With a high number of tubectomies conducted every year and in a camp based approach, tubectomy-related deaths as a result of poor quality of care will be inevitable even when they are done in health-care facilities. Unfortunately, the camp-based approach is set to continue. The pressure to meet targets, the incentives given to motivators and doctors and the permanent nature of sterilization would mean that the question of counselling men and women of the different options may remain on paper. When Mahinda Rajapaksa called a fresh presidential election two years ahead of the scheduled January 2016 end to his second term in office, he did so because he was confident of being voted back for another six years. There was no real challenger on the horizon at that time, and Mr. Rajapaksa, who had made the 2009 military victory over the LTTE the main theme of his government, believed that Sinhalese voters would once again repose their faith in him. Indeed, so entrenched had he become that few imagined he would lose, and that too to a relative unknown like Maithripala Sirisena, who was the Health Minister in the Rajapaksa Cabinet. Mr. Sirisena’s sudden emergence as a candidate of an opposition alliance took Mr. Rajapaksa by surprise. He had been unable to see, surrounded as he was by a cabal, that his one-family authoritarian rule had angered senior members of his Sri Lanka Freedom Party, and taken the shine off his image among the majority Sinhalese as the President who ended a 30-year war. The Tamil voters in the North and East, alienated as they were by the Rajapaksa government’s abject failure to face up to the challenges of post-war ethnic reconciliation, were always going to vote against him. The foot-dragging on investigations into alleged war crimes, the militarisation of the Tamil-dominated North, the hardships that this posed for the people, And the huge political failure on devolution of powers all ensured that the Tamil vote would go against him. Another significant.2005