Union status, marital history and female contraceptive sterilization in the United States

CONTEXT

Much of what is known about the choice of sterilization as a contraceptive method is based on data from married women or couples. Because of increasing rates of cohabitation, divorce and repartnering, however, the relationship context in which sterilization decisions are made has changed.

METHODS

The 1995 National Survey of Family Growth includes the complete birth and union histories of 10,277 white, black and Hispanic women. The distribution of union status and marital history at the time of tubal sterilization was estimated for these three racial and ethnic groups among the 799 women who had had a tubal ligation in 1990-1995 before age 40. Cox proportional hazard regression models were used to estimate the effects of union status and marital history on the risk of tubal sterilization. The analysis controlled for the woman's age, parity, race and ethnicity education, region, experience of an unwanted birth and calendar period.

RESULTS

Among women who obtained a tubal sterilization, most whites (79%) and Hispanics (66%) were married when they had the operation, compared with only 36% of black women. At the time of their sterilization, 46% of black women had never been married. Among all women, regardless of race and ethnicity and net of all controls, the probability of tubal sterilization is about 25% lower for single, never-married women than for cohabiting or married women. Cohabitation does not reduce the likelihood in comparison to marriage, however. Higher rates of tubal sterilization among Hispanic women are accounted for by their higher parity at each age; differences in parity or marriage by race only partially account for the relatively higher rates of tubal sterilization among black women.

CONCLUSIONS

Because women currently spend greater proportions of their lives outside of marriage or in less-stable cohabiting partnerships than they did in the past, they are increasingly likely to make the decision to seek sterilization on their own. As a result, the gender gap in contraceptive sterilization will likely increase. The possibility of partnership change is an important consideration in choosing sterilization as a contraceptive method.

Women, men, and contraceptive sterilization

OBJECTIVE

To review the social and behavior contexts of decisions about contraceptive sterilization and to analyze factors associated with sterilization choices.

DESIGN

Multinomial logit regression of sterilization.

PATIENT(S)

Various subsamples as appropriate to specific analyses drawn from the 10,847 women interviewed in the 1995 National Survey of Family Growth, and the 5,227 men interviewed in the National Survey of Families and Households.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Tubal sterilization and vasectomy.

RESULT(S)

Surprisingly high proportions of recent tubal sterilizations were performed on unmarried women: 1 in 3 overall, 1 in 5 among white non-Hispanic women, and 2 in 3 among black women. Sterilization choice among continuously married couples also revealed large differences by race and ethnicity. Parity at the time of the last wanted birth is a major factor affecting sterilization choices, although significant effects were found as well as for a number of other variables, including age differences between spouses, education, and religion. Compared with other regions, the ratio of tubal sterilizations to vasectomies is extremely low in the Western region of the United States.

CONCLUSION(S)

Analysis of sterilization decisions must be based on time since the completion of childbearing. The findings call attention to the need for measuring variables that mediate observed associations with sterilization outcomes.

Contribution of psychosocial factors to socioeconomic differences in health

The National Survey of Mid-life Developments in the United States (MIDUS) is one of several studies that demonstrate socioeconomic gradients in mortality during midlife. When MIDUS findings on self-reported health, waist to hip ratio, and psychological well-being were analyzed for their possible roles in generating socioeconomic differences in health, they revealed clear educational gradients for women and men (i.e., higher education predicted better health). Certain potential mediating variables, like household income, parents' education, smoking behavior, and social relations contributed to an explanation of the socioeconomic gradient. In addition, two census-based measures, combined into an area poverty index, independently predicted ill health. The results suggest that a set of both early and current life circumstances cumulatively contribute toward explaining why people of lower socioeconomic status have worse health and lower psychological well-being.

The measurement of public opinion on abortion: the effects of survey design

A factorial experiment examined the effects of the wording and sequence of survey questions on the measurement of attitudes toward abortion. When a first-trimester pregnancy is specified, 55% of respondents agree that a woman should be able to obtain a legal abortion for any reason, compared with 44% when no pregnancy duration is stated. Specifying first-trimester pregnancies has little effect on the proportion of respondents who agree that abortion should be available for maternal health, fetal defects or rape, but it significantly increases the proportion who agree that a woman should be able to obtain an abortion if she is single, has financial constraints or wants no more children. When gestational lengths from one to six months are presented to respondents in ascending order, agreement that a woman should be able to obtain an abortion for any reason is lower for any given length of gestation than when pregnancy durations are presented in descending order. Forty-eight percent of respondents agree that abortion should be legal for any reason when that question is posed after a series of specific reasons; however, 60% do so when it is the first question in the sequence. The difference in agreement with abortion for any reason between Catholics and non-Baptist Protestants, and between Republicans and Democrats, is much smaller when the question is asked first than when it is presented last.

Social inequalities in health: next questions and converging evidence

Mortality studies show that social inequalities in health include, but are not confined to, worse health among the poor. There is a social gradient: mortality rises with decreasing socio-economic status. Three large sample studies, one British and two American, brought together for their complementarity in samples, measures, and design, all show similar social gradients for adult men and women in physical and mental morbidity and in psychological well-being. These gradients are observed both with educational and occupational status and are not explained by parents' social status or lack of an intact family during childhood. They are also not accounted for by intelligence measured in school. This suggests that indirect selection cannot account for inequalities in health. Possible mediators that link social position to physical and mental health include smoking and features of psycho-social environment at work and outside.

The changing character of stepfamilies: implications of cohabitation and nonmarital childbearing

Divorce, nonmarital childbearing, and cohabitation are reshaping family experience in the United States. Because of these changes, our traditional definitions of families decreasingly capture of the social units of interest. We have noted how a significant proportion of officially defined single-parent families actually are two-parent unmarried families. The present paper expands on this perspective with respect to stepfamilies. We must broaden our definition of stepfamilies to include cohabitations involving a child of only one partner, and must recognize the large role of nonmarital childbearing in the creation of stepfamilies. We find that cohabitation and nonmarital childbearing have been important aspects of stepfamily experience for at least two decades, and that this is increasingly so. To define stepfamilies only in terms of marriage clearly underestimates both the level and the trend in stepfamily experience: when cohabitation is taken into account, about two-fifths of all women and 30% of all children are likely to spend some time in a stepfamily.

Redefining single-parent families: cohabitation and changing family reality

This paper explores the implications, for the measured prevalence and duration of mother-only families, of marked changes in nonmarital fertility, unmarried cohabitation, and homeleaving and re-entry. Throughout, estimates are compared on the basis of marital definitions and definitions including cohabitation. The duration of the first single-parent spell appears to have increased under the marital definition, but declines substantially when cohabitations are taken into account. A substantial proportion of single mothers have spent some time as single parents while in their parents' household. Hence we argue that definitions of single-parent families must be based on living arrangements rather than on the parents' marital status.

The impact of family background and early marital factors on marital disruption

Data from the National Survey of Families and Households for 1987-1988 are used to explore methodological and substantive issues concerning marital dissolution in the United States. "The analysis finds that marital disruptions are seriously underreported by males, making the analysis of male marital histories problematic. Also, the potential impact of reconciliations on the estimates of recent marital disruption based on separation is explored; no upward bias is likely to result from the inclusion of separations that may subsequently reconcile. The impact of a wide variety of factors on the risk of marital disruption is examined using proportional hazard techniques. Among them are included parental background factors, respondent's characteristics at the time of marriage, differences in spouses' characteristics, and joint activity statuses of marital partners in the first year of marriage. The risk of marital disruption is highest among women with young age at marriage, low education, a cohabitation history, and those whose spouse has been married previously. Parental family disruption affects marital stability primarily through age at marriage and cohabitation. Religious and educational heterogamy and male unemployment reduce marital stability."

Fertility desires and fertility: hers, his, and theirs

The relationship between desired and achieved fertility may be misspecified by excluding husbands' fertility desires or by confounding effects of shared desires with the resolution of conflicting desires. Using couple data from the classic Princeton Fertility Surveys, we find relatively large husband effects on fertility outcomes as well as unique effects of spousal disagreement. Wives and husbands were equally likely to achieve fertility desires, and disagreeing couples experienced fertility rates midway between couples who wanted the same smaller or larger number of children. These conditions do not hold, however, when we include willingness to delay births for economic mobility as part of the measure of fertility desires. Among couples who both wanted a third child, only husbands' willingness to delay births had significant negative effects on birth rates.

Children's experience in single-parent families: implications of cohabitation and marital transitions

Data from the National Survey of Families and Households indicate that 10 percent of children born between 1960 and 1968 were born outside of marriage and that before age 16, another 19 percent experienced the dissolution of their parents' marriage. When parental death and other causes of family disruption are also considered, 36 percent of the children in that age cohort had been separated from at least one parent before they reached age 16, compared with 22 percent of children born two decades earlier. In all, 27 percent of nonmarital births between 1970 and 1984 were to cohabiting couples; the proportion was 40 percent for Mexican Americans, 29 percent for non-Hispanic whites and 18 percent for blacks. About two-thirds of cohabiting couples who had children during the 1970s eventually married; however, before these children reach age 16, 56 percent of them are likely to experience the disruption of their parents' marriage, in comparison with 31 percent of children born to married parents. Overall, about half of all children born between 1970 and 1984 are likely to spend some time in a mother-only family, and more than half of these children reach age 16 without having had a stepfather.

National estimates of cohabitation

Data from the 1987-1988 National Survey of Families and Households are used to provide national estimates of cohabitation trends and levels. The rapid increase since around 1970 is documented over both birth cohorts and marriage cohorts. Almost half of the persons in their early 30s and half of the recently married have cohabited. Changes in the proportion ever married are compared with changes in the proportion who have either married or cohabited. Much of the decline in marriage has been offset by increased living together without being married. The stability of unions of various types is compared. Cohabitations end very quickly in either marriage or disruption. About 60 percent of all first cohabitations result in marriage. Cohabiting unions and marriages preceded by cohabitation are much more likely to break up than are unions initiated by marriage. Multivariate analysis reveals higher rates of cohabitation among women, whites, persons who did not complete high school, and those from families who received welfare or who lived in a single-parent family while growing up.

Recent trends in marital disruption

The post-1980 decline in the crude divorce rate must be interpreted in the context of the long-term trend and in terms of what we know about composition effects on crude measures-particularly given shifts in age at marriage and the age composition effects of the baby boom. Data from the June 1985 Current Population Survey permit more detailed, exposure-specific measurements as well as the use of separation as the event terminating marriage. Estimates from these data suggest a decline followed by a recovery. Taking into account well-known levels of underreporting, we find that recent rates imply that about two-thirds of all first marriages are likely to end in separation or divorce. We examine the persistence of major differences in marital stability and evaluate the comparative stability of first and second marriages.

Analyzing fertility histories: do restrictions bias results?

The straightforward tests we have conducted lead to two major conclusions. First, parameter estimates, such as the proportions that practice contraception or that breastfeed, can be biased in data restricted to the last closed and open interval. This is particularly true the further back in time one goes. However, the second conclusion is that these restrictions do not bias estimates of the structure of the relationships predicting fertility. This may seem surprising, and perhaps even magical. The reason is that multivariate life table techniques allow one to reach the same conclusion even if the proportions in various categories are altered by a criterion such as limiting the analysis to intervals begun by the last and next-to-last live births. Limiting the analysis in this way means that there are fewer short intervals and thus fewer cases of intervals with characteristics associated with short intervals (e.g., no contraceptive use, no breastfeeding, or infant mortality). As long as the model specified in the multivariate life table is an appropriate one, that is, it is not misspecified, and as long as the skew produced by the WFS restriction is not too extreme, then the multivariate life table procedures can produce unbiased estimates of the structure of the relationships predicting birth interval dynamics. Thus even though the WFS data are in fact inappropriate for some simple parameter estimation procedures, they appear to be adequate for the more complex multivariate procedures of the sort used here. Several caveats must be added to the foregoing results. First, we have performed this test in only one country, Korea; it is possible that the same results might not be obtained in other countries. We expect, however, that they would. Second, our procedure only looks at the first 40 months of experience in the birth interval. A procedure that incorporates the long tails of the birth interval distribution may obtain different results. In fact, we caution against analyzing the tail of the distributions using data from the normal WFS sample, since these would be most affected by the restriction to last closed and open intervals. Third, the extent to which these results are generalizable to other types of substantive problems is unknown at present. We suspect, however, that examining the determinants of lengths of breastfeeding will produce similar results. Finally, even with multivariate procedures, it would be highly misleading to impose the WFS restrictions and then examine trends in the length of birth intervals.(ABSTRACT TRUNCATED AT 400 WORDS)

Children and marital disruption: a replication and update

Data from the 1980 June Current Population Survey are used to estimate the incidence and duration of marital disruption as experienced by children. Rates during the 1977-1979 period suggest that about two-fifths of children born to married mothers will experience the disruption of that marriage while they are children. When children born before their mothers' first marriage are included, half of recent cohorts are likely to spend some time in a single parent family. These rates increased consistently over the 1970s. For the majority of those who experience a marital disruption, over five years are likely to elapse before the mother remarries. Furthermore, about half of the children who go through a divorce and remarriage will experience the breakup of the new family as well. At the same time, the interval between separation and divorce is less than a year for most children involved. There are major differences in these rates by race and important differences as well by education and age of mother. Replication of our earlier estimates for comparable periods was quite good for the estimates of the experience of marital dissolution, but somewhat less so for the analysis of mother's subsequent remarriage.

Age and marital status at first birth and the pace of subsequent fertility

Taking care to minimize the truncation bias inherent in cross-sectional data and controlling for other variables, this paper demonstrates the strong effects of both age and marital status at first birth on the pace of subsequent fertility. These effects are particularly strong in the interval immediately following the first birth but persist even into the fourth interval. Important differences are found with respect to the experience of rapid fertility, rather than in the mean lengths of intervals. These results add to the growing attention to the social dimensions of age as a variable in fertility processes.

How old is too old? Age and the sociology of fertility

Are we due for a new baby boom as couples who had postponed childbearing begin to make up for lost time? Analysis of National Fertility Study data suggest that "later means fewer"--quite apart from the declining fecundity that occurs at older ages. Couples who delay having children until relatively late in life are subject to fewer pressures to have children (or more children) even as the reasons not to begin (or increase) their families become more salient.

The continuation of education after marriage among women in the United States: 1970

Data from the 1970 National Fertility Study are used to assess the extent and determinants of post-nuptial education among women in the United States. Over one-fifth of all women have attended high school or college since marriage; over one-third either have returned to school or anticipate returning to an academic institution sometime in the future. This phenomenon is apparently increasing since women married less than five years have already attended school in as great a proportion as women married 15-19 years. Examination of differentials reveals for both blacks and whites that post-nupital education is higher among women who: (1) attended college before marriage, (2) married early, (3) are currently separated or divorced, (4) support egalitarian sex-role attitudes, or (5) whose most recent occupation is in the professional, managerial, or administrative category. Post-nuptial trends in education undoubtedly reflect the much broader social phenomenon of changing sex-role perceptions.