Accounting for Coercion: Sterilization, Dissatisfaction, and Routine Reproductive Injustice in India

Abstract

Repeated Supreme Court cases suggest uninformed sterilization care is a persistent and contemporary issue in India. This article examines patient satisfaction ratings as a potential accountability mechanism to assess normalized forms of coercion. With a sample of over 180, 000 sterilized women in India, it identifies a statistically significant relationship between exposure to coercive care and odds of reporting low quality. However, over 95 percent of women who underwent a tubal ligation procedure rated their care highly even when provided with inadequate information (a recognized form of coercion), with more pronounced discordance when a patient belonged to a historically marginalized caste. System-modifiable factors, such as conditional cash transfers (CCT) to the patient and postpartum procedure timing increased reporting discordance. Using a reproductive justice lens and building on Amartya Sen’s capabilities approach, this work examines how to identify human rights violations in the routine delivery of care.HIGHLIGHTS Often considered historically bounded and isolated, coercive sterilization persists in India to this day.Health system performance metrics, particularly subjective ones, mask routine and normalized forms of coercion.A reproductive justice lens highlights the importance of understanding and interpreting expressed preferences for equitable policy.