Abstract
Objectives
Although female sterilization is the second most commonly used contraceptive method
in the US, research suggests that providers may serve as barriers to desired sterilization.
Study design
We conducted a modified grounded theory analysis of audio-recorded contraceptive counseling
visits with 52 women who specified on a previsit survey that they wanted no future
children and a supplemental analysis of visits with 14 women who wanted or were unsure
about future children in which sterilization was mentioned.
Results
Sterilization was discussed in only 19 of the 52 visits, primarily with patients who
were older women with children. Although some framed sterilization positively, many
clinicians discouraged patients from pursuing sterilization, encouraging them instead
to use long-acting reversible methods and framing the permanence of sterilization
as undesirable. In the 33 remaining sessions, sterilization was not mentioned, and
clinicians largely failed to solicit patients' future reproductive intentions. We
found no clear patterns regarding discussion of sterilization in the 14 supplemental
cases.
Conclusion
Clinicians did not discuss sterilization with all patients for whom it might have
been appropriate and thus missed opportunities to discuss sterilization as part of
the full range of appropriate methods. When they did discuss sterilization, they only
infrequently presented the method in positive ways and more commonly encouraged patients
to choose a long-acting reversible method instead. Clinicians may want to reflect
on their counseling practices around sterilization to ensure that counseling is centered
on patient preferences, rather than driven by their own assumptions about the desirability
of reversibility.
Implications
Clinicians often fail to discuss sterilization as a contraceptive option with potentially
appropriate candidates and, when they do, often discourage its selection. Clinicians
should consider assessing reproductive intentions to ensure that potentially relevant
methods are included in counseling.
Keywords
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Article info
Publication history
Published online: November 04, 2016
Accepted:
October 27,
2016
Received in revised form:
October 26,
2016
Received:
July 1,
2016
Footnotes
☆Source of Funding: This project was supported by the Society of Family Planning and by grant K23HD067197 from the Eunice Kennedy Shriver Nation-al Institute of Child Health and Human Development (NICHD). The content is the responsibility solely of the authors and does not necessarily represent the official views of the NICHD or the National Institutes of Health.
☆☆Conflicts of Interest: The authors report no conflict of interest.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
