Objective: To evaluate the cumulative probability of regret after tubal sterilization, and to identify risk factors for regret that are identifiable before sterilization.
Methods: We used a prospective, multicenter cohort study to evaluate the cumulative probability of regret within 14 years after tubal sterilization. Participants included 11,232 women aged 18–44 years who had tubal sterilizations between 1978 and 1987. Actuarial life tables and Cox proportional hazards models were used to identify those groups at greatest risk of experiencing regret.
Results: The cumulative probability of expressing regret during a follow-up interview within 14 years after tubal sterilization was 20.3% for women aged 30 or younger at the time of sterilization and 5.9% for women over age 30 at sterilization (adjusted relative risk [RR] 1.9; 95% confidence interval [CI] 1.6, 2.3). For the former group, the cumulative probability of regret was similar for women sterilized during the postpartum period (after cesarean, 20.3%, 95% CI 14.5, 26.0; after vaginal delivery, 23.7%, 95% CI 17.6, 29.8) and for women sterilized within 1 year after the birth of their youngest child (22.3%, 95% CI 16.4, 28.2). For women aged 30 or younger at sterilization, the cumulative probability of regret decreased as time since the birth of the youngest child increased (2–3 years, 16.2%, 95% CI 11.4, 21.0; 4–7 years, 11.3%, 95% CI 7.8, 14.8; 8 or more years, 8.3%, 95% CI 5.1, 11.4) and was lowest among women who had no previous births (6.3%, 95% CI 3.1, 9.4).
Conclusion: Although most women expressed no regret after tubal sterilization, women 30 years of age and younger at the time of sterilization had an increased probability of expressing regret during follow-up interviews within 14 years after the procedure.
In the United States, tubal sterilization is the most commonly used form of contraception among women.1 More than 600,000 women choose this procedure each year,2 and approximately 10 million American women have been sterilized.3 Although tubal sterilization is considered a permanent form of contraception, many women may regret their decision during the ensuing years.4 Regret is defined as “distress over a desire unfulfilled or an action performed or not performed” (Webster's New Riverside University Dictionary. Boston: Houghton Mifflin, 1988). The human and economic consequences of regret regarding tubal sterilization may be substantial. The impact of curtailed reproductive potential ranges from the intangible costs of reduced quality of life5 to an increase in the use of expensive procedures with limited success, including reanastomosis and assisted reproductive technologies.
We used data from the largest and longest prospective study of women undergoing tubal sterilization in United States medical centers to identify subgroups who have the highest cumulative probability of regret during the 14 years after tubal sterilization and the strongest risk factors for regret identifiable before sterilization. A preliminary analysis of interim data from this cohort examined the risk of experiencing regret during the first 5 years after tubal sterilization.6 Information on regret within 14 years might help clinicians and women considering sterilization to reduce the prevalence of poststerilization regret and its consequences.
Women 30 years and younger at the time of sterilization have an increased probability of regretting the procedure within 14 years.
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Address reprint requests to: Susan D. Hillis, PhD DRH/NCCDPHP (K-34) Centers for Disease Control and Prevention 1600 Clifton Road Atlanta, GA 30333 E-mail: email@example.com
The U.S. Collaborative Review of Sterilization Working Group: Herbert B. Peterson, MD, Joyce M. Hughes, Zhisen Xia, PhD, Lynne S. Wilcox, MD, and Lisa Ratliff Tylor, Atlanta, Georgia; James Trussell, PhD, Princeton, New Jersey; Norman G. Courey, MD, CM, Buffalo, New York; Philip D. Darney, MD, MSc, San Francisco, California; Ernst R. Friedrich, MD, St. Louis, Missouri; Ralph W. Hale, MD, Washington, DC; Roy T. Nakayama, MD, Honolulu, Hawaii; Jaroslav F. Hulka, MD, Chapel Hill, North Carolina; Alfred N. Poindexter, MD, Houston, Texas; George M. Ryan, MD and Frank Ling, MD, Memphis, Tennessee; Gary K. Stewart, MD, Sacramento, California; and Howard A. Zacur, MD, Baltimore, Maryland.
Supported by an interagency agreement (3-YO2-HD41075-10) with the National Institute of Child Health and Human Development.
Received August 5, 1998. Received in revised form October 27, 1998. Accepted November 25, 1998.