Female Sterilization
This booklet is intended as a practical guide to patient care for registrars, medical officers, interns and medical students attached to the gynaecology units at the University of the Witwatersrand Academic Hospitals. Anyone can use it.
Persons incapable of consenting
STERILIZATION ACT, 1998
This recognizes the rights of individuals ‘to be informed of & to have access to safe, effective, affordable, & acceptable methods of fertility regulation… the inability to give consent should not automatically entail the loss of constitutional rights & … it is necessary to ensure that mentally disabled persons are able to exercise these rights as far as is possible.’
Persons capable of consenting
- No person is prohibited from having a sterilization who is ‘capable of consenting’ & 18 years of age or more.
- ‘A person capable of consenting may not be sterilized without his or her consent.’
- ‘Sterilization may not be performed on a person who is under the age of 18 years except where failure to do so would jeopardize the person’s life or seriously impair his or her physical health.’
Persons incapable of consenting
Sterilization may be performed upon request to ‘the person in charge of a hospital’ by a parent, spouse, guardian, or curator, & after consideration by a panel consisting of “a psychiatrist or a medical practitioner if no psychiatrist is available; & a psychologist or a social worker; & a nurse”, that:
- The person is ‘incapable of making his or her own decision about contraception or sterilization’
- Incapable of ‘developing mentally …to make an informed decision’
- Incapable of ‘fulfilling the parental responsibility associated with giving birth’
- The person must be ‘18 years of age, unless the physical health of the person is threatened’
- There is ‘no other safe & effective method of contraception except sterilization”
General notes
- Laparoscopic & mini-laparotomy tubal ligations may be offered
- It is wise to ask any multiparous woman over the age of 30 if she would consider tubal ligation
- Always ensure that the patient undergoing sterilization is not pregnant – check the last menstrual period, & do a pregnancy test if necessary, ideally, performing in the early follicular phase prevents a luteal phase established pregnancy
- A recent normal Pap smear is essential
- The consent must emphasize permanence & the small chance of failure
- At mini-laparotomy tubal ligation, send the resected tubal segments for histology (both tubes in one container to save costs)
- The ‘Essure’ or hysteroscopically inserted tubal occlusion is available as an out-patient in some centres