Family planning and female sterilization in the United States

This report critically examines the issue of sterilization in the United States based on data from the National Survey of Family Growth, Cycles I and II, spanning the years 1973 to 1976. Of particular concern is analysis of sterilization rates as they vary across categories of race, socioeconomic status, welfare status, number of children and desire for the service. The development of a framework containing competing theories and philosophies, based upon previous literature in the area, provides a useful paradigm for an understanding of the significance of sterilization rates. The methodology includes bivariate techniques involving tabular analysis as well as multivariate techniques through the use of logistic regression analysis. Findings support hypotheses related to class factors and parity, while the racial and altruistic interpretations are not supported. Policy implications and areas requiring further research are specified.     

Depression in the United States and Japan: gender, marital status, and SES patterns

A number of investigators have claimed that higher depression scores and higher rates of depressive disorder are found worldwide in women, unmarried persons, and people of low socioeconomic status (SES). A closer look, however, indicates that patterns for Asian countries are less consistent than claimed. As a case in point, using comparable data from the National Family Research of Japan '98 survey (N=6985) and the National Survey of Families and Households in the US (N=8111), we examine the distributions of depressive symptoms by gender, marital status, and SES, with a short form of the CES-D Scale. Bivariate and multivariate analyses show that depressive symptoms are higher in women, unmarried persons, and those with lower family incomes in both countries, but there is no association between education and depression in Japan while symptoms are inversely related to education in the US. We argue that the lack of relationship between education and depression in Japan is not an artifact of measurement but a product of Japan's distinctive stratification processes relating to occupation. Cross-national variations around "general" patterns are important because they offer clues to more specific cultural and structural factors involved in the social etiology of mental disorder.     

Cardiovascular risk status and oral contraceptive use: United States, 1976-1980

Data from the second National Health and Nutrition Examination Survey, conducted in 1976-1980, were analyzed for the prevalence of cardiovascular risk factors (cigarette smoking, serum cholesterol, and blood pressure) among 2,342 premenopausal women ages 20-44 years, stratified by oral contraceptive use. For oral contraceptive users and non-users, adjusted means were serum cholesterol, 205 vs 188 mg/dl (P less than 0.05); systolic blood pressure, 116 vs 113 mm Hg (P less than 0.01); and diastolic blood pressure, 74 vs 73 mm Hg (NS). The prevalence of cigarette smoking was significantly higher among oral contraceptive users (44% compared with 36% among nonusers; P less than 0.05). Using the 1984 NIH Consensus Development Conference Statement on Lowering Blood Cholesterol to define risk levels for serum cholesterol, 23% of the oral contraceptive users were at high risk compared with 12% of the nonusers, and 16% of the oral contraceptive users vs 11% of the nonusers were at moderate risk. For users and nonusers, the respective prevalence of a blood pressure at or above 140/90 mm Hg was 5.3% vs 8.8% (unadjusted) and 8.6% vs 8.0% (age adjusted). The percentage of women with multiple risk factors was also higher among oral contraceptive user; 14% of the users had two or more risk factors vs 7% of the nonusers (P less than 0.05). These cross-sectional national data support data from clinical studies regarding the effect of oral contraceptives on cholesterol and blood pressure levels. In addition, since the use of oral contraceptives is widespread in the population and users tend to see physicians more regularly than other women, the data suggest that users of the pill are a good target group among which to screen and monitor cardiovascular risk factors.     

Tubal sterilization in the United States, 1994-1996

CONTEXT: Although the number and rate of tubal sterilizations, the settings in which they are performed and the characteristics of women obtaining sterilization procedures provide important information on contraceptive practice and trends in the United States, such data have not been collected and tabulated for manyyears. METHODS: Information on tubal sterilizations from the National Hospital Discharge Survey and the National Survey of Ambulatory Surgery was analyzed to estimate the number and characteristics of women having a tubal sterilization procedure in the United States during the period 1994-1996 and the resulting rates of tubal sterilization. These results were compared with those of previous studies to examine trends in clinical setting, in the timing of the procedure and in patient characteristics. RESULTS: In 1994-1996, more than two million tubal sterilizations were performed, for an average annual rate of 1 1.5 per 1,000 women; half were performed postpartum and half were interval procedures (i. e., were unrelated by timing to a pregnancy). All postpartum procedures were performed during inpatient hospital stays, while 96% of interval procedures were outpatient procedures. Postpartum sterilization rates were higher than interval sterilization rates among women 20-29 years of age; interval sterilization procedures were more common than postpartum procedures at ages 35-49. Sterilization rates were highest in the South. For postpartum procedures, private insurance was the expectedprimary source of payment for 48% and Medicaid was expected to pay for 41 %; for interval sterilization procedures, private insurance was the expected primary source of payment for 68% and Medicaid for 24%. CONCLUSIONS: Outpatient tubal sterilizations andprocedures using laparoscopy have increased substantially since the last comprehensive analysis of tubal sterilization in 1987, an indication of the effect of technical advances on the provision of this service. Continued surveillance of both inpatient and outpatient procedures is necessary to monitor the role of tubal sterilization in contraceptive practice.     

The alternative birth movement in the United States: history and current status

The alternative birth movement is a consumer reaction to paternalistic and mechanistic medical obstetrical practices which developed in the United States early in this century. Alternative birth settings developed as single labor-delivery-recovery rooms in the hospital or as free-standing birth centers. Both alternatives offer family-centered, home-like, low technological maternity care. In order to overcome physician resistance to non-traditional maternity care, alternative birth center policies eliminate all women who are expected to have a complicated pregnancy or delivery. Physician resistance to alternative birthing is publicly based on the issue of maternal and infant safety. Additional issues, however, are that physicians fear economic competition and resist loss of control over obstetric practice. This paper (1) traces the historical antecedents and social factors leading to the alternative birth movement, (2) describes the types of alternative birthing methods, and (3) describes ways in which the obstetrical community has maintained and rationalized dominance over the birthing process.     

Sexual experience and contraceptive use among female teens - United States, 1995, 2002, and 2006-2010

The 2010 U.S. teen birth rate of 34.3 births per 1,000 females reflected a 44% decline from 1990. Despite this trend, U.S. teen birth rates remain higher than rates in other developed countries; approximately 368,000 births occurred among teens aged 15-19 years in 2010, and marked racial/ethnic disparities persist. To describe trends in sexual experience and use of contraceptive methods among females aged 15-19 years, CDC analyzed data from the National Survey of Family Growth collected for 1995, 2002, and 2006-2010. During 2006-2010, 57% of females aged 15-19 years had never had sex (defined as vaginal intercourse), an increase from 49% in 1995. Younger teens (aged 15-17 years) were more likely not to have had sex (73%) than older teens (36%); the proportion of teens who had never had sex did not differ by race/ethnicity. Approximately 60% of sexually experienced teens reported current use of highly effective contraceptive methods (e.g., intrauterine device [IUD] or hormonal methods), an increase from 47% in 1995. However, use of highly effective methods varied by race/ethnicity, with higher rates observed for non-Hispanic whites (66%) than non-Hispanic black (46%) and Hispanic teens (54%). Addressing the complex issue of teen childbearing requires a comprehensive approach to sexual and reproductive health that includes continued promotion of delayed sexual debut and increased use of highly effective contraception among sexually experienced teens.     

The 'natural' body, God and contraceptive use in the southeastern United States

Data collected among African-American and Caucasian women and men in the southeastern USA indicate that participants' perceptions of nature, God's will and the human body influence reproductive health and decision-making. Attitudes about the health care system, pharmaceutical companies and government programmes for fertility regulation reinforce these views and may negatively affect willingness to use contraceptive methods consistently and correctly.     

Factors associated with contraceptive use and nonuse, United States, 2004

CONTEXT: Each year, nearly one in four U.S. women at risk of unintended pregnancy experience one or more months of contraceptive nonuse. Understanding what factors are associated with risky contraceptive use patterns can inform programs and policies designed to reduce levels of unintended pregnancy. METHODS: A nationally representative sample of 1,978 adult women at risk for unintended pregnancy was surveyed over the telephone in 2004. Respondents provided information on contraceptive use over the past 12 months. Multiple logistic regressions were used to identify factors associated with different contraceptive use patterns. RESULTS: Ambivalence about avoiding pregnancy was strongly associated with both contraceptive nonuse and having a gap in use while remaining at risk of unintended pregnancy (odds ratios, 2.4 and 2.0, respectively). Other significant predictors of either of these risky contraceptive behaviors were having less than a college education, being black, being 35-44 years old, having infrequent sexual intercourse, not being in a current relationship, being dissatisfied with one's method and believing that contraceptive service providers were not available to answer method-related questions (1.7-3.8). CONCLUSIONS: Providers could better help women avoid unintended pregnancy by initiating regular assessments of method use difficulties, improving counseling on method choice and pregnancy risk, and identifying and assisting women at higher risk for inconsistent method use because of disadvantage, relationship characteristics or ambivalence about pregnancy prevention. In addition to providers' efforts, broader societal commitment is critical for increasing contraceptive knowledge and expanding access to contraceptive care for all women who are at risk of having an unintended pregnancy.     

Social and clinical correlates of postpartum sterilization in the United States, 1972 and 1980

This analysis is based on the 1972 and 1980 National Natality Surveys, conducted by the National Center for Health Statistics. About 10.6 percent (381,000) of women in the United States who delivered live infants in 1980 were sterilized postpartum. About 93 percent of these postpartum sterilizations were tubal operations; only 1.4 percent were hysterectomies. Because the literature on the health correlates of sterilization is sparse, this analysis was exploratory. In both 1972 and 1980, married mothers were more likely to be sterilized postpartum if they had previous fetal losses, underlying medical conditions, complications of pregnancy, or a cesarean delivery. Inspection of more detailed tabulations reveals that repeat cesarean delivery, multiparity, diabetes and at the higher birth orders, excess weight gain, and toxemia preeclampsia were associated with postpartum sterilization. An apparent association with varicosity may be due to misreporting. The degree to which each of these associations is causal or spurious awaits further research, but preliminary analysis suggests that some maternal health factors may influence some sterilization decisions. Beyond these specific maternal health conditions and complications, the evidence for a connection between poor maternal health and sterilization is equivocal.     

Progestin-only contraceptive pill use among women in the United States

BackgroundProgestin-only contraceptive pills (POPs) offer a safe and effective contraceptive option, particularly for women at increased risk of venous thromboembolism. However, the prevalence of POP use among women in the United States is unknown.Study DesignWe analyzed population-based data from 12,279 women aged 15–44 years in the National Survey of Family Growth. Data were collected continuously from 2006 to 2010 by in-person, computerized household interviews. Analyses describe POP use across sociodemographic and reproductive characteristics and thromboembolic risk profiles.ResultsOverall, 0.4% of all reproductive-aged women in the United States currently use POPs. POP use was higher among parous, postpartum and breastfeeding women than their counterparts (all p values<.001). Women at higher risk of thromboembolism (older, obese, diabetic or smoking women) had similar proportions of POP use as women without those risks.ConclusionPOPs are rarely used by US women. While data on chronic disease were limited, our results suggest that relatively few women with increased risk of thromboembolism are considering POPs when choosing an oral contraceptive.     

Reconsidering racial/ethnic differences in sterilization in the United States

Objective

Cross-sectional studies have found that low-income and racial/ethnic minority women are more likely to use female sterilization and less likely to rely on a partner’s vasectomy than women with higher incomes and whites. However, studies of pregnant and postpartum women report that racial/ethnic minorities, particularly low-income minority women, face greater barriers in obtaining a sterilization than do whites and those with higher incomes. In this paper, we address this apparent contradiction by examining the likelihood a woman gets a sterilization following each delivery, which removes from the comparison any difference in the number of births she has experienced.

Study Design

Using the 2006–2010 National Survey of Family Growth, we fit multivariable-adjusted logistic and Cox regression models to estimate odds ratios and hazard ratios for getting a postpartum or interval sterilization, respectively, according to race/ethnicity and insurance status.

Results

Women’s chances of obtaining a sterilization varied by both race/ethnicity and insurance. Among women with Medicaid, whites were more likely to use female sterilization than African Americans and Latinas. Privately insured whites were more likely to rely on vasectomy than African Americans and Latinas, but among women with Medicaid-paid deliveries reliance on vasectomy was low for all racial/ethnic groups.

Conclusions

Low-income racial/ethnic minority women are less likely to undergo sterilization following delivery compared to low-income whites and privately insured women of similar parities. This could result from unique barriers to obtaining permanent contraception and could expose women to the risk of future unintended pregnancies.

Implications

Low-income minorities are less likely to undergo sterilization than low-income whites and privately insured minorities, which may result from barriers to obtaining permanent contraception, and exposes women to unintended pregnancies.     

First premarital contraceptive use: United States, 1960-82

This study shows the first national estimates of trends and differentials in first contraceptive use for a national sample of all women. Only 47 percent of women aged 15-44 in 1982 (or their partners) used a method at first premarital intercourse. The leading method at first intercourse was the condom, followed by the pill and withdrawal. The percentage using a method increased from the early 1960s to the late 1970s, because of increases in use of the pill and withdrawal. However, in the early 1980s, use at first intercourse increased sharply because of an increase in use of the condom. The proportion who used a method at first intercourse varied from 22 percent among Hispanic women to 74 percent among Jewish women; it was higher among white than black women, and higher in higher socioeconomic categories. After first intercourse, contraceptive use did not vary significantly by socioeconomic characteristics. While the condom was the leading method at first intercourse, women who practiced contraception for the first time after first intercourse typically used the pill.     

European Union bans atrazine, while the United States negotiates continued use

Atrazine is a common agricultural herbicide with endocrine disruptor activity. There is evidence that it interferes with reproduction and development, and may cause cancer. Although the U.S. Environmental Protection Agency (EPA) approved its continued use in October 2003, that same month the European Union (EU) announced a ban of atrazine because of ubiquitous and unpreventable water contamination. The authors reviewed regulatory procedures and government documents, and report efforts by the manufacturer of atrazine, Syngenta, to influence the U.S. atrazine assessment, by submitting flawed scientific data as evidence of no harm, and by meeting repeatedly and privately with EPA to negotiate the government's regulatory approach. Many of the details of these negotiations continue to be withheld from the public, despite EPA regulations and federal open-government laws that require such decisions to be made in the open.     

Demographic trends in tubal sterilization: United States, 1970-1978.

In the period 1970-1977, an estimated 4,236,000 women 15-44 years of age had tubal sterilization operations in United States hospitals. Both the number and the rate of tubal sterilizations increased each year from 1970-1977, but in 1978 both declined. Tubal sterilization rates for Black women were higher than for White women. Black women also tended to be younger at the time of tubal sterilization. For the nation as a whole, the mean age at the time of tubal sterilization remained constant at about 30 with the youngest age group having the highest proportion of never-married women.     

Marital status and longevity in the United States population

PURPOSE: To investigate the relation between marital status and survival. DATA SOURCES: The US 1989 national health interview survey (NHIS) merged with the 1997 US national death index. RESULTS: Among 1989 NHIS respondents, 5876 (8.77%) died before 1997 and 61 123 (91.23%) were known to be alive. Controlling for demographic and socioeconomic characteristics, the death rate for people who were unmarried was significantly higher than it was for those who were married and living with their spouses. Although the effect was significant for all categories of unmarried, it was strongest for those who had never married. The never married effect was seen for both sexes, and was significantly stronger for men than for women. For the youngest age group (19-44), the predominant causes of early death among adults who had never married were infectious disease (presumably HIV) and external causes. In the middle aged and older men and women, the predominant causes were cardiovascular and other chronic diseases. CONCLUSION: Current marriage is associated with longer survival. Among the not married categories, having never been married was the strongest predictor of premature mortality. It is difficult to assess the causal effect of marital status from these observational data.