Academic journal article Sociological Focus

Living in the American South and the Likelihood of Having a Tubal Sterilization

Academic journal article Sociological Focus

Living in the American South and the Likelihood of Having a Tubal Sterilization

Article excerpt

This research uses a nationally representative sample of 7,643 American women from the publicand restricted-use National Survey of Family Growth, Cycle 6 data files and logistic regressions to model for the first time the relationship between having a tubal sterilization and southern region of residence. This research finds a disparity in reproductive health for southern women; women living in the South face about 1.5 greater odds of being sterilized compared with women from other regions, all else being equal. When other potential main and moderating effects are included in the model, rural women are found to have twice greater odds as urban women and Protestant women have 1.5 times greater odds than Catholics of having a tubal sterilization, net of other effects.

Since the 1970s, increasing numbers of American women have had a tubal ligation procedure, also known as tubal sterilization surgery (MacKay et al. 2001). As a result, data over the period 1982 to 2008 show that tubal sterilization is the second most common method of contraception for American women, used slightly less often than the pill (Mosher and Jones 2010). Further contextualizing this, tubal sterilization appears to be even more common among women living in the southern region of the United States than in other regions (Chandra 1998; MacKay et al. 2001; Schwartz et al. 1989; Taffel and Placek 1987). These patterns are unsettling because this procedure largely ends a woman's ability to have children even though less permanent forms of contraception are widely available. While a tubal sterilization provides women a safe, assured method of birth control and a reversal procedure is available, success rates vary, and a reversal is considered an elective procedure which is not usually covered by insurance, so most tubal sterilizations render a woman permanently infertile.

Research indicates that infertility - including voluntary forms of infertility such as tubal sterilization - is associated with higher psychological distress, compared to that undergone by fertile women (McQuillan et al. 2003). The infertility literature indicates that relinquishing fertility intentions is related to emotional distress (White and McQuillan 2006), and that infertility is harmful for women's overall well-being, sense of control, and identity (Williams 1997). Specific to the tubal sterilization procedure, a few studies document a desire for reversal (Borrero et al. 2008; Chandra 1998, and Hillis et al. 1999) and many studies document regret after having a tubal sterilization (Curtis, Mohllajee, and Peterson 2006, Henshaw and Singh 1986, Jamieson et al. 2002, Marcil-Gratton 1988, Remez 1991). One study (Hillis et al. 1999) estimates a woman's cumulative probability of expressing regret after a tubal sterilization over her life course as 12.7 percent. However, regret is not distributed evenly, as the probability of regret is found to be more elevated 7 to 14 years after a tubal sterilization than in the first five years (Jamieson et al. 2002) and among black women compared with white women (Borrero et al. 2008). In addition to the regret and desire for reversal, evidence suggests negative effects on sexual functioning for women who have a tubal sterilization; specifically, those with tubal ligations are more likely to report stress interfering with sex to report seeing a physician about sexual problems in the previous 12 months, compared with women without tubal ligations (Warehime, Bass, and Pedulla 2007). Taken together, these studies highlight three areas of concern - desire for reversal, regret, and negative sexual functioning - as possible adverse consequences of this difficult-to-reverse form of birth control.

Because of the potential for adverse side effects for a substantial proportion of women, and the reality that tubal sterilizations are not distributed evenly, tubal sterilization should be understood as a health disparity issue. Tubal sterilization is more prevalent among black and Hispanic women (Bass and Warehime 2009; Borrero, Moore et al. …

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