Sterilisation uptake in the Dominican Republic: are women begging for it? Tiziana Leone Department of Social Policy

Background Established:  Sterilisation most popular contraceptive method in LEDC both among women and providers  Cheap  No follow up  Less affected by low quality of care  Increasing rates have brought median ages at sterilisation down  Decreasing reproductive spans  Very popular in Latin America and South Asia  The culture of sterilisation in some LA countries

Background 2 In need of more analyses:  Increasing rates of regret  High sterilisation rates linked to very low contraceptive mix-low quality of care  Human rights issue when women not told it’s not reversible  Risk of lower use of condom-impact on HIV rates?  Only limited evidence from Sao Paulo  Is it really what women would choose if they had an informed choice?

Objectives  Investigate the impact of social networking-discussion of FP issues with relatives and peers- on the risk of sterilisation uptake  Hypotheses:  High sterilisation partly due to lack of knowledge and low quality of care  Community interaction has a negative effect on the risk of sterilisation  more likely to be able to make a more informed decision

Why Dominican Republic  One of the highest rates in the world- accounts for over 70% of current users  35% total women  Quality of care and contraceptive mix major issues  Great dataset  Over 22,000 women interviewed  Extra questions asked about Family planning information received

Contraceptive use-58% prevalence Why non users: 15% not married 13% resp opposed 2% knows no method 10% side effects 22% infecund 7% infrequent sex 5% menopausal 2% knows no method/source 11% unmet need

Future preferred method

Settings  62% women were not told about contraceptive method side effects  93% women not told by Family Planning worker about side effects  22% women that visited health centre were told about FP  26% of sterilised women not told sterilisation meant no more children  31% of sterilised women did not sign a consent for sterilisation  59% of sterilised women were sterilised at delivery

Sample selection  2002 DHS  Only women currently using a method  At least one child  Women who were sterilised in the two years before survey date  Whether talked about family planning asked for the previous 12 months only  4537 women

Methods  Multilevel logistic regression-Stata/Gllamm  Individual Level  Household level  Cluster level  Nested modelling  Outcome variable whether woman sterilised or not

Determinants DemographicSocio-economicCommunity/network AgeResidenceTalked about FP ParityEthnicityVisited Health centre Marital statusReligionVisited by FP worker Number of unionsWealth quintileWatch TV Age at first birthListens to radio Whether heard of FP from TV radio or newspapers Median level of education within cluster Percentage sterilised women within cluster

Bi-variate results  Discussing FP issues negatively significant  Wealth not greatly significant (wealthier women slightly less likely)  Hearing about FP from radio and newspaper negatively significant  Not significant when parity considered

Results Talked about FP Visited health centre Visited by Health worker Age NS Parity Number of unions More than one union Age at first birth Residence NS Wealth NS Education Less likely higher levels

Some conclusions  Community effects very significant  Discussing FP with relative and peers decreases risk  Cluster is a factor but not the household  Media not significant when controlling for other factors  Age at first birth more significant than age  Being visited by a health worker has the opposite effect of having visited a health centre: more interaction? More choices offered?

Future research needs  Institutional determinants?  Need to investigate interaction at point of delivery  Not enough choice?  Providers not willing?