Husband or wife? A multivariate analysis of decision making for voluntary sterilization

The increasing popularity of sterilization as a contraceptive choice among married couples underscores the need for knowledge about differences between couples choosing male and female procedures. Data from national surveys suggest some sociodemographic differences, but these variables account for only a small amount of the variance. This research looks at other sets of variables--information sources, influence sources, and reasons husbands and wives give for wanting sterilization--in a multivariate analysis of the choice of a male versus a female operation. Particularly for husbands obtaining a vasectomy, the importance of social support is demonstrated.     

Couples' Unmet Need for Family Planning in Three West African Countries

Unmet need for family planning is typically calculated for currently married women, but excluding husbands may result in misleading estimates of couples' unmet need. This study builds on previous work and proposes a method of calculating couples' unmet need for family planning based on spouses' independent fertility intentions. We analyze Demographic and Health Survey data from couples from three West African countries—Benin, Burkina Faso, and Mali. We find that fewer than half of couples having any unmet need had concordant unmet need (41–49 percent). A similar percentage of couples had wife‐only unmet need (33–40 percent). A smaller percentage had husband‐only unmet need (15–23 percent). Calculating unmet need based only on women's fertility intentions overestimates concordant unmet need. Additionally, that approximately 15–23 percent of couples have husband‐only unmet need suggests that men could be an entry point for contraceptive use for more couples than at present. To calculate husbands' unmet need, population‐based surveys should consider collecting the necessary data consistently.     

The option for vasectomy and gender relations

A qualitative study was performed to: investigate the process that leads couples to decide for vasectomy; characterize the gender relations involved in this process; and identify sources of information on vasectomy. Semi-structured interviews were conducted with 20 couples who had requested vasectomy at the outpatient clinic of the Center for Integrated Women's Health Care, State University in Campinas, S?o Paulo, Brazil. A structured form was used to collect social, economic, and demographic data. The content analysis technique was used for data analysis. The majority of couples opted for vasectomy as a last resort after attempting numerous other contraceptive methods, not always successfully. The emerging gender relations showed fluctuation between: (1) a more rigid, quasi-patriarchal model characterized by male predominance in the family's decision-making and (2) a more ambiguous model in relation to reproductive decisions, whereby women assumed responsibility for contraception until the situation became untenable, at which point men faced up to the unavoidable necessity of sterilization. At this point the male partners felt they should collaborate.     

上海市夫妇产后首选避孕措施社会心理行为学影响因素的研究

对7101对上海市80年末初婚并已生育的队列夫妇进行8年的前瞻性调查。选择14项夫妇社会心理性学变量,拟合多项分布Logistic回归模型,分析影响夫妇产后首选避孕措施因素的重要性。结果显示妻子单位的性质及医务人员掌握放置宫内节育器指征为两项重要外界因素,白领阶层、避孕知识得分较高的妻子、愿意接受新式男用避孕法的丈夫;具有明确避孕动机者或了解避孕套能预防性病或艾滋病的夫妇均明显倾向非首选放置宫内节育器(包括人工流产后)。分析提示单位管理者及医务人员除应继续掌握指征对妇女于产后放置宫内节育器外,有必要结合夫妇特性指导使用各类她们所乐意使用的避孕措施,及进一步开展有关避孕措施健康效益的教育,以增加夫妇对各类常用避孕措施的可接受性和使用效果。     

Contraceptive characteristics: the perceptions and priorities of men and women.

CONTEXT: Despite the fact that choosing a contraceptive method is often a decision made by couples, little is known about how men and women differ in their perceptions of the characteristics of various method types, and in the importance that they attach to those characteristics when choosing a contraceptive method. METHODS: The data analyzed here are subsets from two companion surveys conducted in 1991--1,189 men aged 20-27 who were surveyed in the National Survey of Men and 740 women aged 20-27 who were surveyed in the National Survey of Women. Multivariate ordered logit analysis is used to examine how gender is related to both the importance that individuals assign to seven specific contraceptive characteristics when choosing a method, and to perceptions about the extent to which five common method types possess each of these characteristics. RESULTS: Women rank pregnancy prevention as the single most important contraceptive characteristic when choosing a method, with 90% citing it as "very important." The health risks associated with particular methods and protection from sexually transmitted diseases (STDs) are rated as the second most important characteristics by women (each mentioned as "very important" by 77%). In contrast, men consider STD prevention for themselves and their partner to be just as important as pregnancy protection (each mentioned as "very important" by 84-86%), and they rank STD prevention as more important than other health risks (by 72%). Women, but not men, rank both ease of use and the need to plan ahead as being more important characteristics than a method's interference with sexual pleasure. Both men and women have an accurate understanding of the strengths and weaknesses of particular methods, but differ enough in their perceptions to alter the relative attractiveness of each method. In particular, women have more favorable perceptions than men about the pill, being somewhat more likely than men to believe that the pill is "very good" at preventing pregnancy (75% vs. 67%) and to say that it is very good at not interfering with sexual pleasure (82% vs. 76%). In contrast, women have generally less favorable perceptions than men about other reversible methods, including the condom: Women were less likely than men to consider the condom very good at pregnancy prevention (29% vs. 46%) or at having no need for advance planning (22% vs. 38%). Gender differences in perceptions about the specific characteristics of contraceptive methods often vary by marital status. CONCLUSIONS: Men and women have somewhat different priorities when choosing a contraceptive method. Despite many similarities between women and men in their perceptions about the characteristics of each method type, numerous differences between them may have an important influence on how couples make their method choices.     

High prevalence of vasectomy in New Zealand.

The aim of this study was to examine the prevalence of vasectomy and associated factors in New Zealand, based on interviews with men. Participants were randomly selected from European men, aged between 40 and 74 years, on the general electoral roll. Telephone interviews were completed with 1225 men between 1997 and 1999. Overall, the prevalence of vasectomy was 44% (95% CI, 37-52%), adjusted to the age distribution of all New Zealand men aged 40-74 years. The prevalence ranged from 57% of men aged 40-49 years to 15% of those aged 70-74 years. Catholic men had a significantly lower odds of vasectomy, and there was a trend in increasing odds of vasectomy with increasing number of marriages and level of education of the wife. The results confirm a very high prevalence of vasectomy among New Zealand men. Comparison with earlier surveys based on interviews of women showed an increasing prevalence of vasectomy in each birth cohort from the 1920s to the 1950s. Vasectomy has been popular with men across all socioeconomic groups. New Zealand is an ideal country in which to study consequences of vasectomy.     

Contraceptive sterilization among married adults: national data on who chooses vasectomy and tubal sterilization

BackgroundVasectomy has been found to be a highly cost-effective contraceptive method. For couples, tubal sterilization and vasectomy have the same result, but the two methods are used by different segments of the population.Study designWe conducted an analysis of data from male and female samples of the 2006–2008 National Survey of Family Growth, nationally representative samples of men and women in the United States aged 15–44 years.ResultsAmong married men, 13.1% reported vasectomies (95% confidence interval 10.4%–16.3%), compared to 21.1% (17.8%–24.9%) of married women who reported tubal sterilizations. Men with higher education and income had greater prevalence of vasectomy than those less educated, while women with lower education and income had the highest prevalence of tubal sterilization.ConclusionsEfforts to promote vasectomy use need to understand the reasons behind these differences. Increasing the availability and use of vasectomy will require education about its benefits.     

Characteristics of candidates for surgical sterilization and factors associated with type of procedure

In 1999 the Municipal Health Department in Ribeir?o Preto, S?o Paulo, Brazil, implemented the provision of surgical contraceptive methods according to prevailing legal requirements. This study aimed to characterize the candidates for surgical sterilization and study the variables associated with the type of procedure. A total of 95 candidate patient records were studied, and statistical logistic regression analysis and Fisher's exact test were performed considering a significance level of ? = 0.05. Most candidates had stable partners, low schooling, and low income, were satisfied with their number of children, and had already tried to limit the number of children using reversible contraceptives. Mean age was 34.2 years, 45.3% underwent female sterilization, 35.8% underwent vasectomy, and 18.9% did not submit to any procedure. The odds of a man older than 35 having a vasectomy were 6.1 times that of a younger man (OR = 6.1; 95%CI: 2.4-16.4). More married men submitted to vasectomy than men who cohabited (OR = 4.0; 95%CI: 1.5-12.4). Women with four or more children were more likely to undergo sterilization than those with fewer children (OR = 3.1; 95%CI: 1.1-8.5).     

Why are rates of sterilization in decline? A pilot study designed to explore reasons for declining female sterilization in Scotland

BACKGROUND: In the last decade, female sterilization had been in decline throughout the UK. It is not clear whether fewer women are requesting sterilization or whether the universal enthusiasm for long-acting reversible methods is leading health professionals to discourage women from being sterilized. Since correct and consistent use of alternative, reversible contraceptive methods depends somewhat on their acceptability, it is important to determine whether women are being refused sterilization or whether they are freely choosing other methods. This study aims to explore whether female sterilization is being widely considered as a contraceptive method, the reasons for choosing or rejecting it, and whether women are being discouraged by health professionals from being sterilized. STUDY DESIGN: A self-completed questionnaire survey among 205 women aged 30 to 50 years who felt that their family was complete attending a family planning clinic in Scotland. RESULTS: Of the 203 women included in the study, 151 (74.4%) had heard of female sterilization, 90 had discussed it with someone (60%) and 87 (58%) had considered it as a contraceptive option. Of the 56 women who consulted their family doctor about sterilization, almost half (27; 48%) were not referred to a hospital and fewer than one (17, 30.4%) in three of them was eventually sterilized or had arrangements in place to get it done. Free-text comments from the women revealed a variety of reasons for not choosing female sterilization and suggested that some women are being deterred from sterilization. CONCLUSION: The study suggests that some women are being actively encouraged by health professionals to use long-acting reversible contraceptive methods and discouraged from choosing sterilization. However, other women recognize for themselves the wisdom of keeping their fertility options open.     

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.     

Who requests reversal of female sterilisation? A retrospective study from a Scottish unit.

The characteristics and circumstances of 55 women who underwent reversal of sterilisation were compared with those of 55 women who had a sterilisation performed at the same time, but who did not subsequently undergo reversal. Patients who underwent reversal were sterilised at a significantly younger age, and were more likely to have been sterilised at the time of therapeutic abortion or miscarriage. The parity at the time of sterilisation was the same for both groups. The reason for requesting reversal was a change of partner in the vast majority of cases. From this and other studies we conclude that alternative contraception should be sought in patients who are young or whose relationships appear unsteady at the time of sterilisation request, and that sterilisation at the time of therapeutic abortion should be abandoned in favour of an interval procedure. By so doing we may stem the rising tide of patients who subsequently seek a reversal of their sterilisation.     

Menstrual and Oral Contraceptive Use Patterns Among Deployed Military Women by Race and Ethnicity

Menstrual cycle patterns and concerns and oral contraceptive use in the combat environment were examined in Caucasian, Asian, Hispanic, and African American women to guide the development of educational resources for women soldiers. An anonymous, questionnaire was completed by 455 U.S. Army women—Caucasian (CA: n = 141); Asian (AS: n = 67); Hispanic (HIS: n = 67); and African American (AA: n = 184) to compare menstrual patterns and concerns, dysmenorrhea, and oral contraceptive patterns. Total menstrual concerns were significantly lower among African Americans relative to Caucasians, Asians, or Hispanics; Asians and Hispanics reported the greatest concern. Overall, secondary amenorrhea was noted by 14.9% of women. Severe dysmenorrhea rates were significantly lower in African American (6.1%) compared to Caucasian (11.6%), Asian (20.9%) and Hispanic (19.7%) women. Asian women reported missing less work—only 9.3% with moderate to severe dysmenorrhea missed work compared to 25.1% of all other women. Only 9.2% of women with mild, compared to 25.8% with moderate to severe (OR = 3.44; p ≤ 0.0001) dysmenorrhea sought health care. Less than 50% of women took oral contraceptive, and less than half of those women took oral contraceptive continuously. African Americans seemed to experience menstruation as less bothersome than others, despite no difference in the proportion with menstrual irregularities, mean duration of menses, and/or mean time between cycles.     

Menstrual and oral contraceptive use patterns among deployed military women by race and ethnicity

Menstrual cycle patterns and concerns and oral contraceptive use in the combat environment were examined in Caucasian, Asian, Hispanic, and African American women to guide the development of educational resources for women soldiers. An anonymous, questionnaire was completed by 455 U.S. Army women-Caucasian (CA: n = 141); Asian (AS: n = 67); Hispanic (HIS: n = 67); and African American (AA: n = 184) to compare menstrual patterns and concerns, dysmenorrhea, and oral contraceptive patterns. Total menstrual concerns were significantly lower among African Americans relative to Caucasians, Asians, or Hispanics; Asians and Hispanics reported the greatest concern. Overall, secondary amenorrhea was noted by 14.9% of women. Severe dysmenorrhea rates were significantly lower in African American (6.1%) compared to Caucasian (11.6%), Asian (20.9%) and Hispanic (19.7%) women. Asian women reported missing less work-only 9.3% with moderate to severe dysmenorrhea missed work compared to 25.1% of all other women. Only 9.2% of women with mild, compared to 25.8% with moderate to severe (OR = 3.44; p ≤ 0.0001) dysmenorrhea sought health care. Less than 50% of women took oral contraceptive, and less than half of those women took oral contraceptive continuously. African Americans seemed to experience menstruation as less bothersome than others, despite no difference in the proportion with menstrual irregularities, mean duration of menses, and/or mean time between cycles.     

Vasectomy: who gets one and why?

This study of 173 men who received vasectomies from one urologist shows the male seeking a vasectomy from this clinic is white, middle class, well educated, married once, median age of 36, and with 2 to 3 children. Three quarters of the men had used the condom and found it bothersome. The same number had also used the pill and various other methods of contraception without satisfaction. Other studies have shown economic reasons as the main factor leading to vasectomy whereas this one revealed freedom from anxiety about possible conception and sexual pleasure as the primary reasons. The concern for sexual freedom is considered characteristic of our present culture and probably closely associated with the pill itself. Since the pill is not related as closely with the sex act as other methods of contraception it has given couples the freedom to enjoy sex. Since the late 1960s when the media began publishing the side effects from the pill our society has been seeking a replacement method that will allow that freedom to remain. This group will continue to be followed along with other planned studies, to see if their contraceptive vasectomy has made any changes in their lives.     

Differences in Contraceptive Use Across Generations of Migration Among Women of Mexican Origin

Objectives To explore differences in contraceptive use among women of Mexican origin across generations of migration. Methods Logit models were used to assess contraceptive use among 1,830 women of Mexican origin in Cycles 5 (1995) and 6 (2002) of the National Survey of Family Growth (NSFG). Analyses were stratified by age. Initial models controlled for survey year and underlying differences across generations of migration in age and parity; subsequent models added a range of potential mediating variables. Models account for significant interactions between generation of migration and parity. Results Among women under age 30 who have not yet had any children, women in their twenties with parity 3 or more, and women 30 or older with parity 1 or 2, those born in the US are much more likely to use contraception than immigrant women. For other levels of parity, there are no significant differences in contraceptive use across generations of migration. Generational differences in marital status, socio-economic status, health insurance coverage, and catholic religiosity did little to mediate the association between generation of migration and contraceptive use. Conclusions Among women of Mexican origin, patterns of contraceptive use among first-generation immigrants and women of generation 1.5 are similar to those of women in Mexico, with very low rates of contraceptive use among young women who have not yet had a child. Further research is needed to investigate the extent to which this pattern is due to fertility preferences, contraceptive access, or concerns about side effects and infertility. Patterns of contraceptive use appear to change more slowly with acculturation than many other factors, such as education, income, and work force participation.     

Women on top: the relative influence of wives and husbands on contraceptive use in KwaZulu-Natal

OBJECTIVES: The purpose of this paper is to examine the relative influence of husband and wife on contraceptive practice. METHODS: A cross-sectional survey was conducted among adult men and women in KwaZulu-Natal, South Africa. A matched file for 238 married or cohabiting couples was created. RESULTS: Knowledge of methods of contraception was virtually universal and attitudes to contraception were favorable both in men and women. A substantial proportion of men and women reported using a method of contraception. The wife's desire to stop childbearing was the most powerful predictor of contraceptive use among couples, after adjustment for possible confounders. The husband's approval (or not) of family planning and his preference for future childbearing were not significantly related to contraceptive use. CONCLUSION: Contraceptive use within marital and cohabiting unions is high and the wife's fertility preference was found to be a key determinant of use. This conclusion challenges conventional wisdom that men are the dominant decision-makers in fertility and family planning decisions.     

The vasectomy decision-making process

Vasectomy is greatly underutilized in most countries, in part because it is the least promoted of all modern contraceptive techniques. If providers have favorable attitudes toward vasectomy, a good understanding of the decision making process that leads to vasectomy enhances their ability to encourage the use of this method. Furthermore, thorough counseling of vasectomy seekers will significantly increase acceptance. The purpose of this article is to define the decision making process and to discuss how this information can be used in family planning programs. An in-depth study was made of the decision making processes of 235 couples using the counseling services of the Planned Parenthood Association of Houston, Texas, in order to understand the decision making process. The process took from 2 to more than 10 years and has the following events in common: became aware of vasectomy; talked to a vasectomized man; decided to have no more children; decided temporary contraceptives were no longer acceptable; decided vasectomy was the best contraceptive method; had a scare (a missed period or severe side effects from the pill). Information gathering by acceptors occurred throughout the process, with men faltering on the way toward vasectomy because they lacked information from an influential source, not because they had been exposed to a casual dose of misinformation. Sources questioned include physicians (usually gave incomplete answers); reading material (less than 50% used this source); vasectomized men (9 out of 10 used this source and felt it to be most influential). Questions most men ask are listed in the article. Guidelines for counselling are suggested. Specific suggestions for program administrators are offered, based on the 5 phases most men pass through before getting a vasectomy. Phase 5, when a decision is made, is the best time for an information and education program through the mass media. Other stages suggest capitalizing on the presence of vasectomized men in their communities and in-depth media campaigns.     

Characteristics of men receiving vasectomies in the United States, 1998-1999

CONTEXT: Even though vasectomy is a popular method of contraception in the United States, there is limited information on the characteristics of men choosing vasectomy and why they decide to undergo the procedure.
METHODS: A nationwide, practice-based survey of 719 men receiving vasectomies was conducted between July 1998 and June 1999.
RESULTS: Low-income, minority and less educated men were underrepresented among vasectomy recipients. The majority of men were married or cohabiting (91%), non-Hispanic and white (87%), and educated beyond high school (81%). Only 7% of men had annual household incomes of less than $25,000, and fewer than 1% paid for the procedure using public funding; 81% of respondents paid through private insurance or a health maintenance organization. Half of men reported choosing vasectomy over a reversible method because it is the most secure means of preventing pregnancy, and 62% chose vasectomy over tubal ligation because the procedure is simpler and safer. Doctors and nurses were the most important sources of information about vasectomy (cited by 31% of respondents), followed by wives or partners (25%) and friends (23%).
CONCLUSIONS: Despite the diversity of the U.S. population, vasectomy recipients are a homogeneous group. By identifying users of vasectomy and underserved groups, our findings should assist service providers and program managers in planning strategies to reduce the large difference in levels of vasectomy use among men of different races, ethnicities and income groups.     

Vasectomy and non-fatal acute myocardial infarction: a hospital-based case-control study in Seoul, Korea

One hundred and sixty-three Korean men aged 35-64 who were admitted to a university-affiliated hospital diagnosed for the first time with acute myocardial infarction (AMI) were compared with 326 matched non-AMI patients hospitalized with a diagnosis considered unrelated to vasectomy. When other potentially confounding variables were controlled for, vasectomized men were found to be 2.6 times (adjusted odds ratio) more likely to have had an AMI as compared to the non-vasectomized men (95% CL: 1.1, 6.1). The adjusted odds ratio of AMI for subjects having had a vasectomy less than or equal to 9 years ago was the same as those who had a vasectomy greater than or equal to 15 years (OR = 2.5), although those who had had a vasectomy 10-14 years ago were associated with a higher odds ratio of 4.2. Among those subjects with vasectomies who were also cigarette-smokers and/or hypertensive, the risk of development of AMI increased multiplicatively compared with those with none of these conditions. We suspect that our finding of this positive association may be spurious due to possible bias introduced during selection of controls and during the process of data collection. Cancer patients may have been less likely to undergo an elective surgical procedure such as vasectomy prior to the admission. When multivariate analysis included only controls who were non-cancer patients (N = 241 controls), the adjusted odds ratio between vasectomy and hospitalization for AMI was reduced to 2.1, (95% CL: 0.8, 5.7), which is no longer statistically significant. When the analysis was further limited to only those control subjects admitted with a diagnosis of digestive system problems, the adjusted odds ratio was reduced to close to unity (1.1). Recognizing the importance of the study topic and the fact that all previous epidemiological studies showed no association between vasectomy and cardiovascular diseases, we urge further studies. A historical cohort study in the Korean setting is considered feasible and is recommended.     

Intervening with couples: assessing contraceptive outcomes in a randomized pregnancy and HIV/STD risk reduction intervention trial.

PURPOSE: This study assessed the contraceptive outcomes of the Partners Against Risk-Taking: A Networking, Evaluation and Research Study (PARTNERS). The PARTNERS project developed and evaluated a 3-session intervention to help young women and their male partners reduce their risk for unintended pregnancies, and HIV and other STDs. METHODS: Participating couples were randomly assigned to the 3-session intervention or a 1-session information session for couples. Changes in psychosocial factors related to women's motivation to use contraception and relationship factors were assessed using analysis of variance with repeated measures. Changes in contraceptive outcomes were assessed using logistic regression with generalized estimating equations. RESULTS: Comparison of changes from baseline to 6 months among women who participated in the 3-session intervention with those who participated in the information session showed no significant intervention effect on reports of contraceptive use. Instead, contraceptive use increased in both conditions. Both groups exhibited similar changes in the psychosocial variable measuring the importance of avoiding pregnancy and in the relationship variable measuring women's participation in contraceptive decision making. Members of the intervention group, however, showed greater improvement in the psychosocial variable measuring positive expectations pertaining to partner's support for contraception. CONCLUSION: These findings raise questions for further investigation to better understand couples behavior, and whether and how to intervene with couples.