Surgical contraception: the kindest cut of all?

Abstract

Over 10,000 sterilizations are performed annually in Kenya, 99% of them on women. The mortality associated with female sterilization is only 1/100 that of pregnancy and childbirth, documented in the literature. Sterilization is costly in the short-term, but is cost-effective because it provides contraceptive protection for an average of 12.5 years for Kenyan couples. While 49% of Kenyan women have completed their families, only 5% choose permanent contraception. People need to be counseled that sterilization is permanent, and informed that it can be done as an outpatient with local anesthesia and a mini-laparotomy, through a 3 cm incision. Other barriers to more extensive use of sterilization are the reluctance of men to accept it, low educational status of women, and inadequate services and providers.