Women Who Are Sterilized At Age 30 or Younger Have Increased Odds of Regret

Volume 31, No. 6, November/December 1999

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Women Who Are Sterilized At Age 30 or Younger Have Increased Odds of Regret

American women who undergo surgical sterilization typically express no regret about their decision, but the risk of regret is heightened for particular groups. Those who are aged 30 or younger when they choose the method and those who obtain the procedure postpartum are about twice as likely as others to say at some point during the next 14 years that sterilization was not the right choice for them. For women who are 30 or younger at the time of the procedure, the probability of regret declines steadily as the interval since the last birth increases. These are among the main findings of a prospective, multicenter study of women who underwent sterilization between 1978 and 1987.¹

The study, which was conducted at medical centers in nine cities throughout the country, involved an interview with each participant when she enrolled, five annual follow-up interviews and, for women sterilized between 1978 and 1983, a final interview 8-14 years after the operation. During the first interview, the woman provided information about her background characteristics; follow-up interviews included a question on whether she still thought that sterilization was "a good choice" for her and, if not, the reasons why. Using data on 11,232 women who had completed at least one follow-
up interview and had answered the question about regret, the investigators conducted life-table analyses to assess the cumulative probability of regret and proportional hazards analyses to identify independent risk factors.

Participants were evenly divided between women who were aged 18-30 at sterilization and those who were older. The sample was racially mixed: Fifty-four percent of women were white, 34% black and 12% members of other racial groups. Two-thirds were married when they had their operation, and virtually all (96%) were sterilized for contraceptive reasons. Some 16% of participants had postpartum operations, and 79% obtained interval procedures (i.e., the operation took place neither postpartum nor just after an abortion); 5% had never given birth.

Within three years after undergoing sterilization, 4% of women said the decision had not been right for them; the cumulative probability of regret rose to 8% at seven years and 13% at 14 years. Women who had been sterilized by age 30 had a high cumulative probability of regret (20% at 14 years); levels of regret were also elevated among black women, participants who had been unmarried at sterilization and those whose operation had taken place postpartum (16-22%). Overall, 10% of women who had had interval procedures said at some time during the next 14 years that they had made the wrong choice; the proportion was 18% among those whose surgery took place up to one year after their last birth and fell steadily to 5% among those whose surgery was eight or more years later.

Generally, similar patterns in the cumulative probability of regret were apparent regardless of women's age at sterilization, although levels of regret were consistently higher among those who had been 18-30 years old. In this group, the cumulative proportion expressing regret within 14 years was 30-31% among black women and those who had been unmarried at sterilization; it was 20-24% among women who had chosen sterilization for contraceptive purposes and those who had undergone the procedure postpartum or within a year after giving birth.

Women aged 18-30 at sterilization, but not older women, had a steadily declining cumulative probability of regret as the interval between the last birth and the surgery increased. The probability fell from 22% among those for whom this interval was one year or less to 8% among those for whom it was eight years or more. Regret was low (5-6%) among childless women, regardless of their age at sterilization.

Results of the proportional hazards analyses confirmed that age and timing of sterilization are important factors in the risk of regret. When potentially confounding factors were taken into account, women who were 18-30 years old at sterilization were twice as likely as those who were older to express regret (risk ratio, 1.9). Compared with women who had never given birth or had last delivered eight or more years before undergoing sterilization, participants who had the operation postpartum were 1.6-2.0 times as likely to regret the sterilization decision. More modest increases in risk were apparent among nonwhite women, those who were married at the time of surgery and those who were sterilized within three years after their last birth (risk ratios, 1.3-1.4).

When asked why they felt that sterilization had not been the right choice for them, participants who were young at the time of the procedure were most likely to say that they wanted more children (33%) or they had divorced or remarried (24%). Women who were older than 30 most often cited subsequent gynecologic problems (29%) or the desire for more children (26%). Among women who regretted having had a sterilization, 48% of those in the younger group and 30% of those in the older group requested information about reversing the procedure.

While the investigators acknowledge that the sample was not representative of all women choosing sterilization, they conclude that "a surprisingly high percentage of women sterilized at a young age in the United States will regret their decision at some point." They note that preoperative counseling offers an opportunity for providers to discuss with women the risk factors associated with regret and to assure them that most women who opt to undergo sterilization do not regret the decision.--D. Hollander

Reference
1. Hillis SD et al., Poststerilization regret: findings from the United States Collaborative Review of Sterilization, Obstetrics and Gynecology, 1999, 93(6):889-895.

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