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Try out PMC Labs and tell us what you think. Learn More. African-American women have had higher rates of female sterilization compared to white women since its emergence as a contraceptive method. The reasons underlying this observed racial difference are unknown. We conducted six focus groups stratified by tubal sterilization status and race. During each of the audio-recorded sessions, participants were asked to discuss reasons that women choose sterilization as a contraceptive method.

The participants of the study were 24 African-American women and 14 white women. Transcripts of the sessions were qualitatively analyzed with particular attention to factors that might be unique to each of the two racial groups.

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Preference for a convenient, highly effective contraceptive method was the main reason to get a tubal sterilization for women of both racial groups. We also identified socio-cultural differences that might explain why black women are more likely than white women to choose tubal sterilization over other contraceptive methods.

An unanticipated, but clinically important, finding was that women often reported feeling that their doctors and the health-care system served as barriers to obtaining the desired procedure. Socio-cultural differences may help explain why black and white women choose different contraceptive methods. In the United States USblack women have had higher rates of female sterilization compared to white women since its emergence as a contraceptive method.

Choosing a contraceptive method is a Older black women tubes process that presumably involves the interplay among patient preferences, patient-doctor communication, and health-care system-level factors. There is no published literature that explores the contraceptive decision-making process of women in the US and how race may affect this process.

Study participants were recruited using the following mechanisms: 1 posting flyers in the obstetrics and gynecology clinic of Magee-Womens Hospital and the primary care clinic of Montefiore Hospital University of Pittsburgh Health System ; 2 mailing recruitment letters using the Magee-Womens Hospital Research Registry; 3 posting advertisements on the Internet i.

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Women responding to advertisements for the study were screened for eligibility over the phone. Women were ineligible if they did not speak English. Eligible women were invited to participate. A follow-up letter confirming the date, time, and location of the focus group session was sent to each participant, and a reminder telephone call was placed the night before the scheduled focus group. Because there is no published medical literature about how women make decisions regarding choice of contraceptive method, a qualitative study is a particularly useful approach to gain insight about this unexplored topic area.

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Further, focus groups should occur in non-threatening environments with a group of individuals who share certain characteristics to allow for a good group dynamic and greater self-disclosure. Four of the sessions comprised women who had undergone sterilization two with black and two with white womenand two sessions comprised women who had considered tubal sterilization one with black and one with white women. The focus group discussions were conducted from October to January at the University of Pittsburgh, and each session lasted approximately 90 min.

An introductory script containing all of the elements of informed consent was read to the participants prior to the beginning of each session. The sessions were guided by a trained facilitator with experience in qualitative research methods. At the end of each session, participants were asked to fill out a brief sociodemographic questionnaire.

The focus group transcripts were coded according to concepts of grounded theory. Distinct comments were ased codes indicating emerging factors. The coders met to compare their codes and develop a coding scheme. An iterative process of rereading and recoding transcripts was used to refine the coding scheme.

What every woman should know about female sterilization

A co-investigator KR with vast experience in qualitative research methods was available to adjudicate any differences in interpretation and to review the coding scheme. By applying the final coding scheme to all transcripts, the coders were able to identify central factors that shape decisions about tubal sterilization and recognize factors that might be unique to each of the racial groups.

Thematic saturation was achieved by the fifth focus group. Because clinical decision making is a product of patient- provider- and system-level factors, 22 we chose to organize the emergent factors under these over-arching .

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Representative quotations were selected from the transcripts to illustrate the factors identified. Table 1 shows the sociodemographic characteristics of the 37 women who completed the questionnaire by race and tubal sterilization status. Overall, black women had lower education levels and income Older black women tubes were more likely to rely on public insurance compared to white women.

Characteristics are shown in absolute s except for age and years since sterilization, for which the mean value and range are shown. Percentages are also shown in parentheses for the total cohort of women in each race. Although the focus groups were stratified by race and sterilization status, women who had not undergone sterilization did not present perspectives that were ificantly different than women who had already undergone sterilization.

Rather, these women seemed to represent an earlier stage in the process of obtaining the procedure. Therefore, we combined these two groups within each race category for our. These are discussed below with representative quotations shown in Table 2. An unanticipated, but clinically important, finding was that women did not identify their provider or the health-care system as influencing factors in the sterilization decision-making process, but rather identified them as barriers to getting the procedure once their decisions had been made.

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These provider- and system-level barriers are also discussed below with representative quotations shown in Table 3. Done with child-bearing. The dominant reason that both African-American and white women chose sterilization was that they were finished with child bearing and wanted a convenient contraceptive method. Because sterilization offered permanency and required a one-time effort rather than ongoing or future contraceptive management, most women felt that this was a convenient and effective method of birth control. All you have to do now is protect yourself from STDs.

The majority of participants both African American and white stated that they had reached their desired nuclear family size as the primary reason for being done with child-bearing. African-American women also commonly spoke about having achieved the desired gender make-up of their family.

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“everything i know i learned from my motheror not”: perspectives of african-american and white women on decisions about tubal sterilization

A prevalent theme among African-American women was that they did not want to have children at, what they perceived to be, an older age. Some believed that an older mother was not as capable of addressing the needs of young children. Others explained that they wanted to focus on their own well-being at older ages.

White women who cited age as a possible influence expressed that having at an older age would be more tiring, and one woman feared having a high-risk pregnancy. Difficulties associated with child-rearing. The financial strain of child-rearing was brought up by both groups as a reason to end fertility. In addition, African-American women often spoke about the inherent difficulties of raising children, especially as single mothers. Many of the women alluded to the fact that they had children outside of marriage and often spoke about the biological father being unsupportive or even negligent.

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You have to be worried So that also factored into my decision. Sense of control. Both African-American and white women expressed a desire to control their own fertility and felt that sterilization would give them ultimate control in preventing future unwanted pregnancies.

I started having babies at My daughter had her first at And it was like a cycle And now I have to deal with life and I have to prepare life for her While Older black women tubes women often had discussions with their partner about the decision to sterilize, African-American women frequently spoke about making the decision unilaterally even if they were in a relationship at the time.

This is my decision I made. But I knew I wanted it done just so I knew there was nothing else growing in me. I was done. So when it was time for me to go get my tubes tied, I missed it because I was too busy out there in the streets. Then I ended up getting pregnant with my daughter and using with her. Because I would probably still be out there finger popping Family influences. African-American women were largely influenced by their family members other than their spouse when making the decision to undergo tubal sterilization.

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None of the women reported that their doctors influenced their decisions regarding tubal sterilization as a contraceptive method. However, many of the women, especially African-American participants, expressed frustration that their doctor dissuaded them from getting the procedure once their decision had been made. On the extreme end of the spectrum were African-American women who had not had a sterilization procedure. Half of the women in this group said they wanted the procedure, but that their physicians had refused. She just said if you want it, you got to go to another doctor. It was just point blank They will not tie my tubes.

In response to these discussions about provider reluctance or refusal to perform the sterilization procedure, women in both the African-American and white groups demanded autonomy with regards to contraceptive decision making.

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You know, if I did it, it would be something permanent. I always said back, yeah, but having is permanent too It still comes down to None of the women reported that system-level factors e. Most women reported that their insurance covered sterilization as well as other reversible methods.

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I mean children are highly expensive However, several women reported system-level barriers once they had decided they wanted to undergo sterilization. We found that the dominant reason that women of both races chose tubal sterilization is that it offered a convenient and permanent contraceptive method once a woman had decided to end fertility.

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