Frustrated Demand for Sterilization Among Low‐Income Latinas in El Paso, Texas

Potter, Joseph E.; White, Kari; Hopkins, Kristine; McKinnon, Sarah; Shedlin, Michele; Amastae, Jon; Grossman, Daniel

doi:10.1363/4422812

Cited by 41 publications

(62 citation statements)

References 21 publications

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“…African American and Latina women report their providers dissuaded them from getting a sterilization because they were seen as too young or having too few children [6,7]. Low-income women also cite Medicaid-eligibility requirements, such as signing a consent form 30 days in advance of the procedure, as barriers to obtaining a desired postpartum sterilization [7–10]. Moreover, the inability to obtain a sterilization postpartum may result in subsequent unintended pregnancies [11].…”

Section: Introductionmentioning

confidence: 99%

Reconsidering racial/ethnic differences in sterilization in the United States

White

Potter

2014

Contraception

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Objective Cross-sectional studies have found that low-income and racial/ethnic minority women are more likely to use female sterilization and less likely to rely on a partner’s vasectomy than women with higher incomes and whites. However, studies of pregnant and postpartum women report that racial/ethnic minorities, particularly low-income minority women, face greater barriers in obtaining a sterilization than do whites and those with higher incomes. In this paper, we address this apparent contradiction by examining the likelihood a woman gets a sterilization following each delivery, which removes from the comparison any difference in the number of births she has experienced. Study Design Using the 2006–2010 National Survey of Family Growth, we fit multivariable-adjusted logistic and Cox regression models to estimate odds ratios and hazard ratios for getting a postpartum or interval sterilization, respectively, according to race/ethnicity and insurance status. Results Women’s chances of obtaining a sterilization varied by both race/ethnicity and insurance. Among women with Medicaid, whites were more likely to use female sterilization than African Americans and Latinas. Privately insured whites were more likely to rely on vasectomy than African Americans and Latinas, but among women with Medicaid-paid deliveries reliance on vasectomy was low for all racial/ethnic groups. Conclusions Low-income racial/ethnic minority women are less likely to undergo sterilization following delivery compared to low-income whites and privately insured women of similar parities. This could result from unique barriers to obtaining permanent contraception and could expose women to the risk of future unintended pregnancies.

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Section: Introductionmentioning

confidence: 99%

Reconsidering racial/ethnic differences in sterilization in the United States

White

Potter

2014

Contraception

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“…We are confident of the reliability of the probe regarding desire for sterilization at the time of the last delivery based on a prior study in El Paso. There, we re-interviewed women about 18 months after initially asking this question and found that the large majority still wanted to be sterilized and expressed coherent reasons for this desire(16). We do not yet have such confirmation for the probe regarding interest in LARC, but restricting the criteria for interest in LARC to women who had stated such a preference before the prompt would not alter the results substantially.…”

Section: Discussionmentioning

confidence: 99%

“…In the baseline and 3-month interviews we asked about the method of contraception the participant would like to be using at 6 months after delivery. At the 6-month interview, we also elicited latent demand for LARC and permanent methods with additional questions based on our previous findings that a large percentage of women using oral contraception would have preferred to use one of these more effective methods(16). Non-sterilized women who wanted no more children were asked whether they wished they had been sterilized before leaving the hospital after delivery, and if they would like their husbands to get a vasectomy.…”

Section: Methodsmentioning

confidence: 99%

Barriers to Postpartum Contraception in Texas and Pregnancy Within 2 Years of Delivery

Potter

Hubert

Stevenson

et al. 2016

Obstetrics & Gynecology

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Objectives To assess pregnancies that could have been averted through improved access to contraceptive methods in the 2 years after delivery. Methods In this cohort study, we interviewed 403 postpartum women in a hospital in Austin, Texas who wanted to delay childbearing for at least 2 years. Follow-up interviews were completed at 3, 6, 9, 12, 18, and 24 months after delivery; retention at 24 months was 83%. At each interview, participants reported their pregnancy status and contraceptive method. At the 3- and 6-month interviews participants were also asked about their preferred contraceptive method 3 months in the future. We identified types of barriers among women unable to access their preferred method, and used Cox models to analyze the risk of pregnancy from 6 to 24 months after delivery. Results Among women interviewed 6 months postpartum (n=377), two thirds experienced a barrier to accessing their preferred method of contraception. By 24 months postpartum, 89 women had reported a pregnancy; 71 were unintended. Between 6 months postpartum and 24 months after delivery, 77 of 377 became pregnant (20.4%) with 56 (14.9%) lost to follow-up. Women who encountered a barrier obtaining their preferred method were more likely to become pregnant <24 months after delivery. They had a cumulative risk of pregnancy of 34% (95% CI: 0.25, 0.43) as compared to 12% (95% CI: 0.05, 0.18) for women with no barrier. All but three of the women reporting an unintended pregnancy had earlier expressed interest in using LARC or a permanent method. Conclusion In this study, most unintended pregnancies <24 months after delivery could have been prevented or postponed had women been able to access their desired long-acting and permanent methods.

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“…It is also possible that the sequence of prompts used in our six-month interview to ascertain latent preference may have led to response bias by suggesting that we were not satisfied with the answer already given to the direct question. However, previous experience in El Paso with the question about whether the respondent would have liked to have been sterilized at the time of her last delivery, and found that responses had a very high correspondence with answers given in a more detailed interview conducted a year or two later [10]. Finally, the results reported here only refer to the time period after the cuts in family planning funding enacted in 2011, and do not demonstrate any change in the availability of long-acting and permanent methods that they may have precipitated.…”

Section: Discussionmentioning

confidence: 99%

Unmet demand for highly effective postpartum contraception in Texas

Potter¹,

Hopkins²,

Aiken³

et al. 2014

Contraception

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Objectives We aimed to assess women's contraceptive preferences and use in the first 6 months after delivery. The postpartum period represents a key opportunity for women to learn about and obtain effective contraception, especially since 50% of unintended pregnancies to parous women occur within 2 years of a previous birth. Methods We conducted a prospective cohort study of 800 postpartum women recruited from three hospitals in Austin and El Paso, TX. Women aged 18–44 who wanted to delay childbearing for at least 24 months were eligible for the study and completed interviews following delivery and at 3 and 6 months postpartum. Participants were asked about the contraceptive method they were currently using and the method they would prefer to use at 6 months after delivery. Results At 6 months postpartum, 13% of women were using an IUD or implant, and 17% were sterilized or had a partner who had had a vasectomy. Twenty-four percent were using hormonal methods, and 45% relied on less effective methods, mainly condoms and withdrawal. Yet 44% reported that they would prefer to be using sterilization, and 34% would prefer to be using LARC. Conclusions This study shows a considerable preference for LARC and permanent methods at six months postpartum. However, there is a marked discordance between women's method preference and actual use, indicating substantial unmet demand for highly effective methods of contraception.

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Frustrated Demand for Sterilization Among Low‐Income Latinas in El Paso, Texas

Cited by 41 publications

References 21 publications

Reconsidering racial/ethnic differences in sterilization in the United States

Reconsidering racial/ethnic differences in sterilization in the United States

Barriers to Postpartum Contraception in Texas and Pregnancy Within 2 Years of Delivery

Unmet demand for highly effective postpartum contraception in Texas

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