Tubal sterilization trends in the United States

School of Medicine, University of Manchester, Manchester, Greater Manchester, United Kingdom.
Fertility and sterility (Impact Factor: 4.59). 06/2010; 94(1):1-6. DOI: 10.1016/j.fertnstert.2010.03.029
Source: PubMed


To review the rate, setting, and demographic characteristics of tubal sterilization and its current trend within contraceptive practice in the United States.
Review of U.S. health care statistics, NCHS publications, English-language literature searched using MEDLINE and PubMed, and bibliographies of key references.
Total annual cases of tubal sterilization have declined from 687,000 in 1995 to 643,000 in 2006, despite a 4% population growth. Interval sterilizations decreased by 12%. Postpartum sterilizations remained stable and follow 8%-9% of all live births. Tubal sterilizations remain more common in black and Hispanic women; women with lower income, lower education, and higher parity; and among women living in the South. From 1981 to 1995, inpatient interval sterilizations fully migrated to ambulatory surgery care.
After two decades of stable rates, there is a recent decline in sterilization. Improved access to a wide range of highly effective reversible contraceptives gives women flexibility when deciding how to manage their reproductive ability.

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    • "Taken together, these findings suggest that factors external to the individual are influential in the prediction of tubal sterilization rates, and may further limit medically underserved women's reproductive choices. We are particularly motivated to investigate tubal sterilization as a representation of a health disparity because previous findings have consistently illustrated that they are disproportionately performed on those with Medicaid coverage (ACOG, 2012; Bass & Warehime, 2009; Chan & Westhoff, 2010; Hillis et al., 1999; MacKay et al., 2001). In fact, 12% of women receive Medicaid coverage yet 41% of postpartum tubal sterilizations are paid by Medicaid (ACOG, 2013). "
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    ABSTRACT: Purpose: Tubal sterilization patterns are influenced by factors including patient race, ethnicity, level of education, method of payment, and hospital size and affiliation. However, less is known about how these factors influence tubal sterilizations performed as secondary procedures after cesarean sections (C-sections). Thus, this study examines variations in the prevalence of postpartum tubal sterilizations after C-sections from 2000 to 2008. Methods: We used data from the National Hospital Discharge Survey to estimate odds ratios for patient-level (race, marital status, age) and system-level (hospital size, type, region) factors on the likelihood of receiving tubal sterilization after C-section. Results: A disproportionate share of postpartum tubal sterilizations after C-section was covered by Medicaid. The likelihood of undergoing sterilization was increased for Black women, women of older age, and non-single women. Additionally, they were increased in proprietary and government hospitals, smaller hospital settings, and the Southern United States. Conclusions: Our findings indicate that Black women and those with Medicaid coverage in particular were substantially more likely to undergo postpartum tubal sterilization after C-section. We also found that hospital characteristics and region were significant predictors. This adds to the growing body of evidence that suggests that tubal sterilization may be a disparity issue patterned by multiple factors and calls for greater understanding of the role of patient-, provider-, and system-level characteristics on such outcomes.
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