Based on results from the Pakistan Demographic and Health Survey, female sterilization is viewed by married women as the most preferred method of contraception and should be promoted as an effective method of family planning. Demand currently far exceeds the availability of services, particularly in rural areas where 70% of the population lives. Surgical sterilization is not desired by women and carries with it a certain amount of morbidity. A promising approach is transcervical insertion of active agents to produce tubal occlusion. The historical background and description of how quinacrine acts in the uterus are provided. The results of use of the nonsurgical procedure of quinacrine introduction into the uterine cavity for female sterilization in Pakistan are discussed. From January to December 1990, in rural and urban Failsalabad, Pakistan, 2100 women received a single insertion of 7 pellets (252 mg) of quinacrine hydrochloride through a Copper-T IUD inserter. The procedure was performed by the author and other doctors and traditional birth attendants (TBA). Patients were instructed to return if there was severe pain, bleeding, or a missed period, and TBAs were to maintain regular contact with their clients and report complications immediately. Other patients (167) accepted transabdominal tubal ligation and transvaginal tubal ligation (235); these small numbers show the popularity of the quinacrine procedure. In a sample of 450 patients, 7% showed minor side effects. Vaginal discharge for 5-10 days was reported by all women. Also reported was 1-6 days of pain in the lower abdomen, amenorrhea for 2-3 months, and irregular menstruation, menorrhagia, backache, feelings of heaviness, dyspareunia, and itching. 4% became pregnant in varying periods after insertion. 36/47% continued the pregnancy and the remainder had dilatation and curettage (D and C) with vaginal tubectomy, D and C, or unknown actions. The rates of ectopic pregnancy are one third to one sixth of those with surgical procedures (.24/1000 procedures versus .75/1000 for surgical methods), but the pregnancy rate is higher (4-5% versus .5% for surgical procedures). Reduction of the failure rate to 1% is possible with insertion of 400 mg of Brufen a half hour before quinacrine insertion.