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Female Sterilization and Cognitive Disability in the United States, 2011–2015

Li, Henan, PhD, MS; Mitra, Monika, PhD; Wu, Justine P., MD, MPH; Parish, Susan L., PhD, MSW; Valentine, Anne, MS; Dembo, Robert S., MS

doi: 10.1097/AOG.0000000000002778
Contents: Contraception: Original Research

OBJECTIVE: To compare female sterilization among three mutually exclusive groups of females: 1) those without any self-reported disability, 2) those with noncognitive disabilities (sensory or physical disabilities), and 3) those with cognitive disabilities.

METHODS: We conducted a secondary analysis of nationally representative data from the National Survey of Family Growth 2011–2015, which surveyed individuals aged 15–44 years in the U.S. civilian population. Disability status (self-reported) was ascertained using a standard set of questions about hearing, vision, cognitive, ambulatory, self-care, and independent living difficulties. Regression models were used to calculate odds of female sterilization, hysterectomies, and age of sterilization while accounting for sociodemographic differences.

RESULTS: Female sterilization rates were higher among females with cognitive (22.1% [n=272]) and noncognitive disabilities (24.7% [n=150]) than among those without disabilities (14.8% [n=1,132]). After adjusting for sociodemographic covariates, females with cognitive disabilities had significantly higher odds of female sterilization (adjusted odds ratio [OR] 1.54, 95% CI 1.19–1.98, P<.01) and hysterectomy (adjusted OR 2.64, 95% CI 1.53–4.56, P<.001) than those without cognitive disabilities. Females with cognitive disabilities also underwent sterilization at significantly younger ages (27.3 years, 95% CI 27.0–27.6) than those with noncognitive disabilities (28.3 years, 95% CI 27.9–28.8) and those without any disability (29.8 years, 95% CI 29.5–30.0).

CONCLUSION: U.S. females with cognitive disabilities were more likely to have undergone female sterilizations and hysterectomies and at younger ages than those with other disabilities or without disabilities. Drivers of these disability-related differences in female sterilization patterns must be explored.

U.S. females with cognitive disabilities were more likely to undergo sterilizations and hysterectomies and at younger ages than females with other or no disabilities.

Lurie Institute for Disability Policy, Brandeis University, Waltham, and the Human Services Research Institute, Cambridge, Massachusetts; the Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; and the Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts.

Corresponding author: Henan Li, PhD, MS, Human Services Research Institute, 2336 Mass Avenue, Cambridge, MA 02140; email:

Henan Li received support from National Institute on Disability, Independent Living, and Rehabilitation Research, Advanced Rehabilitation Research Training Projects Grant # 90AR5024-01-00. Monika Mitra received support for this work from the Health Resources and Services Administration grant number R40MC30754. Monika Mitra, Susan L. Parish, and Justine P. Wu receive support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) under award numbers R01HD082105 (Monika Mitra, Susan L. Parish) and 1K23HD084744-01A1 (Justine P. Wu). The content is the responsibility solely of the authors and does not necessarily represent the official views of the NICHD. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; or decision to submit the manuscript for publication. Anne Valentine received support from Lurie Institute for Disability Policy at Brandeis University and from the National Institute on Disability, Independent Living, and Rehabilitation Research, U.S. Department of Health & Human Services Grant # 90DPGE000101. Robert S. Dembo received support from the Lurie Institute for Disability Policy at Brandeis University.

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

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2018 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.