Race, insurance status, and tubal sterilization.

Divison of General Internal Medicine, VA Pittsburgh Healthcare System and University of Pittsburgh School of Medicine, Pittsburgh, PA 15240, USA.
Obstetrics and Gynecology (Impact Factor: 4.37). 02/2007; 109(1):94-100. DOI: 10.1097/01.AOG.0000249604.78234.d3
Source: PubMed

ABSTRACT To examine the independent effects of race or ethnicity and insurance status on use of tubal sterilization rates.
This study used cross-sectional data collected by the 2002 National Survey of Family Growth. The survey is designed to represent women and men aged 15-44 years in the household population of the United States. Our main outcome measure was tubal sterilization at any time before interview. A multivariable logistic regression model was used to estimate the effects of race or ethnicity and insurance status on rates of tubal sterilization after adjusting for important confounders.
The sample consisted of 7,643 women: 66% were white, 15% were Hispanic, and 14% were African American; 68% had private insurance and 32% had public or no insurance. After adjusting for age, insurance status, parity, income, education, marital status, and religion, African-American women were more likely than white women to undergo tubal sterilization (adjusted odds ratio 1.43, 95% confidence interval 1.08-1.88). After adjusting for age, race or ethnicity, parity, income, education, marital status, and religion, women with public or no insurance were more likely to undergo sterilization compared with women with private insurance (adjusted odds ratio 1.38, 95% confidence interval 1.09-1.74).
African-American women and women with no or public insurance were more likely to have undergone tubal sterilization compared with white women and women with private insurance, respectively. Additional research to identify factors that influence women's decision to undergo sterilization is warranted.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective Disparities in unintended pregnancy in the United States are related, in part, to black and Hispanic women being overall less likely to use effective contraceptive methods. However, the fact that these same groups are more likely to use female sterilization, a highly effective method, suggests there may be variability in disparities in contraceptive use across a woman’s life course. We sought to assess the relationship between race/ethnicity and contraceptive use in a nationally representative sample and to approximate a life-course perspective by examining effect modification on these disparities by women’s age, parity and history of unintended pregnancy. Study Design We conducted an analysis of the 2006-2010 National Survey of Family Growth to determine the association between race/ethnicity and 1) use of any method; 2) use of a highly or moderately effective method among women using contraception; and 3) use of a highly effective method among women using contraception. We then performed analyses to assess interactions between race/ethnicity and age, parity and history of unintended pregnancy (ies). Results Our sample included 7,214 women aged 15-44. Compared to whites, blacks were less likely to use any contraceptive method (AOR: 0.65); and blacks and Hispanics were less likely to use a highly or moderately effective method (AORs: 0.49 and 0.57, respectively). Interaction analyses revealed that racial/ethnic disparities in contraceptive use varied by women’s age, with younger women having more prominent disparities. Conclusions Interventions designed to address disparities in unintended pregnancy should focus on improving contraceptive use among younger women.
    American journal of obstetrics and gynecology 06/2014; · 3.97 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The National Survey of Family Growth has been a primary data source for trends in US women's contraceptive use. However, national-level data may mask differences in contraceptive practice resulting from variation in local policies and norms. We used the Pregnancy Risk Assessment Monitoring System, a survey of women who are 2-4 months postpartum. Information on women's current method was available for 18 reporting areas from 2000 to 2009. Using the two most recent years of data, we computed the weighted proportion of women using specific contraceptive methods according to payment for delivery (Medicaid or private insurance) and examined differences across states. We used log binomial regression to assess trends in method use in 8 areas with consecutive years of data. Across states, there was a wide range of use of female sterilization (7.0-22.6%) and long-acting reversible contraception (LARC; 1.9-25.5%). Other methods, like vasectomy and the patch/ring, had a narrower range of use. Women with Medicaid-paid deliveries were more likely to report female sterilization, LARC and injectables as their method compared to women with private insurance. LARC use increased ≥18% per year, while use of injectables and oral contraceptives declined by 2.5-10.6% annually. The correlation in method-specific prevalence within states suggests shared social and medical norms, while the larger variation across states may reflect both differences in norms and access to contraception for low-income women. Surveys of postpartum women, who are beginning a new segment of contraceptive use, may better capture emerging trends in US contraceptive method mix. There is considerable variation in contraceptive method use across states, which may result from differences in state policies and funding for family planning services, local medical norms surrounding contraceptive practice, and women's and couples' demand or preference for different methods.
    Contraception 10/2013; · 3.09 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Cross-sectional studies have found that low-income and racial/ethnic minority women are more likely to use female sterilization and less likely to rely on a partner’s vasectomy than women with higher incomes and whites. However, studies of pregnant and postpartum women report that racial/ethnic minorities, particularly low-income minority women, face greater barriers in obtaining a sterilization than do whites and those with higher incomes. In this paper, we address this apparent contradiction by examining the likelihood a woman gets a sterilization following each delivery, which removes from the comparison any difference in the number of births she has experienced. Study Design: Using the 2006–2010 National Survey of Family Growth, we fit multivariable-adjusted logistic and Cox regression models to estimate odds ratios and hazard ratios for getting a postpartum or interval sterilization, respectively, according to race/ethnicity and insurance status. Results: Women’s chances of obtaining a sterilization varied by both race/ethnicity and insurance. Among women with Medicaid, whites were more likely to use female sterilization than African Americans and Latinas. Privately insured whites were more likely to rely on vasectomy than African Americans and Latinas, but among women with Medicaid-paid deliveries reliance on vasectomy was low for all racial/ethnic groups. Conclusions: Low-income racial/ethnic minority women are less likely to undergo sterilization following delivery compared to low-income whites and privately insured women of similar parities. This could result from unique barriers to obtaining permanent contraception and could expose women to the risk of future unintended pregnancies. Implications Low-income minorities are less likely to undergo sterilization than low-income whites and privately insured minorities, which may result from barriers to obtaining permanent contraception, and exposes women to unintended pregnancies.
    Contraception 01/2013; · 3.09 Impact Factor


Available from
Feb 3, 2015