Trends and Disparities in Postpartum Sterilization after Cesarean Section, 2000 through 2008.
OBJECTIVE
Tubal sterilization patterns are influenced by factors including patient race, ethnicity, level of education, method of payment, and hospital size and affiliation. However, less is known about how these factors influence tubal sterilizations performed as secondary procedures after cesarean sections (C-sections). Thus, this study examines variations in the prevalence of postpartum tubal sterilizations after C-sections from 2000 to 2008.


METHODS
We used data from the National Hospital Discharge Survey to estimate odds ratios for patient-level (race, marital status, age) and system-level (hospital size, type, region) factors on the likelihood of receiving tubal sterilization after C-section.


RESULTS
A disproportionate share of postpartum tubal sterilizations after C-section was covered by Medicaid. The likelihood of undergoing sterilization was increased for Black women, women of older age, and non-single women. Additionally, they were increased in proprietary and government hospitals, smaller hospital settings, and the Southern United States.


CONCLUSIONS
Our findings indicate that Black women and those with Medicaid coverage in particular were substantially more likely to undergo postpartum tubal sterilization after C-section. We also found that hospital characteristics and region were significant predictors. This adds to the growing body of evidence that suggests that tubal sterilization may be a disparity issue patterned by multiple factors and calls for greater understanding of the role of patient-, provider-, and system-level characteristics on such outcomes.
Department of Sociology, Portland State University, Portland, Oregon. Electronic address: gin5@pdx.edu.
Ginny
G
Garcia
School of Community Health, College of Urban and Public Affairs, Portland State University, Portland, Oregon.
Dawn M
DM
Richardson
School of Community Health, College of Urban and Public Affairs, Portland State University, Portland, Oregon.
Kelly L
KL
Gonzales
Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts.
Adolfo G
AG
Cuevas
D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000367:Age Factors; D001509:Bed Occupancy; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000639:trends; D006742:Hospital Bed Capacity; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D016015:Logistic Models; D017533:Marital Status; D008484:Medicaid; D008875:Middle Aged; D049590:Postpartum Period; D057566:Self Report; D013246:Sterilization, Tubal / Q000706:statistics & numerical data* / Q000639:trends; D014481:United States; D055815:Young Adult