An estimated 138 million women of reproductive age -- 43 million more than in 1984 -- are protected from unwanted pregnancy by voluntary female sterilization, says the latest issue of Population Reports, published at the Johns Hopkins School of Public Health.
Female sterilization is not only the world's most widely used family planning method, but it is also one of the fastest growing, according to the report. Worldwide, the number of women using this method has risen by 45 percent since 1984.
Most of the increase in numbers has occurred where female sterilization has long been widespread -- Latin America, Asia and the United States.
Among developed countries, voluntary female sterilization is most popular in the United States. Some 23 percent of married women of reproductive age -- 7.5 million in 1990 -- have been sterilized for contraception purposes. In 1982, the figure was 17 percent.
In this country, the runner-up contraception methods, based on a 1988 survey, are: the pill at 15 percent; vasectomy, 13 percent; and condoms, 11 percent, the report says.
Female sterilization is also the most popular contraceptive method in Bangladesh, Brazil, Colombia, Fiji, India, Mexico, Nepal, the Philippines, Sri Lanka, Taiwan and Thailand.
"Once female sterilization is available, and women learn about it, they make use of it," says Phyllis T. Piotrow, director of the Population Information Program that publishes Population Reports.
"For women who do not want any more children, female sterilization is a simple, effective, one-time choice that has no long-term side effects."
During the procedure, the surgeon blocks the tubes that carry eggs from the ovaries to the uterus. In the past, this required major abdominal surgery, but now there are two simple ways to reach the tubes -- minilaparotomy and laparoscopy.
Minilaparotomy involves making a small incision in the abdomen, moving each tube to the incision, ligating or tying each tube and removing a small segment of the tube.
In the laparoscopy, a thin, tubular optical instrument called a laparoscope is inserted into the abdomen through a small incision. Through the laparoscope, the surgeon sees the tubes and usually applies clips, rings, or heat to block them. Both procedures can be performed under local anesthesia and take only 10 to 20 minutes.
Sterilization is beginning to catch on even in such places as Ghana, Turkey and Kenya, where many thought it never would be popular, the report says. In Kenya, for example, sterilization has become the most widely used contraceptive method among women over age 30. Since 1982, the number of sterilizations has risen from 68 to more than 11,000.
"I would like to spread the gospel of tubal ligation to my friends and others," says one Kenyan women quoted in the Hopkins publication.
"We are all on our way to TL [tubal ligation]," says another.
Where there is opposition to female sterilization, it comes mainly from some policy-makers, religious leaders and physicians, according to the report.
"While this opposition may be well-intentioned -- to protect women from ending child-bearing in cultures where fertility is highly valued -- it may be directly contrary to the wishes and the health of the women themselves," the report says.