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Minilaparotomy and laparoscopy: safe, effective, and widely used.

About 95 million couples are currently protected from unwanted pregnancy by voluntary female sterilization making this the most widely used contraceptive method in the world. The rapid spread of voluntary female sterilization over the past decade has been facilitated by the surgical methods of minilaparotomy and laparoscopy. Both methods are quick highly effective and safe. Either procedure can be performed under local anesthesia on an outpatient basis. Minilaparotomy is the most appropriate method for use after childbirth. Laparoscopy is best suited to large urban hospitals with specially trained surgeons and many clients. Pregnancy rates after 1 year are less than 1/1000 women and major complications occur in fewer than 1% of cases. Recent research has failed to produce evidence that menstrual cycles are altered as a result of sterilization. Sterilization reversal is most successful in cases where less than 3 cm of the tube was damaged. In many areas the demand for female sterilization far exceeds the availability of services. The challenge to health care providers and family planning programs is to meet this growing demand in ways that conform both to medical standards assuring safety and to ethical standards assuring voluntary and informed individual choice. Medical policies that restrict sterilization to women who have had a specified number of children or whose health would be damaged by further pregnancies should be dropped. There is a need for more surgeons to be trained to perform minilaparotomy or laparoscopy. Multiple channels for services including private physicians large urban referral centers rural clinics and mobile teams should be encouraged. Women should be ensured opportunities for both postpartum and interval sterilization and financial support should be available for such services. The mass media as well as personal communication should be used to inform potential acceptors about voluntary sterilization. Finally the quality and availability of sterilization services should be regularly evaluated.