Tubal sterilization in the United States, 1994-1996

Context: Although the number and rate of tubal sterilizations, the settings in which they are performed and the characteristics of women obtaining sterilization procedures provide important information on contraceptive practice and trends in the United States, such data have not been collected and tabulated for many years. Methods: Information on tubal sterilizations from the National Hospital Discharge Survey and the National Survey of Ambulatory Surgery was analyzed to estimate the number and characteristics of women having a tubal sterilization procedure in the United States during the period 1994-1996 and the resulting rates of tubal sterilization. These results were compared with those of previous studies to examine trends in clinical setting, in the timing of the procedure and in patient characteristics. Results: In 1994-1996, more than two million tubal sterilizations were performed, for an average annual rate of 11.5 per 1,000 women; half were performed postpartum and half were interval procedures (i.e., were unrelated by timing to a pregnancy). All postpartum procedures were performed during inpatient hospital stays, while 96% of interval procedures were outpatient procedures. Postpartum sterilization rates were higher than interval sterilization rates among women 20-29 years of age; Interval sterilization procedures were more common than postpartum procedures at ages 35-49. Sterilization rates were highest in the South. For postpartum procedures, private insurance was the expected primary source of payment for 48% and Medicaid was expected to pay for 41%; for interval sterilization procedures, private insurance was the expected primary source of payment for 68% and Medicaid for 24%. Conclusions: Outpatient tubal sterilizations and procedures using laparoscopy have increased substantially since the last comprehensive analysis of tubal sterilization in 1987 an indication of the effect of technical advances on the provision of this service. Continued surveillance of both inpatient and outpatient procedures is necessary to monitor the role of tubal sterilization in contraceptive practice.