Incidence of Male and Female Sterilization Following a Recent Live Birth: Estimates from the Pregnancy Risk Assessment Monitoring System (PRAMS), 2007-2010

Introduction

Although contraceptive use is recommended following a live birth, little is known about use of non-reversible contraception during this period.

Methods

Data were analyzed from 15 states and New York City who participated in Pregnancy Risk Assessment Monitoring System (PRAMS) 2007-2010.  PRAMS  is an ongoing, population-based surveillance system of women surveyed 2-6 months following a live birth. Among women using contraception following delivery, we used polytomous logistic regression to assess predictors of tubal ligation and partner vasectomy compared with reversible methods.

Results

Among 48,519 women who recently delivered, 11.1%(95% CI:10.6-11.5%) had a tubal ligation (range:6.6% in Utah to 20.8% in Mississippi) while 3.4% (3.2-3.7%) reported their partner had a vasectomy (range:1.2% in New York City to 4.9% in Missouri).  Incidence ratio of tubal ligation to vasectomy exceeded 1 in all reporting areas (range:<2 in Utah [tubal ligation: 6.6%; vasectomy: 3.5%] to >10 in Mississippi [tubal ligation: 20.8%; vasectomy: 2.0%]. Multivariable modeling revealed vasectomy was associated with being married[aOR=2.1 (95% CI=1.4-3.0)], having >1 prior birth, increased maternal age [>35 vs 20-24, aOR=2.7(1.8-4.0)], and increased maternal/paternal education [college vs high school, aOR=1.3(1.0-1.8) and aOR=1.3(1.0-1.7)].  Tubal ligation was positively associated with having >1 prior birth [aOR=32.9(24.7-43.8)] and maternal age [>35 vs 20-24, aOR=4.2(3.4-5.2)], but inversely associated with maternal/paternal education [aOR=0.7(0.6-0.8) and aOR=0.6(0.5-0.7)] and being married [aOR=0.8(0.7-0.9)]. 

Conclusions

Although female sterilization was more common than male sterilization, nearly one in four women using non-reversible methods reported their partners had a vasectomy.  PRAMS data suggest significant variation by state in female versus male sterilization and differences in education and marital status for users of these methods.