title: Declining rates of sterilization procedures in Western Australian women from 1990 to 2008: the relationship with age, hospital type, and government policy changes.
abstract: To describe trends in age-specific incidence rates of female sterilization (FS) procedures in Western Australia and to evaluate the effects of the introduction of government-subsidized contraceptive methods and the implementation of the Australian government's baby bonus policy on FS rates.
  
  
  
  Population-based retrospective descriptive study.
  
  
  
  Not applicable.
  
  
  
  All women ages 15-49 undergoing an FS procedure during the period January 1, 1990, to December 31, 2008 (n = 47,360 procedures).
  
  
  
  Records from statutory statewide data collections of hospitals separations and births were extracted and linked.
  
  
  
  Trends in FS procedures and the influence on these trends of the introduction of government policies: subsidization of long-acting reversible contraceptives (Implanon and Mirena) and the Australian baby bonus initiative.
  
  
  
  The annual incidence rate of FS procedures declined from 756.9 per 100,000 women in 1990 to 155.2 per 100,000 women in 2008. Compared with the period 1990-1994, women ages 30-39 years were 47% less likely (rate ratio [RR] = 0.53; 95% confidence interval [CI], 0.39-0.72) to undergo sterilization during the period 2005-2008. Adjusting for overall trend, there were significant decreases in FS rates after government subsidization of Implanon (RR = 0.89; 95% CI, 0.82-0.97) and Mirena (RR = 0.81; 95% CI, 0.73-0.91) and the introduction of the baby bonus (RR = 0.70; 95% CI, 0.61-0.81).
  
  
  
  Rates of female sterilization procedures in Western Australia have declined substantially across all age groups in the last two decades. Women's decisions to undergo sterilization procedures may be influenced by government interventions that increase access to long-term reversible contraceptives or encourage childbirth.
authors.affiliation: Centre for Health Services Research, University of Western Australia, Crawley, Western Australia, Australia. Electronic address: khadra.jamaalol@uwa.edu.au.
authors.forename: Khadra A
authors.initials: KA
authors.lastname: Jama-Alol
authors.affiliation: School of Population Health, University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Alexandra P
authors.initials: AP
authors.lastname: Bremner
authors.affiliation: School of Public Health, Curtin University, Bentley, Western Australia, Australia.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Stewart
authors.affiliation: Centre for Health Services Research, University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Kemp-Casey
authors.affiliation: Centre for Health Services Research, University of Western Australia, Crawley, Western Australia, Australia; School of Paediatrics and Child Health, University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Eva
authors.initials: E
authors.lastname: Malacova
authors.affiliation: Centre for Health Services Research, University of Western Australia, Crawley, Western Australia, Australia; School of Public Health, Curtin University, Bentley, Western Australia, Australia.
authors.forename: Rachael
authors.initials: R
authors.lastname: Moorin
authors.affiliation: Telethon Kids Institute, University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Adeleh
authors.initials: A
authors.lastname: Shirangi
authors.affiliation: Centre for Health Services Research, University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: David B
authors.initials: DB
authors.lastname: Preen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D035881:Compensation and Redress; D003271:Contraceptive Agents, Female / Q000627:therapeutic use; D005260:Female; D033161:Government Regulation; D006291:Health Policy / Q000191:economics / Q000639:trends*; D006761:Hospitals / Q000639:trends*; D006801:Humans; D011050:Policy Making; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000331:legislation & jurisprudence / Q000639:trends*; D011247:Pregnancy; D012189:Retrospective Studies; D013242:Sterilization / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data / Q000639:trends*; D013997:Time Factors; D014904:Western Australia; D016387:Women's Health / Q000191:economics / Q000331:legislation & jurisprudence / Q000639:trends*; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female
keywords: Female sterilization; baby bonus; linked population health data; long-acting reversible contraceptives