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Background: Many women receiving antenatal care in public health services in Cape Town choose bilateral tubal ligation as their preferred method of postpartum contraception during their antenatal course. If the sterilisation does not occur immediately, these women are discharged on an alternative form of contraception and, ideally, an interval date for bilateral tubal ligation is arranged., Objectives: To assess the access to tubal ligation services in the Metro West area of Cape Town, South Africa, in women who request permanent contraception following delivery, looking specifically at the number of women requesting bilateral tubal ligation who receive the procedure intrapartum, immediately postpartum or as an interval procedure. Other objectives included determining the reproductive outcomes if bilateral tubal ligation was not performed, investigating the alternative forms of contraception provided and to study the demographics of the population requesting bilateral tubal ligation as a form of contraception., Methods: The study was conducted as a cross-sectional observational study collecting data over a period of 3 months, from June 2019 to August 2019. Maternity case records for deliveries between June 2019 and August 2019 from four facilities were reviewed. The facilities, representing all levels of care, were Vanguard Midwife Obstetric Unit, Wesfleur Hospital (district hospital), New Somerset Hospital (regional hospital), Groote Schuur Hospital (tertiary hospital)., Results: There were 260 women who requested tubal ligation as their choice of contraception. Only 50% of these received a tubal ligation. Of the 131 tubal ligations performed, 2 were interval sterilisations. Ninety-one percent (120/131) of the tubal ligations were done at the time of caesarean section. Of the 129 women who received alternative forms of contraception, 13 women had a recurrent pregnancy., Conclusion: The study suggests that only 50% of women requesting tubal ligation as form of contraception actually end up receiving the procedure. Alternative forms of contraception are widely used and relied upon, but not without risks of recurrent pregnancy. Interval tubal ligation was not easily accessed by those women who were referred for the procedure.

In this article the results of a pilot project (carried out at King George V Hospital, Durban, and later extended to include all Natal Provincial Administration hospitals) offering free sterilization to persons who attend family planning clinics are reported. A mini laparotomy technique which requires little operative skill, minimizes operative trauma and requires only 24 hours postoperative hospitalization is described.

Sterilisation by the Irving procedure accompanying caesarean section was the favoured form of sterilisation at Paarl Hospital from 1971 to 1985. No subsequent pregnancies have been reported from the 200 cases and this success is compared with sterilisation failure rates of 1.35% with the Pomeroy method, 1.27% with the total fimbriectomy method, 0.41% with the Vienna or modified Pritchard method, and 0.89% with the Filshie-clip method: Irving sterilisation is accordingly advised as the method of choice at the time of caesarean section.

During a 4-year period 9175 women were sterilized under local anaesthesia by the laparoscopic Falope ring method. These procedures were performed in smaller towns in the Cape Province. The method used, its cost-effectiveness, and its acceptability to patients are described in detail. This venture proves convincingly that a highly sophisticated medical service can be made available to rural areas, ensuring greater support for a high-priority primary health care service.

Pregnancy subsequent to postpartum Filshie clip sterilisation has occurred in 8 out of 789 patients operated on at Paarl Hospital since early 1983. As most pregnancies after sterilisation occur within 2 years, more failures can be expected. The use of this method has thus been discontinued.