A new study led by researchers at the University of California, San Francisco (UCSF) has found that tubal sterilization, long considered a permanent form of birth control, may not be as reliable as many women believe. The research, published in NEJM Evidence, suggests that 3 to 5% of women who undergo the procedure later experience unplanned pregnancies.
Rethinking “Permanent” Birth Control
Tubal sterilization, commonly known as “getting your tubes tied,” is the most popular form of contraception in the United States. The procedure involves surgically clamping, cutting, or removing the fallopian tubes to prevent eggs from reaching the uterus. However, this new study challenges the long-held belief that the failure rate is less than 1%.
Dr. Eleanor Bimla Schwarz, chief of the UCSF Division of General Internal Medicine at Zuckerberg San Francisco General and lead author of the study, emphasizes the significance of these findings: “This study shows that tubal surgery cannot be considered the best way to prevent pregnancy. People using a contraceptive arm implant or an IUD are less likely to become pregnant than those who have their tubes tied.”
The research team analyzed data from over 31,000 women, including 4,184 who had undergone tubal sterilization, collected through the National Survey of Family Growth between 2002 and 2015. Their analysis revealed that within the first year after surgery, an estimated 2.9% of women who had the procedure between 2013 and 2015 became pregnant.
Implications for Reproductive Health Choices
These findings come at a crucial time, as interest in permanent contraception has surged following the 2022 U.S. Supreme Court Dobbs decision, which removed federal protections for abortion services. Dr. Schwarz notes, “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 study’s results suggest that other long-acting reversible contraceptives (LARCs) such as arm implants and intrauterine devices (IUDs) may be more effective at preventing unintended pregnancies. These methods have failure rates of less than 1%, making them potentially more reliable options for women seeking highly effective birth control.
However, it’s important to note that tubal sterilization remains a popular choice, especially among certain demographics. The procedure is used by more than 21% of women ages 30 to 39 and 39% of women older than 40. It’s particularly common among low-income individuals and those with chronic medical conditions.
The research also revealed that younger women at the time of their tubal surgery had a higher chance of experiencing an unplanned pregnancy. This finding could have significant implications for counseling and decision-making processes surrounding permanent contraception.
Why it matters: This study challenges long-held assumptions about the effectiveness of tubal sterilization, a procedure that millions of women rely on for contraception. The higher-than-expected failure rate may lead to a reevaluation of birth control options and counseling practices. For women who absolutely want to avoid future pregnancies, especially those with health conditions that make pregnancy risky, this information could be crucial in making informed decisions about their reproductive health.
The research also raises questions about informed consent and whether women undergoing tubal sterilization are fully aware of the procedure’s potential failure rate. It may prompt healthcare providers to update their counseling practices and offer more comprehensive information about all available contraceptive options.
Furthermore, the study’s findings could have broader implications for healthcare policy and insurance coverage. If LARCs prove to be more effective than tubal sterilization, there may be a push for increased access to and coverage of these methods.
As with any study, there are limitations to consider. The research relied on self-reported data, which can be subject to recall bias. Additionally, the study does not account for differences in surgical techniques or changes in practice over time that might affect failure rates.
Despite these limitations, the UCSF study provides valuable insights into the real-world effectiveness of tubal sterilization. It serves as a reminder that no contraceptive method is 100% effective and that ongoing research is crucial to ensure that individuals have access to the most accurate information when making decisions about their reproductive health.
As Dr. Schwarz concludes, “When choosing what birth control will work best for them, people consider many different things including safety, convenience and how fast they can start to use the method. For people who have chosen a ‘permanent’ method, learning they got pregnant can be very distressing. It turns out this is unfortunately a fairly common experience.”
