Session 20 sterilization

Abstract

The retrospective study on voluntary surgical birth control for the medical program of the Salvadoran Demographic Association had as its objective the characterization of effective demand trends and an evaluation on the evolution of the quality of services offered. Some 59 583 registered cases were analyzed between January 1, 1973 and November 30, 1991 (54 080 female and 5503 male). The data was entered in a simultaneous manner with the recollection of information, which allowed one to make periodic inconsistency checks. The medical diagnostics were reviewed and classified by medical specialists. Among the principal results we can mention that the demand of female procedures has shown a growing trend (during the 19 years of the study, the contrary happens with male procedures and therefore it deserves syste-matic promotion and information similar to that for any other method of family planning. Average age for women was 7 years less than that for men (27.7 and 34.7 years, respectively), but the average number of children was similar (3.6 and 4). Average education for men (in years of school) was more than double that for women and only the women showed an increase during the period. In this respect, the study confirms that with higher schooling, women as well as men choose voluntary surgical birth control at a younger age but above all, if they have less children. The proportion of complications found in feminine procedures (3%) is comparable to that reported in multiple studies, but not to that found in vasectomies for which an increase was observed throughout the period (8.1% for the period 71-75 and 23.6% for the period 86-91) which allows one to infer that when higher experience and dexterity are expected, important technical details are omitted at the moment of the procedure and probably less emphasis is placed in post-operative care. The global rates of registered failure, 2.2 per thousand for female and 9.4 per thousand for male procedures, are found within the expected ranges. The low rate of requested reversals reported implies the assumption that the decision was taken in conscious and informed manner with reference to the definite character of the procedures. On the other hand, since the use of temporary methods during the previous month to the procedure was low especially among young women who are prone to a high parity, their reproductive risk may be reduced promoting and making more accessible temporary birth control methods, which at the same time will contribute to the decline in fecundity in E1 Salvador.