Update in female sterilisation

Abstract

Despite enormous efforts in research and development to produce a safer and more effective method of contraception, female sterilisation both globally and nationally is still the most widely used method of contraception and the number of patients accepting this method is still increasing. This is particularly the case in the USA where the introduction of new products is limited because of registration formalities. It is estimated that over 138 million women of repro-ductive age throughout the world have been sterilised. 1 Evidence in developed countries and also less developed countries would suggest that more young women are being sterilised. 2,3 It is estimated that over 50% of all couples over the age of 40 have been sterilised in the UK and over 50% of these are women. In the USA the figure is slightly less. 4 In Europe, the UK has the highest rate of sterilisation being 54% between the ages of 41 and 45 whereas in Germany this figure is 36%. France is reported to have a prevalence of 12% in this age group, but this figure has recently plummeted because sterilisation is basically illegal and more recently an anaesthetist has been prosecuted for actively taking part in an illegal sterilisation operation. Spain and Italy have prevalent rates of less than 3%. In less developed countries there is an immense variation in terms of prevalence. 5 In China it is estimated that 36% of married women of reproductive age are sterilised and in India this figure is as high as 31%. In the Dominican Republic, Puerto Rico, Panama and E1 Salvador the figures are in excess of 36%. Despite this high prevalence rate in developing countries the population is continuing to increase at an alarming rate and it is anticipated that by the end of the 1990s almost double the present projected numbers of sterilisation procedures will need to be performed to