Why are rates of sterilization in decline? A pilot study designed to explore reasons for declining female sterilization in Scotland

BackgroundIn the last decade, female sterilization had been in decline throughout the UK. It is not clear whether fewer women are requesting sterilization or whether the universal enthusiasm for long-acting reversible methods is leading health professionals to discourage women from being sterilized. Since correct and consistent use of alternative, reversible contraceptive methods depends somewhat on their acceptability, it is important to determine whether women are being refused sterilization or whether they are freely choosing other methods. This study aims to explore whether female sterilization is being widely considered as a contraceptive method, the reasons for choosing or rejecting it, and whether women are being discouraged by health professionals from being sterilized.Study DesignA self-completed questionnaire survey among 205 women aged 30 to 50 years who felt that their family was complete attending a family planning clinic in Scotland.ResultsOf the 203 women included in the study, 151 (74.4%) had heard of female sterilization, 90 had discussed it with someone (60%) and 87 (58%) had considered it as a contraceptive option. Of the 56 women who consulted their family doctor about sterilization, almost half (27; 48%) were not referred to a hospital and fewer than one (17, 30.4%) in three of them was eventually sterilized or had arrangements in place to get it done. Free-text comments from the women revealed a variety of reasons for not choosing female sterilization and suggested that some women are being deterred from sterilization.ConclusionThe study suggests that some women are being actively encouraged by health professionals to use long-acting reversible contraceptive methods and discouraged from choosing sterilization. However, other women recognize for themselves the wisdom of keeping their fertility options open.