Unintended Pregnancy Influences Racial Disparity in Tubal Sterilization Rates
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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.
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.
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.
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: 0.95–1.4 for AA women and OR: 1.3; 95% CI: 1.0–1.6 for Hispanic women).
Minority women, who more frequently experience unintended pregnancy, may choose tubal sterilization in response to prior experiences with an unintended pregnancy.
KEY WORDSunintended pregnancy minority women tubal sterilization
This manuscript was made possible by Dr. Borrero’s grant (05 KL2 RR024154-04) from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official view of NCRR or NIH.
Conflict of Interest
- 3.Chandra A. Surgical sterilization in the United States: prevalence and characteristics, 1965–95. Hyattsville, Maryland: National Center for Health Statistics; 1998.Google Scholar
- 6.Mosher WDMG, Chandra A, Abma JC, Wilson SJ. Use of contraception and use of family planning services in the Unites States: 1982–2002. Hyattsville, Maryland: National Center for Health Statistics; 2004.Google Scholar
- 9.Borrero S, Nikolajski C, Rodriguez KL, Creinin MD, Arnold RM, Ibrahim SA. “Everything I Know I Learned from My Mother...or Not”: Perspectives of African-American and White Women on Decisions About Tubal Sterilization. J Gen Intern Med. 2008.Google Scholar
- 12.Lepkowski JM, Mosher WD, Davis KE, Grove RM, van Hoewyk J, Willem J. National survey of family growth, cycle 6: Sample design, weighting, imputation, and variance estimation. National center for health statistics. Vital Health Stat. 2006;2(142).Google Scholar
- 14.Brown S, Eisenberg L. The best intentions: unintended pregnancy and the well-being of children and families. Washington, DC: National Academy Press; 1995.Google Scholar
- 15.Borrero S, Lin Y, Dehlendorf C, et al. Differences in knowledge may contribute to racial variation in tubal sterilization rates [Abstract P25]. Contraception 2009;80.Google Scholar
- 16.Borrero SB, Reeves MF, Schwarz EB, Bost JE, Creinin MD, Ibrahim SA. Race, insurance status, and desire for tubal sterilization reversal. Fertility and sterility. 2007.Google Scholar
- 23.Kaeser L. Title X and the US family planning effort. New York: Alan Guttmacher Institute; 1997.Google Scholar
- 26.Smedley BD, Stith AY, Nelson AR, eds. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press; 2003.Google Scholar
- 34.Wulf D, Donovan P. Women and societies benefit when childbearing is planned. Issues Brief (Alan Guttmacher Inst) 2002;1–4.Google Scholar