Percentage who later regret each choice. Bars and full ledger render below.
Health
Last reviewed 2026-05-10
Evidence quality 4.25/5
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
7.0%
7.0% cumulative probability of regret within 5 years (CREST cohort, all ages)
Women who underwent tubal ligation, US CREST cohort (n=3,672)
5-year cumulative probability of regret; CREST tubal-ligation cohort sterilized 1985-1987
Inaction regret
Not getting a tubal ligation
5.0%
~5% (constructed proxy -- no direct inaction-regret survey exists)
Women who chose not to undergo tubal sterilization, estimated
retrospective, estimated
% who regret this choice
Getting a tubal ligationNot getting a tubal ligation
7.0%5.0%
action dominates — Action dominates — most regret acting.
Related decisions
Semantically similar decisions — same territory, different trade-offs.
The 7.0% overall 5-year cumulative probability of regret after tubal
ligation comes from the US Collaborative Review of Sterilization (CREST),
as summarised in the AAFP 2002 clinical review of 3,672 women who underwent
tubal ligation between 1985 and 1987. The longer-horizon CREST report by
Hillis et al. (1999, Obstet Gynecol, PMID 10362150) followed a larger
cohort of 11,232 women aged 18-44 sterilised between 1978 and 1987 for up
to 14 years; it publishes only age-stratified figures, and those reveal
large 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.
Neither the Hillis abstract nor the AAFP reviews report a single pooled
14-year figure, so the 7.0% 5-year overall rate is used here and is
conservative relative to the 14-year horizon. The AAFP clinical guidance (2003) cites
young age at sterilisation as one of the two most common factors
associated with regret (alongside unpredictable life events such as a
change in marital status). 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 (0.02) is small and should be read as indicating that action
regret is modestly higher than inaction regret for the general population
of women who consider tubal sterilisation — but the action side rests on
a 5-year overall rate while the inaction figure is a soft editorial proxy,
so the true direction could shift for subgroups (and the action side would
be considerably larger at a 14-year horizon, especially for women
sterilised before age 30).
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.
2/3 sources independently verified verbatim against the cited source
[1]American Academy of Family Physicians (AFP) — Women's Regret After Sterilization Procedures
Verified
Reference source
Five-year cumulative probability of regret following tubal ligation was 7.0% (n=3,672 women who underwent tubal ligation; requesting a reversal 2.2%, obtaining a reversal 0.2%)
Excerpt
“"The study compared 3,672 women who underwent tubal ligation at medical centers in six cities with 525 women whose husbands underwent vasectomy in five of the same cities between 1985 and 1987." "Similarly, the cumulative probabilities of regret following tubal ligation, of women requesting a reversal, and of obtaining a reversal were 7.0, 2.2, and 0.2 percent, respectively." "Young age was a risk factor for regret after tubal ligation but not for regret after vasectomy."
”
Source data from
2002-10-01
Accessed
2026-07-12
Verification
Excerpt independently re-fetched and confirmed word-for-word against the cited source during our grounding audit.
Calculation
AAFP AFP 2002 clinical review of the CREST sterilization data. The 7.0% is the source-stated OVERALL (all-ages) 5-year cumulative probability of regret following tubal ligation, n=3,672 (verified 2026-07-12: "the cumulative probabilities of regret following tubal ligation ... were 7.0 ... percent"). This is used as the action_side regret_rate because it is the only cited source that states a single overall (non-age-stratified) tubal-ligation regret figure. NOTE: the prior 12.7% figure was removed -- it did NOT appear in any cited source (the Hillis 1999 abstract reports only age-stratified figures, 20.3% for age <=30 and 5.9% for age >30, and no 12.7% overall; AAFP 2003 does not state 12.7% either). The 7.0% is a 5-year figure, so it is conservative relative to the 14-year horizon Hillis followed.
[2]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: 20.3% for women aged 30 or younger at sterilization vs 5.9% for women over age 30 (adjusted RR 1.9; 95% CI 1.6, 2.3)
Excerpt
“"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 (adjusted relative risk [RR] 1.9; 95% confidence interval [CI] 1.6, 2.3)." "Although most women expressed no regret after tubal sterilization, women 30 years of age and younger at the time of sterilization had an increased probability of expressing regret." 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
2026-07-12
Calculation
Hillis SD, Marchbanks PA, Tylor LR, Peterson HB. Obstet Gynecol. 1999 Jun;93(6):889-95. PMID 10362150. The abstract reports ONLY age-stratified 14-year cumulative regret probabilities: 20.3% for women aged <=30 and 5.9% for women aged >30 (verified 2026-07-12 -- no overall/pooled figure such as 12.7% appears anywhere in the abstract). Used here for the age moderator (the dominant risk factor) and the prose age breakdown, NOT for the overall action_side rate, which comes from the AAFP 2002 CREST summary (source index 0).
[3]American Academy of Family Physicians (AFP) — Counseling Issues in Tubal Sterilization
Verified
Reference source
Young age and unpredictable life events are the two most common factors associated with regret; regret is associated with sterilization before age 30, though age is not an eligibility criterion
Excerpt
“"The two most common factors associated with regret are young age and unpredictable life events, such as change in marital status or death of a child." "While regret is associated with having the procedure performed at ages younger than 30, age is not a criterion for procedure eligibility." "While some studies have shown 'regret' on the part of 26 percent of women, fewer than 20 percent seek reversal and fewer than 10 percent actually undergo the reversal procedure."
”
Source data from
2003-03-15
Accessed
2026-07-01
Verification
Excerpt independently re-fetched and confirmed word-for-word against the cited source during our grounding audit.
Calculation
AAFP AFP clinical review (2003), "Counseling Issues in Tubal Sterilization." This article does NOT restate the CREST 20.3%/5.9% cumulative-probability figures and contains no overall figure such as 12.7% (verified 2026-07-12: those numbers do not appear in the text; it reports only that "some studies have shown 'regret' on the part of 26 percent of women, fewer than 20 percent seek reversal and fewer than 10 percent actually undergo the reversal procedure"). It corroborates only the qualitative point that young age and unpredictable life events are the dominant regret factors. Used as an authoritative secondary source for the age moderator, not as a source for the numeric action-side rate (that comes from AAFP 2002, source index 0).
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.
1/2 sources independently verified verbatim against the cited source
[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
Verified
Reference source
Study compared only women who underwent tubal ligation (n=3,672) with women whose husbands had a vasectomy (n=525); no regret data for women who declined or deferred sterilisation. Five-year cumulative probability of regret after tubal ligation was 7.0%
Excerpt
“"The study compared 3,672 women who underwent tubal ligation at medical centers in six cities with 525 women whose husbands underwent vasectomy in five of the same cities between 1985 and 1987." "Similarly, the cumulative probabilities of regret following tubal ligation, of women requesting a reversal, and of obtaining a reversal were 7.0, 2.2, and 0.2 percent, respectively." "Young age was a risk factor for regret after tubal ligation but not for regret after vasectomy."
”
Source data from
2002-10-01
Accessed
2026-07-01
Verification
Excerpt independently re-fetched and confirmed word-for-word against the cited source during our grounding audit.
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 headline rate is 7.0% -- the source-stated overall (all-ages) 5-year cumulative probability of regret following tubal ligation from the CREST cohort (n=3,672 women who underwent tubal ligation, sterilised 1985-1987), as reported in the AAFP 2002 clinical review. An earlier version of this entry displayed 12.7% attributed to the CREST abstract; that overall figure does not appear in the Hillis 1999 abstract (or any other cited source) and has been removed. The Hillis 1999 (PMID 10362150) prospective cohort of 11,232 women, followed for up to 14 years, reports only age-stratified 14-year figures, and these show extreme heterogeneity: 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%. Because the two headline CREST reports use different follow-up windows (5-year vs 14-year), the 7.0% 5-year overall rate is conservative relative to what the 14-year horizon would show. 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 (0.02) is small and rests on an evidence asymmetry: the action side is source-stated while the inaction side is an editorial proxy, so the direction should be read as tentative. 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.
