Eight-dimension review score against the
quality rubric
. Each dimension scored 1–5.
D1 Source verification
5/5
D2 Source authority & independence
5/5
D3 Regret-rate accuracy
2/5
D4 Source comparability
3/5
D5 Gilovich pattern
5/5
D6 Prose quality
5/5
D7 Caveat completeness
5/5
D8 Sample quality
4/5
Average4.25/5
Proxy data — no direct regret survey exists for this decision. Rates are derived from satisfaction scores and access-barrier data rather than questions that directly asked about regret. See caveats below.
Action regret
Getting a tubal ligation
13%
12.7% cumulative probability of regret within 14 years (CREST)
Women who underwent tubal sterilization, US prospective cohort (n=11,232)
The 12.7% cumulative probability of regret within 14 years after tubal
ligation is one of the most rigorously measured action-regret rates in the
surgical literature. It comes from the US Collaborative Review of
Sterilization (CREST), a prospective cohort study of 11,232 women aged
18-44 who underwent tubal sterilisation at six US medical centres between
1978 and 1987, followed by Hillis et al. (1999, Obstet Gynecol, PMID
10362150). The figure conceals large age heterogeneity: women sterilised
at age ≤30 had a 14-year regret probability of 20.3%, compared to 5.9%
for women sterilised after age 30. The AAFP clinical guidance (2003) cites
age at sterilisation as the single strongest predictor of regret. On the
inaction side, no published survey directly measures regret among women
who chose not to have tubal ligation; the 5% inaction proxy is constructed
from unintended-pregnancy burden data and is a placeholder estimate, not
a finding.
Tubal ligation is one of the most clearly documented exceptions to the
Gilovich and Medvec pattern that inaction regret dominates over time. The
mechanism is well understood: the procedure is surgically permanent,
irreversible without costly and uncertain reversal surgery, and often
performed at ages when life circumstances — partner status, child survival,
financial stability — can change substantially. The three most common
precipitants of regret identified in CREST follow-up data were a change in
marital status (divorce, remarriage), the death of a child, and a desire
for more children with a new partner. These are not predictable at the
time of surgery and are not failures of informed consent; they are
inherent features of a permanent decision made in a probabilistic future.
Women who were sterilised after age 30 with completed families and stable
relationships had very low regret rates (5.9%), suggesting the procedure
is nearly regret-free when the risk factors for life-circumstance change
are lower.
The inaction proxy is deliberately conservative. A woman who chose not
to undergo tubal ligation retains reproductive options and can revisit the
decision at any time — the classic Gilovich mechanism for suppressing
inaction regret. However, women who forewent sterilisation and subsequently
experienced unintended pregnancies, or who bore the full contraceptive
burden for years while their partners avoided vasectomy, may harbour
meaningful retrospective inaction regret that no current survey captures.
The delta (0.077) should be read as indicating that action regret is
substantially higher than inaction regret for the general population of
women who consider tubal sterilisation — but the inaction figure is soft
enough that the true direction could shift for subgroups.
Sources: action
Claim ledger
Every number below is what each source reported, with the verbatim quote we relied on and how we arrived at our figure. Click any link to verify directly.
[1]Obstetrics and Gynecology (CDC / CREST Study) — Poststerilization regret: findings from the United States Collaborative Review of Sterilization
Primary study
14-year cumulative probability of expressing regret: 12.7% overall; 20.3% for women aged ≤30 at sterilization; 5.9% for women aged >30
Excerpt
“"[Paraphrase from abstract -- full text paywalled] The 14-year cumulative probability of self-reported regret was 12.7% (95% CI not reported in abstract). The cumulative probability of expressing regret during a follow-up interview within 14 years after tubal sterilization was 20.3% for women aged 30 or younger at the time of sterilization and 5.9% for women over age 30 at sterilization. Factors associated with regret included age at sterilization, change in marital status, loss of a child, and desire for more children. N=11,232 women aged 18-44 who underwent tubal sterilization at US medical centres between 1978 and 1987 and were followed prospectively."
”
Source data from
1999-06-01
Accessed
2026-05-10
Calculation
Hillis SD, Marchbanks PA, Tylor LR, Peterson HB. Obstet Gynecol. 1999 Jun;93(6):889-95. PMID 10362150. The 12.7% is the overall 14-year cumulative probability across all ages in the CREST cohort. This is the gold-standard figure for tubal ligation action-regret. The age breakdown (20.3% for ≤30 vs 5.9% for >30) is used in the prose to illustrate the dominant age moderator. The overall 12.7% is used as the action_side regret_rate rather than the age-stratified figures, because the entry represents the general population of women seeking sterilisation.
[2]American Academy of Family Physicians (AFP) — Counseling Issues in Tubal Sterilization
Reference source
The 14-year cumulative probability of regret is 12.7% overall; age ≤30 is the single strongest predictor of regret
Excerpt
“"The 14-year cumulative probability of regret was 12.7 percent, with women younger than 30 years being more likely to regret the procedure (20.3 percent) compared with those 30 years of age or older (5.9 percent). The most important predictor of regret is age at sterilization: the younger the woman, the more likely she is to regret the procedure."
”
Source data from
2003-03-15
Accessed
2026-05-10
Calculation
AAFP AFP clinical review (2003) citing the Hillis 1999 CREST findings and placing the 12.7% figure in clinical counselling context. Confirms the 12.7% overall figure and the age-stratified breakdown. Used as corroborating authoritative secondary source for the action-side rate.
Sources: inaction
Claim ledger
Every number below is what each source reported, with the verbatim quote we relied on and how we arrived at our figure. Click any link to verify directly.
[1]Centers for Disease Control and Prevention — Unintended Pregnancy | Reproductive Health | CDC
Government report
Approximately 41.6% of all US pregnancies in 2019 were unintended; the unintended pregnancy rate was 35.7 per 1,000 females aged 15-44
Excerpt
“"The percentage of U.S. pregnancies that were unintended declined from 43.3% in 2010 to 41.6% in 2019. Unintended pregnancy rates declined by 15%, from 42.1 per 1,000 females aged 15-44 years in 2010 to 35.7 per 1,000 in 2019. Despite this progress, about 4 in 10 pregnancies in the United States are still unintended."
”
Source data from
2024-01-01
Accessed
2026-05-10
Calculation
CDC Reproductive Health fact sheet. Used as context for constructing the inaction proxy, not as a direct regret measure. Among women who chose not to pursue tubal sterilisation and subsequently experienced one or more unintended pregnancies, a subset will retrospectively regret the inaction. The 5% proxy is derived from the assumption that roughly 10-15% of women who delay or forgo tubal sterilisation eventually experience an unintended pregnancy they would have preferred to avoid, and approximately one-third to one-half of these women will express lasting regret about not having acted. This construction is speculative: no direct survey measures this. The 5% is an order-of-magnitude placeholder proxy -- see caveats.
[2]American Academy of Family Physicians (AFP) — Women's Regret After Sterilization Procedures
Reference source
No data on regret among women who chose not to undergo sterilisation; clinical review focused exclusively on post-sterilisation regret
Excerpt
“"[Paraphrase from abstract -- full text paywalled] This AAFP clinical review summarised the evidence on regret after tubal sterilisation. It did not assess or report regret among women who declined or deferred sterilisation. The review concluded that young age, ambivalence, and partner pressure are the key modifiable risk factors for post- sterilisation regret. Women over 30 with completed families had very low regret rates (5.9% at 14 years)."
”
Source data from
2002-10-01
Accessed
2026-05-10
Calculation
AAFP AFP 2002 clinical review. Cited here to establish that the peer-reviewed clinical literature does not contain a direct measurement of inaction-regret for tubal sterilisation. The 5% proxy is an editorial construction and should not be interpreted as a finding from this or any other source.
Caveats
The action-side 12.7% is one of the best-evidenced regret rates in the entire regret-pairs dataset: it comes from the CREST prospective cohort study of 11,232 women followed for up to 14 years (Hillis et al. 1999, PMID 10362150). The overall figure masks extreme age-stratification: women sterilised at age ≤30 had a 14-year cumulative regret probability of 20.3%, while those sterilised at age >30 had only 5.9%. The inaction- side 5% is a constructed placeholder proxy: no published survey directly asks women who chose not to have tubal ligation whether they regret that decision. The proxy is built from unintended-pregnancy burden data and the assumption that a small but real subset of non-sterilised women who experienced unintended pregnancies will express lasting inaction regret. The delta (0.077) therefore reflects the asymmetry of the evidence as much as the asymmetry of the underlying experience. Tubal ligation is one of the clearest documented exceptions to Gilovich and Medvec's typical finding that inaction regret dominates in the long run: the permanence of the procedure, the real possibility of wanting more children after a life change (new partner, loss of a child, divorce), and the young age at which many women undergo it combine to sustain action regret in a way unusual for a deliberate elective procedure. Regret rates are substantially lower in women sterilised after age 30 with completed families -- for that subgroup, the Gilovich inaction- dominance prediction may apply. Racial and ethnic differences in regret rates have been documented in some studies, with Black and Hispanic women showing somewhat higher rates of desire for reversal, potentially reflecting socioeconomic barriers to sterilisation access at optimal ages. Survey data are from US cohorts; patterns in countries with different reproductive health access and family size norms may differ.
