“Everything I Know I Learned from My Mother...or Not”: Perspectives of African-American and White Women on Decisions About Tubal Sterilization



African-American women have had higher rates of female sterilization compared to white women since its emergence as a contraceptive method. The reasons underlying this observed racial difference are unknown.


The goals of this study were to (1) explore what factors shape black and white women’s decisions about tubal sterilization as a contraceptive method and (2) generate hypotheses about the relationship of race to the decision-making process.


We conducted six focus groups stratified by tubal sterilization status and race. During each of the audio-recorded sessions, participants were asked to discuss reasons that women choose sterilization as a contraceptive method.


The participants of the study were 24 African-American women and 14 white women.


Transcripts of the sessions were qualitatively analyzed with particular attention to factors that might be unique to each of the two racial groups.


Personal factors shaped black and white women’s decisions regarding tubal sterilization. Preference for a convenient, highly effective contraceptive method was the main reason to get a tubal sterilization for women of both racial groups. We also identified socio-cultural differences that might explain why black women are more likely than white women to choose tubal sterilization over other contraceptive methods. An unanticipated, but clinically important, finding was that women often reported feeling that their doctors and the health-care system served as barriers to obtaining the desired procedure.


Socio-cultural differences may help explain why black and white women choose different contraceptive methods.

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This publication was made possible by Dr. Borrero’s grant (no. 1 KL2 RR02415403) from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The sponsors had no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, or in the preparation, review, or approval of the manuscript. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official view of the NCRR or NIH. Dr. Ibrahim is supported by grant no. K24AR055259 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Rodriguez is supported by a VA HSR&D Merit Review Entry Program Award (MRP 04-410) and a Minority Supplement Award from the National Cancer Institute (3R01 CA-100387-03S1).

Conflict of Interest

Drs. Borrero, Rodriguez, Arnold, Ibrahim, and Ms. Nikolajski report no conflicts of interest. Dr. Creinin is a consultant for Schering-Plough and Bayer and has received honoraria from Schering Plough, Bayer and Ortho and research grants from Schering-Plough, Bayer, and Galen.

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Corresponding author

Correspondence to Sonya Borrero MD, MS.

Appendix A

Appendix A

Focus Group Interview Guide

Opening question:

  1. (1)

    Tell me where you usually get information about contraception or birth control.

Key questions:

  1. (2)

    Tell me how you first heard about tubal ligation.

    • Probes:

      • What did you hear about it?

  2. (3)

    What do you think are some reasons that a woman might get a tubal ligation?

  3. (4)

    Tell me about how you came to the decision to get (or not get) your tubes tied.

    • Probes:

      • When you were thinking about getting the tubal, what other birth control methods were you thinking about?

      • What kinds of things were important to you when thinking about a birth control method?

      • How did your experiences with other types of birth control influence your decision?

      • Who, if anyone, influenced your decision? (e.g., partner, friends/family, health-care provider)

      • How did your health-care provider influence your decision?

      • What other things influenced your decision to undergo (or not undergo) tubal ligation? (e.g., insurance issues, availability)

  4. (5)

    What advice would you give to doctors and nurses about how to advise or counsel a woman about getting their tubes tied?

    Concluding question:

  5. (6)

    Okay, going around the room one last time, is there anything you want to add that we have not discussed?

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Borrero, S., Nikolajski, C., Rodriguez, K.L. et al. “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 24, 312–319 (2009). https://doi.org/10.1007/s11606-008-0887-3

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  • tubal sterilization
  • race
  • qualitative research
  • focus groups
  • decision making