According to a 2008 study, “Sterilization . . . is used by more people than any other method of contraception” (Peterson, 2008). Female sterilization, also referred to as tubal ligation and tubal occlusion, is a medical procedure that closes or cuts the fallopian tubes. This impedes a woman’s eggs from reaching her uterus and, consequently, permanently prevents her from becoming pregnant. By the mid-2000s, more than 10 million women in the U.S and over 200 million married women around the world had undergone tubal ligation (Curtis, et al., 2006).
Between 1 and 26 percent of the millions of women who undergo the procedure subsequently experience regret (Division of Reproductive Health, CDC). What follows describes what has been studied about regret after sterilization: Why some women experience it while some do not; why young women experience regret after sterilization at greater rates; and what leads some women to regret their decision to such an extent that they try to reverse the operation or seek fertility treatments.
The proportion of women who feel regret after tubal ligation is not monumental among the general population. When data are broken down by age, however, the results are strikingly different. Young women experience feelings of regret at a much greater rate than other women, and the degree of regret they feel can be substantial. A close examination of the literature on the subject reveals that although the majority of women choose to limit their fertility, and the fraction of women who experience regret after sterilization is not large, losing the ability to conceive causes some women to value that ability more highly. Unfortunately, such feelings are accompanied by the natural side-effects of regret: Self-blame, a sense of loss or sorrow, and at times chronic stress.
Among older women (30 years or older), estimated rates of regret after sterilization vary across studies from 5.9 percent (Hillis et al., 1999) to 20 percent (Marcil-Gratton, 1988). Study after study has found that young women are more likely to experience regret (CDC, 2010; Bartz & Greenberg, 2008; Curtis & Peterson, 2006; Peterson, 2008; Wilcox et al., 1991; and Hillis et al., 1999). A recent systematic review illustrates the magnitude of the difference: Overall, young women “were about twice as likely as those over 30 to express regret”(Curtis et al., 2006).In the 1990s, the U.S. Collaborative Review of Sterilization found that a mere 5.9 percent of older women experienced regret within 14 years after undergoing tubal ligation, versus 20.3 percent of young women (Hillis et al., 1999). More recently, a number of studies from the mid to late 2000s (CDC, 2010; Bartz & Greenberg, 2008; Curtis & Peterson, 2006; and Peterson, 2008) have also stressed that young women are at an increased risk of regret following sterilization.
Researchers examining regret after sterilization across different populations1 and utilizing distinct methods have identified fairly consistent common risk factors that explain why certain women report regret after sterilization while others do not (Chi & Jones, 1994).
The most common risk factor for regret is young age at the time of the procedure (Chi & Jones, 1994; Bartz & Greenberg, 2008; Grubb et al., 1985; and Platz-Christensen et al., 1992). Only a few studies elaborate on why young women have a greater risk of regret than older women. Marcil (1988) pointed to the “timing of the sterilization” among young women. Similarly, Wright (1981) compiled reports from women stating that they regretted their age at the time of the procedure. Marcil (1988) also found that young women experience a longer “length of exposure to the risk of sterilization regret.” That is, because they spend more of their lives unable to become pregnant, they are more likely to encounter occasions that make them desire to conceive. Correspondingly, Hillis et al. (1999) found that regret after sterilization increased with time (found in follow-ups after both seven and 14 years), especially among young women.
Another repeatedly noted reason for post-sterilization regret is the desire for another child (Marcil, 1988; Hillis et al., 1999; and Wright, 1981). The regret felt by women with this desire can be bitterly difficult. As Marcil (1988) describes: “[the regret] may become a major obstacle to personal happiness… Feelings of regret can run the gamut from a transitory yearning that the woman experiences in the presence of a newborn baby, to an overwhelming sorrow that impels the woman to seek reversal of sterilization.” This is significant in that this is “the most commonly reported reason for regret” (Hillis et al., 1999) among young women: The women who are the most vulnerable to regret, who disproportionally experience it, are also more likely to experience deep regret (regardless of their family size [Marcil, 1988]). Unfortunately, although the regret of some women is so great that they invest large funds to regain the ability to conceive, there is no certainty that the existing medical procedures will be effective in restoring it (Peterson, 2008).
Closely tied to regret due to wanting to conceive is regret due to a change in marital situation or status (Platz-Christensen et al., 1992; Marcil, 1988; Bartz & Greenberg, 2008; and Chi & Jones, 1994). Specifically, Marcil (1988) found that strong regret was more common among women who were formerly married but had become widowed, separated, or divorced. This is due in large part to the frequency of marital conflict in previous relationships of those who experience regret (Chi & Jones, 1994 and Wright, 1981). However, strong regret is not confined to unstable unions; it is just as prevalent among women whose marital status remains stable but who were sterilized at a young age (Marcil, 1988).
Additional less recurrent risk factors for regret include sterilization at a emotionally traumatic time such as abortion (Wellings, 1986) or becoming sterilized post-partum, including after a C-section (Wellings, 1986; Chi & Jones, 1994; Bartz & Greenberg, 2008; and Grubb et al., 1985); experiencing the death of a child (in developing countries) (Chi & Jones, 1994); severe social problems (cases in which the respondent was responsible for a severely dependent baby, teenager, or husband, in addition to being responsible for other dependent children) (Wright, 1981); undergoing the procedure due to medical reasons (Wright, 1981); “major contraceptive problems before operation” (Wright, 1981); and particularly among older women, “sex problems and loss of libido” (Wright, 1981); and “gynecologic or menstrual changes” (Hillis et al., 1999).
More than a century after the first tubal ligation was performed, and despite how popular the procedure has become, some women who undergo the procedure come to regret it even today. Although post-sterilization regret does not affect the majority of women, this is not an insignificant issue; as Chi & Jones (1994) stress: “Even a small proportion of women incurring poststerilization regret would translate into a large number of sufferers.” Given that as many as four in ten women sterilized between ages 18 and 24 feel so much regret that they will request reversal information within 14 years of the procedure (Schmidt, et al., 2000), it is clear that many women are suffering and that voluntary infertility can be a major source of grief.
Maria E. Kaufmann, M.A., recently worked for MARRI (Marriage and Religion Research Institute) at the Family Research Council and has previously contributed to Family Studies. She is expecting her second child this summer.
1. For example: “Studies reported from Africa, Asia, Oceania, Latin America, Europe, Canada, and the U.S., generally revealed similar risk factors” (Chi & Jones, 1994).