Patient-provider conversations about sterilization: A qualitative analysis.
OBJECTIVE
Although female sterilization is the second most commonly used contraceptive method in the US, research suggests that providers may serve as barriers to desired sterilization.


METHODS
We conducted a modified grounded theory analysis of audio-recorded contraceptive counseling visits with 52 women who specified on a previsit survey that they wanted no future children and a supplemental analysis of visits with 14 women who wanted or were unsure about future children in which sterilization was mentioned.


RESULTS
Sterilization was discussed in only 19 of the 52 visits, primarily with patients who were older women with children. Although some framed sterilization positively, many clinicians discouraged patients from pursuing sterilization, encouraging them instead to use long-acting reversible methods and framing the permanence of sterilization as undesirable. In the 33 remaining sessions, sterilization was not mentioned, and clinicians largely failed to solicit patients' future reproductive intentions. We found no clear patterns regarding discussion of sterilization in the 14 supplemental cases.


CONCLUSIONS
Clinicians did not discuss sterilization with all patients for whom it might have been appropriate and thus missed opportunities to discuss sterilization as part of the full range of appropriate methods. When they did discuss sterilization, they only infrequently presented the method in positive ways and more commonly encouraged patients to choose a long-acting reversible method instead. Clinicians may want to reflect on their counseling practices around sterilization to ensure that counseling is centered on patient preferences, rather than driven by their own assumptions about the desirability of reversibility.


CONCLUSIONS
Clinicians often fail to discuss sterilization as a contraceptive option with potentially appropriate candidates and, when they do, often discourage its selection. Clinicians should consider assessing reproductive intentions to ensure that potentially relevant methods are included in counseling.
Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, USA. Electronic address: katrina.kimport@ucsf.edu.
Katrina
K
Kimport
Family Community Medicine, University of California, San Francisco, San Francisco, CA, USA.
Christine
C
Dehlendorf
Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Sonya
S
Borrero
D000328:Adult; D003142:Communication; D003267:Contraception; D003268:Contraception Behavior; D003376:Counseling; D005193:Family Planning Services; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D008875:Middle Aged; D057240:Patient Preference; D013245:Sterilization, Reproductive; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult
Contraceptive counseling; Female sterilization; Qualitative methods; Reproductive intentions