title: Desire for female sterilization among women wishing to limit births in rural Rakai, Uganda.
abstract: OBJECTIVE
  Uganda has an unmet need for family planning of 34% and a total fertility rate of 6.2. We assessed the desire for female sterilization among sexually active women who wanted to stop childbearing in rural Rakai district, Uganda.
  
  
  METHODS
  7192 sexually active women enrolled in a community cohort between 2002 and 2008 were asked about fertility intentions. Those stating that they did not want another child (limiters) were asked whether they would be willing to accept female sterilization, if available. Trends in desire for sterilization were determined by chi-square test for trend, and Modified Poisson regression was used to estimate prevalence rate ratios and 95% confidence intervals of the associations between desire for sterilization and socio-demographic characteristics and HIV status.
  
  
  RESULTS
  From 2002 to 2008, the proportion of limiters dropped (from 47.2% to 43.7%; p<.01). Use of pills and injectables among limiters significantly increased, 38.9% to 50.3% (p<.0001), while use of intrauterine devices and implants declined from 3.3% to 1.7% (p<0.001). The desire for sterilization significantly increased from 54.2% to 63.1% (p<0.0001), and this was consistently higher among the HIV-positive (63.6-70.9%, p<0.01) than HIV-negative women (53.3-61.2%, p<0.0001). Factors significantly associated with the desire for sterilization included higher number of living children (>=3), being HIV-infected and having received HIV counseling and testing.
  
  
  CONCLUSIONS
  There is latent and growing desire for sterilization in this population. Our findings suggest a need to increase permanent contraception services for women who want to limit childbearing in this setting.
  
  
  CONCLUSIONS
  A large unmet need for permanent female contraception services exists in Uganda. Efforts to increase the method mix by increasing permanent contraception services could reduce fertility rates and undesired births.
authors.affiliation: Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda. Electronic address: tlutalo@rhsp.org.
authors.forename: Tom
authors.initials: T
authors.lastname: Lutalo
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Ron
authors.initials: R
authors.lastname: Gray
authors.affiliation: Joseph L Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Sanyukta
authors.initials: S
authors.lastname: Mathur
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Wawer
authors.affiliation: Makerere University School of Public Health, Kampala, Uganda.
authors.forename: David
authors.initials: D
authors.lastname: Guwatudde
authors.affiliation: Joseph L Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: John
authors.initials: J
authors.lastname: Santelli
authors.affiliation: Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda.
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.affiliation: Makerere University School of Public Health, Kampala, Uganda.
authors.forename: Fredrick
authors.initials: F
authors.lastname: Makumbi
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003268:Contraception Behavior / Q000523:psychology* / Q000706:statistics & numerical data; D005191:Family Characteristics; D005193:Family Planning Services / Q000706:statistics & numerical data*; D005260:Female; D006679:HIV Seropositivity / Q000523:psychology; D006801:Humans; D008875:Middle Aged; D016012:Poisson Distribution; D011247:Pregnancy; D012424:Rural Population; D012959:Socioeconomic Factors; D013245:Sterilization, Reproductive / Q000523:psychology*; D014454:Uganda; D055815:Young Adult
keywords: Female sterilization; HIV; Limiting births; Permanent contraception; Uganda; Women