Huge decline in female sterilisation, study reveals

MORE women in Ireland are opting for newer, long-acting contraception instead of female sterilisation, a study has shown.

It found that “keyhole” laparoscopic female sterilisations, or tubal ligations, dropped from 2,566 in 1999 to 910 in 2004.

Over the same period sales of the Mirena Coil, an intrauterine contraceptive device that is effective for five years, increased from 4,840 to 20,703. Implanon, a contraceptive rod which inserted into the arm and is effective for three years, was introduced in 2001 and from 2002 to 2005 more than 30,000 units were distributed.

Researchers from University College Cork, Cork Maternity Hospital and the Mid-Western Regional Maternity Hospital in Limerick, believe that the swift decline in female sterilisation is probably because it is irreversible and, sometimes, serious complications can occur.

The study, published in the latest issue of the Irish Medical Journal, also points out the change was probably doctor led, rather than patient demand led.

“It may reflect that doctors, particularly gynaecologists, were not very enthusiastic about laparoscopic sterilisation and were eager to adopt potentially safer and reversible alternatives,” it states.

The study found there was no remarkable decline in non-laparoscopic sterilisation, almost always performed at a time of Caesarean section.

Tubal ligations following a Caesarean averaged about 940 a year between 1999 and 2004. There was no data available for 2005.

“This suggests that there is no aversion to sterilisation per se among obstetricians or patients, but rather the method involved.”

Female sterilisation is usually requested by the patient for social reasons and not a treatment prescribed by a doctor. But, because the result is permanent, the onus is on the doctor to ensure that the patient has all the information required to make an informed decision.

While death caused by laparoscopic sterilisation is a rare event, serious complications, such as injuries to the bowel, bladder or blood vessels, can occur.

Some of the newer long-acting contraceptive methods can be performed in a doctor’s surgery, require relatively little training and carry a small risk of procedure-related injury.

The researchers point out that in their own units laparoscopic sterilisation has almost disappeared. Some consultants stopped offering laparoscopic sterilisation once the Mirena coil received its first licence in 1999.