Sterilisation uptake in the Dominican Republic: are women begging for it?

1. Sterilisation uptake in the Dominican Republic: are women begging for it? Tiziana Leone Department of Social Policy

2. 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

3. 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?

4. 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

5. 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

6. Contraceptive use-58% prevalence • 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

7. Future preferred method

8. 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

9. 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

10. Methods • Multilevel logistic regression-Stata/Gllamm • Individual Level • Household level • Cluster level • Nested modelling • Outcome variable whether woman sterilised or not

11. Determinants

12. 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

13. Results

14. 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?

15. Future research needs • Institutional determinants? • Need to investigate interaction at point of delivery • Not enough choice? • Providers not willing?