Permanent Female Contraception in the US: Don't Call It Sterilization

Andrew M. Kaunitz, MD


October 25, 2022

This transcript has been edited for clarity.

In recent decades, as the use of intrauterine devices (IUDs) and contraceptive implants has increased, permanent female contraception has received less attention.

However, permanent birth control continues to represent an important contraceptive choice.

For more than two decades, Dr Carolyn Westhoff, who serves as editor-in-chief of the journal Contraception, and her colleagues have updated readers regarding trends in permanent contraception. These authors point out that because the term sterilization has been associated with involuntary procedures, permanent contraception is a more appropriate term.

In recent years, almost 1 in 5 US women using any form of contraception had undergone a permanent contraceptive procedure. Although the percentage of US women in their 20s who have chosen permanent contraception has declined, the proportion of older reproductive-age women choosing this approach has been stable.

The review notes that the incidence of postpartum permanent contraceptive procedures, which is six times higher following cesarean than vaginal births, has declined as postpartum placement of IUDs and implants has increased.

Among permanent contraceptive procedures not associated with pregnancy, also known as interval procedures, hysteroscopic approaches were popular for almost two decades. However, almost 1 in 4 attempts to place Essure coils were unsuccessful. These and other limitations of hysteroscopic permanent contraceptive procedures led to their being withdrawn from the US market.

Among women who have undergone permanent contraceptive procedures via the abdominal route, the risk for ovarian cancer is reduced by one third. Based on the assumption that removal of the tubes may provide even more protection from ovarian cancer than tubal interruption, the incidence of salpingectomy employed for permanent contraception has skyrocketed.

In their review, Westhoff and colleagues also document obstacles faced by women who choose permanent contraception. These obstacles lead to more unintended pregnancies. In some centers, almost half of women choosing postpartum permanent contraception do not undergo the procedure prior to hospital discharge. Among factors the review identified as reducing access to postpartum permanent contraception were overly restrictive Medicaid regulations and the rising proportion of US women delivering in Catholic hospitals.

In summary, even as growing use of IUDs and implants has likely contributed to fewer younger women undergoing permanent contraceptive procedures, many of our patients in the United States continue to choose postpartum and interval permanent contraception.

I am Andrew Kaunitz. Please take care of yourself and each other.

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