Factors associated with sterilization use among women leaving a U.S. jail: a mixed methods study

BACKGROUND Despite the high rates of reported sterilization use among women who have spent time in correctional facilities, little is known about the context in which women in this population choose this option. The objective of our study was to use both quantitative and qualitative methods to understand factors associated with sterilization use among women leaving a U.S. jail. METHODS We administered a cross-sectional survey with 102 jailed women who were participating in a study about contraceptive use after release from jail, and then conducted semi-structured interviews with 29 of those women after their release from jail. We used logistic regression and analytic induction to assess factors associated with self-reported sterilization use. RESULTS In our cross-sectional survey, one-third of our sample reported a history of sterilization use. Controlling for age and past pregnancies, the only factor associated with sterilization use was physical abuse history before age 16. In semi-structured interviews, we found that women's primary motivation for sterilization was the desire to limit childbearing permanently, in some cases where other contraceptive methods had failed them. The decision for sterilization was generally supported by family, partners, and providers. Many women who opted for sterilization expressed financial concern about supporting children and/or reported family histories of sterilization. CONCLUSIONS The decision to use the permanent method of sterilization as a contraceptive method is a complex one. Results from this study suggest that while explicit coercion may not be a factor in women's choice for sterilization, interpersonal relationship histories, negative experiences with contraceptives, and structural constraints, such as financial concerns and ongoing criminal justice involvement, seem to influence sterilization use among the vulnerable group of women with criminal justice histories. Public health programs that connect women to reproductive health services should acknowledge constraints on contraceptive decision-making in vulnerable populations.