A Comparative Study of Sterilization Regret: Analysing the Differential Effects of Social, Economic and Service-related Factors in EAG and non-EAG States in India

Abstract

Background Globally, sterilization has become a popular method of contraception. But since 1994, there has been notable change in the global landscape, with a decrease in the frequency of female sterilization everywhere except in Central and Southern Asia, where it has increased significantly, from 17% to 21.8% in 2019. The National Family Health Survey-5 (NFHS-5, 2019-2021) reveals a significant reliance on permanent sterilization among Indian women, with 38% opting for this method—a 2% increase from NFHS-4 (2015-2016) out of this 4.92%, 4.82%, 5.46% women reported regret of sterilization in India, non-EAG states and EAG states respectively. Data and Methods The study uses data from NFHS 1, NFHS 3, NFHS 4. We have been majorly used NFHS 5 data to explore the experience of regret among ever-married women aged 15-49 who underwent female sterilization between Empowered Action Group states (EAG states) and non-empowered Action Group states (Non-EAG States) with socio-economic variables, types of facility and women characteristics etc. The method used to analyses are bivariate analysis, chi-square test, and binary logistic regression. Results The trend of regret of female sterilisation reveals that from NFHS 1 to 5, there was a decline in regret percentages during NFHS 3, followed by subsequent fluctuations with an initial increase and subsequent decrease during NFHS 5, observed across both Empowered Action Group (EAG) and non-EAG states. The findings from the bi-variate analysis of sterilization regret in Hindus shows 4.8% of surveyed women conveyed remorse regarding their decision to undergo sterilization. Regionally, the regret percentage was slightly higher in Empowered Action Group (EAG) States, accounting for 5.8%, compared to 4.2 % in non-EAG states. The findings derived from the regression analysis indicates the analysis indicates in EAG states Muslim women have a 19 % (OR-1.19; CI-1.10-1.3; P-0.03) higher likelihood of regretting sterilization whereas in non-EAG states Muslim women have an 81 % (OR-1.81; CI-1.64-1.98; P-0.00) higher likelihood of regretting sterilisation. Quality of care emerges as a pertinent factor, with women rating care during and after sterilization as "bad" exhibiting a higher likelihood of regret (OR-4.70; CI-3.551-6.13; P-0.00) in EAG states, (OR-1.79; CI-1.306-2.445, P-0.00) in non-EAG states. In non-EAG states, women undergoing sterilization at other facilities exhibit a higher likelihood of regret compared to those choosing public facilities (OR-1.92; CI-1.123-3.279, P-0.02). Child loss after sterilization emerges as a significant predictor of regret, with women who have lost a child exhibiting a higher likelihood of regret in EAG states (OR-1.99; CI-1.704-2.315; P-0.00), non-EAG states (OR-2.30; CI-1.992-2.661; P-0.00). Conclusion The factors contributing to sterilization regret encompass a spectrum of influences, prominently featuring religion, parity of women, son preference, child loss, and the perceived quality of care post-sterilization. Among these, religion emerges as a particularly influential determinant, with a distinctive pattern observed at the national level in India. Consequently, states should persist in their efforts to reduce infant mortality rate and focused to prioritizing quality care to help reduce regret to sterilization in female. States can also promote other kind of contraceptive those have no negative impact of female body.