Unintended Pregnancy Influences Racial Disparity in Tubal Sterilization Rates

Abstract

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: 0.95-1.4for 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.KEY WORDS: unintended pregnancy; minority women; tubal sterilization.

Surgical sterilization, regret, and race: Contemporary patterns

“…According to national surveys, Black and Native American women are about twice as likely to have had tubal sterilization as non-Hispanic Whites (Borrero et al 2010; Volscho 2010). As our data is similarly nationally representative, we expect to find similar racial/ethnic differences in sterilization patterns.…”

Use of a Low-Literacy Informed Consent Form to Improve Women's Understanding of Tubal Sterilization

“…3 Misinformation about sterilization and limited awareness of contraceptive alternatives are common. For example, 62% of African American and 36% of white women thought that sterilization reversal could easily restore fertility.…”

The perplexing links between contraceptive sterilization and (dis)advantage in ten low-fertility countries

“…At the same time, it did not substantially alter the links between contraceptive sterilization and socioeconomic status. U.S. studies since the mid-twentieth century have almost unanimously reported a strong negative association between socioeconomic status and female contraceptive sterilization but a strong positive association between socioeconomic status and male contraceptive sterilization (Bumpass and Presser 1972; Presser and Bumpass 1972; Shapiro et al 1983; Philliber and Philliber 1985; Chandra 1998; Bumpass et al 2000; Godecker et al 2001; Borrero et al 2009; Chan and Westhoff 2010; Anderson et al 2012; Bertotti 2013). …”