Ensuring Informed Choice | Family Planning

IMPORTANT: A friendly counselor who listens to a woman’s concerns, answers her questions, and gives adequate, clear, and practical information about the procedure—especially its permanence—will help a woman make an informed choice and be a successful and satisfied user, without later regret (see Because Sterilization Is Permanent). Involving her partner in counseling can be helpful but is not necessary or required.

The 7 Points of Informed Consent
Counseling must cover all 7 points of informed consent. In some programs the client and the counselor also sign an informed consent form. To give informed consent to sterilization, the client must understand the following points: Temporary contraceptives also are available to the client, including long-acting reversible contraceptives. Voluntary sterilization is a surgical procedure. There are certain risks of the procedure as well as benefits. (Both risks and benefits must be explained in a way that the client can understand.) If successful, the procedure will prevent the client from ever having any more children. The procedure is considered permanent and probably cannot be reversed. The client can decide against the procedure at any time before it takes place (without losing rights to other medical, health, or other services or benefits). The procedure does not protect against sexually transmitted infections, including HIV.

The 7 Points of Informed Consent

Counseling must cover all 7 points of informed consent. In some programs the client and the counselor also sign an informed consent form. To give informed consent to sterilization, the client must understand the following points:

Temporary contraceptives also are available to the client, including long-acting reversible contraceptives.
Voluntary sterilization is a surgical procedure.
There are certain risks of the procedure as well as benefits. (Both risks and benefits must be explained in a way that the client can understand.)
If successful, the procedure will prevent the client from ever having any more children.
The procedure is considered permanent and probably cannot be reversed.
The client can decide against the procedure at any time before it takes place (without losing rights to other medical, health, or other services or benefits).
The procedure does not protect against sexually transmitted infections, including HIV.

Because Sterilization Is Permanent
A woman or man considering sterilization should think carefully: “Could I want more children in the future?” Health care providers can help the client think about this question and make an informed choice. If the client is considering having more children, another family planning method would be a better choice. Asking questions can help. The provider might ask: "Do you want to have any more children in the future?" "If not, do you think you could change your mind later? What might change your mind? For example, suppose one of your children died?" "Suppose you lost your spouse, and you married again?" "Does your partner want more children in the future?" Clients who cannot answer these questions may need encouragement to think further about their decisions about sterilization. In general, people most likely to regret sterilization: Are young Have few or no children Have just lost a child Are not married Are having marital problems Have a partner who opposes sterilization Also, for a woman, just after delivery or abortion is a convenient and safe time for voluntary sterilization, but women sterilized at this time may be more likely to regret it later. Thorough counseling during pregnancy and a decision made before labor and delivery or before abortion care help to avoid regrets. The Decision About Sterilization Belongs to the Client Alone A man or woman may consult a partner and others about the decision to have sterilization and may consider their views, but the decision cannot be made for that person by a partner, another family member, a health care provider, a community leader, or anyone else. Family planning providers have a duty to make sure that the decision for or against sterilization is made by the client and is not pressured or forced by anyone.

Because Sterilization Is Permanent

A woman or man considering sterilization should think carefully: “Could I want more children in the future?” Health care providers can help the client think about this question and make an informed choice. If the client is considering having more children, another family planning method would be a better choice.

Asking questions can help. The provider might ask:

"Do you want to have any more children in the future?"
"If not, do you think you could change your mind later? What might change your mind? For example, suppose one of your children died?"
"Suppose you lost your spouse, and you married again?"
"Does your partner want more children in the future?"

Clients who cannot answer these questions may need encouragement to think further about their decisions about sterilization.

In general, people most likely to regret sterilization:

None of these characteristics rules out sterilization, but health care providers should make especially sure that people with these characteristics make informed, thoughtful choices.

Are young
Have few or no children
Have just lost a child
Are not married
Are having marital problems
Have a partner who opposes sterilization

Also, for a woman, just after delivery or abortion is a convenient and safe time for voluntary sterilization, but women sterilized at this time may be more likely to regret it later. Thorough counseling during pregnancy and a decision made before labor and delivery or before abortion care help to avoid regrets.

The Decision About Sterilization Belongs to the Client Alone

A man or woman may consult a partner and others about the decision to have sterilization and may consider their views, but the decision cannot be made for that person by a partner, another family member, a health care provider, a community leader, or anyone else. Family planning providers have a duty to make sure that the decision for or against sterilization is made by the client and is not pressured or forced by anyone.