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Sterilisation in India (and globally) has a contentious and deeply politicised history. Despite this troubling legacy, India continues to rely on female sterilisation as the main form of contraception and family planning. Abortion, which has been legal under broad grounds since 1971, intersects with sterilisation at different points over women's reproductive lifecourse. Drawing on three case studies exploring women's abortion trajectories in Karnataka, India (2017), this chapter examines sterilisation as a reproductive technology (RT) in women's abortion narratives. These include experiences of failed sterilisation necessitating abortion, as well as narratives around pre- and post-abortion counselling with sterilisation conditionalities. Women report healthcare workers shaming or scolding them for not being sterilised after their last pregnancy – demonstrating the prominence of sterilisation as an enforced social norm using ‘health’ frames. Using reproductive justice (RJ) as a lens, I analyse how sterilisation interacts with abortion and the narratives of shame and stigma that surround the two technologies and make visible the ways in which it results in the denial and restriction of women's reproductive freedoms.

Achieving reliable instrument reprocessing requires finding the right balance among cost, productivity, and safety. However, there have been few attempts to comprehensively examine sterile processing department (SPD) work systems. We considered an SPD as an example of a socio-technical system – where people, tools, technologies, the work environment, and the organization mutually interact – and applied work systems analysis (WSA) to provide a framework for future intervention and improvement.

The study was conducted at two SPD facilities at a 700-bed academic medical center servicing 56 onsite clinics, 31 operating rooms (ORs), and nine ambulatory centers. Process maps, task analyses, abstraction hierarchies, and variance matrices were developed through direct observations of reprocessing work and staff interviews and iteratively refined based on feedback from an expert group composed of eight staff from SPD, infection control, performance improvement, quality and safety, and perioperative services. Performance sampling conducted focused on specific challenges observed, interruptions during case cart preparation, and analysis of tray defect data from administrative databases.

Across five main sterilization tasks (prepare load, perform double-checks, run sterilizers, place trays in cooling, and test the biological indicator), variance analysis identified 16 failures created by 21 performance shaping factors (PSFs), leading to nine different outcome variations. Case cart preparation involved three main tasks: storing trays, picking cases, and prioritizing trays. Variance analysis for case cart preparation identified 11 different failures, 16 different PSFs, and seven different outcomes. Approximately 1% of cases had a tray with a sterilization or case cart preparation defect and 13.5 interruptions per hour were noted during case cart preparation.

While highly dependent upon the individual skills of the sterile processing technicians, making the sterilization process less complex and more visible, managing interruptions during case cart preparation, improving communication with the OR, and improving workspace and technology design could enhance performance in instrument reprocessing.

Biodegradable polymers are widely used in personalized medical devices or scaffolds for tissue engineering. The manufacturing process should be finished with sterilization procedure. However, it is not clear how the different sterilization methods have an impact on the mechanical strength of the three-dimensional (3D)-printed parts, such as bone models or personalized mechanical devices. This paper aims to present the results of mechanical testing of polylactide-based bone models before and after sterilization.

Polylactide specimens prepared in fused filament fabrication technology were sterilized with different sterilization methods: ultraviolet (UV) and ethylene oxide. Mechanical properties were determined by testing tensile strength, Young’s modulus and toughness.

The tensile strength of material after sterilization was significantly higher after ethylene oxide sterilization compared to the UV sterilization, but in both sterilization methods, the specimens characterized lower tensile strength and Young’s modulus when compared to the control. In comparison of toughness results, there was no statistically significant differences. The findings are particularly significant in the perspective of using individual implants, bone grafts and dental guides.

Although fused filament fabrication (FFF) 3D printing devices equipped with UV light sterilization options are available, experimental results of the effect of selected sterilization methods on the mechanical strength of additively manufactured parts have not been described. This paper completes the present state of the art on the problem of sterilization of FFF parts from biodegradable materials.

In a rapidly changing environment, many health-care systems are forced to survive with rising costs and the need for proper resources utilization. To address the requirements for effective strategic planning, business process reengineering (BPR) is inevitable for health-care systems. This study aims to focus on the reengineering of central sterilization unit’s business processes to obtain performance improvement and efficiency. With the obtained new process design, it is expected to get standardization in all level of the central sterilization unit.

This paper presents a BPR method for modeling the system in health-care sector to improve the productivity of the sterilization process of surgical equipment. The case study is conducted in a large hospital in Istanbul, Turkey. First, “as-is” process is modeled and the problems are determined. Then, solution methods are developed and the target system (to-be process) is redesigned and the workflows of each phase are remodeled by using ARIS tool. Enterprise resource planning (ERP)-driven BPR is used to reengineer the current processes and the future processes are operated through the modeled ERP system. Finally, by using a statistical analysis, performance of the new process is compared with the existing process using the first data obtained from the case hospital.

In many sterilization services, the control procedures are rarely used. Thus, an ERP solution is developed to automate sterilization tasks and track down the information flow. With the ERP solution, it is possible to track in which dates, where and by whom the items are processed. On the other hand, in the sterilization process, the sets are used efficiently according to the last sterile dates of the items. Also, with the ERP system, it is possible to reduce unnecessary paper usage and this gives the hospitals the opportunity to be more ecological and sustainable. As a result, a centralized sterilization process with an IT support provides efficiency, economy and patient safety.

This study seeks for the potential benefits of an ERP implementation in health-care sector. As a result of this project, improvements in productivity, cost and quality are expected in sterilization processes because the new process design will bring automation, human-related error reduction and equipment tracking system. For this purpose, a business process management software is developed and implemented to the central sterilization unit so that the information flows more safely and the managers can track the results quickly by charts and reports.

Polymethyl methacrylate (PMMA) is a remarkable biocompatible material for bone cement and regeneration. It is also considered 3D printable but requires in-depth process–structure–properties studies. This study aims to elucidate the mechanistic effects of processing parameters and sterilization on PMMA-based implants.

The approach comprised manufacturing samples with different raster angle orientations to capitalize on the influence of the filament alignment with the loading direction. One sample set was sterilized using an autoclave, while another was kept as a reference. The samples underwent a comprehensive characterization regimen of mechanical tension, compression and flexural testing. Thermal and microscale mechanical properties were also analyzed to explore the extent of the appreciated modifications as a function of processing conditions.

Thermal and microscale mechanical properties remained almost unaltered, whereas the mesoscale mechanical behavior varied from the as-printed to the after-autoclaving specimens. Although the mechanical behavior reported a pronounced dependence on the printing orientation, sterilization had minimal effects on the properties of 3D printed PMMA structures. Nonetheless, notable changes in appearance were attributed, and heat reversed as a response to thermally driven conformational rearrangements of the molecules.

This research further deepens the viability of 3D printed PMMA for biomedical applications, contributing to the overall comprehension of the polymer and the thermal processes associated with its implementation in biomedical applications, including personalized implants.

Sterilization is endorsed as a method of family planning by international governmental organizations; abortion is not. Focusing on policy development for these two issues in a single country, Peru, we ask how power and inequality operate under conditions of global consensus or dissensus. The case of sterilization unfolded the way many previous research studies would predict, with Peruvian state actions corresponding to a global diffusion process. We find that global consensus provided cover for top-down actions that violated the human rights of indigenous women in the country, who were predominantly poor, non-Spanish speakers, and residents of the mountainous, sparsely populated parts of the country. With respect to abortion in Peru, in the absence of global consensus, the state resisted calls for change, advocacy networks have worked at cross-purposes, and a powerful local actor, the Catholic Church, has effectively blocked liberalization efforts. As with sterilization, however, marginalized indigenous women and their interests were rendered invisible.

In The Road to Serfdom, Hayek argued against planned economies that “the close interdependence of all economic phenomena makes it difficult to stop planning just where we wish…once the free working of the market is impeded beyond a certain degree, the planner will be forced to extend his controls till they become all-comprehensive” (Hayek, 1944, p. 79). According to Hayek, and especially Mises, there exists no stable condition in-between laissez faire capitalism and the planned economy. Once politicians engaged in acts of interventionism further interventions would successively lead them towards a condition where the state fully planned and controlled the economy and civil society. According to Austrians, ‘interventionism’ thus represented an unstable and self-reinforcing condition (Burton, 1984, p. 110). In John Gray's words “whenever an interventionist policy…fails to achieve the desires result, the practical and theoretical response of the interventionist ideologue is to demand an extension of the policy to new fields…interventionist policies will always interpret the failure of any such policy, not as a reason in favour of its abandonment, but rather as one supporting its wider application”(Gray, 1984, p. 32).

The purpose of this paper is to analyse the budget of the Indian family planning programme from a human rights perspective. Family planning services play an important role in the realisation of the reproductive rights of women. In India, the family planning programme is one of the largest in the world with thousands of patients, mostly women, accessing services every year. Although the Indian legal system guarantees the right to health, Indian women from marginalised sections of society still battle inadequate services and the absence of health care that respects their right to reproductive autonomy and choice. Therefore, the question is: in the presence of a strong legal framework, what are the factors that contribute to this phenomenon?

The authors have gathered data from the project implementation plans at the state level comparing year-wise expenditure for family planning against overall expenditure for reproductive, maternal and child health expenditure. The data are then compared to the number of women using sterilisation to suggest a relationship between both. Finally, the article relies on desk research to review scholarship on the Indian family planning programme and applicable human rights obligations.

The paper finds that social-economic rights such as the right to health are applicable to government spending and budgeting. It also finds current spending in the NHM is insufficient to guarantee women’s reproductive rights as the vast majority of resources are spend on sterilisation, thus limiting women’s ability to choose the number and spacing of children.

The data used in this research bears one limitation: the propensity of the government to change the guidelines as to how States should present their budgets in the project implementation plans. The authors have adjusted the data so that it remains comparable. However, the adjustment was not possible for all expenditure data, which is why the current study is limited to the family planning programme alone.

The paper argues that to be human rights compliant, health budgets of the NHM need to be geared towards the specific needs of women in terms of family planning. Finally, the article briefly outlines the role played by human rights and human rights litigation in impacting government budgets.

India’s family planning programme has been examined from a performance and medical standpoint, focussing on medical indicators such as total fertility rate, unmet needs for family planning, amongst others. Academic scholarship has investigated through statistical analysis patterns of contraceptive use and contraceptive mix. What is absent, however, is an assessment of the programme from a right-based perspective by looking at the human rights obligations of India and their normative implications for the Indian family programme.

Data from the National Survey of Family Growth suggest that poor women and women of color are more likely than privileged women to use long-lasting contraception such as sterilization, intrauterine devices (IUD), and Depo Provera. This disparity is noteworthy because long-lasting methods can and have been used coercively. To analyze this disparity, I constructed multivariate binary logistic regression models for female sterilization, IUD, and Depo Provera using the most recent National Survey of Family Growth available (Cycle 6, conducted by the National Center for Health Statistics (NCHS) in 2002). I examined the effect of both personal factors, including age, parity, and number of marriages, and social factors, including education and health coverage. Personal factors were strong predictors but could not explain racial and economic disparities that exist among contraceptive users. This analysis found that education and health coverage were also important variables. Even controlling for personal factors, women with less education were more likely to be sterilized or use Depo Provera than women with a bachelor's degree or more. Women covered by Medicaid or public, government, or military coverage were more likely to use Depo Provera than women with private insurance. Women covered by Medicaid were also more likely to be sterilized since 2000. And uninsured women were more likely to use an IUD than women with private health insurance. However, none of the independent variables completely erased the effect of race and income, suggesting further research is necessary to understand the disparity in use of long-lasting contraceptives.

The use of laser sintering (LS) in the medical sector has increased dramatically in recent years. With the move towards direct use of these parts in clinical applications, there is a greater need to understand the effects of standard processes on the part properties. The purpose of this study is to determine the effect that steam sterilisation has on the mechanical properties of LS polyamide 12 parts.

The research presented here focusses on the effect of a single steam sterilisation cycle on the mechanical properties of polyamide 12 parts manufactured using LS. The influence of water content on the properties was investigated, with additional drying steps trialled to establish the potential to reverse any changes observed and to determine their root cause.

The results show that steam sterilisation has a significant effect on the mechanical properties of LS polyamide 12 parts, with a 39% reduction in elastic modulus, a 13% decrease in ultimate tensile strength and a 64% increase in the elongation at break. These properties were also all found to correlate with the water content, suggesting that this was the cause of the difference. The original properties of the parts were able to be recovered after oven drying.

These results show that with an additional drying step, LS polyamide 12 parts can be steam sterilised with no effect on the mechanical properties.

This is believed to be the first investigation into the effects of steam sterilisation in isolation on LS polyamide 12 parts, the first instance of drying parts to recover mechanical properties and the first instance of multiple water content measurements being directly linked to the mechanical properties.