Women, men, and contraceptive sterilization

Abstract

Objective: To review the social and behavior contexts of decisions about contraceptive sterilization and to analyze factors associated with sterilization choices.

Design: Multinomial logit regression of sterilization.

Patient(s): Various subsamples as appropriate to specific analyses drawn from the 10,847 women interviewed in the 1995 National Survey of Family Growth, and the 5,227 men interviewed in the National Survey of Families and Households.

Intervention(s): None.

Main outcome measure(s): Tubal sterilization and vasectomy.

Result(s): Surprisingly high proportions of recent tubal sterilizations were performed on unmarried women: 1 in 3 overall, 1 in 5 among white non-Hispanic women, and 2 in 3 among black women. Sterilization choice among continuously married couples also revealed large differences by race and ethnicity. Parity at the time of the last wanted birth is a major factor affecting sterilization choices, although significant effects were found as well as for a number of other variables, including age differences between spouses, education, and religion. Compared with other regions, the ratio of tubal sterilizations to vasectomies is extremely low in the Western region of the United States.

Conclusion(s): Analysis of sterilization decisions must be based on time since the completion of childbearing. The findings call attention to the need for measuring variables that mediate observed associations with sterilization outcomes.

PIP: This study was conducted to review the social and behavior contexts of decisions about contraceptive sterilization and analyze factors associated with sterilization choices. Various subsamples were drawn from the 10,847 women interviewed in the 1995 National Survey of Family Growth, and the 5227 men interviewed in the National Survey of Families and Households in the US. Using multinomial logistic multiple regression, subgroup differences in the probability of having sterilization within 5 years of the last wanted birth were compared. The two outcome measures of the study were tubal sterilization and vasectomy. Significantly high proportions of tubal sterilization were performed on never-married women: 1 in 3 overall, 1 in 5 among White non-Hispanic women, and 2 in 3 among Blacks. Sterilization choice among continuously married couples also revealed large differences by race and ethnicity. Parity at the time of the last wanted birth is a major factor affecting sterilization choices, although significant effects were found, as well as for a number of other variables, including age differences between spouses, education, and religion. Compared with other regions, the ratio of tubal sterilization is extremely low in the Western region of the US. In conclusion, analysis of sterilization decisions should be based on time since the completion of childbearing. The results suggest the need for measuring variables that mediate observed associations with sterilization outcomes.