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
About this Master's Thesis
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