Complex Family Planning fellowship graduates' intended practice plans and barriers to practicing in areas of unmet need.

OBJECTIVES: To describe practice patterns and challenges encountered by Complex Family Planning (CFP) fellowship graduates. STUDY DESIGN: We invited all 110 obstetrics and gynecology physicians who graduated from the CFP fellowship from 2017-2020 via email to complete an anonymous online survey. We inquired about demographics, intended and obtained postfellowship positions, and successes and challenges in obtaining jobs. We used Fisher's exact test to assess if the proportion of graduates who grew up, attended residency, and completed fellowship in a US region (Northeast, Midwest, South, and West) and practiced in that same region differed. RESULTS: Ninety-nine (90.0%) graduates completed the survey. When entering fellowship, most (n = 92 [92.9%]) expected to practice in an academic environment. About half (n = 49 [49.5%]) pursued fellowship with the intent to practice in a location with an unmet need for abortion providers, of which 22 (44.9%) did so. Forty-nine (49.5%) respondents did not practice after fellowship where they initially intended, citing common challenges of job availability, family-related concerns, safety concerns, and relationship status changes. We found associations between regions where graduates completed residency and currently practice (p = 0.004), driven primarily by higher associations in the South (76.9%) and West (70.6%) and a lower association in the Midwest (22.7%). We found no association between current practice region and where graduates grew up (p = 0.15) or completed fellowship (p = 0.23). CONCLUSIONS: CFP fellowship graduates from 2017-2020 primarily intended to practice in academic environments with half planning to practice in underserved locations. However, more than half of those who entered fellowship hoping to fill an unmet need for abortion providers did not do so. IMPLICATIONS: About half of CFP fellowship graduates from 2017-2020 intended to obtain positions in areas they defined as having an unmet need for abortion provision. Personal life and job barriers prevented many from serving in such positions after fellowship. Practice location intentions and outcomes may be different in a post-Dobbs environment.

Contraceptive plans before preoperative assessment and at procedure in surgical abortion patients.

OBJECTIVE: To describe changes in contraceptive method plans pre-appointment, after counseling, and post-procedure in patients having an abortion. STUDY DESIGN: We reviewed electronic medical records of University of California, Davis Health patients who had an operating room abortion from January 2015 to December 2016. We excluded persons with procedures for fetal anomaly or demise. We extracted patient demographics and contraceptive plans reported at each encounter (telephone intake, pre-operative appointment, and day of abortion). We evaluated individual contraceptive plans across the encounters, identified patient characteristics that contributed to plan change, and created a multivariable logistic regression model for predictors of contraception method plan change from telephone intake to post-procedure. RESULTS: The 747 patients had a mean gestational age of 16 4/7 ± 5 0/7 weeks with 244 (32.7%) <15 weeks and 235 (31.5%) ≥20 weeks. At telephone intake, 273 (36.4%) wanted a long-acting method (139 [50.9%] intrauterine device [IUD]; 99 [36.3%] implant; 35 [12.3%] unspecified), 11 (3.9%) permanent contraception, and 248 (33.2%) a less effective or no method; 215 (28.8%) stated they were undecided. Most (357/433 [82.4%]) patients who planned a reversible method based on the telephone intake obtained that or a similar method. Of the 273 patients planning a long-acting method, 258 (94.5%) received an IUD (158 [40.9%]) or implant (100 [36.6%]). Of the 215 undecided patients, 88 (40.9%) received an IUD and 55 (25.6%) an implant. No demographic factors predicted a change in method plan. CONCLUSIONS: Most patients will receive the method they initially identified at the telephone intake after an abortion, especially those planning an IUD or implant. Undecided patients are commonly open to discussing options.

Progestin-only pill use over 6 months postpartum.

OBJECTIVES: To determine progestin-only pill (POP) use at 3 and 6 months postpartum among women who chose POPs at the postpartum visit. STUDY DESIGN: Secondary data analysis of a prospective observational study with telephone interviews at 3 and 6 months postpartum to assess contraceptive use. RESULTS: Of 440 women who attended the postpartum visit, 92 (20.9%) chose POPs. Current POP use was 44/84 (52.4%) at 3 months, 33/76 (43.4%) at 6 months, and 32/76 (42.1%) at both 3- and 6-month follow-up assessments. CONCLUSION: About half of women who plan POP use at the postpartum visit are not using this method at 3 months after delivery. IMPLICATIONS: About half of women with a prescription for progestin-only pills will be not using this method at 3 months postpartum; further understanding of continued sexual activity and breastfeeding may clarify pregnancy risk for those not reporting modern contraception use during the postpartum period.

An updated assessment of postpartum sterilization fulfillment after vaginal delivery.

OBJECTIVE: To describe sterilization completion rates after vaginal delivery and indications for unfulfilled procedures. STUDY DESIGN: We used labor and delivery operating room and delivery logs to identify all women over 20years of age with a completed live vaginal birth beyond 24weeks gestation over a 33-month period (March 1, 2012 to November 30, 2014). We reviewed the electronic medical records of all of these patients and identified those who requested a sterilization procedure as indicated in a physician's admission note or antenatal record. RESULTS: We identified 3514 live vaginal births beyond 24weeks gestation during the study period of which 219 requested postpartum sterilization. Sterilization occurred in 114 (52%). The most common reason for unfulfilled procedures was lack of valid federally mandated consent (n=46 [44%]). Fifty-nine percent (27 of 46) of these women had little or no prenatal care. Only one (0.5%) woman had documented completion of consent with the required time elapsed prior to delivery and no consent form available. Of the women with valid consent documentation, the most common indication for an unfulfilled procedure was patient refusal (n=30 [51%]). Body mass index was an independent predictor of an unfulfilled procedure (p<.001) among women with adequate consent. CONCLUSIONS: Inability to complete federally mandated consent is a principal cause of unfulfilled postpartum sterilization and primarily affects women desiring sterilization who lack sufficient prenatal care. Of women who meet consent criteria, the primary reason women eligible for sterilization did not undergo the procedure was due to withdrawing their request. IMPLICATIONS: Because women commonly do not undergo a requested sterilization after vaginal deliveries, antepartum counseling should include alternate contraception choices. Documented consent that fulfills all federally mandated criteria remains the most common barrier to requested sterilization after vaginal delivery; providers and policymakers should work together to help unburden women from this mandate.

The US etonogestrel implant mandatory clinical training and active monitoring programs: 6-year experience.

OBJECTIVE: The objective was to monitor the effectiveness of the etonogestrel implant clinical training program through a voluntary active monitoring program (AMP). STUDY DESIGN: US health care providers underwent mandatory training by the manufacturer on etonogestrel implant insertion, localization and removal. After training, health care providers could enroll in a voluntary AMP to provide outcome data to meet a postmarketing commitment of the manufacturer with the US Food and Drug Administration (FDA). Those who volunteered completed and faxed forms to the manufacturer after implant insertion and removal detailing the procedure and device-related outcomes, including insertion-, localization- or removal-associated events. Experts reviewed outcome data quarterly, which the Sponsor then reported to the FDA. RESULTS: Among 42,337 health care providers completing the training program, 4294 (10.1%) volunteered to participate in the AMP. The 26,198 forms submitted over 6.4 years included more insertion (n=20,497) forms than removal forms (n=5701). The volunteers reported 646 events on 566 (2.2%) forms related to insertion (n=197), localization (n=34), removal (n=357) and "other" (n=58). Clinically important events included noninsertion (n=4), serum etonogestrel positive but implant not found (n=1), and possible nerve (n=66) or vascular (n=5) injury. The reports did not include any insertion-, localization- or removal-associated hospitalizations. Eight (0.14%) removal reports described referral for surgical implant removal. CONCLUSION: Events related to insertion, localization or removal of the etonogestrel implant are uncommon among US providers who received mandatory training in the use of the implant. IMPLICATIONS: This report presents results from the first mandatory US contraceptive training program. Health care providers volunteered to report information about etonogestrel implant insertion, localization and removal. Although the data do not demonstrate whether a mandatory program improves outcomes, they elucidate the utility and real-life experience that clinical training programs can provide.

A prospective assessment of pelvic infection risk following same-day sexually transmitted infection testing and levonorgestrel intrauterine system placement.

BACKGROUND: Misperceptions persist that intrauterine device placement is related to pelvic infections and Chlamydia and gonorrhea testing results are needed prior to placement. OBJECTIVE: We sought to evaluate the relationship of Chlamydia and gonorrhea screening to pelvic infection for up to 2 years following placement of the levonorgestrel 52-mg intrauterine system. STUDY DESIGN: A total of 1751 nulliparous and multiparous females 16 to 45 years old enrolled in a multicenter trial designed to evaluate the efficacy and safety of a new levonorgestrel intrauterine system for up to 7 years. Participants had Chlamydia screening at study entry and yearly if they were age ≤25 years. Women also had baseline gonorrhea screening if testing had not been performed since starting their current sexual relationship. Those who changed sexual partners during the trial had repeated Chlamydia and gonorrhea testing. Intrauterine system insertion could occur on the same day as screening. Participants did not receive prophylactic antibiotics for intrauterine system placement. Investigators performed pelvic examinations after 12 and 24 months and when clinically indicated during visits at 3, 6, and 18 months after placement and unscheduled visits. Pelvic infection included any clinical diagnosis of pelvic inflammatory disease or endometritis. RESULTS: Most participants (n = 1364, 79.6%) did not have sexually transmitted infection test results available prior to intrauterine system placement. In all, 29 (1.7%) participants had positive baseline testing for a sexually transmitted infection (Chlamydia, n = 25; gonorrhea, n = 3; both, n = 1); 6 of these participants had known results (all with Chlamydia infection) prior to intrauterine system placement and received treatment before enrollment. The 23 participants whose results were not known at the time of intrauterine system placement received treatment without intrauterine system removal and none developed pelvic infection. The incidence of positive Chlamydia testing was similar among those with and without known test results at the time of intrauterine system placement (1.9% vs 1.5%, respectively, P = .6). Nine (0.5%) participants had a diagnosis of pelvic infection over 2 years after placement, all of whom had negative Chlamydia screening on the day of or within 1 month after intrauterine system placement. Infections were diagnosed in 3 participants within 7 days, 1 at 39 days, and 5 at ≥6 months. Seven participants received outpatient antibiotic treatment and 2 (diagnoses between 6-12 months after placement) received inpatient treatment. Two (0.1%) participants had intrauterine system removal related to infection (at 6 days and at 7 months after placement), both of whom only required outpatient treatment. CONCLUSION: Conducting Chlamydia and gonorrhea testing on the same day as intrauterine system placement is associated with a low risk of pelvic infection (0.2%). Over the first 2 years of intrauterine system use, infections are infrequent and not temporally related to intrauterine system placement. Pelvic infection can be successfully treated in most women with outpatient antibiotics and typically does not require intrauterine system removal. Women without clinical evidence of active infection can have intrauterine system placement and sexually transmitted infection screening, if indicated, on the same day.

Probability of pregnancy after sterilization: a comparison of hysteroscopic versus laparoscopic sterilization.

OBJECTIVE: To compare the expected probability of pregnancy after hysteroscopic versus laparoscopic sterilization based on available data using decision analysis. STUDY DESIGN: We developed an evidence-based Markov model to estimate the probability of pregnancy over 10 years after three different female sterilization procedures: hysteroscopic, laparoscopic silicone rubber band application and laparoscopic bipolar coagulation. Parameter estimates for procedure success, probability of completing follow-up testing and risk of pregnancy after different sterilization procedures were obtained from published sources. RESULTS: In the base case analysis at all points in time after the sterilization procedure, the initial and cumulative risk of pregnancy after sterilization is higher in women opting for hysteroscopic than either laparoscopic band or bipolar sterilization. The expected pregnancy rates per 1000 women at 1 year are 57, 7 and 3 for hysteroscopic sterilization, laparoscopic silicone rubber band application and laparoscopic bipolar coagulation, respectively. At 10 years, the cumulative pregnancy rates per 1000 women are 96, 24 and 30, respectively. Sensitivity analyses suggest that the three procedures would have an equivalent pregnancy risk of approximately 80 per 1000 women at 10 years if the probability of successful laparoscopic (band or bipolar) sterilization drops below 90% and successful coil placement on first hysteroscopic attempt increases to 98% or if the probability of undergoing a hysterosalpingogram increases to 100%. CONCLUSION: Based on available data, the expected population risk of pregnancy is higher after hysteroscopic than laparoscopic sterilization. Consistent with existing contraceptive classification, future characterization of hysteroscopic sterilization should distinguish "perfect" and "typical" use failure rates. IMPLICATIONS: Pregnancy probability at 1 year and over 10 years is expected to be higher in women having hysteroscopic as compared to laparoscopic sterilization.

Federally funded sterilization: time to rethink policy?

In the 1970s, concern about coercive sterilization of low-income and minority women in the United States led the US Department of Health, Education, and Welfare to create strict regulations for federally funded sterilization procedures. Although these policies were instituted to secure informed consent and protect women from involuntary sterilization, there are significant data indicating that these policies may not, in fact, ensure that consent is truly informed and, further, may prevent many low-income women from getting a desired sterilization procedure. Given the alarmingly high rates of unintended pregnancy in the United States, especially among low-income populations, we feel that restrictive federal sterilization policies should be reexamined and modified to simultaneously ensure informed decision-making and honor women's reproductive choices.

Comparison of medical abortion follow-up with serum human chorionic gonadotropin testing and in-office assessment.

BACKGROUND: The study was conducted to compare lost to follow-up (LTFU) rates in women having a medical abortion who chose follow-up by in-office ultrasound assessment or serum beta human chorionic gonadotropin (ß-hCG) testing. METHODS: This retrospective chart review included 865 women who underwent medical abortion in a free-standing outpatient clinic from September 1, 2007, through September 30, 2010. Patients had a 1-week follow-up evaluation after receiving the medications consisting of in-office ultrasound assessment or serial serum ß-hCG testing. Ultrasound assessment was offered throughout the study period, and serum ß-hCG testing was offered as of September 1, 2008. Demographic and medical data were reviewed to evaluate LTFU rates based on patient's chosen method of follow-up. Multivariable logistic regression analysis was performed to evaluate factors that were independently associated with lack of follow-up. RESULTS: LTFU rates increased from 18% to 27% in the first and third years of the study period, respectively (p=.009). LTFU rates with ultrasound and ß-hCG testing were 22.9% and 33.7%, respectively (p=.024). In multivariable analysis, follow-up method was not associated with increased LTFU. Increased parity, any previous induced abortion, increased distance from home to clinic site and unemployment were independently associated with increased LTFU. CONCLUSIONS: Although LTFU rates are higher with serum ß-hCG testing than in-office ultrasound follow-up in our patient population, the women who choose this method are inherently more likely not to follow-up because of other characteristics that predict a high likelihood of being LTFU. Offering serum ß-hCG testing does not decrease the LTFU rate in women having a medical abortion.

The impact of out-of-pocket expense on IUD utilization among women with private insurance.

BACKGROUND: The study was conducted to evaluate the impact of out-of-pocket expense on intrauterine device (IUD) utilization among women with private insurance. STUDY DESIGN: We reviewed the records of all women with private insurance who requested an IUD for contraception from an urban academic gynecology practice from May 2007 through April 2008. For each patient, we determined the out-of-pocket expense that would be incurred and whether she ultimately had an IUD placed. The total charge for placement of a copper or levonorgestrel IUD (including the device) was $815. RESULTS: Ninety-five women requested an IUD during the study period. The distribution of out-of-pocket expense was bimodal: less than $50 for 35 (37%) women and greater than $500 for 52 (55%) women. Intrauterine device insertion occurred in 24 (25%) women, 19 of whom had an out-of-pocket expense less than $50. In univariate and multivariable analysis, women with insurance coverage that resulted in less than $50 out-of-pocket expense for the IUD were more likely to have an IUD placed than women required to pay $50 or more (adjusted odds ratio=11.4, 95% confidence interval=3.6-36.6). CONCLUSIONS: Women requesting an IUD for contraception are significantly more likely to have an IUD placed when out-of-pocket expense is less than $50.

Reliability of laparoscopic compared with hysteroscopic sterilization at 1 year: a decision analysis.

OBJECTIVE: To estimate the probability of successful sterilization after an hysteroscopic or laparoscopic sterilization procedure. METHODS: An evidence-based clinical decision analysis using a Markov model was performed to estimate the probability of a successful sterilization procedure using laparoscopic sterilization, hysteroscopic sterilization in the operating room, and hysteroscopic sterilization in the office. Procedure and follow-up testing probabilities for the model were estimated from published sources. RESULTS: In the base case analysis, the proportion of women having a successful sterilization procedure on the first attempt is 99% for laparoscopic sterilization, 88% for hysteroscopic sterilization in the operating room, and 87% for hysteroscopic sterilization in the office. The probability of having a successful sterilization procedure within 1 year is 99% with laparoscopic sterilization, 95% for hysteroscopic sterilization in the operating room, and 94% for hysteroscopic sterilization in the office. These estimates for hysteroscopic success include approximately 6% of women who attempt hysteroscopically but are ultimately sterilized laparoscopically. Approximately 5% of women who have a failed hysteroscopic attempt decline further sterilization attempts. CONCLUSION: Women choosing laparoscopic sterilization are more likely than those choosing hysteroscopic sterilization to have a successful sterilization procedure within 1 year. However, the risk of failed sterilization and subsequent pregnancy must be considered when choosing a method of sterilization.

Racial variation in tubal sterilization rates: role of patient-level factors.

OBJECTIVE: To assess racial differences in attitudes and knowledge about sterilization. DESIGN: Cross-sectional survey. SETTING: Questionnaires were mailed to participants' home addresses. PATIENT(S): One hundred ninety-three women, aged 18-45, who had undergone tubal sterilization. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Attitudes and knowledge about tubal sterilization and awareness of contraceptive alternatives. RESULT(S): We received 193 completed surveys (64% response rate). African American (AA) woman were more likely to have a family member who had undergone tubal sterilization, to report that their mothers influenced their sterilization decisions, and to report that prior unintended pregnancy and desire to avoid insertion of a foreign object were very important factors in their decision to choose sterilization over other methods. Compared with white women, AA women more often thought that sterilization reversal could easily restore fertility (62% vs. 36%); that a woman's sterilization would reverse itself after 5 years (60% vs. 23%); and that a man cannot ejaculate after vasectomy (38% vs. 13%). Fewer AA women had ever heard of intrauterine contraception (90% vs. 98%). Racial differences in knowledge remained statistically significant after adjusting for socioeconomic confounders. CONCLUSION(S): Misinformation about sterilization and limited awareness of contraceptive alternatives among AA women may contribute to racial disparities in tubal sterilization rates.

Unintended pregnancy influences racial disparity in tubal sterilization rates.

BACKGROUND: 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. OBJECTIVE: 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. MAIN MEASURES: 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. KEY RESULTS: 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). CONCLUSION: Minority women, who more frequently experience unintended pregnancy, may choose tubal sterilization in response to prior experiences with an unintended pregnancy.

Low rates of vasectomy among minorities: a result of differential receipt of counseling?

Male sterilization is a highly effective contraceptive method that is underused especially among minorities. This analysis examined the association between race/ethnicity and receipt of sterilization counseling. This study used data collected by the 2002 National Survey of Family Growth. The analysis included men 15 to 44 years old who had not undergone sterilization. The outcome was receipt of sterilization counseling in the 12 months prior to interview, and the primary predictor was race/ethnicity. Sociodemographic characteristics, history of fathering an unintended birth, intention for more children, and access to health care were examined as confounders. Sixty-one (1.7%) men reported receiving sterilization counseling. Although counseling was reported more commonly by Black and Hispanic men compared with White men, the rates were not significantly different (odds ratio [OR] = 2.4, 95% confidence interval [CI] = 0.8-7.1 and OR = 1.9, 95% CI = 0.9-4.1, respectively). In this nationally representative sample of men aged 15 to 44 years, there were exceedingly low rates of sterilization counseling for all men regardless of race/ethnicity.

Contraception services for incarcerated women: a national survey of correctional health providers.

BACKGROUND: Incarcerated women have had limited access to health care prior to their arrest. Although their incarceration presents an opportunity to provide them with health care, their reproductive health needs have been overlooked. STUDY DESIGN: We performed a cross-sectional study of a nationally representative sample of 950 correctional health providers who are members of the Academy of Correctional Health Providers. RESULTS: A total of 405 surveys (43%) were returned, and 286 (30%) were eligible for analysis. Most ineligible surveys were from clinicians at male-only facilities. Of eligible respondents, 70% reported some degree of contraception counseling for women at their facilities. Only 11% provided routine counseling prior to release. Seventy percent said that their institution had no formal policy on contraception. Thirty-eight percent of clinicians provided birth control methods at their facilities. Although the most frequently counseled and prescribed method was oral contraceptive pills, only 50% of providers rated their oral contraceptive counseling ability as good or very good. Contraception counseling was associated with working at a juvenile facility, and with screening for sexually transmitted infections. CONCLUSIONS: Contraception does not appear to be integrated into the routine delivery of clinical services to incarcerated women. Because the correctional health care system can provide important clinical and public health interventions to traditionally marginalized populations, services for incarcerated women should include access to contraception.

Incarcerated women and abortion provision: a survey of correctional health providers.

CONTEXT: Many women entering jail or prison are pregnant, and correctional facilities are therefore an important venue for providing a range of pregnancy-related care, including access to abortion services. However, the availability of abortion services to inmates in the United States is unknown. METHODS: Between October 2006 and March 2007, surveys about abortion provision were mailed to 951 health professionals who provided clinical care in correctional facilities. Descriptive statistics were tabulated, and measures of association were calculated using chi-square analysis. RESULTS: Of the 286 respondents who returned analyzable surveys, 68% indicated that inmates at their facility can obtain "elective" abortions. Eighty-eight percent of this group indicated that their facility provides transportation, but only 54% said that they help arrange appointments. Responses did not differ by providers' individual or institutional characteristics. However, providers from states with a Republican-dominated legislature or with a Medicaid policy that severely restricted coverage for abortion were more likely to indicate that availability of abortion services was limited than were those whose state had a predominantly Democratic legislature or a Medicaid program that covered all or most medically necessary abortions. CONCLUSIONS: Although incarceration does not preclude women's need for access to abortion, full access to services is not available in all settings. Improving women's overall health care in correctional settings should include increasing the accessibility of abortion services.

"Everything I know I learned from my mother...Or not": perspectives of African-American and white women on decisions about tubal sterilization.

BACKGROUND: 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. OBJECTIVES: 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. DESIGN: 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. PARTICIPANTS: The participants of the study were 24 African-American women and 14 white women. APPROACH: Transcripts of the sessions were qualitatively analyzed with particular attention to factors that might be unique to each of the two racial groups. RESULTS: 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. CONCLUSION: Socio-cultural differences may help explain why black and white women choose different contraceptive methods.

Race, insurance status, and desire for tubal sterilization reversal.

OBJECTIVE: To examine the independent effects of race/ethnicity and insurance status on desire for tubal sterilization reversal. DESIGN: Secondary analysis of cross-sectional data collected by the 2002 National Survey of Family Growth (NSFG). SETTING: Interviews were conducted in person by a trained female interviewer in the participant's home. PATIENT(S): The NSFG is designed to represent women and men 15-44 years of age in the U.S. household population. The sample consisted of 934 women who had undergone tubal sterilization at any time before being interviewed. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Desire for sterilization reversal. RESULT(S): Among women older than 30 years at time of surgery, black women were significantly more likely to desire sterilization reversal compared with white women (adjusted odds ratio, 2.6; 95% confidence interval, 1.2, 5.8). In the total cohort and in the subset of women 30 years or younger, there were no significant racial/ethnic variations in desire for sterilization reversal. CONCLUSION(S): Among women over age 30 at the time of tubal sterilization, black women were much more likely to express desire for reversal than white women.