During pregnancy, women older than 35 and women who have had four or more
children are at increased risk of hemorrhage and high blood pressure, two of the
most common causes of maternal death in developing countries. 1 Because
women in the developing world often start to have children in their late teens or
early twenties and do not practice family planning to space their pregnancies,
women often achieve high parity at a comparatively young age and are thus exposed
to the dangers of high-risk pregnancies for many years. As a result, most
women in regions where the total fertility rate is high face an elevated risk of
maternal morbidity and mortality during their later childbearing years. It is,
therefore, important for high-parity women to have access to a troublefree, reliable
method of contraception to protect them from potentially dangerous pregnancies.
Voluntary female sterilization is one of the most widely used methods of
contraception, especially among women over the age of 35, in every region of the
world except Sub-Saharan Africa. Among currently married women age 35-44
practicing contraception, 43 percent in Asia, 42 percent in Latin America and 25
percent in the Middle East rely on sterilization.