Success rates vary widely from center to center, and even if your operation is successful technically, there is no guarantee that pregnancy will follow. And if you happen to be unsuccessful after a long and costly operation, statistics will not be comforting.

Some women will consider tubal ligation as an option if they have been unable to find any safe and/or satisfying method of birth control. For example, a good candidate for tubal ligation is Sally, 36 years old, who had her first pregnancy with an IUD in place and her second while using a diaphragm. She can't use the pill because of troublesome side effects. Her partner feels threatened by the idea of vasectomy and dislikes condoms. She is also certain that she doesn't want any more children.

Important Considerations Before Tubal Ligation

Other important considerations before tubal ligation include:

1. The degree of certainty that you will never want to have another child under any circumstances.

2. Your physical, emotional, mental and spiritual ability to care for and guide the children that you already have; your children's attitude to having a new family member.

3. Your financial resources; your support network of family and friends; the amount of support you can realistically expect from your partner in raising the kids and in sharing household chores.

4. The level of co-operation of your partner in birth control matters and his feelings about vasectomy.

5. Your level of energy, major health problems, and your age.

6. Your feelings about yourself as a woman and the role of children in your life.

7. Your goals for work, schooling or training.

8. Your religious beliefs and your personal feelings about birth control and abortion.

Further, you must also ask yourself how you would feel if one of your children died; or if your partner died and you remarried; and exactly how you would respond to a pregnancy at this point in your life and later on.

Occasionally, tubal ligation is performed immediately after childbirth, Cesarean section or therapeutic abortion. I don't recommend this timing for tubal ligation for several reasons. After childbirth, you are in vulnerable state emotionally and psychologically. At this time also, your body's tissues are more delicate and prone to bleed. In addition, there is a slightly higher failure rate of the operation than when it is performed between pregnancies. Moreover, some serious health problems with babies do not develop until after birth, and this could greatly affect your decision.

Having said all this, if you have carefully considered the decision before childbirth or abortion, tubal ligation performed at the same time can still be a good choice for you.

Having a tubal ligation is an important turning point in a woman's life marking the end of her reproductive potential. It changes how she thinks of herself as a woman and her orientation in the world. It may signal her going back to school or her re-entry into the work force. It frees a woman to develop other aspects of herself besides mothering, without the fear of unwanted pregnancy or the burden of birth control. The decision is a crucial one and should not be taken lightly.

Of course, with vasectomy, a woman reaps the same benefits without taking on any additional risks to her health.

At least one woman in 200 will end up changing her mind about tubal ligation and seek a reversal of the operation. Some studies indicate that almost 30 percent of women express some regrets after the operation.

You are more likely to regret your decision:

• If you undertake the tubal ligation with doubts in your mind.

• If you are younger than 27 years old.

• If your religion or culture has strong beliefs about the fertility of women.

• If someone else has pressured you into it as your only choice.