Pre-service Education on FP

and AYSRH
Session II, Topic 10
Female Sterilization

Female Sterilization, Session II Topic 10 Slide 1

Female Sterilization, Slide 1
What is Female Sterilization ?

• A safe and simple surgical procedure that

provides permanent contraception for
women who do not want any more children.
• It involves cutting or blocking the two
fallopian tubes.
• Other names are tubal sterilization, tubal
ligation, voluntary surgical contraception,
tubectomy, Bi-lateral tubal ligation.
• The method is generally irreversible so
informed consent is key

Female Sterilization, Session II Topic 10 Slide 2

Female Sterilization, Slide 2
What is Female Sterilization
(continued)

Two surgical approaches most often used:

•Minilaparotomy using local anesthesia and light
sedation is the approved standard procedure for
BTL. A small incision is made on the abdomen and
the tubes are brought to the incision to be cut and
blocked.
•Laparoscopy – a long thin tube with a lens in it is
inserted in the abdomen through a small incision;
the tubes are visualized, blocked or cut.

Female Sterilization, Session II Topic 10 Slide 3

Female Sterilization, Slide 3
Mechanism of Action
• The fallopian tubes that carry the eggs from
the ovaries are cut off and blocked.
• Eggs released from the ovaries cannot move
down the fallopian tubes to meet the sperm.
• Works because the fallopian tubes are
blocked or cut. Eggs released from the
ovaries cannot move down the tubes, and so
they do not meet sperm.

Female Sterilization, Session II Topic 10 Slide 4

Female Sterilization, Slide 4
Diagram Showing the Female
Reproductive Organs

Female Sterilization, Session II Topic 10 Slide 5

Female Sterilization, Slide 5
Effectiveness of Female Sterilization

• Female sterilization is one of the most effective

methods of contraception but carries a small risk of
failure.
• It is 99.5% effective, which means that the failure rate
of the method is 5 pregnancies per 1,000 during the
first year following the surgery
• Varies slightly depending on how the tubes are
blocked, but pregnancy rates are still low with all
techniques.
• One of the most effective methods is cutting and
tying the ends of the fallopian tubes after childbirth.

Female Sterilization, Session II Topic 10 Slide 6

Female Sterilization, Slide 6
Effectiveness of Female Sterilization

In this progression of effectiveness, you can see

that female sterilization is very effective.
More effective
Implants
Male Sterilization
Female Sterilization
Intrauterine Devices
Progestin-only Injectables
Combined Oral Contraceptives

Male Condoms
Standard Days Method
Less effective
Female Condoms
Female Sterilization, Session II
Spermicides Female Sterilization,
Topic 10 Slide 7
Slide 7
Advantages of Female Sterilization
• Permanent method of contraception which protects
against risk pregnancies
• Nothing to remember, no supplies needed, and no
repeated clinic visits required
• Does not interfere with sex
• Does not affect a woman’s ability to have sex
• Results in increased sexual enjoyment - no need to
worry about pregnancy
• No effect on breastfeeding
• No known long-term side effects or health risks
• Can be performed immediately after delivery
• Is effective immediately
Female Sterilization, Session II Topic 10 Slide 8
Female Sterilization, Slide 8
Disadvantages of Female Sterilization

• Requires minor surgery by a specially trained

physician
• Requires an operating room set-up
• Considered to be permanent
• Does not protect against STIs and HIV if at risk of
HIV or STI he couple has to use condoms as well.
• Limitation of physical activities for about one week
Related to surgical procedure:
• May have pain and swelling over the operative site
(diminishes in a day or two)
• Superficial bleeding
Female Sterilization, Session II Topic 10 Slide 9
Female Sterilization, Slide 9
 When You Can Have Sterilization ?

Most women can have

sterilization at any time

But may need to wait if:

• Gave birth •Some other

between 1 and 6 • May be serious health
pregnant • Infection or conditions
weeks ago other problem in
female organs Female Sterilization, Session II Topic 10 Slide 10
Session II, Slide #10
Source: WHO decision making tool for FP2005
Time for Performing Female
Sterilization

Postpartum
• Immediately or within seven days after giving birth

Interval
• From six weeks after childbirth if it is reasonably
certain that the woman is not pregnant (see handout
for screening to check if client is not pregnant)
• Within seven days after the start of the woman’s
menstrual cycle
• At any time if it is reasonably certain that the woman
is not pregnant
Female Sterilization, Session II Topic 10 Slide 11
Female Sterilization, Slide 11
Time for Performing Female
Sterilization (continued)
• During caesarian section
• If switching from oral contraceptives, she can
continue taking the pills until she has finished
that pack

• After using emergency pill - within 7 days

after she starts her menstrual periods

• Post abortion: Within 48 hours after

uncomplicated abortion.
Female Sterilization, Session II Topic 10 Slide 12
Female Sterilization, Slide 12
Who Can Have Female Sterilization
• All women can have female sterilization.
Including women who;
– Have no children or few children
– Are not married
– Do not have husbands permission
– Are young
– Just give birth within the last 7 days
– Are breast feeding
– Are infected with HIV whether or not on ARVs

• No medical conditions prevent a woman from

using female sterilization.
Female Sterilization, Session II Topic 10 Slide 13
Female Sterilization, Slide 13
Who Can Have Female Sterilization
(continued)
In the checklist (hand out):
Caution means the procedure can be
performed in a routine setting but with extra
preparation and precautions, depending on
the condition.
• Delay means postpone female sterilization.
These conditions must be treated and
resolved before female sterilization can be
performed. Give the client another method to
use until the procedure can be performed.

Female Sterilization, Session II Topic 10 Slide 14

Female Sterilization, Slide 14
Who Can Have Female Sterilization
(continued)
• Special means special arrangements should
be made to perform the procedure in a
setting with an experienced surgeon and
staff, equipment to provide general
anesthesia, and other backup medical
support.
• For these conditions, the capacity to decide
on the most appropriate procedure and
anesthesia regimen also is needed. Give the
client another method to use until the
procedure can be performed.
Female Sterilization, Session II Topic 10 Slide 15
Female Sterilization, Slide 15
 “Come Back Any Time”
Reasons to Return
In first week, come at once if:

• Pus or • Steady or
• High fever • Pain, heat, • Fainting
bleeding worsening
swelling, or very
from pain,
redness of dizzy
wound cramps,
wound
tenderness
At any time in the future, come at once in belly
if:
• You think • Pain or
you may be tenderness
pregnant in belly, or
fainting
Female Sterilization, Session II Topic 10 Slide 16
Female Sterilization, Slide 16
Source: WHO Decision Making Tool for FP for Clients and Providers 2005
Counseling Process: Client has Selected
Female Sterilization

• Key counseling points to check for before procedure of

referral for procedure:
• That client understands that:
o This is a permanent method
o There are other options that they can use that are just
as effective like Implants and IUDs.
o She will have the surgery under local and might
experience some pain after the procedure for first few
days.
Method does not protect against HIV and STDs she will
have to use condoms of at risk

Female Sterilization, Session II Topic 10 Slide 17

Female Sterilization, Slide 17
Counseling a Client for Female
Sterilization
• Determine that the woman is not pregnant.
• Assess client’s reproductive needs, risks for
STIs, status of relationship with partner, and
knowledge on FP method.
• Use the FP Service record cards (or any
approved assessment form) as a tool for
undertaking assessment.
• Use appropriate types of questions (i.e.,
closed, open-ended, probing) during
assessment of the client.
Female Sterilization, Session II Topic 10 Slide 18
Female Sterilization, Slide 18
Counseling a Client for Female
Sterilization (continued)
• Describe available family planning (FP)
methods based on client’s reproductive need.
• Discuss BTL as a FP method in terms of:
Definition, Mechanism of action.,
Effectiveness, Advantages and
Disadvantages, Possible side effects
• Correct rumors and misconceptions.
• Identify the reasons for clients’ return visits.

Female Sterilization, Session II Topic 10 Slide 19

Female Sterilization, Slide 19
Counseling a Client for Female
Sterilization (continued)
• Ensure informed choice and consent
form signed – clients must understand
the following:- that temporary methods are
also available, voluntary sterilization is a
surgical procedure, there are certain risks
of the procedure as well as benefits, if
successful is permanent, client can decide
against the procedure at any

Female Sterilization, Session II Topic 10 Slide 20

Female Sterilization, Slide 20
Summary

• A woman 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.

Female Sterilization, Session II Topic 10 Slide 21

Female Sterilization, Slide 21