Rural-Urban Differences in Tubal Ligation Incidence in Georgia Öffentlichkeit
Travers, Curtis (2014)
Published
Abstract
Rural-urban health disparities are apparent in family planning and contraception availability, affecting over 50 million people in America. Tubal ligations are a very effective form of contraception; however, their permanency can result in regret and requests for reversals to restore fertility. Using data from the FUCHSIA Women's Study, we examined the differences in tubal ligation incidence between large metropolitan, small metropolitan, and rural counties among 2160 women aged 22-45 in the state of Georgia. County of residence was categorized using the National Center for Health Statistics Urban-Rural Classification Scheme. We estimated the effect of residence on tubal ligation using Cox regression. Women without a tubal ligation were censored at age of hysterectomy, age of double oophorectomy, or current age. After adjustment for covariates, women residing in rural counties had nearly twice the incidence rate of tubal ligations compared with women in large metropolitan counties (Hazard Ratio = 1.8, 95% Confidence Interval = 1.3, 2.5). No differences were observed between small metropolitan and large metropolitan counties. Rural women were also less likely to have used hormonal contraception or long acting reversible contraception (LARC) prior to their tubal ligation and were less likely to experience regret. The American College of Obstetricians recommends increased availability and usage of LARC as alternatives to tubal ligations. Our results suggest this message is less likely to reach residents of rural counties.
Table of Contents
CHAPTER 1: 1
Importance of Family Planning Research 1
Physician Contraception Knowledge and Attitudes: 2
History and Trends of Tubal Ligations: 5
Tubal Ligation Procedures: 7
Prevalence of Regret: 8
Long Acting Reversible Contraception Trends and Advantages: 9
Factors Affecting Tubal Ligation Rates: 11
Rural-Urban Health Disparities Background: 14
Rural Health Disparities in Contraception: 17
Contribution of Research: 21
CHAPTER 2: 23
ABSTRACT: 23
INTRODUCTION: 24
METHODS: 25
RESULTS: 28
DISCUSSION: 30
REFERENCES: 35
TABLES: 40
FIGURES: 46
APPENDIX A: RURAL-URBAN COUNTIES OF GEORGIA 48
APPENDIX B: IRB APPROVAL 49
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