Psychological aspects of genetic counselling / edited by Alan E.H. Emery, Ian M. Pullen.

Date:
1984
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Psychological aspects of genetic counselling / edited by Alan E.H. Emery, Ian M. Pullen. Source: Wellcome Collection.

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    STERILIZATION 175 ogy have also promoted adoption of this method. Finally, removal of age and parity restrictions and the development of simpler surgical techniques reduc¬ ing the expense, surgical involvement and convalescence previously associated with traditional methods of tubal ligation have also promoted greater availability and reliance on sterilization. A number of studies have investigated the factors considered in the lengthy decision making process leading to method selection (Mumford, 1983). The primary motivating factor is a desire to terminate childbearing, based on economic or emotional considerations, sometimes accompanied by an unwanted last birth, an unplanned pregnancy, and/or high parity. Fear of an unwanted pregnancy rather than the previous birth of an unwanted child is the more important characteristic. The average age and parity of sterilization users differs by country, associated with legal restrictions on availability, differences in the number of children desired, overall contraceptive preva¬ lence, and the mix of methods available. Research based on the 1965 and 1970 US National Fertility Studies (NFS) based on samples of women under age 45, married with husband present have shown that couples waited an average of four years following the birth of the last wanted child before becoming sterilized, and delay time was longer among low-parity couples and couples selecting vasectomy (Bumpass and Presser, 1972). Secondary factors in the decision to select sterilization are negative attitudes toward temporary female contraceptive methods, concern regarding the effectiveness or long-term side effects of other methods, and reduction in sexual satisfaction associated with other methods. Reported medical prob¬ lems and contraindications to use of other methods have also been reported. In contrast, the safety, effectiveness, and convenience of sterilization as well as its noninterference with sexual enjoyment are the attributes of sterilization most frequently mentioned in its favour (Houser and Beckman, 1978). A third factor implicated in the sterilization decision is consultation with trusted friends who also have elected the procedure and from whom detailed information on the procedure as well as possible physical, psychological, and sexual sequelae can be obtained. This applies particularly to vasectomy decision making, in which friends are often cited as the primary source of information on the procedure. The decision for sterilization is usually made as a couple, although considerable discussion and joint decision making are more typically reported in the selection of vasectomy than in the selection of female sterilization (Alder et al., 1981; Mumford, 1983; Reading eíd/., 1980). A fourth factor affecting sterilization decisions is the availability of various procedures, dependent upon the medical and family planning infrastructure in a country, and the cost of the method - both money and time costs (costs of the procedure, travel time, and time lost postoperatively), as well as legal age and parity restrictions on availability.