Interest in nonsurgical female permanent contraception among men in Portland, Oregon and eastern Maharashtra, India

OBJECTIVE

We examined the men's attitudes and perceptions toward the concept of female nonsurgical permanent contraception (NSPC) or novel approaches to permanent contraception (PC) that do not require incisions or surgical equipment/hysteroscope.

STUDY DESIGN

Cross-sectional survey of married/partnered men in Portland, OR, and rural eastern Maharashtra, India. Descriptive analysis was performed.

RESULTS

In India (N=150), most men (80%) anticipated that their partners would undergo PC in the future, compared to 30% in Portland (N=170). About a third (39.6% in India, 82% in Portland) reported being uncomfortable with PC for partners due to the need for surgery. Most men (85% in India, 82% in Portland) expressed a preference for a hypothetical new method of female NSPC over surgery, if safe and effective.

CONCLUSION

Most men sampled in two diverse settings expressed interest in NSPC for women.

IMPLICATIONS

Men's perceptions of new female contraceptive methods are important to the contraceptive development process. Men may find a safe and effective nonsurgical method of permanent female contraception more acceptable than surgical PC.

Unintended pregnancy influences racial disparity in tubal sterilization rates

BACKGROUND

Minority women are more likely than white women to choose tubal sterilization as a contraceptive method. Disparities in rates of unintended pregnancy may help explain observed racial/ethnic differences in sterilization, but this association has not been investigated.

OBJECTIVE

To examine the associations among race/ethnicity, unintended pregnancy, and tubal sterilization.

DESIGN AND PARTICIPANTS

Cross-sectional analysis of data from a nationally representative sample of women aged 15-44 years [65.7% white, 14.8% Hispanic, and 13.9% African American (AA)] who participated in the 2002 National Survey of Family Growth.

MAIN MEASURES

Race/ethnicity, history of unintended pregnancy, and tubal sterilization. A logistic regression model was used to estimate the effect of race/ethnicity on unintended pregnancy while adjusting for socio-demographic variables. A series of logistic regression models was then used to examine the role of unintended pregnancy as a confounder for the relationship between race/ethnicity and sterilization.

KEY RESULTS

Overall, 40% of white, 48% of Hispanic, and 59% of AA women reported a history of unintended pregnancy. After adjusting for socio-demographic variables, AA women were more likely (OR: 2.0; 95% CI: 1.6-2.4) and Hispanic women as likely (OR: 1.0; 95% CI: 0.80-1.2) as white women to report unintended pregnancy. Sterilization was reported by 29% of women who had ever had an unintended pregnancy compared to 7% of women who reported never having an unintended pregnancy. In unadjusted analysis, AA and Hispanic women had significantly higher odds of undergoing sterilization (OR: 1.5; 95% CI: 1.3-1.9 and OR: 1.4; 95% CI: 1.2-1.7, respectively). After adjusting for unintended pregnancy, this relationship was attenuated and no longer significant (OR: 1.2; 95% CI: 0.95-1.4 for AA women and OR: 1.3; 95% CI: 1.0-1.6 for Hispanic women).

CONCLUSION

Minority women, who more frequently experience unintended pregnancy, may choose tubal sterilization in response to prior experiences with an unintended pregnancy.

Female sterilization in New South Wales, 1981 to 1994-1995

This paper investigates and confirms the dramatic decline in female sterilization in New South Wales over the past decade, a period when male sterilization has remained fairly constant. The most significant decline occurred among women under 30 years of age, which resulted in a rise in the mean age at sterilization. In 1994-1995, 70% of sterilization operations were performed for contraceptive management only, 11% were concurrent with Caesarean section, and 9% with abortion. Incidental findings were an increase in Caesarean section and the proportion of women having concurrent sterilization, and a large decline in intrauterine device removals, more than half of which were accompanied with sterilization in 1994-1995. Currently-married women accounted for 80% of sterilization cases. Immigrant women generally had lower incidence of sterilization compared to the Australian-born.

Update on transcervical sterilization

Transcervical sterilization techniques as of 1980 are reviewed. A personal and literature search is reported on developments between 1980 and 1992. The potential of endometrial ablation for a transcervical method of fertility control is explored. An appraisal of the more promising methods for future study is made, including silastic tubal plugs, quinacrine, Femcept delivery of an iodine mixture and endometrial ablation.

The evolution of methods for female sterilization

Methods for the sterilization of women by occlusion of the Fallopian tubes have evolved by changes in the approaches to the tubes and trials of various methods for occluding the tubal lumen. Approaches to the tube have included: the anterior abdominal wall routes by laparotomy, minilaparotomy and laparoscopy; a vaginal approach through the posterior vaginal fornix; and transcervical approaches, either blind, or via the hysteroscope. Methods for obtaining tubal occlusion have included: excision and suture techniques; electrocautery; clips and rings; intratubal occlusive devices and chemicals introduced into the tubal lumen. The development of each of the approaches to the tube and of the methods for obtaining tubal occlusion are discussed.

Female sterilization in Thailand: past, present and future

Female sterilization is the most effective contraception and has a very high demographic effectiveness. In the past, there have been developments in technological aspects. At present, the minilaparotomy and laparoscopic sterilization have been well developed and widely used, but the number of new acceptors is declining, and there is still a large number of unmet demands. Social action rather than technological action is needed. In the future, steps to increase the number of acceptors, are, proper management of the sterilization services, including adequate monitoring and a good surveillance system.

Trends in contraception and sterilization in Australia

Life-history data collected in a national survey of women in 1986 are used to derive the first national estimates of trends in contraception and sterilization in Australia over the last 30 years. The pill rapidly became the method of choice after its release in 1961. The intrauterine device, the other truly modern method, has never attained the same popularity. The move toward sterilization dates from the early 1970s and has been so complete that women of 35 or older are now more likely to be protected by a ligation or laparoscopic sterilization than by the pill or, indeed, by all other methods combined. Unmarried women are now indistinguishable from married women on the basis of their use of contraception, and childless married women are now more likely to be using a reversible method than married women with children.

[The effect of cesarean section deliveries on female sterilization in Puerto Rico]

For the last decades Puerto Rico has had the highest rate of female sterilization of the world. However, it was to be expected that the increasing trend will slow down with the appearance of new and effective birth control methods and the increasing educational level of the population. The data obtained from an island-wide sample survey undertaken in 1982 demonstrated that this was not the case and that the rate of female sterilization continued to increase. The authors hypothesis was that this unexpected situation was a result of the remarkable increase observed in cesarean childbirth in the Island. Thus, the main objective of this study was to examine the relationship between cesarean childbirth and female sterilization. Utilizing the 1982 sample survey data the authors demonstrated that surgical deliveries had increased so rapidly during the last decades that Puerto Rico seems to be the leading country of the world, confirming the findings of a 1980 study. These data also showed that there was a very strong association between cesarean childbirth and female sterilization. A partial correlation analysis tend to demonstrate that surgical delivery in Puerto Rico, is at present, a stronger determinant of female sterilization than fertility.

Sterilization: Canadian choices

Significant differences in cost and safety between vasectomy and tubal ligation have been reported. For this reason the incidence of these two procedures between 1976 and 1986 was studied to obtain information upon which future policy decisions might be based. Although tubal ligation predominated in almost every province and year its rate declined by 27.6% over the study period, whereas the rate of vasectomy increased by 39.1%. When projected to 1988 the national rates for the two procedures became nearly equal; those for Quebec had become equal by 1986. Provincial differences were most marked in eastern Canada, where neighbouring provinces had the highest and the lowest rates of sterilization in the country. Given the relative economic and surgical disadvantages of tubal ligation, policymakers may wish to consider fostering an increased acceptance of vasectomy, particularly in areas where such acceptance continues to be slow.

Sterilization in the northeast of Brazil

Results of household surveys carried out in four states in the Northeast of Brazil showed that female sterilization is the most prevalent method among women who want no more children. Many women who indicated an interest in tubal ligation, however, had not been sterilized. Access to sterilization depends on the type of hospital in which the child was delivered and the type of delivery the woman had. Over 60% of the sterilized women reported that they had a tubal ligation at the time they were hospitalized for a cesarean delivery. Compared with unsterilized women, the sterilized women are characterized by relatively higher education levels and a greater likelihood of urban residence and were far more likely to have had cesarean deliveries and, therefore, to have qualified for postpartum sterilization on medical grounds.

Public policy and female sterilization in Costa Rica

For 20 years, female sterilization has been increasing in popularity as a contraceptive method in Costa Rica. However, contraceptive sterilization has never been allowed explicitly under Costa Rican law. In 1976 the Costa Rican National Assembly instituted more stringent guidelines regarding medical sterilizations in order to eliminate contraceptive sterilizations, which had been occurring under relatively loose interpretations of national policy. Data from the 1976 National Fertility Survey and the 1981 Contraceptive Prevalence Survey indicate that the change in policy had only a short-term effect. Period sterilization rates fell substantially after 1976 but rebounded considerably by 1980, and the estimate of the proportion of married women who will ultimately be sterilized was approximately .5 for the periods both before and after 1976.

Sterilization in Honduras: assessing the unmet demand

The purpose of this study was to evaluate and compare the availability of sterilization services at two hospitals in Honduras. Approximately 7,000 women who had given birth at the Hospital Materno Infantil in Tegucigalpa and the Hospital Leonardo Martinez in San Pedro Sula were asked about their desire for sterilization. Of the women who wanted to be sterilized, a considerable percentage had not been sterilized four months after they had given birth--58 percent of those who had delivered at Materno Infantil and 79 percent of those who had delivered at Leonardo Martinez. Twenty-three percent of the women who delivered at Materno Infantil and 4 percent of the women who delivered at Leonardo Martinez were sterilized before they were discharged. The difference may be attributed to the poor quality of the facilities at Leonardo Martinez.

Ectopic pregnancies in upstate New York

Data on ectopic pregnancies reported to the New York State Department of Health for upstate residents for the years 1971 through 1979 were analyzed by maternal age, race, and gravidity. Trends in the rate of ectopic pregnancies were also examined for this time period. The rate of ectopic pregnancies per 1,000 conceptions increased with increasing maternal age and was higher for nonwhite women compared with white women. There was a slight increase in the rate of ectopic pregnancies with increasing gravidity, but this was due in part to the interaction of age with gravidity. The rate of ectopic pregnancies per 1,000 conceptions increased by 217% from 1971 to 1979. This trend differed within subgroups of maternal age, race, and gravidity. The percentage of increase was greater for women 30 years of age or older compared with women 30 years of age or younger, greater for white women compared with nonwhite women, and greater for women with three or more previous pregnancies compared with women with fewer previous pregnancies.

Family planning and female sterilization in the United States

This report critically examines the issue of sterilization in the United States based on data from the National Survey of Family Growth, Cycles I and II, spanning the years 1973 to 1976. Of particular concern is analysis of sterilization rates as they vary across categories of race, socioeconomic status, welfare status, number of children and desire for the service. The development of a framework containing competing theories and philosophies, based upon previous literature in the area, provides a useful paradigm for an understanding of the significance of sterilization rates. The methodology includes bivariate techniques involving tabular analysis as well as multivariate techniques through the use of logistic regression analysis. Findings support hypotheses related to class factors and parity, while the racial and altruistic interpretations are not supported. Policy implications and areas requiring further research are specified.

Cumulative prevalence rates and corrected incidence rates of surgical sterilization among women in the United States, 1971--1978

The authors used data from the 1970 National Fertility Survey and Centers for Disease Control surveillance of surgical sterilizations to estimate the cumulative prevalences of hysterectomy and tubal sterilization among women of reproductive age in the United States between 1971 and 1978. In 1978, the cumulative prevalence rate of tubal sterilization was more than twice as high for women aged 15--44 years as it was in 1971 and at least three times as high for women under 30. Although the increase in the cumulative prevalence rate of hysterectomy was not as marked, by 1978, 19% of women aged 40--44 had undergone hysterectomy. The authors used the cumulative prevalence rate to estimate the population at risk for surgical sterilization, and calculated the corrected incidence rates for these procedures. While corrected incidence rates of tubal sterilization among women aged 15--44 doubled between 1971 and 1978, corrected hysterectomy rates remained stable. The largest age-specific increase in incidence rates of tubal sterilization was among women 40--44, with rates six times higher in 1978 than in 1971. These findings can be used to recompute incidence rates of endometrial and cervical cancers, abortions, and ectopic pregnancies, allowing more precise analysis of related trends.

The impact of laparoscopy on tubal sterilization in United States hospitals, 1970 and 1975 to 1978

During the 1970s, tubal sterilization became an important method of fertility control in the United States. Over the same period laparoscopy emerged as an important innovation, one that has been associated with both a shift from postpartum to interval sterilization and a dramatic decrease in length of hospital stay required for sterilization. The use of laparoscopy has also been associated with an increase in hospital-based outpatient sterilization, particularly in the West. The number of sterilizations performed in hospitals and the use of laparoscopy for interval sterilization in hospitals both appear to have peaked. The laparoscope is an example of a technologic advance that has reduced medical care costs.

Demographic trends of tubal sterilization in the United States 1970-75

An estimated 2,300,000 women in the United States underwent tubal sterilizations in 1970-1975. During this period the rate of tubal sterilizations per 1,000 women 15-44 years of age rose from 4.7 to 11.7. We studied the influence on sterilization trends of four demographic variables: age, region of residence, race, and marital status. Women 25-34 years of age were twice as likely to be sterilized as older or younger women. Rates were about 40 per cent lower in the West than in the rest of the country. In 1970 rates for non-white women were double those for Whites. Rates for Whites rose faster than those for non-Whites, however, and by 1975 the rates were similar for the 2 races. Non-Whites still tended to be sterilized about one year younger than Whites, and marked regional differences existed in the race-specific rate trends. Rates rose more sharply for previously married women than for currently married women; by 1975 rates for these two groups were similar. Never married women had rates about 1/7 of those of currently married and previously married women. Among the never married, tubal sterilization rates for non-Whites were nine times higher than those for Whites.

Prospects for improved contraception

Some important new birth control methods have been developed in the postpill, post-IUD era; others are on the way. But shrinking dollars in research (especially R&D), inadequate coordination and planning by donors and programs, and costly and complex regulatory requirements frustrate efforts to use current knowledge to make major breakthroughs.

Puerperal tubal ligation in Cape Town

Major changes have occurred in the nature of the obstetric population under the care of the Department of Obstetrics and Gynaecology in Cape Town between 1974 and 1978. In the Coloured group, a settled population, these changes were: a decrease in the number of teenage deliveries, a shift from the very young to the older teenage patient, and a decrease in the number of elderly obstetric patients and of grand multiparas. Puerperal sterilization virtually doubled during this period. Similar trends in Black and White patients must be interpreted with caution since the former constitutes a shifting population and the latter are not representative of White obstetric practice in Cape Town. Family planning education and the greater acceptance of voluntary sterilization have contributed to the declining numbers of socially and obstetrically disadvantaged patients.