Research focuses on sterilization regret

Black women who undergo tubal sterilization to prevent future pregnancies are more likely than their white counterparts to regret the decision, results from a new study indicate.1

According to the analysis of data from the National Survey of Family Growth (NSFG), age at the time of sterilization was the most powerful predictor of post-sterilization regret, which is consistent with other studies, states Sonya Borrero, MD, lead author of the current research and assistant professor of medicine at the University of Pittsburgh School of Medicine. The likelihood of regret declines continuously until a woman reaches her 40s, she explains.

"Because young age was such a strong predictor of regret, we stratified our analyses by age group to look at factors influencing regret in older women," Borrero reports. "Among women ages 30-44, black race predicted subsequent regret even after controlling for socioeconomic factors."

Borrero says it is unclear if this current finding is related to racial differences in decision making, counseling at the time of sterilization, or subsequent life events that might be more likely to occur to black women compared to white women, such as a change in partner or loss of a child. More studies are needed to sort out the reasons for the racial disparity. In the meantime, providers should keep the findings in mind when counseling patients on tubal sterilization, the research concludes.

Why is it so important to understand the impact of regret when it comes to female sterilization? Tubal sterilization is the second most popular method of contraception in the United States.3 Racial/ethnic variations exist in the use of sterilization; in an analysis using the 2002 NSFG, black women were more likely to be sterilized compared with white women after controlling for important socioeconomic confounders such as age, insurance status, marital status, education, parity, religion, and income.4

Keep in mind that few of the women who undergo tubal sterilization or whose husbands undergo vasectomy later go on to regret either procedure, according to a study drawn from CREST data. Its findings indicate that the proportion of women who experience regret essentially is the same (about 7%) five years after their husbands' vasectomy or their own tubal sterilization.5

Analysis of the CREST data indicates the 14-year cumulative probability of requested reversal information was 14.3%; but in women under age 24 who underwent sterilization, the request for reversal information was as high as 40.4%. Risk factors for increased regret include having received less information about the procedure, having had less access to information or support for other contraceptive method use, and having made the decision under pressure from a spouse or because of medical indications.6

"Those women who do express regret are generally either very young; in an unstable relationship; are experiencing general life stresses — financial, relationship ending; having the procedure based on someone else's needs; counting on the possibility of reversal; counting on adoption later in life; just gave birth or had an abortion; or not consulting a partner or . . . telling anyone," says Marsha Gelt, MPH, project director at the Center for Health Training in Oakland, CA. Gelt has provided training on sterilization counseling.

Consider it permanent

There are unique ethical considerations when it comes to sterilization as a method of contraception because, unlike other methods, it is permanent and has far-reaching implications, according to a 2007 committee opinion issued by American College of Obstetricians and Gynecologists (ACOG).7

Women considering sterilization need comprehensive counseling on all of the reversible contraceptive alternatives, advises the ACOG committee opinion. Women considering sterilization also need to understand that while there are techniques that attempt to reverse tubal ligations, they require invasive surgery and have no guarantees of success, the opinion advises.

Talk with women about the potential of future regret with sterilization, as well as inform them about the estimated failure rate as well as the risk of ectopic pregnancy with sterilization. According to Contraceptive Technology, failure rates for tubal sterilization are roughly comparable to those of the intrauterine device: the copper T380A device has a five-year cumulative failure rate of 14 per 1,000 procedures, and levonorgestrel devices range from five to 11 failures per 1,000 procedures.6

Although women do not need consent from others to undergo sterilization, encourage them to discuss their decision with their husband or other appropriate intimate partner because sterilization affects them as well, advises the ACOG opinion.

References

  1. Borrero SB, Schwarz EB, Reeves MF, et al. Race, insurance status, and desire for tubal sterilization reversal. Fertil Steril 2008; 90:272-277.
  2. Hillis SD, Marchbanks PA, Tylor LR, et al. Poststerilization regret: Findings from the United States Collaborative Review of Sterilization. Obstet Gynecol 1999; 93:889-895.
  3. National Center for Health Statistics. National Survey of Family Growth, Cycle 6. Accessed at www.cdc.gov/nchs/nsfg.htm.
  4. Borrero S, Schwarz B, Reeves MF, et al. Race, insurance status, and tubal sterilization. Obstet Gynecol 2007; 109:94-100.
  5. Jamieson DJ, Kaufman SC, Costello C, et al. A comparison of women's regret after vasectomy vs. tubal sterilization. Obstet Gynecol 2002; 99:1,073-1,079.
  6. Pollack AE, Thomas LJ, Barrone MA. "Female and Male Sterilization." In: Hatcher RA, Trussell J, Nelson AL, et al. Contraceptive Technology: 19th revised edition. New York City: Ardent Media; 2007, pp. 368-369.
  7. Committee on Ethics. Sterilization of women, including those with mental disabilities. ACOG Committee Opinion No. 371. Obstet Gynecol 2007; 110:217-220.