This study was supported by the Bill & Melinda Gates Foundation, Global Development Grants OPP1060424, OPP1084270.
Sterilization (Birth control) -- Complications, Contraception -- Decision making, Contraception -- Complications
Objective: Novel approaches to nonsurgical permanent contraception (NSPC) for women that are low cost and require no incision or hysteroscope/surgical equipment could improve access to, and the acceptability of permanent contraception (PC). To better understand opportunities and limitations for NSPC approaches, we examined women's and OB/GYN providers' perceptions of NSPC in Portland, OR.
Study Design: Semi-structured, qualitative interviews were conducted with 40 women recruited from outpatient clinics with purposive sampling, and a focus group was conducted with 9 OB/GYNs in academic and community practice. Transcripts were coded and inductively analyzed with a grounded theory approach.
Results: The majority of women identified as white (67%) or Latina (25%). They had a median age of 31.5, and median number of children was one. Perspectives on NSPC were closely aligned with women's general attitudes towards PC; over half were considering PC for themselves or partners in the future. Most respondents valued multiple aspects of a nonsurgical approach, with themes of minimizing recovery time, invasiveness, risk, and avoiding hormonal contraception. Many assumed NSPC would be less effective than surgery, however, and felt a confirmation test would be necessary regardless of the failure rate. Providers welcomed efforts to expand contraceptive choice with NSPC, but would require long-term safety and efficacy data before recommending, and voiced concerns that NSPC's potential relative ease of administration could undermine the inherent seriousness of choosing PC.
Conclusions: Women’s and providers’ perceptions of NSPC hinged on the ways in which they conceptualized risk and effectiveness. While perceptions were generally favorable, confirmation of safety and effectiveness would be required for a new approach to be accepted.
Implications: This hypothesis-generating study elucidates women’s and provider’s perspectives on new methods of NSPC, and contributes to understanding their perceptions of various types of risk. A technique to verify tubal occlusion would be needed for women and providers to accept NSPC.
Harrington Elizabeth K., Gordon Diana, Osgood-Roach Isabel, Jensen Jeffrey T., Aengst Jennifer, Conceptualizing risk and effectiveness: A qualitative study of women’s and providers’ perceptions of nonsurgical female permanent contraception, Contraception (2015)