• In 1999, 47 000 tubal occlusions and 65 000 vasectomies was performed in England.
  • Both women and men have access to sterilization. Consent is only necessary from the patient.
  • Female contraceptives are meant to empower women, to maximise their choices and to give them control over their fertility, and thus their lives.
  • Information on other long acting contraceptives should be provided, including failure rates.
Legal issues
  • Spousal consent is not required for sterilisation.
  • Prior sanction by a high court judge should be sought in all cases of sterilisation when there is doubt over mental capacity to consent.
  • Full consent requires that patients should be informed that reversal operations, IVF and ICSI (intracytoplasmic sperm injections) are rarely provided by the NHS.
Ethical issues
  • Each person has autonomy over their own body.
  • All reproductive issues, including abortion, contraception and sterilization can be performed over the objection of the spouse.
Clinical issues
  • Female sterilization is safe, simple and very effective surgical procedure.
  • Surgery to reverse sterilization is difficult and has a low success rate. Further pregnancy has a higher risk of ectopics.
  • Sterilization should thus be considered permanent.
  • Decision should thus be made by the woman based on voluntary informed choice and should not be made under duress.
  • Similarly the International Federation of Gynaecology and Obstetrics (FIGO) stated that, "no incentives should be given to promote or discourage any particular decisions regarding sterilization".
  • Royal College of Obstetrics and Gynaecology guidelines state that women under the age of 30 (or those without children) should be counselled in case of later regret.
  • Care should be actioned in women who have recently experienced a loss in relationship, or during pregnancy.
  • Human Fertilisation and Embryology Act 2008
  • The Parental Orders (Human Fertilisation and Embryology) Regulations 2010
  • Surrogacy Arrangements Act 1985 (c.49)
  • Bromham DR, Journal of Assisted Reproduction and Genetics 12 (8) 1995 "Surrogacy: Ethical, Legal, and Social Aspects"
  • Royal College of Obstetricians and Gynaecologists: Male and Female sterilisation Guidelines 2004
  • Recommendations on Ethical Issues in Obstetrics and Gynaecology (FIGO 2000)