Female Sterilization in Latin America: Cross-National Perspectives

Abstract

Fertility levels have dropped substantially in Latin America in recent decades, fuelled by increased contraceptive use and notably a method mix skewed towards female sterilization. This study examined choice of female sterilization in four Latin American countries: Brazil, Colombia, the Dominican Republic and Peru. Data were drawn from national Demographic and Health Surveys conducted in 1995-1996. Discrete-time hazard models were used on the five-year calendar modules of women's reproductive histories to consider the effects of a number of sociodemographic and contextual determinants as they pertained to status at the moment of the event. The results revealed that the likelihood of a woman's having undergone contraceptive sterilization was increasing over time in Brazil and Peru, suggesting that the potential for future growth of this method remains strong. A consistent pattern of increased probability of sterilization with higher education was seen across all countries, seemingly dispelling certain controversial claims that the procedure may have been disproportionately performed on the poor. At the same time, the multilevel analytical approach pointed to significant cluster-level random effects, suggesting that there were additional unmeasured contextual influences on women's propensity to choose sterilization.

Determinants of Tubal Ligation in Puebla, Mexico

“…9% in 19799% in to 44% in 20009% in (CONAPO, 1999CONAPO, 2004), while use of other, reversible, means of contraception has declined (Miranda, 2006). Similar trends have been seen in other parts of Latin America and the Caribbean (Leite et al, 2004), with a TL prevalence of up to 50% in some countries (Population Reference Bureau, 2008). Our results echoed this trend of increasing use of TL during the span of years represented by these participants.…”

“…Because having surpassed her own ideal level of fertility increases a woman's risk of TL in Mexico (Zuñiga-Herrera, 2004), seeing a peak at parity of 5 to 7 suggests that while fertility overall may drop, some women may still desire larger families. At the same time, in countries where TL occurs frequently, the peak of TL risk comes at lower parities (Leite et al, 2004), suggesting that those women who do decide to undergo TL may be more comfortable doing so sooner in a context in which TL is frequent and familiar.…”

“…Interviews included questions about characteristics found in other studies to be related to a woman's decision to undergo TL (Adesiyun, 2007;Carvalho et al, 2004;Chen et al, 2008;Gilliam et al, 2008;Landry, 1990;Leite et al, 2004;Martin and Wu, 2000;Westhoff and Davis, 2000). Demographic questions included age, marital status, years of education, and occupation.…”

“…Over half had six years of schooling or less, with an overall mean of 8.1 years of schooling. Education, which can be reasonably assumed to have been completed before women started their families, provides a proxy of socio-economic status prior to TL (Leite et al, 2004). …”

“…TL is an effective and reliable method by which women can choose to limit the number of children they will bear (Leite et al, 2004). Post-partum TL by removal of a portion of the fallopian tubes is the most effective method, with a 10-year failure rate of 7.5/1000 procedures, while other methods of TL, mostly used beyond the post-partum period, have somewhat higher failure rates (between 7.5 and 36.5/1000 procedures depending on the method used; Peterson et al, 1996).…”