Tubal sterilization, often regarded as a permanent method of birth control, may not be as effective as previously thought. A new study led by researchers at UC San Francisco reveals that this surgical procedure has a higher failure rate than commonly understood, suggesting that alternative contraceptive methods might offer better protection.
The study, published on August 27 in NEJM Evidence, found that 3 to 5% of women in the United States who underwent tubal sterilization later experienced an unplanned pregnancy. This failure rate prompts the authors to recommend contraceptive options like arm implants or intrauterine devices (IUDs) for those seeking more reliable prevention of future pregnancies.
Rising Interest in Permanent Contraception
Interest in permanent contraception has surged following the 2022 U.S. Supreme Court Dobbs decision, which overturned federal abortion protections and limited access to abortion services in various states. As a result, understanding the effectiveness of different contraceptive methods has become increasingly crucial.
“Since the Dobbs decision, there has been heightened concern about how unintended pregnancy could affect health and family life,” said Dr. Eleanor Bimla Schwarz, the study’s lead author and chief of the UCSF Division of General Internal Medicine at Zuckerberg San Francisco General. “This is particularly relevant for individuals with health conditions such as diabetes or high blood pressure, which can complicate pregnancy.”
Dr. Schwarz emphasized that the study indicates tubal sterilization may not be the most reliable method for preventing pregnancy. “Our findings suggest that individuals using a contraceptive arm implant or an IUD are less likely to become pregnant compared to those who have undergone tubal sterilization.”
Prevalence and Effectiveness of Tubal Sterilization
According to national statistics, approximately 65% of women aged 15 to 49 in the U.S. use some form of birth control. Among these, tubal sterilization—an abdominal procedure where the fallopian tubes are clamped, cut, or removed—accounts for more than 21% of women aged 30 to 39 and 39% of women over 40. This method is notably prevalent among low-income individuals and those with chronic medical conditions.
Despite its aim to permanently end fertility, the new study indicates that tubal sterilization does not guarantee prevention of pregnancy. Previous data from the American College of Obstetricians and Gynecologists suggested a pregnancy rate of less than 1% after tubal sterilization. However, the recent study, which analyzed data from four rounds of the National Survey of Family Growth between 2002 and 2015, found that 2.9% of women who had undergone the procedure between 2013 and 2015 became pregnant within the first year.
Pregnancy rates were found to be higher among younger women who had the procedure. The study also noted that women with Medicaid-funded sterilizations were no more likely to experience an unplanned pregnancy compared to those with private insurance. The proportion of tubal sterilizations funded by Medicaid increased from 18% in 2002 to approximately 36% from 2013 to 2015.
Conclusion
The study underscores the importance of considering more reliable contraceptive methods for those seeking permanent birth control. While tubal sterilization remains a widely used option, the evidence suggests that arm implants and IUDs may offer superior effectiveness in preventing unplanned pregnancies. This information is particularly relevant in the context of evolving reproductive health policies and heightened awareness of contraceptive options.
