A model of pre-sterilization ambivalence and post-sterilization regret in married couples

"We have presented a general theoretical perspective on couple decision-making and subsequent adaptation which serves as a framework for understanding the complex phenomenon commonly referred to as post-sterilization regret. We have anchored this framework by means of a series of specific hypotheses about ambivalence and post-sterilization regret among both tubal ligation and vasectomy married couples. Using our hypotheses, we constructed three models. These were tested on data gathered from 400 married couples.... The results, including unanticipated pathways and differences in specific areas of each model between sexes and method groups, not only provide a confirmation of our general theoretical perspective but also allow us to have insights and to speculate about the psychological and marital dynamics of sterilization decision-making and adaptation." Data are from a longitudinal study conducted in Santa Clara, California, in 1985.

Sterilisation of married couples: husband versus wife sterilisation

Sterilisation has been increasing in the United States in recent decades. Using the National Survey of Families and Households, this paper examines sterilisation among married couples using event history techniques, viewing husband and wife sterilisation as competing risks. Wives are more likely to experience sterilisation and at shorter durations of marriage. Number of children has a curvilinear effect on sterilisation, increasing and then decreasing its likelihood. Wives who are older than their husbands are more likely to get sterilised themselves. Black and Hispanic husbands are more likely to undergo sterilisation.

A comprehensive and efficient process for counseling patients desiring sterilization

To optimize the time spent counseling a sterilization patient, this article presents a 10-step process that includes all steps necessary to ensure a comprehensive counseling session: (1) Discuss current contraception use and all available methods; (2) assess the client's interest in/readiness for sterilization; (3) emphasize that the procedure is meant to be permanent, but there is a possibility of failure; (4) explain the surgical procedure using visuals, and include a discussion of benefits and risks; (5) explain privately to the client the need to use condoms if engaging in risky sexual activity; (6) have the client read and sign an informed consent form; (7) schedule an appointment for the procedure and provide the patient with a copy of all necessary paperwork; (8) discuss cost and payment method; (9) provide written preoperative and postoperative instructions; and (10) schedule a postoperation visit, or a postoperation semen analysis.

Female sterilization in Ramathibodi Hospital: 1987-1993

A 7 year (1987-1993) restropective review of female sterilization in the Department of Obstetrics and Gynecology, Ramathibodi Hospital was reported. This paper is part of a continuing study of female sterilization in Ramathibodi Hospital. A total of 9,968 cases of female sterilization was done from January 1987 to December 1993. Post partum acceptors accounted for 63 per cent of total female sterilization, the overall postpartum female sterilization rate was 117.4 per 1,000 deliveries. 37 per cent was interval sterilization. The peak of interval sterilization was in March. 69.8 per cent of interval sterilization was performed by minilaparotomy technique, the remainder were by laparoscopy.

The pre- and poststerilization predictors of poststerilization regret in husbands and wives

Husbands and wives from 141 tubal sterilization couples and 162 vasectomy couples were interviewed just prior to sterilization and then again 1 and 2 years later. We conducted linear regression analyses to determine the pre- and poststerilization predictors of poststerilization regret in each of the four gender x method groups (tubal husbands, tubal wives, vasectomy husbands, vasectomy wives). We confirmed a number of hypotheses based on the research literature and our own earlier work. Both individual and couple factors contributed to the development of regret, as did both pre- and poststerilization factors. An important finding was the degree to which regret among the nonsterilized respondents (tubal husbands, vasectomy wives) was affected by pre- and poststerilization interaction with their spouses.

Tubal sterilization or vasectomy: how do married couples make the choice?

OBJECTIVE

To examine the relative importance of husband, wife, and couple factors as determinants of sterilization method choice.

DESIGN

Married couples seeking sterilization interviewed before surgery and again 1 year later.

SETTING

Kaiser Permanente Medical Care Program subscribers seeking care at the Kaiser Foundation Hospital, Santa Clara, California.

PARTICIPANTS

Two hundred married women seeking a tubal sterilization and their husbands and 200 married men seeking a vasectomy and their wives.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Sterilization method chosen.

RESULTS

In a logistic regression model, nine predictor variables correctly classified 94.9% of 395 couples (P less than 0.000).

CONCLUSIONS

The choice of a sterilization method is achieved primarily through processes that involve both spouses. The motivations of both husband and wife, their mutual influence and communication, their present pattern of contraceptive use, and what they know about the satisfactions or dissatisfactions of other people who have had sterilizations are all factors that should be taken into account when the clinician helps a patient make the method-choice decision.

Voluntary sterilisation among Canadian women

Using data from the 1984 Canadian Fertility Survey, proportional hazards modelling was employed to determine factors associated with the likelihood of voluntary sterilisation among 5315 women of childbearing age, and the trends in timing and differences in the likelihood associated with different age cohorts. Multivariate analysis suggests that educational attainment, parity and duration since last birth at the time of sterilisation, religious commitment, province of residence and marital status at the time of sterilisation, are all important predictors. Education and parity attainment emerged as the best predictors of the timing of voluntary sterilisation in all age cohorts, but the contribution of other covariates varies between cohorts.

An evaluation of Profamilia's female sterilization program in Colombia

The findings of three surveys and three studies used by Profamilia to evaluate and improve their voluntary female sterilization program are presented. The surveys measured sociodemographic characteristics of users, factors behind the sterilization decision, and user satisfaction with the operation in the short run and over time. The studies explored methodologies for more accurate cost-effectiveness analysis. Results of the projects were used by Profamilia management to identify areas of program strengths and weaknesses and to implement operational changes.

Vasectomy in review

In Queensland 60 per cent of vasectomies are performed by general practitioners. Recent statistics are reviewed and suggest a guide to the selection of men for the operation. Improvements in the technique, which increase the possibility of successful reversal, and which speed the testing for sterility, are discussed, and will be described in detail in a second article.

Regret of laparoscopic sterilization

A follow-up study with questionnaires was performed 4-8 years after laparoscopic sterilization. The follow-up questionnaires were answered for 90.5%. The study revealed that 7.1% of the women were dissatisfied at some stage with the decision to undergo sterilization. However, only 1.8% requested reversal of the sterilization. 40% of the dissatisfied women were between 25-29 years of age, and every fifth sterilized woman in this age group regretted the sterilization.

Incidence of hysterectomy and tubal ligation in public hospitals in south Australia, 1980-82

This paper presents information on the incidence of hysterectomy and tubal ligation in South Australia in the period 1980–82, and on the age, marital status and ethnicity of women undergoing these procedures in public hospitals during the period. A typical woman undergoing one of these procedures was married or previously married and in her mid-40s for hysterectomy or mid-30s for tubal ligation. South Australian women had a lifetime chance of one in six of undergoing hysterectomy and of one in five of undergoing tubal ligation. The findings are consonant with the suggestion that increasing numbers of women are choosing forms of sterilization as means of contraception.

What do women use when they stop using the pill?

Current use of oral contraceptives among currently married women aged 15-44 declined from 25 percent to 13 percent between 1973 and 1982, while ever-use increased from 60 percent to 80 percent. By 1982, the pill appeared to be used mainly to delay first pregnancies, secondarily to space subsequent conceptions, and only rarely as a means of ending childbearing. Most women who had stopped using the pill by 1982 had done so on their own initiative: Only about one-third had been advised by a doctor to discontinue use. Virtually all former users gave some physical problem connected with pill use as a reason for quitting the method. At the time they quit, former users had been taking the pill for an average of 3.2 years. The decline in current use of the pill during the 1970s coincided with a marked increase in contraceptive sterilization, but was not the result of a direct switching from the pill to sterilization by individual women. Only 21 percent of women who quit the pill chose sterilization as their next method. The majority--60 percent--switched to nonpermanent methods, the condom being the most popular in all age-groups; the proportions selecting the condom as their next method ranged from 20 percent of 15-19-year-olds to 12 percent of 30-44-year-olds. Nineteen percent of former pill users did not adopt any method after discontinuing the pill.

Interval out-patient female sterilization in Lagos

Out-patient sterilization services were introduced by the Family Planning Clinic of the Department of Obstetrics and Gynaecology, College of Medicine, Lagos, in September, 1981. This paper reviews the results of the first five years of its availability. There were 96 out-patient interval sterilizations, 47 were by the laparoscopic and 49 by the minilaparotomy procedures, representing 0.7% of maternities. Both local and general anaesthesia was used for the procedures. The patients' ages ranged from 28-52 years, all but three being above 31 years. Their parity ranged from 2-15 with between 2-10 living children. Only five patients had less than four children. 37.5% had used no contraception before. Termination of pregnancy was performed at the same time as tubal ligation in 12.5%, and 75% of these were secondary to contraceptive failure. Three patients had emergency laparotomy although in only one was it related to the sterilization procedure. Three patients were observed for 24 hours with no complications. Two patients were re-admitted after one week with pelvic peritonitis. The major complication rate was 3.1%. The failure rate was one per cent. There have been no requests for reversal. The results are compared with those of patients having puerperal sterilization during the same period, who totalled 2% of the maternities.

Reversal of female sterilisation: a comparative study

In 80 women who had reversal of sterilisation, a study was made of their clinical features at the time of sterilisation and of the factors related to successful outcome. Compared with controls at the time of sterilisation, the women requesting reversal were younger, of lower social class and of higher parity; in addition they were more likely to have an unstable relationship and to have been sterilised following a recent pregnancy. After reversal, intrauterine pregnancy occurred in 26/80 (32.5%) and ectopic pregnancy in 6/80 (7.5%), the majority of successful pregnancies occurring in younger women within one year of reversal following a non-destructive method of tubal occlusion. There was no evidence that techniques of management, including the use of an operating microscope, significantly influenced outcome, and controlled trials will be required to establish their efficacy.

Mortality associated with sterilization: preliminary results of an international collaborative observational study

Sterilization is the contraceptive method most widely used worldwide, yet the case-fatality rate of deaths attributable to sterilization is not known. We used data collected from 1971-1979 from 28 countries by Family Health International to estimate case-fatality rates. We adjusted these rates for individuals lost to follow-up. Of 41,834 sterilizations, 23 resulted in deaths temporally associated with the procedure used. The adjusted attributable case-fatality rates were 13.4 per 100,000 for interval procedures, 53.3 per 100,000 for postabortion procedures, and 43.4 per 100,000 sterilizations after vaginal delivery. Multiple factors contributed to the deaths, including pre-existing health problems, infection and anesthesia. Prevention of deaths resulting from sterilization depends on complete ascertainment of deaths associated with sterilization and careful investigation to determine preventable risk factors. We conclude that, overall, sterilization in these programs was conducted with very low attributable mortality.

Who has a vasectomy reversal?

The characteristics of the first 200 cases of vasectomy reversal have been analysed. The mean time from vasectomy to reversal was 4.8 years. It varied according to the reason for requesting reversal, and was particularly short when the operation had been performed at the time of the partner's pregnancy. Thirty percent of the men were with the same partner and 70% a new partner. Vasectomy reversal cases tended to be younger than vasectomy patients as a whole but did not differ significantly in social class. In this series of reversals, spermatozoa were present in the ejaculate throughout the 20-week follow-up time in 80% of the men; the pregnancy rate was 44%.

Recent changes in the sociodemographic profile of sterilization acceptors in Nepal

The records of 8056 Nepalese males and 9291 females sterilized from 1979-1983 were analyzed. Compared with data from previous studies (1970-1976), significant decreases occurred in the average age of female acceptors (30.6 vs. 33.1, P less than 0.01) and wives of male acceptors (28.4 vs. 31.7, P less than 0.01). Also, the average number of living children per couple decreased by one child (4.9-3.9, P less than 0.01) for male acceptors and 0.6 (4.8-4.2, P less than 0.01) for female acceptors. Finally in 83.2% of the cases, the operation was performed within 3 years of the last delivery.

Social and psychological perspectives on voluntary sterilization: a review

This paper reviews social science research on the antecedents and consequences of voluntary sterilization. The major conclusions are that socioeconomic status has little impact on the decision to be sterilized and that sterilizations are rare among those without sons and among male non-whites. Significant others are important sources of encouragement and information, and good marital relations increase the likelihood of having the procedure performed. Most acceptors experience no change in sexual activity, quality of marital relationships, or work-related behavior, and few regret their choice. Negative consequences are more likely among those in India, those coerced into having a sterilization, those who did not understand the consequences of the procedure, those with health complications after sterilization, and those couples who have unstable marriages or who disagree about sterilization.

Fertility, sterilization, and population growth in Shanti Nagar, India: a longitudinal ethnographic approach

The results of the 1981 Indian census showed a slight increase in the rate of population growth despite an energetic governmental campaign to reduce fertility, the growing use of contraception, a substantial number of sterilized persons, and a declining birthrate. The longitudinal ethnographic analysis of population data from Shanti Nagar dating from the 1950s and the 1970s suggests that the growth rate of the population might be better understood if analytical emphasis were to be shifted somewhat from birth and death rates to survivorship, that is, the average number of living children per mother, thus focusing attention on the family, the social unit in which the decisions are made that give rise to national demographic rates and averages. Currently, the principle fertility decision that a Shanti Nagar couple must make is whether to undergo sterilization and how many children are deemed necessary before taking this step. Analysis of the Shanti Nagar data shows that women of completed fertility in the 1970s had more living children than comparable women in the 1950s, and that even the sterilized couples of the 1970s had only slightly fewer children than the almost entirely noncontracepting women of the 1950s. Although the age of women at their own (or their husbands') sterilization is falling and the operation takes place after fewer children than formerly, the average sterilized couple nonetheless has more than 4 children instead of the 2 or 3 that the Government of India prefers. An analysis of the relationship to fertility of various modernization variables, such as urbanization and enhanced economic status, fails to show any consistent correlation of such variables with reduced fertility. School attendance by females is perhaps the most promising of the modernization veriables, but its effect is somewhat ambiguous and relatively weak until women achieve the college level. Current trends suggest that soon after 2025, India may surpass China as the world's most populous nation.

Demography of sterilization: Indian experience

Using program statistics and a few local studies, the paper examines the prevalence of sterilization in India and makes demographic analysis of the performance. Major points of note are that the prevalence rates expressed in terms of currently married women showed irregular fluctuations across time and the age pattern of acceptance hardly agreed with that of the married population. The selectivity of high fertility couples for sterilization had been fairly high, resulting in a low fertility impact. Estimates of births averted due to the program were derived by using a computerized microsimulation model CONVERSE. It appears that the path of fertility changes was not smooth in the last decade and the impact has been, as a rule, greatest 2 years after acceptance.

A comparison of definable traits in women requesting reversal of sterilization and women satisfied with sterilization

More women of reproductive age are being sterilized. Some of these women regret the decision and subsequently request a reversal of sterilization, whereas others do not. This study was undertaken to develop a profile of easily definable traits of 159 women who requested a reversal of sterilization and compare it with that of 160 women who apparently were satisfied with sterilization. Statistically significant differences were found. Remarriage was the most common cause for regret among women in the group which requested reversal of sterilization. Women in this group married younger, completed their family earlier, and were sterilized at a younger age. These women had significantly fewer live children and had undergone more therapeutic abortions (p less than 0.005).

The choice of sterilization procedure among married couples

Surgical sterilization is playing a growing role in contraception among married couples. Both vasectomy and tubal ligation can be done as outpatient procedures. Neither procedure has overwhelming advantages over the other. This study sought to determine why one member of a couple, rather than the other, decided to undergo the sterilization procedure. There do not seem to be any significant demographic differences between those couples who choose vasectomy and those who select tubal ligation. Men may undergo vasectomy because they feel it is the easier procedure. A significant number of women also feel that vasectomy is easier, yet for various reasons they are motivated to undergo tubal ligation. In many couples, the choice is made because one partner will not consider becoming sterilized, and this is twice as likely to be the husband. Family physicians can play an important role in assisting couples to choose the best alternative.

Voluntary sterilization in Flanders

In a follow-up of males and females after voluntary surgical sterilization, the social characteristics of the applicants, their fertility and contraceptive history, their motivation, the indication for and mode of surgical contraception, the physical and psychological consequences of the operation, and the outcome of the selection and counselling procedures applied, were studied in a sample of 275 applications with a total of 540 subjects. The survey comprised the pre-operative examination, the first post-operative evaluation 4 months after surgery and the second after 12 months.

The main reasons for applying for sterilization were excess fertility due to contraceptive failures and side-effects of reversible contraceptive methods. Almost all of the patients were satisfied with the operation, one of the highest proportions reported so far. Nevertheless, many experienced a real adjustment period. Notwithstanding the careful pre-operative information and counselling, serious fears were often observed, and many found the operation more severe than expected. For the vast majority of the patients the operation had no influence on their family relations. The sexual relationship too was usually unchanged. If there were changes, the positive effects always exceeded the negative ones.

The high response to both the evaluations and the high proportions of satisfied individuals are in favour of the selection procedures and multidisciplinary counselling and follow-up practised.

A survey of sterilization acceptors in a family planning program in rural Bangladesh

The results of a survey of 275 Bangladeshi women who were sterilized at a rural family planning clinic are presented. The survey comprised two interviews of each woman: one conducted immediately prior to the sterilization procedure and the second conducted one month after each woman was sterilized. Sociodemographic data were gathered for the survey from the patients' clinic records. Reasons for the choice of sterilization and sociodemographic impact of the procedure are discussed, as are implications of the results on other rural family planning programs.