Marital status and female and male contraceptive sterilization in the United States

Capsule:
Frequent use of sterilization by unmarried women highlights the importance of educating women on the permanency of sterilization, and an opportunity to increase reliance on long-acting reversible contraceptives.

Authors:
Mieke Carine Wim Eeckhaut, Ph.D.

Volume 103, Issue 6, Pages 1509-1515

Abstract:

Objective:
To examine female and male sterilization patterns in the United States based on marital status, and to determine if sociodemographic characteristics explain these patterns.

Design:
Survival analysis of cross-sectional data from the female and male samples from the 2006–2010 National Survey of Family Growth.

Setting:
Not applicable.

Patient(s):
The survey is designed to be representative of the US civilian noninstitutionalized population, ages 15–44 years.

Intervention(s):
None.

Main Outcome Measure(s):
Vasectomy and tubal sterilization.

Result(s):
In the United States, vasectomy is the near-exclusive domain of married men. Never-married and ever-married single men, and never-married cohabiting men, had a low relative risk (RR) of vasectomy (RR = 0.1, 0.3, and 0.0, respectively), compared with men in first marriages. Tubal sterilization was not limited to currently married, or even to ever-married women, although it was less common among never-married single women (RR = 0.2) and more common among women in higher-order marriages (RR = 1.8), compared with women in first marriages. In contrast to vasectomy, differential use of tubal sterilization by marital status was driven in large part by differences in parity.

Conclusion(s):
This study shows that being unmarried at the time of sterilization—an important risk factor for poststerilization regret—was much more common among women than men. In addition to contributing to the predominance of female, vs. male, sterilization, this pattern highlights the importance of educating women on the permanency of sterilization, and the opportunity to increase reliance on long-acting reversible contraceptive methods.

  • Does this NSFG survey also address reversal of sterilization? This data is very robust and may also shed additional light as to those that seek reversal and their demographics, etc.

    • Mieke Eeckhaut

      Yes, the NSFG also includes information on sterilization reversal. I am looking at that question in ongoing work.

  • jimdupree4

    A very interesting analysis. Were you able to determine the sterilization status of partners of the NSFG respondents? If so, do you have any comments about the characteristics of couples that might predict whether the female or male partners in a couple chose to undergo permanent sterilization?

    • Mieke Eeckhaut

      Thank you for your interest in my article.
      The NSFG includes information regarding the sterilization status of some, but not all, coresidential partners (mainly information regarding previous coresidential partners is lacking) meaning that it was not possible to determine for all respondents if they were protected by a (previous) partner’s sterilization operation in the past. I mention this as one of the limitations of using this dataset (p. 6 of the online first version of the article). I also mention (on p. 7) that sensitivity analyses, censoring respondents who indicated that their current partner was surgically sterile at the start of their cohabitation or marriage, or at the date of the operation (available only for the female sample), whichever occurred last, did not lead to substantively different conclusions.
      Regarding your second question: I am currently working on an article that examines decisions regarding female versus male sterilization within coresidential partnerships based on the NSFG data. I hope to share results of
      those analyses later this year.

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