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Poststerilization Regret: Findings From the United States Collaborative Review of Sterilization

HILLIS, SUSAN D. PhD; MARCHBANKS, POLLY A. PhD; TYLOR, LISA RATLIFF; PETERSON, HERBERT B. MD

Original Research

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.

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: seho@cdc.gov

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.

© 1999 The American College of Obstetricians and Gynecologists