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

Legal medicine aspects of female sterilization: our experience

Introduction

The most frequent sterilization procedures include postpartum tubal ligation, laparoscopic tubal disruption or salpingectomy, and hysteroscopic tubal occlusion. It may be performed via laparoscopy, mini-laparotomy, or hysteroscopy. Safety, efficacy, short-term complications, long-term complications, and non-contraceptive benefits of sterilization are different for each procedure. Female sterilization has become an important professional liability problem in obstetrics and gynecology.

Materials and methods

We analyzed 6 cases of surgical sterilization that have been the subject of civil proceedings. We review indications, contraindications, and complications associated with each sterilization procedure.

Results

In our small number of cases, women who have undergone sterilization performed negligently are entitled to recover damages for wrongful conception, negligence, and wrongful birth. We also consider the issue of female sterilization of minors.

Discussion

Tubal sterilization can be performed with different techniques, chosen in light of the various situations involved, with the goal of reducing as many as possible any failures. Thorough and complete communication of information is of primary importance.

Conclusion

Sterilization is the most widely used birth control method around the world. The procedure is generally safe and highly effective. As reported in the literature, the decision concerning method depends on the setting, the surgeon's experience, the country's economic development, and the woman's preference, but we think that some techniques present a greater risk of failure and expose the surgeon to malpractice litigation.

Limited detraditionalization of intimacy: Growing socioeconomic differences in contraceptive use at first intercourse in Italy

This paper investigates links between social inequality and reproductive behavior. It complements the extensive research on the stratification of young adults' life chances in education and the labor market by considering changes over time in the stratification of contraceptive use at first intercourse by parental background. We seek to understand detraditionalization trends in young people's sexually intimate behavior by investigating whether these trends were driven by particular social groups and how they were supported by policy initiatives. We study Italy from 1950 to 2006, which shows strong regional and socioeconomic disparities, and comparatively slow changes in religiosity and gender norms. Data from the "Survey on Italians' Sexual Behavior" (2006) and macro indicators on family planning centers are used. The findings show a steep increase in contraceptive use at first sexual intercourse over time, stratified by parental background, but only for condom use. We did not find that family planning centers intervened in these relationships.

Women's Use of Long-Acting Reversible Contraception for Birth Timing and Birth Stopping

The use of long-acting reversible contraceptive (LARC) methods-intrauterine devices (IUDs) and implants-has recently expanded rapidly in the United States, and these methods together approach the contraceptive pill in current prevalence. Research on LARCs has analyzed their use to reduce unintended pregnancies but not their use to enable intended pregnancies. Knowledge of both is necessary to understand LARCs' potential impacts on the reproductive life courses of U.S. women. We combine data from two nationally representative surveys to estimate women's likelihood and timing of subsequent reproductive events, including births resulting from an intended pregnancy up to nine years after discontinuing LARC use. We estimate that 62% of women will give birth, and 45% will give birth from an intended pregnancy. Additionally, 18% will have a new LARC inserted, and 13% will transition to sterilization. Most of these reproductive events occur within two years after discontinuing LARC use. Births from an intended pregnancy are especially common when no intervening switch to another contraceptive method occurs. We infer that women's motives for using LARC are varied but include the desire to postpone a birth, to postpone a decision about whether to have a(nother) birth, and to transition definitively to the completion of childbearing.

Microarray patches: Breaking down the barriers to contraceptive care and HIV prevention for women across the globe

Despite the existence of a variety of contraceptive products for women, as well as decades of research into the prevention and treatment of human immunodeficiency virus (HIV), there is still a globally unmet need for easily accessible, acceptable, and affordable products to protect women's sexual and reproductive health. Microarray patches (MAPs) are a novel platform being developed for the delivery of hormonal contraception and antiretroviral drugs. MAPs provide enhanced drug delivery to the systemic circulation via the transdermal route when compared to transdermal patches, oral and injectable formulations. These minimally invasive patches can be self-administered by the user, reducing the burden on health care personnel. Since MAPs represent needle-free drug delivery, no sharps waste is generated after application, thereby eliminating possible MAP reuse and risk of needle-stick injuries. This review discusses the administration of contraceptive and antiretroviral drugs using MAPs, their acceptability by end-users, and the future perspective of the field.

Revisiting Post-Sterilization Regret in India

Aim

This study analyses the socio-demographic characteristics associated with post-sterilization regret.

Study Design

The study uses cross-sectional data from the fourth round of National Family Health Surveys (2015-2016).

Methods

Simple bivariate and binary logistic regressions analyses were used.

Results

Research shows that 7% of women aged 15-49 reported sterilization regret, which increased by 2% from 2005 to 2016. It was found that factors significantly associated with sterilization regret were years since sterilization, child loss experience, regions of residence, and quality of services. Women who got sterilized at the age of 30 or more were more likely to express regret, than women who were sterilised before 25 years of age, when adjusted for confounding variables (aO.R= 1.006). Women having sons were less likely to report sterilization regret than women who had only daughters (aO.R.=1.3 for each) but on the contrary women having both son and daughter are significantly less likely to express regret in comparison with women having only sons (aO.R. = 0.8 for each. Women who had experienced child loss had higher odds of reporting sterilization regret in rural (aO.R =1.2) as well as in urban (aO.R = 1.3) areas respectively, compared to those who did not experience any child loss.

Conclusion

Women need to be counselled about the permanent nature of sterilization in order to avoid future regret as sterilization is largely dominated by socio-economic conditions. Thus, couples' decision-making towards using the contraceptive from the basket of choice would help in uplifting the social and cultural status of women in conservative societies and will have a positive effect on contraceptive use. In addition, efforts should be made to educate both the partners equally about contraceptive methods that have higher efficiency. Further, there is also a need to improve the quality of services, both in terms of counselling and service provision. Lastly, health-related policies should tackle disparities in the empowerment, and economic status of women that would result in decreased post-sterilization regret, and will improve sexual relationships following sterilization.

Changing Educational Differentials in Female Sterilization

CONTEXT

Female surgical sterilization is widely used in the United States. Educational differentials in sterilization are large, but poorly understood. Improved understanding of these differences is important to ensure that all women have access to the full range of contraceptive methods.

METHODS

Data from the National Survey of Family Growth (1973-2015) from 8,100 women aged 40-44 were used to describe trends in sterilization and other contraceptive methods by educational attainment. Demographic standardization was employed to examine how compositional changes in marital status and age at first birth contribute to aggregate changes in sterilization prevalence.

RESULTS

In 1982, women with a high school diploma and those with at least a bachelor's degree reported similar levels of sterilization use (38% and 32%, respectively), but by 2011-2015, prevalence had declined to 19% among college-educated women and had increased to 44% among those with a diploma. The trend among college graduates was largely attributable to delayed fertility; all other things being equal, if their age at first birth had not increased, the prevalence of sterilization would have declined by approximately 3% instead of 14% between 1982 and 2002. Increased use of sterilization among women with a high school diploma was only weakly related to changes in birth timing and marital status.

CONCLUSIONS

Among women with a high school diploma, elements other than childbearing and marital status-such as contraceptive preferences and access-appeared to influence their contraceptive behavior. Sterilization differentials between high school and college graduates may reflect or exacerbate other socioeconomic disparities that affect women's health and well-being.

Desire for Sterilization Reversal Among U.S. Females: Increasing Inequalities by Educational Level

CONTEXT

For decades, high reliance on female sterilization in the United States has been accompanied by a high level of desire for sterilization reversal, and less-educated women have been more likely than better educated women to use the method and desire a reversal. Little is known about how levels of and educational differentials in such desire have changed in recent decades.

METHODS

Data from 4,147 women who reported being sterile from a tubal sterilization in the 1995, 2002 and 2006-2010 waves of the National Survey of Family Growth were analyzed using chi-square and Wald tests and binary logistic regression analyses. Predicted probabilities were calculated to determine the likelihood of desire for procedure reversal by wave and educational level.

RESULTS

The prevalence of desire for sterilization reversal rose by 41%, from 18% in 1995 to 23% in 2002 and 25% in 2006-2010. Overall, women with a bachelor's degree were less likely than those who had not finished high school to desire a reversal (odds ratio, 0.2), and this educational differential was larger in 2006-2010 than in earlier waves. Predicted probabilities indicate that 9% of sterilized women with less than a high school education and 8% of those with a bachelor's degree expressed a desire for procedure reversal in 1995, as did 15% and 3%, respectively, in 2006-2010.

CONCLUSION

Future research should consider how insurance coverage of all methods under the Affordable Care Act may affect use of sterilization and desire for reversal.

Similarities and differences in contraceptive use reported by women and men in the National Survey of Family Growth

OBJECTIVE

To compare use of contraceptive methods at last heterosexual intercourse among 15-44year-old women and men at risk of unintended pregnancy in the United States.

STUDY DESIGN

We employed data from the National Survey of Family Growth 2006-2013. We considered women and men to be at risk of unintended pregnancy if they had intercourse in the last month, regardless of contraceptive use, and if they or their partner had the ability to get pregnant and was not trying to become pregnant. We categorized multiple method use according to the most effective method reported. To explore the contributions of age and relationship status to differences in reporting between women and men, we conducted sensitivity analyses, limiting age to 25-44years and union status to married and cohabiting.

RESULTS

Distributions of methods used at last intercourse differed for women and men. A positive difference reflects higher reporting among women, while a negative difference reflects higher reporting among men. Percentage-point differences were largest for reported use of no method (-7.6) and female sterilization (+7.4), each p<.001. These differences persisted even when the sample was restricted by age and relationship status.

CONCLUSION

Estimates of men's contraceptive use may be subject to underreporting of their partners' method use, particularly when their female partner is sterilized. Neither older age nor married and cohabiting relationship status accounted for the observed differences. Further research is needed to explore the factors underlying reporting differences between women and men with respect to female sterilization and use of no method. IMPLICATIONS (50): Characterizing the determinants of contraceptive use among men and the relationship of men's pregnancy intentions, feelings and desires to contraceptive use are important future research goals. To ensure valid results, researchers must be aware of the potential for underreporting of method use among men, particularly with respect to female sterilization.