SPECIAL ISSUE: Sexual and Reproductive Health of Women with Disability
Research paper
Female sterilization is more common among women with physical and/or sensory disabilities than women without disabilities in the United States

https://doi.org/10.1016/j.dhjo.2016.12.020Get rights and content

Abstract

Background

Female sterilization accounts for 50% of all contraceptive use in the U.S. The extent to which U.S. women with physical and/or sensory disabilities have undergone female sterilization is unknown.

Objective

Our primary objective was to determine the prevalence of sterilization for women with physical/sensory disabilities, and compare this to the prevalence for women without disabilities. We also compared use of long-acting reversible contraceptive (LARC) methods between women with and without disabilities.

Methods

We conducted a secondary analysis of data from the National Survey of Family Growth 2011–2013, a population-based survey of U.S. women aged 15–44. Bivariate comparisons between women with and without disabilities by female sterilization and LARC use were conducted using chi-square tests. Using logistic regression, we estimated the odds of female sterilization based upon disability status.

Results

Women with physical/sensory disabilities accounted for 9.3% of the total sample (N = 4966). Among women with disabilities only, 28.2% had undergone female sterilization, representing 1.2 million women nationally. LARC use was lower among women with disabilities than those without disabilities (5.4%, 9.3%, respectively, p < 0.01). After adjusting for age, race/ethnicity, education, insurance, marital status, parity, and self-reported health, women with disabilities had higher odds of sterilization (OR 1.36, 95% CI 1.03, 1.79).

Conclusions

The odds of female sterilization is higher among women with physical/sensory disabilities than those without disabilities. Future research is necessary to understand factors contributing to this finding, including possible underutilization of LARC methods.

Section snippets

Study population: the National Survey of Family Growth, 2011–2013

We conducted a secondary analysis of data from the National Survey of Family Growth (NSFG), a survey of a nationally representative sample of non-institutionalized, civilian women and men aged 15–44.11 The NSFG sampling strategy includes oversampling for minorities and teens and adjustment for non-response.11 A complete description of the NSFG survey and methods are available elsewhere.11 We used data from the 2011–2013 cycle of the NSFG, which for the first time, included self-reported,

U.S. women who have physical and/or sensory disability, by sterilization status (Fig. 1)

Among the total sample of 4966 women, 461 (9.3%) reported at least one physical and/or sensory disability. Among disabled women, 130 (28.2%) had undergone sterilization, representing 1.2 million women nationally.

Selected characteristics among women with and without disabilities (Table 1)

More women aged 35–44 reported disability than women aged 15–24 [prevalence ratio (PR) 1.66, 95% confidence interval (CI) 1.35–2.04]. Hispanic women, black women, and women of lower socioeconomic status, as reflected by education and insurance, were also more likely to report

Discussion

From 2011 to 2013, nearly one-third of U.S. women with physical/sensory disabilities, representing 1.2 million women, used female sterilization as a primary contraceptive method. Even after adjusting for age, race/ethnicity, education, insurance, marital status, parity and self-reported health, the odds of sterilization were higher for women with disabilities.

There are several possible explanations for this observed difference. Women with disabilities reported fair or poor health more often and

Disclosures

No financial disclosures were reported by the authors of this paper.

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