Unfulfilled Sterilization Requests Linked to Low Contraceptive Use


LA JOLLA, CALIF. — Women who request sterilization but do not undergo the procedure may be at high risk for contraceptive nonuse and repeat pregnancy, according to a descriptive pilot study conducted in Chicago.

University of Illinois researchers recruited a total group of 103 postpartum patients, predominantly African American and Latino women; 29 of these patients did not request sterilization. Of the 74 who did request sterilization, 34 failed to undergo the procedure, said Dr. Melissa Gilliam, now section chief of family planning and contraceptive research at the University of Chicago.

Women who requested sterilization were more likely to be of lower gravidity, to have a preexisting medical condition, to have a history of pregnancy while using birth control, and to be younger at first pregnancy, Dr. Gilliam said at the annual meeting of the Association of Reproductive Health Professionals.

Reasons for not choosing sterilization included fear of the procedure or of anesthesia, the existence of a medical condition, institutional logistics, and poor birth outcome, Dr. Gilliam explained.

“At discharge, one-quarter of women in the unfulfilled sterilization group were more likely to be using no method of contraception and have no plan for future contraceptive use, and those who chose a method were likely to be dissatisfied with it.

“In the cohort that had not requested sterilization, all but 4% were satisfied with the contraceptive choice they had made—chiefly IUDs—suggesting that they were counseled for reversible contraception,” she said.

However, more than 30% of the women said that they had received no predischarge counseling about reversible contraceptives, Dr. Gilliam noted.

At 6 months after discharge, she said, the data showed that women who did not undergo sterilization after having requested it were still not using a contraceptive and in some cases had become pregnant.

At 1 year, of the 34 women who had requested but did not undergo postpartum sterilization, 8 had undergone sterilization, 6 were pregnant, 2 were lost to follow-up, and the rest were using some type of contraceptive, primarily Depo-Provera (7) or condoms (3).

Dr. Gilliam believes that women often seek sterilization because they have gotten pregnant while on the birth control pill and now want control over their own fertility.

“And for many women, this can be quite hard to achieve,” she said. “We have to realize that these women are at risk for repeat pregnancies and that they experience difficulties dealing with contraception post partum,” she said in an interview.

'We have to realize that these women are at risk for repeat pregnancies.' DR. GILLIAM

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