Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #115897

Youssef Waheeb, Ton Van der Velden, MD, MPH, and Nabil Sobhy. TAHSEEN/CATALYST, 53 Manial, 4th Floor, Cairo, 11451, Egypt, (20)2-532-5065, tvandervelden@tahseen.org

Tubal ligation for medical reasons (TLMR) reduces maternal morbidity and mortality by reducing exposure to pregnancy for women for whom pregnancy is absolutely contra-indicated. Although the procedure is permitted in Egypt (due to these reasons) it is rarely performed in public sector hospitals. The exception is in the case of repeated cesarean sections. Thirty-seven focus group discussions (FGDs) were conducted with physicians of different specialties, nurses, women medically indicated for tubal ligation, and their husbands. Gynecologists see themselves as the key player in influencing a woman's decision to have the operation. Although most gynecologists say they would perform the procedure, they rarely do so. Husbands are seen as the main decision maker within the family and say they would allow the procedure for their wives. Women play a little or no role in TLMR decision making. Clients had many misconceptions about the procedure (e.g the introitus gets narrower after ligation and femininity would no longer be complete). Religious leaders' perspectives ranged from "it is not allowed" to "it is acceptable if strongly indicated." Physicians are more likely to base their opinions on TLMR on their cultural backgrounds than professional training. Husbands and wives appear are more amenable to the procedure than most physicians would think. Removing observed obstacles to TLMR has the potential to double or triple current utilization rates, particularly when performed during cesarean section after proper counseling. It is not expected to become a major contraceptive method in Egypt, however, due cultural and religious constraints.

Learning Objectives:

• After this presentation the participants will be able to describe the constraints to tubal ligation services posed by the cultural environment in a Muslim country.

Keywords: Barriers to Care, Family Planning

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.