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Sterilization of Rural and Urban Women in the United States

Lunde, Britt MD, MPH; Rankin, Kristin PhD; Harwood, Bryna MD, MS; Chavez, Noel PhD

doi: 10.1097/AOG.0b013e31829b5a11
Original Research

OBJECTIVE: To examine the prevalence of sterilization among women aged 20–34 years in rural and urban areas in the United States.

METHODS: Data were obtained from the 2006–2010 National Survey of Family Growth, a cross-sectional survey conducted by the Centers for Disease Control and Prevention. The study population included the 4,685 female respondents who did not want to become pregnant at the time of the survey. Women who were not sexually active with men or were infertile for reasons other than contraception were excluded. We performed bivariate and stratified analysis and multivariable logistic regression modeling to determine the associations between place of residence and sterilization after considering other demographic characteristics.

RESULTS: Rural women were at increased odds of undergoing sterilization compared with urban and suburban women (22.75% compared with 12.69%, respectively; crude odds ratio [OR] 2.03, 95% confidence interval [CI] 1.44–2.86; risk difference 0.10, 95% CI 0.05–0.16). Education level was found to be a significant effect modifier of the relationship between location of residence and sterilization. In adjusted analysis, controlling for age, parity, race and ethnicity, income, insurance status, history of unintended pregnancy, and relationship status, rural women without a high school degree were more likely to have undergone sterilization compared with urban and rural women with greater than a high school education (OR 8.34, 95% CI 4.45–15.61).

CONCLUSIONS: Rural women with low education levels have a high prevalence of sterilization. Future studies need to address the reasons for this interaction between education and geography and its influence on contraceptive method choice.


In the United States, rural women with low education levels have the highest prevalence of sterilization.

Icahn School of Medicine at Mount Sinai, New York, New York; Cedars-Sinai Medical Center, Los Angeles, California; and the University of Illinois at Chicago College of Medicine, Chicago, Illinois.

Corresponding author: Britt Lunde, MD, MPH, 1176 Fifth Avenue, 9th Floor, Box 1170, New York, NY 10029; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.