Few adults without biological children regret decision for permanent contraception

Key takeaways:

• People who underwent permanent contraception reported a variety of reasons as to why.
• All respondents who underwent permanent contraception reported satisfaction with their decision.

Adults who do not have biological children had various reasons for undergoing permanent contraception and most experienced no regret after the procedure, according to an exploratory survey study published in Contraception.

“Among people who are highly motivated to seek out permanent contraception in order to maintain a child-free lifestyle, regret for this decision is very low,” Amy G. Bryant, MD, MSCR, associate professor, fellowship director and division director of Complex Family Planning in the department of obstetrics and gynecology at the University of North Carolina School of Medicine, told Healio. “It’s important for physicians to honor patients’ requests and provide patient-centered care that takes into account the preferences and values of the patients they’re taking care of, and to understand that historical measures of paternalism in medicine and historical practices of denying permanent contraception under certain circumstances should be examined more carefully and most likely discarded.”

Bryant and colleagues conducted a cross-sectional survey of 400 U.S. adults with no biological children (83% women) who were seeking or previously sought permanent contraception. Respondents completed an online Research Electronic Data Capture (REDcap) survey distributed over Reddit, TikTok and Facebook from May to June 2022.

Overall, 38% of respondents underwent a permanent contraception procedure, 11% found a physician to perform the procedure but had not yet undergone it, 8% were unable to find a physician to perform the procedure, 21% were seeking physicians and 22% did not yet seek out a physician.

The most reported reasons for seeking permanent contraception included:

• not wanting children (96%);
• not wanting to parent (85%);
• fear of pregnancy and/or childbirth (70%);
• the current state of the world (68%);
• financial reasons (60%); and
• environmental reasons (59%).

Respondents reported cost of permanent contraception (30%) and the inability to find a physician to perform the procedure (42%) as barriers to care.

Most respondents who underwent permanent contraception had a bilateral salpingectomy (78%). Other forms of permanent contraception respondents received included tubal ligation (7%), other surgery (8%), partial salpingectomy (2%) or a permanent birth control device (Essure, Bayer; no longer sold).

Of respondents who underwent permanent contraception, 99% responded “strongly agree” when asked if the procedure was the right decision. All respondents who underwent a procedure responded “strongly agree” or “agree” when asked if they were satisfied with their decision.

According to Bryant, it was surprising to observe an “overwhelming” lack of regret after choosing permanent contraception and that 47% of respondents were denied the procedure by multiple physicians before finding one to perform the procedure.

“We need longer-term studies and we need to study a population that is more representative of the entire U.S. population to understand whether people are obtaining the permanent contraception they need, what the barriers are and whether there are differences among more marginalized populations,” Bryant told Healio. “Historically, in our country, there has continued to be instances of reproductive coercion, so it is incredibly important to ensure that that never occurs.”

For more information:

Amy G. Bryant, MD, MSCR, can be reached at amy_bryant@med.unc.edu.