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The prevalence of female sterilization has grown rapidly throughout the world, especially in the United States. Yet the psychosocial impact of tubal ligation is incompletely understood. Most previous research has been retrospective and has lacked comparison groups of women using other birth control methods. This study used procedures developed in World Health Organization research to study the impact of voluntary tubal ligation on Alabama women. The design was prospective, included a comparison group, and called for 6- and 12-month follow-ups. Tubal ligation reduced follow-up pregnancy rate and scores on a measure of fear of pregnancy. Sterilization also produced a small increase in menstrual distress but did not affect sexual satisfaction or mental health nor did it increase regrets about contraceptive choice over other methods. These results imply women attained the goals that led them to choose sterilization.