Counseling must cover all 6 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:

1. Temporary contraceptives also are available to the client.
2. Voluntary sterilization is a surgical procedure.
3. 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.)
4. If successful, the procedure will prevent the client from ever having any more children.
5. The procedure is considered permanent and probably cannot be reversed.
6. 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).

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 answer is "Yes, I could want 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 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 them 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.