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While most women don’t regret their decision to undergo tubal sterilization, new research indicates that one in five women sterilized at a young age do.1
These results come from the largest and longest prospective study of women undergoing tubal sterilization in the United States, which was conducted by researchers at the Centers for Disease Control and Prevention (CDC) in Atlanta and the U.S. Collaborative Review of Sterilization (CREST) Work Group, with support from the National Institutes of Health in Bethesda, MD. (Contracep tive Technology Update has covered other findings from this multicenter research project. See the August 1996 issue, pp. 93 and 99, for information on sterilization failure rates, and the June 1997 issue, p. 67, for an overview of ectopic pregnancies following tubal sterilization.)
"Young age at the time of tubal sterilization is the most important risk factor for subsequent regret," reports Susan Hillis, PhD, reproductive health epidemiologist at the CDC and lead author of the current study.
Previous studies have indicated young age as the principal determinant of regret following sterilization,2,3 notes Amy Pollack, MD, MPH, president of AVSC International in New York City. This study confirms that data and reinforces the need to ensure adequate counseling at the time of decision making, she states.
Sterilization is the most popular form of birth control among American women,4 a fact that prompted researchers to undertake the CREST study. More than 11,000 women ages 18 to 44 years who underwent sterilization between 1978 and 1987 were included in the overall study. More than 65% were married at the time of ster ilization, and more than 95% chose the method for contraceptive rather than health reasons.
At follow-up interviews, women were considered to have expressed regret if they responded negatively to the question, "Do you still think tubal sterilization as a permanent method of birth control was a good choice for you?" Some 20% of women who underwent a tubal sterilization at 30 or younger expressed regret within 14 years after the procedure, researchers found. In contrast, about 6% of women who underwent sterilization after 30 expressed regret.
Regret is hard to quantify because its definition differs from person to person, and it is difficult to gauge its intensity and impact on an individual’s life, says Herbert Peterson, MD, chief of the CDC’s women’s health and fertility branch and a co-author of the paper. Despite these challenges, researchers say the issue should be examined because sterilization is intended to be a permanent form of birth control.
The study’s results show that if sterilization of young women occurred within a year of the birth of their youngest child, regret was similar to that for women undergoing postpartum sterilization — more than 20% in both cases — and was substantially higher than that for the 8.3% of women sterilized eight or more years after the birth of their youngest child. The probability of regret was lowest among women with no previous births.
A change in the desired family size was the most common reason for regret among young women. Since almost half of all U.S. marriages end in divorce, young women who choose sterilization are more likely to be of child-bearing age upon remarriage — and prone to regret their contraceptive choice, Peterson says. Almost half of young women expressing regret also requested information about reversing their sterilization procedure, study results show. Researchers plan to examine the link between requests for reversals with actual reversal procedures in a future paper, he says.
While most women do not express regret, even many years after sterilization, family planning clinicians now can predict who will be in the highest risk category, says Peterson. The CREST study confirms that age is a key determinant, he says.
With these findings in hand, clinicians can use presterilization counseling to help identify those women who may experience doubts later on and reassure others that most sterilized women are comfortable with their decision, Peterson says.
"It is also reassuring to note that rates of regret are so much lower in older women and indicates the need to assure that this contraceptive method continues to be widely available to all women," says Pollack.
1. Hillis SD, Marchbanks PA, Tylor LR, et al. Poststeriliza tion regret: Findings from the United States Collaborative Review of Sterilization. Obstet Gynecol 1999; 93:889-895.
2. Wilcox LS, Chu SY, Eaker ED, et al. Risk factors for regret after tubal sterilization: Five years of follow-up in a prospective study. Fertil Steril 1991; 55:927-933.
3. Hardy E, Bahamondes L, Osis MJ, et al. Risk factors for tubal sterilization regret, detectable before surgery. Contraception 1996; 54:159-162.
4. Centers for Disease Control and Prevention. Fertility, family planning, and women’s health: New data from the 1995 National Survey of Family Growth. (DHHS publication no. PHS 97-1995.) Vital Health Stat 1997; 23.