Race, Insurance Status, and Tubal Sterilization

Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Obstetrics and Gynecology (Impact Factor: 5.18). 02/2007; 109(1):94-100. DOI: 10.1097/01.AOG.0000249604.78234.d3
Source: PubMed


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.

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Available from: Matthew Reeves, Feb 03, 2015
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    • "In fact, 12% of women receive Medicaid coverage yet 41% of postpartum tubal sterilizations are paid by Medicaid (ACOG, 2013). Prompting additional concerns are higher rates of regret and sterilization misinformation among Black women (Borrero et al., 2007), and findings that low-income Black and Latina women are more often advised to limit childbearing (Downing et al., 2007). Further motivating our research is the dearth of information on postpartum sterilizations performed during C-section. "
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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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    ABSTRACT: To examine the independent effects of race/ethnicity and insurance status on desire for tubal sterilization reversal. Secondary analysis of cross-sectional data collected by the 2002 National Survey of Family Growth (NSFG). Interviews were conducted in person by a trained female interviewer in the participant's home. The NSFG is designed to represent women and men 15-44 years of age in the U.S. household population. The sample consisted of 934 women who had undergone tubal sterilization at any time before being interviewed. None. Desire for sterilization reversal. Among women older than 30 years at time of surgery, black women were significantly more likely to desire sterilization reversal compared with white women (adjusted odds ratio, 2.6; 95% confidence interval, 1.2, 5.8). In the total cohort and in the subset of women 30 years or younger, there were no significant racial/ethnic variations in desire for sterilization reversal. Among women over age 30 at the time of tubal sterilization, black women were much more likely to express desire for reversal than white women.
    Full-text · Article · Oct 2007 · Fertility and sterility
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