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PART 6: STERILIZATION AMONG CANADIAN WOMEN AND THEIR PARTNERS: PRACTICES AND OPINIONS.

SUMMARY: Two-thirds of the women in the 1998 Canadian Contraception Study are familiar with sterilization as a method of birth control, and they generally think highly of this method. Among women who have been sterilized or whose partners have undergone vasectomy, rates of satisfaction are very high. The rate of sterilization, 23% overall, includes 10% of women who have had the operation, and 14% of their partners. The increasing use of male sterilization is appropriate, given the low morbidity attached to this procedure. This operation should continue to increase in prevalence, as 75% of women who have decided on future sterilization wish their partner to have the operation.

Key words:

Sterilization Vasectomy Tubal ligation Knowledge Attitudes

INTRODUCTION

For many women and their partners, the last contraceptive choice in their reproductive lives is sterilization. Sterilization has many positive features: it is safe, permanent, and highly effective. Male sterilization is even more attractive a choice for women, with all of the advantages of permanent contraception, and no personal risks or discomfort. Male sterilization, done under local anaesthetic, is also a safer and simpler operation than tubal occlusion. This part of the 1998 Canadian Contraception Study reports on the knowledge, attitudes, and behaviour of respondents concerning sterilization.

FAMILIARITY WITH STERILIZATION

The question: "Which of the birth control methods below are you familiar with?"

As noted earlier in Fig. 2.1, 64% of women were familiar with sterilization as a method of birth control and equally so for male sterilization and female sterilization. Familiarity was higher among older women (e.g., 84% in married women over 40 years old, 77% in unmarried women in that age group) than in younger women. Familiarity was also higher overall in married women (73%) than in unmarried women (52%). On a regional basis, familiarity with sterilization was higher in British Columbia (72%) and Ontario (67%) than in Quebec (60%) and the Atlantic provinces (56%).

OPINIONS ABOUT STERILIZATION

The question: "What is your opinion of each of the following methods of contraception ?"

Women answered this question on a four-response Likert scale: 1 - very unfavourable; 2 = somewhat unfavourable; 3 = somewhat favourable; and 4 = very favourable. Overall, among respondents familiar with each operation, women had a more positive opinion of the male operation (mean score 3.07) than of the female procedure (mean score 2.79). The male operation was viewed more positively by married women (mean score 3.28) than by unmarried women (mean score 2.64), as was the female operation (2.95 versus 2.51). The highest subgroup opinion score for female sterilization was found among married women aged 40 to 44 years, with a rating at 3.42.

There were no clear differences in opinion between women on the basis of educational background. Regionally, women from the Prairies had slightly higher opinions of both types of sterilization than did women from either Ontario or British Columbia.

The question: "In general, how satisfied are you (is your partner) with the method you are currently using?"

Opinions here were reported on a 5-response Likert scale (1,2 = very or somewhat unsatisfied, 3 = neutral; 4, 5 = somewhat or very satisfied). The degree of satisfaction among women who had undergone sterilization or hysterectomy, or whose partners had undergone vasectomy, was very high (mean 4.88), significantly higher than for any other method. Similarly, the degree of satisfaction that women perceived their partners to have for sterilization (regardless of who had undergone the procedure) was very high (mean score 4.89), again significantly higher than any other method.

DEMOGRAPHICS OF STERILIZATION

The question: "Which method(s) of birth control, if any, are you currently using?"

Sterilization was the current method of birth control for 23% of respondents: 14% of male partners had been sterilized, and 10% of women. An additional 3% of women had hysterectomies, and fewer than 1% were postmenopausal, for a total of over 26% of women permanently unable to have children (with their current partners). No regional differences were seen in the rates of either operation. The female operation was used more by women with high school education (13%) than those with either more (10%) or less (6%) education.

Rates of sterilization were high among married couples: 24% of married women's male partners had been sterilized, and 16% of married women had themselves been sterilized. Figure 6.1 shows age-related differences in the percentages of married women and men who have been sterilized. Among unmarried women, sterilization was much less often the method currently used: just 1% of male partners had vasectomy, and 3% of unmarried women had been sterilized.

[Figure 6.1 ILLUSTRATION OMITTED]

The question: "If you had sexual intercourse in the last six months, and used a method of contraception, which methods did you use?"

Among the 889 women who had had intercourse in the last 6 months and were using contraception, 25% were using sterilization as their birth control method.

INTENTIONS CONCERNING STERILIZATION

The question: "Do either you or your husband/ partner intend to be sterilized at some time in the future?"

Fig. 6.2 provides a sumary of all women's future intentions with respect to sterilization. Of those not yet sterilized (or infertile) (about 70% of the sample), half did not know and the remainder was slightly more inclined toward sterilization than not. Women's expectations with respect to who specifically will be sterilized are shown in Table 6.1.

[Figure 6.2 ILLUSTRATION OMITTED]

Table 6.1 Partner who will be Sterilized, by Marital Status and Age Group (Among Those Intending Sterilization). 1998 Canadian Contraception.
 Percentage of
 Respondents

 Married
 Total
Person to be Sterilized (n=225) 18 to 34 35 to 44

Myself 20 15 22
Husband/partner 58 62 68
Uncertain 22 24 10

 Percentage of
 Respondents

 Unmarried
 Total
Person to be Sterilized (n=89) 18 to 34 35 to 44(*)

Myself 28 28 49
Husband/partner 44 42 29
Uncertain 26 30 22


(*) Only 9 women in this column, small cell size distorts results. Column totals may vary from 100 because of rounding.

DISCUSSION

Familiarity with sterilization as a method of birth control was high, but not uniform: approximately two-thirds of respondents said they were familiar with this method. Understandably, familiarity increases significantly with age, as women either have personal experience with the operations, or have social contacts who have had them. The wording used in the questionnaire might explain part of the low awareness: the terms vasectomy, and tubal ligation, might have been more familiar to women than the formal term sterilization.

Women's opinion of sterilization was quite positive, with only the oral contraceptive and condoms having a higher rating. The preference for male sterilization over female is understandable on several levels. Not only is there a natural wish to personally avoid undergoing an operation, but when examined impartially, the male operation is simpler: a 15-minute office procedure under local anaesthetic, compared with a 30-minute operating room procedure requiring general anaesthesia. Also understandable is the more positive opinion of both operations held by married women, who presumably feel more comfortable making such a permanent contraceptive choice. Married women may have a positive opinion because of personal experience with the operation, or because of the attributes of this method.

The rate of sterilization found in this study, 23% overall, is slightly less than the 25% rate found in the previous similar study (Boroditsky, Fisher & Sand, 1996). While the male sterilization rate has stayed the same in the intervening years, at 14%, the rate of the female operation declined from 12% to 10%. The declining rate of female sterilization, and thus the shift to relatively more male operations, continues a trend that has developed over the last 15 years. In their 1984 study, Balakrishnan and colleagues (1993) found that 35% of Canadian women had been sterilized, compared with just 12.7% of men. Speculatively, while women in the past may have yielded to partner pressure and had tubal ligations performed, women now may be empowered to insist on the male operation. If the responses to the question on future intent concerning sterilization are followed by action, then the trend to decreasing female sterilization will continue: women in this study who intend sterilization now plan that their male partner, not themselves, will undergo this operation, by a 3:1 ratio (see Part 9 for further discussion of sterilization trends in Canada).

References

Balakrishnan, T.R., Lapierre-Adamczyk, E., & Krotki, K.K. (1993). Family and Childbearing in Canada: A Demographic Analysis. Toronto: University of Toronto Press Inc.

Boroditsky, R., Fisher, W., & Sand, M. (1996). The 1995 Canadian Contraception Study. Journal of the Society of Obstetricians and Gynaecologists (Supplement), 18, 7, 1-31.
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Article Details
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Publication:The Canadian Journal of Human Sexuality
Article Type:Polling Data
Geographic Code:1CANA
Date:Sep 22, 1999
Words:1435
Previous Article:PART 5: CONDOM USE AMONG CANADIAN WOMEN: PRACTICES AND OPINIONS.
Next Article:PART 7: CONTRACEPTIVE ATTITUDES AND PRACTICES OF CANADIAN WOMEN IN THEIR LATER REPRODUCTIVE YEARS.
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