Policy Dialogue Population Council, Bangladesh Regret after Sterilization - Can It Be Averted?

Sterilization is a convenient method of avoiding further pregnancies for couples who do not want any more children. Its finality implies that its use should as far as possible be restricted to men and women who will not decide later that they would have liked to have had more children. About one in six currently married women in Bangladesh aged under fifty years who are using a permanent method of family planning (tubectomy or vasectomy) regret that they or their husbands were sterilized, according to the Bangladesh Demographic and Health Survey conducted in 1993-94 (Mitra et al., 1994: 58-9). The proportion who regretted that their husbands had undergone vasectomy (29 per cent of women whose husbands have had the operation) was considerably higher than the proportion who regretted having had a tubal ligation themselves (14 per cent of women who had undergone tubal ligation). In one sense, these are not high numbers, because they imply that a large majority of women who are using a permanent method of family planning express no regrets about it. Even so, the number who do have regret is large enough to dispel complacency and to compel an examination of the reasons. When they are examined, the reasons give cause for considerable concern. Over 60 per cent of the women who reported regret that they or their husbands had been sterilized said that the reason was that they themselves wanted another child, and this proportion becomes almost 80 per cent after inclusion of women who said that the reason was that their husbands wanted another child. 1 Whether it is the woman or her husband, regret for the reason of being unable to bear more children is qualitatively different from regret because of perceived side effects of sterilization, which account for most of the remaining cases. This Policy Dialogue will explore the possibilities for reducing the level of regret about sterilization. The main question is: 'Are there identifiable warning signs that a couple might later regret accepting a sterilization procedure?' We concentrate our attention on those cases where the reason for regret is that either the woman or her husband wants another child. Our conclusion is that some minor adjustments to policy, more or less in accord with actual practice and certainly in accord with common sense, would reduce the level of regret markedly.