Medicalization, reproductive agency, and the desire for surgical sterilization among low-income women in urban Brazil

Autonomy in Austerity Times. Examining Hormonal Contraceptive Implants in Argentina

We present findings from a study on the implementation of hormonal contraceptive implants during the last wave of austerity measures in Argentina (2015-2019). Through the lens of "reproductive governance," we discuss continuities and changes in policy discourse that justified the provision of implants from 2014, before austerity measures started to be implemented, and after 2015. Using the concept of "stratified reproduction" in the light of demographic anxiety about teenage pregnancies, we also observe the key role of health professionals in actually enacting in the clinic key policy changes that characterized pregnancy among low-income, young, low-adherence and/or disabled women as a problem to be eradicated.

Politicized Demography and Biomedical Authority in post-Soviet Russia

We explore obstetrician-gynecologists' (ob-gyns') shifting involvement in late Soviet and post-Soviet reproductive politics and track broader political-economic dynamics of the profession's ambivalent relations with state demographic discourses. Soviet ob-gyns largely distanced themselves from explicitly pronatalist agendas. Post-soviet national politics of 'population renewal' and the neoliberalization of health care have significantly restructured ob-gyns' orientations. To assert their authority and gain economic footing, ob-gyns have highlighted their contributions to the state's demographic agendas. The post-Soviet context illustrates how understanding the medicalization of population problems requires examining the political-economic relations between physicians and the state - dynamics that can transform ideologies and medical practices.

Incidence and determinants of hysterectomy in a low-income setting in Gujarat, India

Hysterectomy is a leading reason for use of health insurance amongst low-income women in India, but there are limited population-level data available to inform policy. This paper reports on the findings of a mixed-methods study to estimate incidence and identify predictors of hysterectomy in a low-income setting in Gujarat, India. The estimated incidence of hysterectomy, 20.7/1000 woman- years (95% CI: 14.0, 30.8), was considerably higher than reported from other countries, at a relatively low mean age of 36 years. There was strong evidence that among women of reproductive age, those with lower income and at least two children underwent hysterectomy at higher rates. Nearly two-thirds of women undergoing hysterectomy utilized private hospitals, while the remainder used government or other non-profit facilities. Qualitative research suggested that weak sexual and reproductive health services, a widespread perception that the post-reproductive uterus is dispensable and lack of knowledge of side effects have resulted in the normalization of hysterectomy. Hysterectomy appears to be promoted as a first or second-line treatment for menstrual and gynaecological disorders that are actually amenable to less invasive procedures. Most women sought at least two medical opinions prior to hysterectomy, but both public and private providers lacked equipment, skills and motivation to offer alternatives. Profit and training benefits also appeared to play a role in some providers’ behaviour. Although women with insecure employment underwent the procedure knowing the financial and physical implications of undergoing a major surgery, the future health and work security afforded by hysterectomy appeared to them to outweigh risks. Findings suggest that sterilization may be associated with an increased risk of hysterectomy, potentially through biological or attitudinal links. Health policy interventions require improved access to sexual and reproductive health services and health education, along with surveillance and medical audits to promote high-quality choices for women through the life cycle.

Low-income women's navigation of childbearing norms throughout the reproductive life course

Shifts in family structure have affected age norms about both teenage childbearing and reproductive sterilization, but we lack research examining how childbearing norms are connected across the reproductive life course. Drawing on interviews from 40 low-income women in Colorado, we explored linkages between early childbearing and the desire for early sterilization. Specifically, we examined two narratives women use to negotiate competing norms throughout the reproductive life course. The low-income women in our study characterized their teenage childbearing experiences negatively and justified them using a "young and dumb" narrative. Women also asserted that reversible contraceptives do not work for them, using a "hyper-fertility" narrative to explain both their early childbearing and their desire for early sterilization. Our results illustrate the influence of mainstream social norms about childbearing timing on low-income women's lives and provide evidence of how women use narratives to explain and justify their violation of childbearing norms.

Factors influencing physicians' advice about female sterilization in USA: a national survey

BACKGROUND

Tubal ligation can be a controversial method of birth control, depending on the patient's circumstances and the physician's beliefs.

METHODS

In a national survey of 1800 US obstetrician-gynecologist (Ob/Gyn) physicians, we examined how patients' and physicians' characteristics influence Ob/Gyns' advice about, and provision of, tubal ligation. Physicians were presented with a vignette in which a patient requests tubal ligation. The patient's age, gravida/parity and her husband's agreement/disagreement were varied in a factorial experiment. Criterion variables were whether physicians would discourage tubal ligation, and whether physicians would provide the surgery.

RESULTS

The response rate was 66% (1154/1760). Most Ob/Gyns (98%) would help the patient to obtain tubal ligation, although 9-70% would attempt to dissuade her, depending on her characteristics. Forty-five percent of physicians would discourage a G2P1 (gravida/parity) woman, while 29% would discourage a G4P3 woman. Most physicians (59%) would discourage a 26-year-old whose husband disagreed, while 32% would discourage a 26-year-old whose husband agreed. For a 36-year-old patient, 47% would discourage her if her husband disagreed, while only 10% would discourage her if her husband agreed. Physicians' sex had no significant effect on advice about tubal ligation.

CONCLUSIONS

Regarding patients who seek surgical sterilization, physicians' advice varies based on patient age, parity and spousal agreement but almost all Ob/Gyns are willing to provide or help patients obtain surgical sterilization if asked. An important limitation of the study is that a brief vignette, while useful for statistical analysis, is a rough approximation of an actual clinical encounter.