Rethinking health system accountability to patients: female sterilization & patient reported performance measurement

Woskie, Liana Rosenkrantz (2022) Rethinking health system accountability to patients: female sterilization & patient reported performance measurement. PhD thesis, London School of Economics and Political Science.

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Abstract

Female sterilization is a widespread and viable method of fertility control, but this is only the case when done with the full consent of women undergoing the procedure. Involuntary sterilization is considered an act of violence and, when systematic, a crime against humanity. While often framed as a historical practice or limited to isolated cases, I find that routinized forms of coercive sterilization are a widespread and contemporary issue. Made up of four related papers, this dissertation examines how we think about and measure informed consent, and in turn quantify human rights abuses amongst sterilized women. In the first empirical chapter, I provide the first quantification of a human rights-based framework presented in the WHO's “Interagency Statement on Eliminating Forced, Coercive and Otherwise Involuntary Sterilization,” using patient-level data from over 180,000 sterilized women. The second empirical chapter re-evaluates the roll out of a large nation-wide policy; employing an instrumental variable (IV) approach to estimate the effect of increased institutional delivery on tubal ligation practice patterns. The third and fourth empirical chapters look at how people rate their care. This process involves testing conceptual equivalence and construct validity of patient ratings with 65 qualitative subjects as well as an examination of how these measures preform quantitatively. The goal of this work is to see if commonly used performance measures adequately capture instances of coercion and explore why patients who are subject to coercion might rate their care highly. This body of work problematizes status quo approaches in patient-centeredness measurement with practical implications for quantifying rights abuses for an important population: sterilized women. The findings are relevant given current accounting practices that may mask, rather than reveal, issues of coercion in healthcare as well as the demographic effects of uninformed sterilization concentrated within specific populations.

Item Type:	Thesis (PhD)
Additional Information:	© 2022 Liana Rosenkrantz Woskie
Library of Congress subject classification:	R Medicine > RA Public aspects of medicine R Medicine > RG Gynecology and obstetrics
Sets:	Departments > Social Policy
Supervisor:	Papanicolas, Irene and Wenham, Clare
URI:	http://etheses.lse.ac.uk/id/eprint/4683

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