Sterilisation trends.

If the pill was the contraceptive phenomenon of the third quarter of the twentieth century that of the final quarter must surely be sterilisation. World wide, one in three couples using some form of contraception chose this method in 1980-five times as many as in 1970.' In Britain the recently published General Household Survey, which in 1983 introduced questions on contraception, shows that, though single women still prefer the pill, it has now been replaced by sterilisation as the method of choice among those who are married or cohabiting.2 In 1970 some 4% of all married women relied on their own or their partners' sterilisation for contraception3; by 1976 the proportion had risen to 15%4; and by 1983 it had reached 24%. What was once seen as an extreme and coercive form of birth control suitable only for the reproductive control of the socially unfit has become established as a safe, simple, and effective procedure for those who seek permanent infertility. Total yearly statistics for sterilisation are not systematically recorded in Britain so the total number of procedures carried out each year is difficult to estimate accurately. The 79000 inpatient sterilisations of women performed in National Health Service hospitals in Britain in 1983 is almost certainly an underestimate since it excludes the increasing number of day cases. Family planning clinics add some 3000 operations to the total, and the private sector probably a further 10%, providing an estimate for the year of over 90000. Vasectomies are even more difficult to estimate because of the unknown numbers performed by general practitioners. But adding the 44 000 men sterilised in NHS hospitals to the 15 000 in family planning clinics in Britain and including a rough estimate of 12000-15000 treated in private clinics and 15 000 by general practitioners gives a total not far short of that for women's sterilizations for 1983. Yearly figures have tended to rise with improvements in the ease and availability of the operation and also with dissatisfaction with other contraceptive methods. Sterilisation ofwomen, for example, increased rapidly during the late 1960s with the introduction of simpler laparoscopic techniques, and vasectomies showed a similar rise in the early 1970s after the 1972 NHS (Family Planning) Amendment Act empowering local authorities to provide the operation on the NHS. The dramatic increase in the number of operations on both men and women between 1977 and 1979 (see figure) coincided with reports linking the use of the pill with a higher