Transcript Sterilisation uptake in the Dominican Republic: socio-economic and network factors.

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
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Increasing rates have brought median ages at
sterilisation down
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Cheap
No follow up
Less affected by low quality of care
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
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Risk of lower use of condom-impact on HIV
rates?
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Human rights issue when women not told it’s not
reversible
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:
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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
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One of the highest rates in the worldaccounts for over 70% of current users
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35% total women
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Quality of care and contraceptive mix major
issues
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Great dataset
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Over 22,000 women interviewed
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Extra questions asked about Family planning information received
Contraceptive use-58% prevalence
PA/w ithdraw al Other
2%
3%
Pill
18%
IUD
2%
Injections
3%
Condom
3%
Female Sterilization
69%
11% unmet need
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
Future preferred method
Norplant
5%
Female Sterilization
20%
Pill
43%
Condom
4%
Other
4%
Injections
18%
IUD
6%
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
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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
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Sample selection
 2002
DHS
 Only women currently using a method
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At least one child
 Women
who were sterilised in the two
years before survey date
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Whether talked about family planning asked for the previous
12 months only
4537 women
Methods
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Multilevel logistic regression-Stata/Gllamm
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Individual Level
Household level
Cluster level
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Nested modelling
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Outcome variable whether woman sterilised
or not
Determinants
Demographic
Age
Socio-economic
Residence
Community/network
Talked about FP
Parity
Marital status
Number of unions
Ethnicity
Religion
Wealth quintile
Visited Health centre
Visited by FP worker
Watch TV
Age at first birth
Listens 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
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Not significant when parity considered
Results
Talked about FP
Visited health centre
Visited by Health worker
Age
Parity
Number of unions
Age at first birth
Residence
Wealth
Education
NS
More than one union
NS
NS
Less likely higher levels
Some conclusions
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Community effects very significant
Discussing FP with relative and peers decreases
risk
 Cluster is a factor but not the household
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Media not significant when controlling for
other factors
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Age at first birth more significant than age
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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?