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A new study led by the University of California, San Francisco (UCSF) has challenged the perception of tubal sterilization as a fail-proof method of birth control. The research, published on August 27 in NEJM Evidence, indicates that tubal sterilization, often considered a permanent form of contraception, has a notable failure rate, with 3 to 5% of women in the United States who underwent the procedure later experiencing unplanned pregnancies.
Tubal sterilization involves an abdominal surgery where the fallopian tubes are either clamped, cut, or removed, aimed at permanently ending fertility. Despite its intended permanence, the study highlights that this method is not as reliable as once believed. According to Dr. Eleanor Bimla Schwarz, MD, chief of the UCSF Division of General Internal Medicine at Zuckerberg San Francisco General and the study’s lead author, alternatives like contraceptive arm implants or intrauterine devices (IUDs) prove to be more effective.
The study’s findings are particularly relevant in the wake of the 2022 U.S. Supreme Court Dobbs decision, which removed federal protections for abortion services and limited access to abortion in several states. This change has heightened the demand for reliable contraception options. Dr. Schwarz emphasizes, “Since the Dobbs decision, many more people are worried about how pregnancy may impact their health and family life. This is especially true for patients with medical conditions like diabetes and high blood pressure that can complicate pregnancy.”
The researchers analyzed data from four rounds of the National Survey of Family Growth spanning from 2002 to 2015, involving over 31,000 women, including 4,184 who reported having undergone tubal sterilization. They found that within the first year after the procedure, 2.9% of women who had been sterilized between 2013 and 2015 became pregnant. The likelihood of pregnancy was notably higher among younger women who had the procedure.
Interestingly, the study revealed no significant difference in pregnancy rates between those who had Medicaid-funded tubal sterilizations and those with private insurance. However, the proportion of women with Medicaid funding for the procedure increased from 18% in 2002 to approximately 36% from 2013 to 2015.
Dr. Schwarz cautions that tubal sterilization should not be solely relied upon for permanent contraception. “When choosing what birth control will work best for them, people consider many factors including safety, convenience, and the method’s effectiveness. For those who have chosen a ‘permanent’ method, discovering they are pregnant can be distressing. Unfortunately, this is a fairly common experience.”
The study underscores the importance of exploring and understanding all contraceptive options, particularly for those seeking permanent solutions to avoid unintended pregnancies.
Source: University of California – San Francisco
Journal Reference: Schwarz, E. B., et al. (2024). Pregnancy after Tubal Sterilization in the United States, 2002 to 2015. NEJM Evidence. doi.org/10.1056/EVIDoa2400023
