Design: Randomised controlled trial with attention control
Population: 350 US adults considering tubal sterilisation, mostly publicly insured
Primary outcome: Perceived access to six contraceptive methods at 3 months
Effect: 62% vs 58% (adjusted mean difference 3.24, 95% CI 1.81 to 4.67)

A US trial randomised 350 people considering tubal sterilisation to review either a purpose-built educational website or the federal sterilisation consent form plus an existing provider website. Most had public insurance and low household incomes. The primary outcome was perceived access to six contraceptive methods at 3 months.

Perceived access rose more with the website (62% vs 58%), and knowledge scores improved more within a week (68% vs 52% of questions correct) and stayed higher at 3 months (61% vs 52%). Sterilisation remained the most preferred method in both groups (30% vs 25%), while preference for the contraceptive implant rose in the website group (17% vs 9%).

About one in five people who undergo tubal sterilisation later report wanting it reversed, and a consent form is not a decision aid. The trial did not measure regret, so it cannot show that better knowledge prevents it.

In Indian practice, where female sterilisation is the most common contraceptive method and is often done soon after delivery, the underlying point applies: make sure the person has heard about long-acting reversible options before the decision is final.

Before tubal sterilisation, check the person can name at least one long-acting reversible alternative, such as an IUD or implant.
Mention vasectomy as an option where a partner is involved.
A signed consent form does not show understanding; ask the person to explain the choice back.
Revisit the decision if it was made under time pressure, such as during labour.
Give written or online information in advance rather than on the day of surgery.

Why it matters

Regret after sterilisation is common enough that the quality of the counselling, not just the consent, deserves attention.

The statistics, in plain English

The differences are in percentage scores on questionnaires, so a 9-point knowledge gap at 3 months is meaningful but modest. The shift towards implants (17% vs 9%) had a p value of 0.05, right at the conventional threshold, so it is suggestive rather than firm.