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Unintended Pregnancy Prevention: Female Sterilization: Summary of Surgical Sterilization

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Female Sterilization: Summary of Surgical Sterilization in the United States: Prevalence and Characteristics, 1965-1995

The complete report may be printed by downloading the
Vital and Health Statistics Series 23/No.20 PDF version (288KB).

Objectives

This report presents national data on the prevalence of surgical sterilization from 1965 to 1995 among women 15–44 years of age. Data are shown by type of sterilizing operation and demographic characteristics of the women. For the 1995 survey data, reasons for the three most common sterilizing operations (tubal ligation, vasectomy, and hysterectomy) are shown, as well as the desire for reversal among those with potentially reversible operations.

Methods

Data are based on nationally representative samples of women 15–44 years of age: the 1965 National Fertility Study (NFS), and the 1973, 1982, 1988, and 1995 cycles of the National Survey of Family Growth (NSFG).

Results

After rising from 16 to 42 percent between 1965 and 1988, the prevalence of surgical sterilization among married women 15–44 years old remained stable at 41 percent in 1995. Age, parity, religious affiliation, and education continued to be strongly associated with overall surgical sterilization levels. Tubal ligation and vasectomy were equally prevalent in the 1965 and 1973 surveys, but since 1982, tubal ligation has been more prevalent than vasectomy.

Conclusions

Several factors contributed to the rise in reliance upon surgical sterilization among women 15–44 years old over the last 3 decades: (a) aging of the post-World War II Baby Boom women  (and their partners) through the primary reproductive years; (b) relatively high contraceptive failure rates, particularly among socioeconomically less advantaged women; and (c) higher expectations for contraceptive effectiveness, safety, and convenience. Overall sterilization prevalence may be leveling off among women 15–44 years old, in part due to greater delay of first and subsequent births, thus making sterilization less of a concern while women are in this age range.

Highlights

  • Between the 1965 and 1988 surveys, the prevalence of surgical sterilization rose dramatically among married women 15–44 years of age in the United States from 16 to 42 percent. In 1995, the prevalence remained about the same at 41 percent.
     
  • In the 1965 and 1973 surveys, tubal ligation and vasectomy were equally common among currently married and ever-married women aged 15–44 (and their partners). Since the 1982 survey, tubal ligation has become more prevalent than vasectomy, occurring 1½ to 2 times as often. Among married women in 1995, 24 percent reported a tubal ligation, compared with 15 percent reporting that their husbands had a vasectomy.
     
  • The profile of the typical ever-married woman with a tubal ligation has changed over time, as has the profile of the typical woman who reported that her husband or partner had a vasectomy. From 1973 to 1995, an increasing proportion of tubal ligations occurred among ever-married women aged 35–44 years with 1 or 2 births (as opposed to 3 or more births) and with education beyond high school. Over the same period, a similar shift toward older age, lower parity, and higher education occurred for vasectomies. In addition, vasectomies reported by Catholic women represented a greater proportion of all vasectomies reported in the 1995 survey than in the 1973 survey. Some of these shifts reflect similar changes among the general population of ever-married women between the survey years.
     
  • Age, parity, religious affiliation, and education continued to be strongly associated with overall surgical sterilization rates. Marital status, race and Hispanic origin, and socioeconomic factors such as education and income were also strongly associated with particular types of sterilizing operations.
     
  • Among ever-married women aged 15–44 years in 1995, 41 percent were surgically sterile (15.3 million women), 26 percent reported having a tubal ligation, 7 percent had a  hysterectomy, and 12 percent were currently living with a husband or partner who had a vasectomy.
     
  • The most frequently cited reasons for tubal ligation and vasectomy among women who had any births were that one or both partners wanted no more children. Among nulliparous women with tubal ligation, medical reasons and problems with their birth control method were cited most often. As expected, medical problems were the most frequent reason given for hysterectomy, cited by 90 percent.
     
  • Nearly 25 percent of women with an unreversed tubal ligation in 1995 expressed a desire for reversal of the operation, on the part of herself, her husband or partner, or both. About 11 percent of married or cohabiting women whose partner had a vasectomy reported some desire for reversal. Higher levels of desire for tubal ligation reversal were seen among younger women, Hispanic women, and women with lower levels of education and income.

 

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Page last reviewed: 5/7/09
Page last modified: 4/4/07
Content source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion

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