Voluntary Sterilization Research Articles

Influence of Pregnancy Intention on Postpartum Contraceptive Choice at an Urban Academic Medical Center.

This study aimed to describe postpartum contraception preferences in the context of pregnancy intention (PI). A prospective cohort study analyzing postpartum contraceptive choice (PCC) in 431 postpartum women who delivered at a single academic medical center. PCC in women with an unintended or mistimed pregnancy was compared to contraceptive choice in women with an intended pregnancy using the adapted National Survey of Family Growth categorization. Mistimed and unintended pregnancies were grouped for analysis. Generalized linear modeling estimated the relative influence of PI on PCC adjusting for maternal age, race, and parity. Nearly three out of four (71.9%) pregnancies were mistimed or unintended. These pregnancies were more likely in women who were non-Hispanic Black (62.3%), unmarried (86.3%), 18 to 24 years (51.3%), and insured by Medicaid or Medicare (82.1%), compared to women with an intended pregnancy, p-value <0.001. Women with mistimed or unintended pregnancy were 83% more likely to choose highly effective, user-independent methods compared to any other or no method, adjusted relative risk (aRR) = 1.83 (95% confidence interval [CI]: 1.36, 2.47), and more likely to desire voluntary sterilization, aRR = 2.70 (95% CI: 1.58, 4.59). Additionally, women with these pregnancies were 56% more likely to use user-independent methods compared to user-dependent methods, aRR = 1.56 (95% CI: 1.18, 2.06). Women with mistimed or unintended pregnancies are 83% more likely to choose highly effective postpartum contraception or voluntary sterilization, and thus initiatives are necessary to increase access and affordability to these methods before hospital discharge after delivery. · Nearly three out of four pregnancies in this study were mistimed or unintended.. · Women with mistimed or unintended pregnancies are more likely to choose highly effective postpartum contraception or voluntary sterilization.. · Public health initiatives to improve access to family planning services and postpartum contraception, including surgery for bilateral tubal ligation before discharge from the hospital postdelivery, are important areas of focus to help attenuate the rates of unintended pregnancy in the United States..

Three Arguments Against Institutional Conscientious Objection, and Why They Are (Metaphysically) Unconvincing.

The past decade has seen a burgeoning of scholarly interest in conscientious objection in healthcare. While the literature to date has focused primarily on individual healthcare practitioners who object to participation in morally controversial procedures, in this article we consider a different albeit related issue, namely, whether publicly funded healthcare institutions should be required to provide morally controversial services such as abortions, emergency contraception, voluntary sterilizations, and voluntary euthanasia. Substantive debates about institutional responsibility have remained largely at the level of first-order ethical debate over medical practices which institutions have refused to offer; in this article, we argue that more fundamental questions about the metaphysics of institutions provide a neglected avenue for understanding the basis of institutional conscientious objection. To do so, we articulate a metaphysical model of institutional conscience, and consider three well-known arguments for undermining institutional conscientious objection in light of this model. We show how our metaphysical analysis of institutions creates difficulties for justifying sanctions on institutions that conscientiously object. Thus, we argue, questions about the metaphysics of institutions are deserving of serious attention from both critics and defenders of institutional conscientious objection.

NON-MATERNITY AND THE OPTION FOR THE VOLUNTARY SURGICAL STERILIZATION: Narratives of SUS users

With the modification in women's social roles, motherhood has become an option and no longer something mandatory or a dream for all women, and there is a growing search for effective contraceptive methods capable of avoiding unwanted pregnancies, such as voluntary surgical sterilization (VSS). This qualitative, exploratory-descriptive, and cross-sectional study aimed to understand the experiences, motivations, and trajectories of single women who opt for non-maternity through voluntary surgical sterilization in the Unified Health System (SUS). Five women with an average age of 27.8 years who are currently undergoing family planning or have already undergone VSS participated in the research. The participants responded to a socio-demographic and health data questionnaire and a semi-structured interview, understood through thematic analysis. The results highlighted four themes: Perceptions about “being a mother” and “being a father”; Life today; Non-motherhood as a possibility of being; and Surgical sterilization: freedom versus obstacles. It is clear that the choice for non-maternity is multicausal and complex, as is the option for VSS, involving aspects of each woman’s life story. Furthermore are several obstacles within the scope of the SUS for women who seek the method, proving necessary for the qualification of professionals in these services and knowledge about family planning legislation.

MEDICAL, LEGAL, PHILOSOPHICAL AND SOCIO-ECONOMICAL PREREQUISITES OF DECREASE OF THE FERTILITY RATE IN EUROPE

During less than a century number of our population halved. Fertility rate in Europe as well as in the whole World decreases constantly. There are numerous prerequisites because of which we can observe an aforementioned tendency. We are emphasizing here namely medical, legal, moral, philosophical and socio-economical ones. Not to underestimate remain postulates that separate a vision that we deserve to reach as a society i.e. equity, equality, personal freedom, zero discrimination etc., and tendencies, biases and prejudices that slow us down every single day and make those goals impossible to reach with our current state of mind. On one hand, there is number of reasons which explain an actual decrease of fertility rate clearly enough. Among them we are emphasizing high level of domestic violence, violence against women, weak abortion legislation which enslaves human rights of women in most of European countries, and, therefore, voluntary or forced sterilization, child-free tendencies, moral traumas, victim syndromes because of personal weakness and inability to do as we/or particularly woman pleases to. Additionally, rich black market of illegal abortions which consequences are often lethal or acutely dangerous for a female reproductive system, alongside with female organs mutilations committed by perpetrators of domestic violence etc, all these prerequisites lead to a visible decrease of the statistics that were mentioned before. However, at the same time, the modernly promoted desire to “live one’s life in full”, to “enjoy life without special responsibilities being husband/wife/parent”, lack of desire to create a family “until the studies will be completed, house will be bought, financial stability will be reached, all dreams will come true and so on, also keeps the idea of family life and parenthood on distance, as individuals want to maximize their happiness and pleasure with minimizing worries and “pains” at the same time. In addition, because of child-free tendency lovers and children’s haters, along with childfree hotels, restaurants, flights and other services make parents actually into outcasts from the other “proper society, that knows how to live this life without worries”. Parents of small children cannot obtain some services, are limited from visiting some places (and most of the times not because of rational reason, but rather in the aim of protecting other people’s tranquillity), experience a high level of moral pain and feeling “non-normal” when their life is different from of those, who “properly knows what and how to do”. At the same time, we shall claim that as long as the parenthood become popular and societally accepted again, and will not be associated with becoming outcasts anymore, and as long as the abortion legislation will not be optimized and become pro-feminine, along with anti-violence practical tools of fighting with perpetrators, we will not be able to talk about successful overcoming of the fertility crisis in Europe.

EVALUATION OF POSTPARTUM FEMALE STERILIZATIONS: A RETROSPECTIVE STUDY AT TERTIARY CARE HOSPITAL IN JAMMU

Background: Female sterilization is a surgical procedure which permanently prevents pregnancy it works by blocking the fallopian tube and hence it is also known as tubal ligation. However, female sterilization can be performed at puerperal or postpartum period. Methods: In this retrospective study, we will analyze the postpartum female sterilizations and evaluate the factors that play significant role among women for this option. Results: During the study period, out of 33219 women only 7701 opt for sterilizations, we observed that educational level, sex of new born child at different parity and previous procedural techniques significantly affects postpartum sterilization. Conclusion: These finding show that the voluntary sterilization depends on so many factors like education, parity, sex of new born child and previous procedures. However, in order to curtail the high maternal mortality graph, there must be counseling cells which will help women to attain feasible health benefits and consequently help to reduce maternal mortality.

The Voluntary Sterilisation Act: Best Interests, Caregivers, and Disability Rights.

How can caregivers' interests be balanced with disability rights in decisions about whether to sterilise an intellectually disabled person? This question is considered in the context of Singapore, a commonwealth country that lacks a test case. Singapore has a lesser-known history of eugenics, and has struck an uneasy compromise between communitarian values and obligations under the United Nations Convention on the Rights of Persons with Disabilities (CRPD) in recent years. This article provides an overview of Singaporean law under the Voluntary Sterilisation Act 1974 and the Mental Capacity Act 2008, and compares this with the law in Canada, England and Wales, and Australia. This article also situates the CRPD in the context of Singapore's dualist view of international law and communitarian approach to disability policy. It argues that CRPD rights to bodily integrity can be presumptively upheld in best interests determinations on sterilisation, while caregivers' interests can be accommodated in a relational understanding of best interests. A decisional framework along these lines is proposed.

Barriers to Women’s Access to Voluntary Sterilization in Canada

Introduction: In Canada, any adult who is aware of the permanent consequences of a tubal ligation is allowed to receive it, yet many doctors refuse to perform the procedure on women, especially those from marginalized communities. The purpose of this report is to investigate and identify some of the barriers that impede Canadian women’s ability to access voluntary sterilization. There is a particular focus on how Canada's history of eugenics and coerced sterilization shapes the current conditions under which women seek and are too often refused access to permanent contraception. Methods: Six qualitative, semi-structured interviews were conducted with scholars and activists in the field of Reproductive Justice (RJ) and reproductive healthcare. The interviews facilitated discussions about reproductive autonomy, patient rights, and patriarchal attitudes in medicine. An RJ framework and thematic analysis were used to uncover systemic barriers from the interview responses. Results: As discovered through the interviews, the most prevalent barriers to access to voluntary sterilization in contemporary Canada include race, class, language, ethnicity, disability, age and parity. An RJ framework identifies historical parallels to these present-day barriers by looking at the historical and colonial forces that disempower intersectional marginalized communities and influence their reproductive decisions today. Discussions: Canada’s eugenics attitudes from the past seep into the current barriers to access faced by women of colour, low-income women, female newcomers, women with disabilities, and young or nulliparous women. The assumption that these women are not capable of deciding the right course of action for their own bodies and thus should not be trusted by healthcare providers in making these decisions is a consistent problem in both time frames. Conclusion: The restrictions and modes of disempowerment placed on variously positioned women in the past come back in a new form that leads to those same groups being doubted and denied reproductive justice in the present. Many of the interviewees believed that increasing diversity in the medical field is necessary to help alleviate the discrepancies in how contraceptive healthcare is given.

Childfree Sterilization: A Normative Rhetorical Theory Analysis of Paradoxical Dilemmas Encountered by Childfree Patients and Providers

Abstract Guided by normative rhetorical theory, this study utilizes thematic analysis to explore narratives about sterilization consultations posted by childfree patients and medical providers to Reddit. This study explores the multiple meanings of sterilization, the paradoxical dilemmas competing conversational purposes create, and the communicative practices, interpretive lenses, and environmental resources patients and providers employ to manage dilemmas. The analysis reveals that voluntary sterilization inheres task, relational, and identity meanings for both patients and providers, creating paradoxical dilemmas and rendering sterilization consultations additionally challenging to navigate. Patients and providers both accept and confront paradox, adopt cultural and contextual interpretive lenses to evaluate others’ talk, and rely on childfree patient and physician social networks as environmental resources to shift the context in which talk occurs. The conclusion offers theoretical implications for normative rhetorical theory and practical implications, including: illuminating features influencing interactions in which sterilization requests are made and evaluated, and underscoring the multiple meanings that constrain patients and providers during these consultations.

Chapitre 7. La réception de la stérilisation volontaire dans la législation du Brésil et de la France et ses principales conséquences

L’un des plus grands problèmes dont s’interrogent les législateurs, dans l’actualité, se trouve axé sur la question de savoir comment traiter les découvertes scientifiques dévoilées par les nouvelles technologies. Les évolutions scientifiques dans le champ de la santé éveillent, chez l’être humain, le désir d’essayer de dépasser la nature et les développements dans le champ de la santé sexuelle et reproductive, défient non seulement les lois de la nature elle-même, mais aussi les lois mises en place par l’humanité. Parmi les avancées dans le domaine de la contraception humaine, on souligne la stérilisation volontaire, utilisée dans le monde entier comme mesure contraceptive à 99% efficace. Au Brésil, la stérilisation volontaire a été formalisé par la loi de planification familiale qui a imposé, parmi d’autres restrictions, la nécessité du consentement d’une autre personne pour sa réalisation. Il s’agit d’une imposition violente, au service du contrôle sur les corps, de la part de l’Etat. Ce contrôle est notamment imposé sur le corps de la femme, réduisant ainsi son autonomie qui est à la base de sa dignité. Cela étant, le but de cet article est d’interroger les fondements sur lesquels s’appuie et se justifie l’adoption d’une telle limitation de l’autodétermination corporelle. Pour cela, les contributions juridico-philosophiques des auteurs Ronald Dworkin et Jürgen Habermas seront examinées, à la lumière de la bioéthique. L’axe des questions sera sur l’analyse des façons dont le Brésil et la France ont accueilli le procédé de stérilisation volontaire, et quelles ont été les conséquences les plus importantes de cette légalisation-là.

Creating Choice and Building Consensus

According to a recent study by the Brookings Institution (Reeves &amp; Krause, 2016), vasectomies are safer, more effective, and less expensive than most other voluntary sterilization methods. While the procedure has grown in popularity in recent years, particularly in the United Kingdom and Canada, it is much less common in the United States. This discrepancy can be attributed to both social (a perception that contraception is “women’s work”) and policy-­based factors (lack of coverage under the Affordable Care Act). This paper examines the role and extent to which invitational rhetoric could be a useful communicative lens for both partners and providers considering vasectomies, thus increasing access to and utilization of the safe, effective, and affordable procedure. In this policy brief, we suggest strategies for incorporating invitational rhetoric into health professions education curricula, patient counseling literature, and policy language in order to address some of the social stigma around the procedure.

KNOWLEDGE ATTITUDE AAND PRACTICE OF MALE PARTNER REGARDING FAMILY PLANNING, EASTERN PROVINCE, SAUDI ARABIA

BACKGROUND: Family planning is the act of controlling birth numbers and intervals by using contraception or voluntary sterilization, the availability of a variety of female contraceptive methods led to an increase in family planning programs and researches that targets women. It is important to identify the perception of Saudi men, regarding the use of contraception methods and the effect of socio-demographic characteristics on this perception and to identify their requirements to encourage them to be involved in family planning. this study is aimed to address the knowledge, practice and attitude of Saudi men toward family planning. METHOD: A descriptive cross-sectional study in 2020 on 1610 respondents using a structured questionnaire distributed online. RESULT: Most of the respondents heard about the term of family planning (69.1%), and were able to recognize the most commonly used contraceptives however, the majority of our sample are not using contraception (56.3%). their attitude toward family planning was positive. Conclusion: Our sample population has a positive attitude toward family planning and they were willing to participate in family planning counseling and health care visit.

Enabling Restrictions

In Costa Rica today, where the use of contraceptives is widespread, the most popular method is female sterilization. Notably, Costa Rica’s high rates of this surgery were attained in the context of a very restrictive legal framework for the provision of sterilization. Until 1999, when a presidential decree explicitly regulated and permitted sterilization for contraceptive purposes, only therapeutic sterilization was legally allowed (i.e., to prevent a woman who had a serious health condition from becoming pregnant). Between 1970 and 1999, successive governments and state judicial bodies were unwilling to resolve the legal status of voluntary contraceptive sterilization. Government bureaucracies and different judicial branches repeatedly bounced the legal problem back to physicians to resolve. In the uncomfortable position of having to respond to an increasing demand for the surgery, specialist physicians responsible for sterilization, and their professional association, created a regulatory legal framework that ostensibly restricted the practice while actually enabling it. The provisions established by the professional association dictated access to sterilization in the country for over two decades, and were acknowledged not only by the population but also by state institutions, including those charged with surveying and protecting legality. A kind of judicial surrogacy was created in Costa Rica, though this surrogate role was not one Costa Rican physicians ever wanted, or felt comfortable playing.

A Inconstitucionalidade do artigo 10, I e § 5°, da Lei do Planejamento Familiar

O presente artigo tem como objeto de estudo a Lei nº 9.263/96, que regula o direito constitucional ao planejamento familiar, posicionando seu enfoque nos dispositivos que estabelecem requisitos para a realização da esterilização voluntária, quais sejam o seu art. 10, I e §5º. Partindo-se da suposição de que as atuais regras que disciplinam o ato de esterilização voluntária no Brasil são injustificadamente restritivas, objetivou-se confrontar a lei em exame com normas-princípios constitucionais. O presente trabalho baseou-se em pesquisa qualitativa e revisão de literatura, e com a aplicação de método dedutivo, os resultados do trabalho demonstraram que há incompatibilidade entre as disposições infraconstitucionais examinadas e a Constituição, revestindo de inconstitucionalidade os fragmentos em análise.

Voluntary sterilisation of young childless women: not so fast

An increasing number of bioethicists are raising concerns that young childless women requesting sterilisation as means of birth control are facing unfair obstacles. It is argued that these obstacles are...

The Knowledge, Attitude and Practice of Long Acting Contraceptive Methods among Reproductive Age Women of Kometa, Mizan Aman town, Southwest Ethiopia

Background: The Ethiopian population with an estimated current population of over 77.4 million people is the second most populous country in Africa next to Nigeria. The population is growing at a rate of 2.7 percent annually. All modern methods which provide a wide range of protection from durations of as short as days (pills, injectables, condoms and other barrier methods) to permanent protection such as voluntary surgical sterilization, implants, intra uterine device, are available in Ethiopia. However, utilization is limited more to the shorter-term methods such as pills and injectables. Objective: the study aims to assess the knowledge, attitude and practice of LACMs among child-bearing age women visiting Shanan Gibe hospital, Jimma town, southwest Ethiopia. Methods: A Cross-sectional study was conducted. To obtain a representative sample, systematic random sampling technique was used based on list of the house numbers of the kebele. Data was collected using questionnaire based interview to assess socioeconomic status, and the knowledge, attitude and practice towards LARCMs. Results, conclusion and recommendations: Among the 359 reproductive age women studied, only 205 (57.1%) know LARCMs while the remaining 154 (42.9%) do not know them. Generally, the knowledge, attitude and practice of the respondents were found to be poor but generally comparable with literatures. This may be due to inadequate health education provision to the clients during their visits to the health care workers and comprehensive health education on the merits and demerits of different alternatives of family planning should be provided to the clients during their visits to the health care facilities. The rate of use of LARCMs which was 115 (56.1%) among the 205 respondents who know LARCMs. The responsible health care workers should be committed in creating awareness about LARCMs and health education, appropriate medical treatment and counseling services should be consistently provided to the clients.

A Defence of Voluntary Sterilisation

Many women identify sterilisation as their preferred form of contraception. However, their requests to be sterilised are frequently denied by doctors. Given a commitment to ensuring women’s reproductive autonomy, can these denials be justified? To answer this question, I assess the most commonly reported reasons for a denied sterilisation request: that the woman is too young, that she is child-free, that she will later regret her decision, and that it will lower her well-being. I argue that these worries are misplaced and hence insufficient reasons for denying a request. I also argue that even if concern for patient welfare provides doctors with a valid reason to withhold sterilisation, this is overriden by respect for patient autonomy and the importance of enabling women’s reproductive control. Consequently, I suggest that adequately informed, decision-competent women should have their requests for sterilisation agreed to, even if they are young and/or child-free. In addition, I examine the impact of pronatalism on how women’s requests are understood and responded to by doctors. I show that the equation of women with motherhood can make it unjustifiably hard for them to access sterilisation, especially if they are child-free. Consequently, part of ensuring women’s access to sterilisation involves challenging pronatalist beliefs and practices.

Childfree by Choice: Stigma in Medical Consultations for Voluntary Sterilization

Nearly one half of women between the ages of 40 and 44 who do not have children are voluntarily childless, or “childfree” (Pew Research Center, 2015). Many childfree women (and men) request sterilization from medical providers (Richie, 2013). Childfree women and men who request sterilization face questioning about their nulliparous status, risk of regretting the procedure, and age (ACOG, 2017). Narrative accounts of medical interactions from Reddit’s /r/childfree were analyzed for evidence of experienced and anticipated stigma. Results indicated that clinicians’ mention of a patient’s age and the risk of regret during the sterilization counseling process were negatively predictive of procedural approval.

Legal and ethical implications of voluntary non-therapeutic sterilization as a way of realization of human reproductive rights

This article deals with legal and ethical aspects of sterilization of capable women of reproductive age. The authors point to the ethical and legal contradiction of establishing a high age criterium. Also, the authors consider the most common reasons for litigation during voluntary sterilization.

Regret, shame, and denials of women's voluntary sterilization.

Women face extraordinary difficulty in seeking sterilization as physicians routinely deny them the procedure. Physicians defend such denials by citing the possibility of future regret, a well-studied phenomenon in women's sterilization literature. Regret is, however, a problematic emotion upon which to deny reproductive freedom as regret is neither satisfactorily defined and measured, nor is it centered in analogous cases regarding men's decision to undergo sterilization or the decision of women to undergo fertility treatment. Why then is regret such a concern in the voluntary sterilization of women? I argue that regret is centered in women's voluntary sterilization due to pronatalism or expectations that womanhood means motherhood. Women seeking voluntary sterilization are regarded as a deviant identity that rejects what is taken to be their essential role of motherhood and they are thus seen as vulnerable to regret.

A comparative study of scalpel versus no scalpel vasectomy

Background: The objective of this study was to compare the standard vasectomy method and no scalpel vasectomy and complications, effectiveness, safety and acceptability of standard vasectomy (SV) versus no-scalpel standard vasectomy (NSV).Methods: Informed man who does not want to become father of any children and who desires an inexpensive outpatient method of voluntary permanent surgical sterilization, explain to patient and his wife regarding both procedure, semen analysis done after 3 months in every patient. Results: In NSV 72% patients required 10 to 20 minutes and in SV 100% required 20 to 35 minutes operative time. NSV, out of which 28% and in SV performed 60% having perioperative pain. NSV only 8% and 40% in SV having pain during follow up. In NSV average analgesic requirement was 2-3 days while among SV average analgesic requirement was 6-8 days. NSV, average antibiotic requirement was 5 days while among SV average antibiotic requirement was 7-10 days. In NSV 8% and in SV 32% were having infection during follow up. In NSV8% having wound problem during follow-up. In SV 32% having wound problem during follow-up. NSV 0% and in SV4% having vasectomy failure.Conclusions: Compared to the standard vasectomy technique, the no-scalpel vasectomy approach to the vas resulted in less bleeding, less pain during or after the procedure, and infection, as well as a shorter operative time, no longer day’s analgesic and antibiotic requirement and a more rapid resumption of sexual activity.