Sterilization

Women can be prevented from bearing children by various operations on the uterus and Fallopian tubes, indications for which are contraceptive, medical, eugenic, and psychiatric. Sterilization is the most effective and widespread contraceptive method.

A large number of studies have looked at the effect of sterilization on mental health, but many had methodological weaknesses. The samples were small or unrepresentative. The authors did not report exclusions, refusals, or drop-out rates, or these were too high. Those who sought the operation for contraception or for medical reasons were not separated. It was unclear how psychiatric disorder, regret, and psychosexual dysfunction were defined and measured. Some studies failed to compare postoperative with preoperative status. An important early study, however, was that of Ekblad,(4) who studied 225 women sterilized in Stockholm during 1951 and interviewed 99 per cent of these women 5 to 6 years later. Some early studies reported frequent depression, but prospective studies have failed to confirm this.

Cooper and colleagues in Oxford(5) interviewed 201 women 4 weeks before they underwent non-puerperal tubal sterilization for contraceptive reasons; 190 were re-interviewed 6 months later, and 193 at 18 months after sterilization. The number with psychiatric illness fell from 21 before the operation to 9 at 6 months later, and then rose to 18 at 18 months. Not surprisingly, the presence of psychiatric disorder before the operation was a predictor of its continued presence; only two who were in good psychological health before the operation developed psychiatric illness 6 months later.

In a WHO collaborative study, the report from the Nottingham field centre (6) compared 138 women sterilized after childbirth, in 69 of whom the operation was unrelated to pregnancy, with 135 controls; there was little evidence of psychiatric disorder either before or after sterilization. Of the 138 sterilized women, nine were 'cases' before the operation, but there were only three new cases 6 weeks afterwards and four more at the 6-month assessment, i.e. less than the control group.

Pregnancy And Childbirth

Pregnancy And Childbirth

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