Racial variation in tubal sterilization rates: Role of patient-level factors

Divison of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
Fertility and sterility (Impact Factor: 4.59). 01/2011; 95(1):17-22. DOI: 10.1016/j.fertnstert.2010.05.031
Source: PubMed


To assess racial differences in attitudes and knowledge about sterilization.
Cross-sectional survey.
Questionnaires were mailed to participants' home addresses.
One hundred ninety-three women, aged 18-45, who had undergone tubal sterilization.
Attitudes and knowledge about tubal sterilization and awareness of contraceptive alternatives.
We received 193 completed surveys (64% response rate). African American (AA) woman were more likely to have a family member who had undergone tubal sterilization, to report that their mothers influenced their sterilization decisions, and to report that prior unintended pregnancy and desire to avoid insertion of a foreign object were very important factors in their decision to choose sterilization over other methods. Compared with white women, AA women more often thought that sterilization reversal could easily restore fertility (62% vs. 36%); that a woman's sterilization would reverse itself after 5 years (60% vs. 23%); and that a man cannot ejaculate after vasectomy (38% vs. 13%). Fewer AA women had ever heard of intrauterine contraception (90% vs. 98%). Racial differences in knowledge remained statistically significant after adjusting for socioeconomic confounders.
Misinformation about sterilization and limited awareness of contraceptive alternatives among AA women may contribute to racial disparities in tubal sterilization rates.

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Available from: Sonya Borrero
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    • "Such variations may be explained in part by racially driven attitudinal differences and/or preference for the procedure (Potter et al., 2012). For instance, Black women are more likely to express familiarity with the procedure and to desire a method that does not require insertion of a foreign object (Borrero et al., 2011). Nonetheless, given the higher likelihood of Medicaid usage in low-income Black and Latina women (Borrero, Zite, & Creinin, 2012) coupled with persistent findings that a disproportionate share of sterilizations are covered by Medicaid (ACOG, 2012; Bass & Warehime, 2009; Chan & Westhoff, 2010; Hillis et al., 1999; MacKay et al., 2001); we agree with Bass' argument that greater usage may reflect a restricted set of reproductive options (2009). "
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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.
    Full-text · Article · Aug 2015 · Women s Health Issues
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    • "Lingering safety or ethical concerns about LARCs or sterilization may increase misperceptions about the methods or inhibit their use, both in the general population and among communities historically targeted by coercive contraceptive practices (Higgins, 2014). There is a growing body of research investigating knowledge and perceptions of LARCs among adolescents (Brown, Auerswald, Eyre, Deardorff, & Dehlendorf, 2013), young adults (Kavanaugh et al., 2013; Spies et al., 2010), and Latinas (White, Hopkins, Potter, & Grossman, 2013), as well as attitudes toward sterilization among women of color (Borrero et al., 2011; Borrero, Nikolajski, Creinin, Arnold, & Ibrahim, 2009). However, more work is needed to develop an effective public health strategy for helping women to achieve their desired family planning size that ensures full access to quality information and services and respects the rights of all women. "
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    ABSTRACT: Long-acting reversible contraception (LARC) and sterilization are popular contraceptive methods. However, they have been associated with safety concerns and coercive practices. We aimed to understand women's opinions and experiences related to these methods, including whether the methods' fraught histories influence use or interest. Between May and July 2013, we conducted an online survey with a convenience sample of 520 women aged 14 to 45. We used quota sampling to ensure women of color were at least 60% of our sample. Descriptive statistics, χ(2) tests, and multivariable logistic regression were used to estimate participants' awareness of, interest in, and experiences with LARCs and sterilization. Overall, 30% of women reported current LARC use and 67% interest in future LARC use. Four percent reported sterilization use and 48% interest in future sterilization. In multivariate analyses, current LARC use was lower among Asian women versus White women (odds ratio [OR], 0.24), and interest in future use was higher among women aged 14 to 24 versus 35 to 45 (OR, 5.49). Interest in sterilization was higher among women aged 14 to 24 and 25 to 34 versus 35 to 45 (ORs, 3.29-3.66) and women with disabilities (OR, 1.64), and lower among Black compared with White women (OR, 0.41). Method misperceptions were evident, and concerns about contraceptive coercion were reported. Concerns about contraceptive coercion were not predominant reasons for noninterest in LARCs and sterilization, but were reported by some participants. Lower sterilization interest among Black women and higher sterilization interest among women with disabilities warrant further research. Efforts to address misperceptions about LARCs and sterilization, including their safety and efficacy, are needed. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
    Full-text · Article · Mar 2015 · Women s Health Issues
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    • "of 191 Black and White women who had undergone tubal sterilization found that Black women were nearly twice as likely as White women to think that sterilization reversal could easily restore fertility ( 62% vs . 36% ) and nearly three times as likely to believe that a woman ' s sterilization would reverse itself after five years ( 60% vs . 23% ) ( Borrero et al . , 2011 ) . When sterilization is not freely chosen , as is the case for many surgeries due to medical problems , it can lead to regret and psychological distress for women and couples . A longitudinal study of 1140 premenopausal women who underwent hysterectomy surgery revealed that over 10% of the women expressed regret about not being able t"
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    ABSTRACT: Surgical sterilization is a relatively permanent form of contraception that has been disproportionately used by Black, Hispanic, and Native American women in the United States in the past. We use a nationally representative sample of 4,609 women ages 25 to 45 to determine whether sterilization continues to be more common and consequential by race for reproductive-age women. Results indicate that Native American and Black women are more likely to be sterilized than non-Hispanic White women, and Hispanic and Native American women are more likely than non-Hispanic White women to report that their sterilization surgeries prevent them from conceiving children they want. Reasons for sterilization differ significantly by race. These findings suggest that stratified reproduction has not ended in the United States and that the patterns and consequences of sterilization continue to vary by race.
    Full-text · Article · Nov 2014 · Social Science Research
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