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This bulletin is being sent by the Health Care Authority (HCA) in partnership with the Reproductive Health Access Project (RHAP).
Since the Dobbs decision, as access to abortion services has become more challenging in many parts of the country, the possibility of contraceptive failure has become more distressing. Unintended pregnancy is relatively common, even among patients who use contraception.1 Because many patients and clinicians remain under the misperception that permanent birth control (e.g., tubal ligation or salpingectomy) is the most effective way for people to prevent pregnancy, a growing number of people in the US have been undergoing tubal sterilization surgeries.2
However, in a recent analysis of multiple waves of representative data from the National Survey of Family Growth3 real-world tubal sterilization failure rates ranged from 2.9% to 5.2%, suggesting that these surgeries are far less effective than many have believed.4 An analysis of California Medicaid data found similar rates of failure after hysteroscopic and laparoscopic tubal sterilization. There were approximately 2.61 pregnancies after laparoscopic tubal sterilization per hundred-woman years of observation.5 This means that intrauterine contraceptives, which can be used for up to 12 years, are at least as effective as tubal surgery, and may be more effective if an IUD is used.6 The subdermal implant which can be safely used for 5 years, is typically even more effective and is likely the most effective contraceptive method available.7 Pelvic pain, which is another important consideration for many patients, is less common with the use of a contraceptive implant or IUD placement than after tubal surgery.6 Vasectomy is also typically safer, more effective, and more easily reversed than tubal sterilization.8
There is a critical need to ensure patients receive evidence-based information prior to irreversible contraceptive surgeries. While there are many factors to consider when identifying which contraceptive method will best meet a patient’s personal needs, for those seeking information on the comparative effectiveness of available contraceptives we need to communicate that the implant, vasectomy, and the IUD are all more effective than tubal surgery with fewer complications.
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