Female sterilisation declines as birth control method in Finland
Hormonal IUDs more popular as tubal ligations decrease
Tubal ligations, or female sterilisations for the purpose of birth control, are rapidly decreasing in popularity. In the mid 1990s, more than 12,000 women each year opted for this most irreversible of contraceptive methods, involving the severing of the fallopian tubes. The current annual rate of such surgeries is less than 6,000.
In 2004 the number of female sterilisation operations was the same as in 1984 and 1970.
Dr. Oskari Heikinheimo calls the change "dramatic".
"Although the age groups are smaller, the decrease should not be this great."
Heikinheimo works at the Women's Clinic of the Helsinki University Central Hospital, where he teaches medical students the procedure for tubal ligations. It is not always easy.
"A few sterilisations are performed each week. It is getting to be difficult to get them to coincide with days of instruction."
Heikinheimo and Professor Jorma Paavonen wrote about the decline in the procedure in a lead editorial in Suomen Lääkärilehti, the journal of the Finnish Medical Association. They see the increasing popularity of the hormone-emitting intrauterine device (IUD) as the main reason for the trend. The hormone-emitting IUD was invented in Finland and came on the market in the 1990s.
The device was seen as an appropriate contraceptive especially for older women, because it was felt that birth control pills should not be used after the age of 40. Today the pill is known to be safe to use all the way until menopause, if there are no complications.
Sterilisation surgery is decreasing in all Nordic Countries, says Mika Gissler, head of development at the National Research and Development Centre for Welfare and Health (STAKES). He says that women are having children later in life, and demand for sterilisations is decreasing, as the risk of becoming pregnant declines with age. "However, the effect should not be seen this quickly."
Experts believe that women are increasingly reluctant to have the procedure, which is very difficult - and sometimes impossible - to reverse.
Instead of sterilisation, many women are opting for a contraceptive method that leaves open the possibility for pregnancy later on.
This seems to be the trend in Helsinki, where the number of sterilisations relative to the number of women of the appropriate age is the lowest in Finland. The rate is twice as high in the rest of Uusimaa, and four times as high in the north of Finland.
In Helsinki, those considering a tubal ligation visit the family planning clinic at the Kätilöopisto Maternity Hospital, where they discuss their options with a specialist nurse.
"More than one in five opt for another alternative", says Dr. Satu Suhonen.
The hormone-emitting IUD, which was developed at the clinic, is often the method of choice. "A hormone-emitting IUD is about as effective a contraceptive as sterilisation, but it also relieves menstrual problems. Sterilisation has no effect on them", notes Dr. Maija Haukkamaa, head of the Obstetrics and Gynaecology Division at the Helsinki-Uusimaa Hospital District.
Male sterilisations, or vasectomies, are rarely requested, even though the procedure is simpler than that for a woman.
The number of vasectomies has decreased steadily from the record level of ten years ago. Nevertheless, they account for an increasing proportion of all sterilisations performed in Finland, rising from the previous five percent to 20 percent, because of the even sharper decline in the number of women's sterilisations.
In Denmark, men account for half of all sterilisations, and in The Netherlands, the vasectomies constitute a majority of surgical sterilisations.
Helsingin Sanomat
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| 18.9.2006 - TODAY |
 Female sterilisation declines as birth control method in Finland
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