Used consistently and correctly, condoms help prevent transmission of HIV and other STIs.
No one should be coerced or pressured into having female sterilization, and that includes women with HIV.

The Importance of Clinical Assessment
Because female sterilization involves a surgical procedure and the administration of local anesthesia (with or without mild sedation and analgesia), the client must undergo a careful, comprehensive yet focused clinical assessment. This assessment is important in every case, but it is even more important when the procedure is performed in hard-to-reach areas, in an outreach service, or in facilities far from supporting higher-level health services. The assessment must include review of the Medical Eligibility Criteria (above) and a pelvic/genital examination. See the Importance of Selected Procedures for Providing Family Planning Methods in Chapter 26.

The Importance of Clinical Assessment

Because female sterilization involves a surgical procedure and the administration of local anesthesia (with or without mild sedation and analgesia), the client must undergo a careful, comprehensive yet focused clinical assessment. This assessment is important in every case, but it is even more important when the procedure is performed in hard-to-reach areas, in an outreach service, or in facilities far from supporting higher-level health services.

The assessment must include review of the Medical Eligibility Criteria (above) and a pelvic/genital examination. See the Importance of Selected Procedures for Providing Family Planning Methods in Chapter 26.