The Mystery of Sterilization

Skalm_2The New York Times recently posted a fascinating series of charts showing the percentage of women who will have an unplanned pregnancy over a 10-year period of “typical use” of contraceptives. The results were really surprising to me. Here are a few key examples:

  • birth-control pill: 61%
  • Depo-Provera: 46%
  • condom (male): 86%

Those numbers seem incredibly high to me, but that’s the data. The important note is the difference between “typical” use and “perfect” use. The perfect-use percentages are much better, but apparently very few people use contraceptives perfectly and consistently.

However, the most shocking number to me was this: Only 2% of women have unplanned pregnancies if the contraceptive is male sterilization.

It’s not the number that’s shocking. Rather, it’s that with a number that low, why is male sterilization not the contraceptive of choice by far over all other options?

I’m assuming that the male sterilization in question here is a vasectomy. Perhaps the answer is right there: I don’t know of many men who want to sign up for a doctor to snip anything down there. It’s a no-scissors, no-scalpel zone.

But there’s still a part of me that wonders if the good that could come from a huge decrease in unplanned pregnancies as a result of male sterilization would be worth a week of discomfort. It seems like society largely puts the impetus of preventing pregnancy on women, and that doesn’t seem fair.

I understand this might be a sensitive topic for some people, so I apologize in advance if I accidentally struck a chord. It’s just that I’ve been trying to wrap my mind around this data for a week now, and I thought I’d share it in case others have some thoughts and insights.

13 thoughts on “The Mystery of Sterilization”

  1. I imagine the main reason it’s not done is because sterilisation is permanent.
    If there’s a chance you’ll ever want to have children in the future, then being sterilised is out right away. Every other contraceptive leaves the option open.

    Speaking from experience, seven years or so back my wife wanted me to get a vasectomy (we already had three kids), having made up her mind that she’d “never want to have another baby.”

    When we get a big smile from our (very planned) four-month old every morning, we’re both glad we went with the less permanent option! Seven years isn’t that long a time to change your mind on something you were definite about.

    • I was going to post something similar. Vasectomies can be reversed, but the most generous success rate I found online was 97.5%. Web MD states 50% chance of pregnancy if done within 10 years, 30% if done afterwards. Those %s probably take into consideration the factor that some folk can’t get pregnant anyway.

      However, I would still rather keep my options open for future, rather than have even a 2.5% chance that I can never have children. Pregnancies can still be aborted.

    • Thanks for sharing your experience. I realized this morning while thinking about the post that an “unplanned pregnancy” has a negative connotation that isn’t necessarily fair. Just because something is unplanned doesn’t mean it’s bad (though it’s great you were happy with your choice to plan your fourth pregnancy!).

  2. A vasectomy is a very serious decision and requires a lot of discussion and thought with your spouse. The health of your spouse can be a very strong deciding factor. My wife has Multiple Sclerosis and the birth of our twins was very difficult for her but we left our options open for years after the birth of the twins with her on birth control. As my wife’s MS progressed, we had many discussions with her doctors about our family options. It was determined that another birth would be high risk for my wife and that sterilization surgery for her was a risk as well. Adoption would be an option if we wanted a larger family, but with MS’s impact on her health and energy levels we had determined not to increase our family size. With that news and a few days of discussion and prayer, we made the decision. A vasectomy was no risk to her and was the most effective birth control option for us. I will be honest, I was very nervous and the post surgery recovery was not enjoyable. Now, over ten years later, I am so glad we made that decision. Birth control is not a worry for us and our family is doing very well.

    • I know plenty of people who’ve had them – I don’t think they are bad in and of themselves, but everything I’ve read about them says “assume it’s permanent”. In your family’s case it makes a lot of sense when taking your wife’s health into consideration, but as you’ve said, it’s definitely not something to take lightly.

    • T.R.: Thank you for sharing your experience! I’m glad you feel like the right choice for you and your family, and it’s admirable you were willing to do that despite the difficult post-surgery recovery.

  3. On a lighter note, I admittedly laughed out loud when I read, “society largely puts the impetus of preventing intercourse on women”. Is that really what you intended, or do you mean “preventing pregnancy”?

  4. There are some problems with assumptions Aisch and Marsh are making in interpreting probabilities, which probably is why they don’t jive with common sense. They started with the “typical use” pregnancy rates for a given year and raised them to the Nth power where n = the number of years using that method. That would work for something like a coin flip where the probability of heads or tails in each flip is unrelated to the previous flip. That’s probably not the case with “typical use” birth control failure rates when they get applied to individuals.

    Here’s why: at a population level, “typical use” failure rates include cases of incorrect and inconsistent use due to foolishness/carelessness/clumsiness, which are not evenly distributed among the population. If you only look at the woman who _didn’t_ get pregnant in a given year, you are selecting for carefulness. The next year, the chance that this sub-group gets pregnant is almost certainly _not_ the rate of the general population the year before, as Aisch and Marsh’s method assumes.

    This guy goes into a lot more detail:

    • Andrew: That’s a great point that typical use failure rates probably vary widely from woman to woman. I think the mystery is still there, but perhaps the numbers are a little misleading.


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