Question

As Salaam Alaikum,

I am on my 4th pregnancy in 4 years and me and my spouse both don’t wish to have more kids. We have tried every method and this 4th pregnancy was not expected even after using preventive measures. Is it permissible for me to get my tubes tied to prevent pregnancy in the future?

Answer

Waʿalaykum al-Salām wa Raḥmat Allāh wa Barakātu-h.

In the name of Allah, The Most Gracious, The Most Merciful.

Sister in Islam,

For the last few weeks, the Darul Iftā’ committee spent several hours discussing and researching your case in conjunction with the Darul Qasim medical team. Your case was discussed from a social, medical, and theological angle.

Raising children in the current climate with Islamic ethics and morals is perhaps the greatest challenge for American Muslims. To make it even more challenging, parents in the West are more often than not left to raise children alone. Your particular situation is even more challenging. We make du‘ā’ that Allah assists you in every step of the way. With that said, children are undoubtedly a blessing from Allah ﷻ. “He gifts to whomsoever He wishes females, and He gifts to whomsoever He wishes males. Or, He gives them both males and females. And He makes barren whomsoever He wishes [Qur’ān, Sūrat al-Shūrā (42):49-50].” Furthermore, The Messenger of Allah (peace be upon him) has instructed us, “Marry and have plenty of offspring, for verily I will vie with other nations by virtue of your numbers.”[1] Since tubal ligation in all practicality is a form of permanent contraceptive (as will be discussed later), it stands in opposition to this societal ideal. Research also shows that tubal ligation, at times, comes with an emotional and psychological cost, translated as the "risk of regret".       

From a medical standpoint, tubal ligation – (intended as) a permanent contraceptive measure that is for all practical purposes an irreversible sterilization procedure that employs a few different methods in order to produce the desired effect.

Typically, it is often done immediately at the time of C-section or after a vaginal delivery via mini-laparotomy (a “small incision”, not requiring general anesthesia given ease of epidurals) via either electrosurgical desiccation (using radiofrequency energy to disrupt/dry out the tubal lining), mechanical methods (silicone band, titanium clip, or spring clip resulting in tubal occlusion), and/or salpingectomy (partial or complete removal of the fallopian tubes). 

Immediate complications from surgical sterilization may include bleeding, injury to other structures, and/or pain (common and not debilitating). Long term and the most serious delayed complication of tubal ligation is ectopic pregnancy (extrauterine pregnancy, when a fertilized egg grows outside a woman's uterus), which carries a high risk of tubal rupture resulting in increased maternal mortality.

Analyzing original data, the failure rate (resultant pregnancy status post tubal ligation) was approximately 23 pregnancies per 1000 procedures at 10 years after sterilization, with ectopic pregnancies accounting for 32.9 percent of all pregnancies reported in CREST (trial subjects), for an ectopic pregnancy rate of 7.3 per 1000 sterilization procedures. However, the rate of ectopic pregnancy is likely much lower using modern techniques, dramatically decreasing the cumulative pregnancy rate to 3.2 per 1000 procedures upon re-analysis of existing data correcting for updated surgical methods (whereas in comparison to a failure rate of 1:1000 for IUDs/hormonal implants such as NEXPLANON®).

In light of the above, even tubal ligation is not a guaranteed form of contraception and carries its own risks. 

From the theological aspect, we must accept that our bodies are a trust from Allah (swt). He has prohibited us from altering or changing the normal function of anything in our bodies (Qur’ān, al-Nisāʾ(4):119).[2] The Messenger of Allah (upon him be peace) severely prohibited the practice of castration for the same reason.[3] By extension of this principle, tubal ligation under normal circumstances would not be permissible. Yes, if a medical practitioner confirms that future pregnancies will pose an actual risk to the mother's health, tubal ligation would be allowed with the fatwa of a knowledgeable scholar. 

As for your particular situation (in light of the above considerations), we would advise you to consider other methods of contraception, such as an IUD. This is where we stand. You are welcome to seek a second opinion.    

Allah knows best.

Mufti Hisham Dawood

Corroborated by,

Shaykh Amin Kholwadia

Darul Ifta, Darul Qasim

Mufti Ehzaz Ajmeri

Darul Ifta, Darul Qasim