Sterilisation uptake in the Dominican Republic: are women begging for

it? Tiziana Leone

Department of Social Policy

Background

Established: Sterilisation most popular contraceptive method in

LEDC both among women and providers Cheap No follow up Less affected by low quality of care

Increasing rates have brought median ages at sterilisation down Decreasing reproductive spans

Very popular in Latin America and South Asia The culture of sterilisation in some LA countries

Background 2

In need of more analyses: Increasing rates of regret High sterilisation rates linked to very low

contraceptive mix-low quality of care Human rights issue when women not told it’s not

reversible Risk of lower use of condom-impact on HIV

rates? Only limited evidence from Sao Paulo

Is it really what women would choose if they had an informed choice?

Objectives

Investigate the impact of social networking-discussion of FP issues with relatives and peers- on the risk of sterilisation uptake

Hypotheses: High sterilisation partly due to lack of knowledge and low

quality of care Community interaction has a negative effect on the risk of

sterilisation more likely to be able to make a more informed decision

Why Dominican Republic

One of the highest rates in the world- accounts for over 70% of current users 35% total women

Quality of care and contraceptive mix major issues

Great dataset Over 22,000 women interviewed

Extra questions asked about Family planning information received

Contraceptive use-58% prevalence

Pill18%

IUD2%

Injections3%

Condom3%

Female Sterilization69%

Other3%

PA/w ithdraw al2%

Why non users:•15% not married•13% resp opposed•2% knows no method•10% side effects•22% infecund•7% infrequent sex•5% menopausal•2% knows no method/source

11% unmet need

Future preferred method

Pill43%

IUD6%

Injections18%

Other4%

Condom4%

Female Sterilization20%

Norplant5%

Settings 62% women were not told about

contraceptive method side effects 93% women not told by Family Planning

worker about side effects 22% women that visited health centre were

told about FP

26% of sterilised women not told sterilisation meant no more children

31% of sterilised women did not sign a consent for sterilisation

59% of sterilised women were sterilised at delivery

Sample selection

2002 DHS Only women currently using a method

At least one child

Women who were sterilised in the two years before survey date Whether talked about family planning asked for the previous

12 months only 4537 women

Methods

Multilevel logistic regression-Stata/Gllamm Individual Level Household level Cluster level

Nested modelling

Outcome variable whether woman sterilised or not

DeterminantsDemographic Socio-

economicCommunity/network

Age Residence Talked about FP

Parity Ethnicity Visited Health centre

Marital status Religion Visited by FP worker

Number of unions

Wealth quintile Watch TV

Age at first birth Listens to radio

Whether heard of FP from TV radio or newspapers

Median level of education within cluster

Percentage sterilised women within cluster

Bi-variate results

Discussing FP issues negatively significant Wealth not greatly significant (wealthier

women slightly less likely) Hearing about FP from radio and newspaper

negatively significant Not significant when parity considered

ResultsTalked about FP

Visited health centre

Visited by Health worker

Age NS

Parity

Number of unions More than one union

Age at first birth

Residence NS

Wealth NS

Education Less likely higher levels

Some conclusions Community effects very significant

Discussing FP with relative and peers decreases risk

Cluster is a factor but not the household

Media not significant when controlling for other factors

Age at first birth more significant than age Being visited by a health worker has the

opposite effect of having visited a health centre: more interaction? More choices offered?

Future research needs

Institutional determinants? Need to investigate interaction at point

of delivery Not enough choice? Providers not willing?