Tubal ligation regret and related risk factors: fi ndings from a case-control study in Pernambuco State, Brazil Fatores de risco para o arrependimento da laqueadura tubária: resultados de um estudo de caso-controle em Pernambuco, Brasil

A case-control study was carried out at a public teaching hospital in Recife, Pernambuco State, Brazil in 1997 to investigate risk factors among women who feel regret after undergoing sterilization through tubal ligation. The study compared sterilized women who had requested or undergone a tubal reversal with women who were also sterilized but had not undergone this surgery, nor had requested to do so. Women showing a significantly greater probability of regret were those sterilized at a young age, those who had not themselves made the decision to undergo surgery , those for whom the sterilization was carried out up to the 45th day after childbirth and those who had acquired knowledge about contraceptive methods after the tubal ligation procedure. Having had a deceased child, a partner with no children prior to the current union or a change of partner after the tubal sterilization procedure were also associated to the request for or submission to tubal sterilization reversal. It is necessary to assess women’s psycho-socio-demographic profiles, their reasons for requesting tubal ligation and to advise the patient about family planning in order to reduce rates of post-sterilization regret. Sterilization Reversal; Tubal Sterilization; Family Planning Introduction Tubal ligation (or sterilization) is the most common form of contraception in Brazil, and the country currently has one of the highest female sterilization rates in the world 1,2. Although illegal in Brazil before 1997, tubal sterilization has been a common practice in the private sector and public health system for many years 3. A number of authors 3,4 have reported rising rates of unnecessary cesarean sections as an opportunity to perform tubal ligation. A national study carried out by BEMFAM (Bem Estar Familiar no Brasil) in Brazil in 1996 revealed that approximately 40% of women between the ages of 15 and 49 who had a partner and used some form of contraception were sterilized 5. The age at which women seek sterilization has dropped and a large number of surgeries are carried out before the patient has reached the age of 25 5,6. The lack of information on the part of women, the scarcity of contraceptive methods in the public sector, the interventionist power of doctors regarding the bodies and health of women, and the lack of technical training among health professionals in dealing with family planning are factors that influence a woman’s ability to make autonomous decisions about contraceptive methods 7. An increasing number of women have shown regret after undergoing tubal ligation. Regret rates in Brazil vary from 10% to 20% of ARTIGO ARTICLE Ludermir AB et al. 1362 Cad. Saúde Pública, Rio de Janeiro, 25(6):1361-1368, jun, 2009 all sterilized women 8,9,10,11,12,13. Although the term regret is frequently associated with feeling of sadness, sorrow, pain, affliction, hurt, dissatisfaction and anxiety, some authors have considered “clearly regretful” only the women who manifest their desire and intent to undergo surgery for tubal reversal 1. The request for tubal reversal is a complex phenomenon. The literature has shown an association between regret after tubal sterilization and the death of children, a new marriage, changes in socioeconomic status, whether the decision for surgery came from the woman herself, the woman’s age and number of children at the time of tubal ligation, the lack of information about surgical sterilization (including the issue of irreversibility), and the time the surgery is performed in relation to delivery 1,13,14,15. This study investigates risk factors for regret following tubal ligation at a public teaching hospital in Recife, Pernambuco State, Northeast Brazil.