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Patient-provider conversations about sterilization: A qualitative analysis.

Katrina Kimport1, Christine Dehlendorf2, Sonya Borrero3

  • 1Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, USA.

Contraception
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Summary

Healthcare providers often fail to discuss female sterilization, a common contraceptive method, with patients desiring permanent birth control. When discussed, clinicians frequently discourage sterilization in favor of reversible methods.

Keywords:
Contraceptive counselingFemale sterilizationQualitative methodsReproductive intentions

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Area of Science:

  • Reproductive Health
  • Contraception Counseling
  • Patient-Centered Care

Background:

  • Female sterilization is a widely used contraceptive method in the U.S.
  • Provider practices may act as barriers to patients' desired sterilization procedures.

Purpose of the Study:

  • To analyze provider discussions of female sterilization during contraceptive counseling.
  • To identify patterns in how clinicians discuss or omit sterilization with patients.

Main Methods:

  • Modified grounded theory analysis of audio-recorded contraceptive counseling sessions.
  • Analysis included 52 women desiring no future children and 14 women mentioning sterilization.

Main Results:

  • Sterilization was discussed in only 19 of 52 visits, primarily with older, parous women.
  • Clinicians often discouraged sterilization, promoting long-acting reversible methods instead.
  • In 33 visits, sterilization was not mentioned; reproductive intentions were often not solicited.

Conclusions:

  • Clinicians missed opportunities to discuss sterilization with appropriate candidates.
  • When discussed, sterilization was infrequently presented positively, with a bias towards reversible methods.
  • Counseling should prioritize patient preferences over provider assumptions about method desirability.