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OriginalArticle

Socio-demographicFactorsaffectingFemaleSterilizationOperationamong

CouplesofAhmedabadCity:ARecordBasedStudy1 2 1 1 1VirajPanchal ,VaibhaviPatel ,AasthaNayak ,JayParikh ,BansariParikh

1 2MBBSStudent, AssistantProfessor,DepartmentofCommunityMedicine,Smt.NHLMunicipalMedicalCollege,

Ahmedabad,Gujarat,India

Correspondence:VirajPanchal,Email:virajpanchal611@gmail.com

Accessthisarticleonline

Website:

www.healthlinejournal.org

DOI:

10.51957/Healthline_206_2021

QuickResponseCode Howtocitethisarticle:

PanchalV,PatelV,NayakA,ParikhJ,ParikhB.Socio-

demographic Factors affecting Female Sterilization

Operation among Couples of Ahmedabad City: A

RecordBasedStudy.Healthline.2021;12(2):43-48.

Abstract:

Introduction:Unplannedpregnancymaybethereasonofmanyneonatalandmaternaladverse

effects. Many factors have been reported to be associated with acceptance of female sterilization.

Objective:Toidentifyvarioussocio-demographicfactorsaffectingthedecisionofchoiceofTubalLigation

(TL).Method: A recordbased studywasdoneusingdata from the registermaintained at the Family

PlanningUnitofObstetricsandGynaecologydepartment.AnalysisofdataofTLoperationsconducted

betweenApril2018toMarch2019wereperformed.Results:Atotalof675tuballigationoperationswere

conducted.ThemeanageoffemalesundergoingTLwas28.8±3.9yearsandtheirhusbandswas33.25±

4.38years.Outofthetotal,484(71.1%)coupleswereMuslims.Total74(10.8%)femaleswereilliterateand

39(5.8%)maleswereilliterate.Among440(65.1%)coupleswhohadunderwentTLhad3livingchildren.

Majorityi.e.,518(76.7%)hadtheageoftheirlastlivingchildlessthan1month.Ninetyonepercentof

coupleshadatleastonemalechild.Therewasasignificantrelationshipoffemaleeducationwithtotal

numberoflivingchildren.Relationshipoftotalnumberoflivingchildrenwithreligionwasalsosignificant

statistically.Conclusion:Thestudyconcludesthatfemaleeducationaswellasreligiousandculturalbeliefs

playsamajorroleindecidingthefemalesterilization.

Keywords:Femaleeducation,Femalesterilization,Religion,Tuballigation.

Introduction:

Unplannedpregnancymaybeamajorsocialand

publichealthissuewithadverseeffectsonneonatal

anddevelopmentaloutcomesandalsoonmaternal[1]

health and wellbeing. In India, the birth control

program was implemented in 1952, as a national

population policy to regulate the rapid rise of

population and reduce poverty. Initially, variety of

recent methods were focused and later shifted

toward male sterilization, but female sterilization

becametheprimefocusfromlate1970.However,the

persistent dominance of sterilization in the family

program is largely affected by the socioeconomic[2]

conditions. The use of contraceptive methods

among Indian women is related to several factors

such as personal, interpersonal, partner related,[3]

service related and/or method related. Various

factorslikeage,educationofboththeparents,ageof

the last livingchildwerereported tobeassociated

with acceptance of female sterilization in the[4]populationofruralAhmedabad,Gujarat. Itwasalso

seen that e i ther lack of in format ion or

misinformation regarding temporary methods and

less opportunity to prefer modern temporary

HealthlineJournalVolume12Issue2(April-June2021)

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Panchaletal Socio-demographicFactorsaffectingFemaleSterilization...

methodsduetoaffordabilityandaccessibilityissues

also affect women's choice of selecting female[5]sterilizationinruralpartsofIndia. Onequalitative

study from Mumbai showed that from a women

perspective, the choice to undergo sterilization

makesthemeffectivelycontroltheirfertilityleading

totheirimprovedsexualrelationshipsandemotional[6 ]health. However, a major determinant in

sterilizationwassonpreference,asitwasfoundthat

manywomenpreferredsterilizationevenwith two

sons than if they had two daughters, especially in

stateslikeGujarat,Punjab,Rajasthan,UttarPradesh[7]

andBihar. Due to scarce data onmultiple factors

affectingtheselectionofcontraceptive,itisworthto

analysetherecordbaseddataanduseittoidentify

thevarioussocio-demographic factorsaffectingthe

decisionofchoiceofTubalLigation(TL).

Objectives:

• Tostudythesocio-demographicprofileofvarious

couplesundergoingTubalLigation

• To correlate the various socio-demographic

factors affecting thedecisionof choiceofTubal

Ligation.

Method:

A record based study carried out at the Family

planningunitofObstetricsandGynaecology,atoneof

thetertiarycarehospitalofAhmedabadcity.Dataof

theCouplesundergoingTuballigation(TL)operation

attheabovehospitalduringtheoneyearperiodfrom

April 2018 to March 2019 was collected with

permission. The data included the variables like

education of couple, their age, and number of

children, occupation and age of last child, religion,

andtimeofselectionofTL.

Results:

Atotalof675coupleshadoptedTLoperationsat

the Family Planning Unit of Obstetrics and

GynaecologyDepartmentfromApril2018toMarch

2019. Out of the total, 486 (72%) couples were

Muslim, one was Sikh and rest 188(27.9%) were

Hindu.Itmaybeduetomajorityofthepopulationin

thenearbyareaofthehospitalisMuslim.Meanageof

femalesundergoingTLwas28.8±3.9yearsandtheir

husbandwas 33.25 ± 4.38 years.Maximum age in

femaleswasfoundtobe41yearsandinmalesitwas

50years,while theminimumage found in females

was 20 years and in males was 23 years. Most

commonagegroupatthetimeofTLoperationamong

femalewasof21-30yearsandamongmaleswas31-

40years.Majority(75%)ofthefemaleand65%ofthe

malehadcompletededucationuptoprimary level.

(Table1)

Themeannumberofchildreninthefamilywas

3.09±0.72.Themeannumberoffemalechildrenwas

1.53±1andthemeannumberofmalechildrenwas

1.56±0.8.Therewere92(13.6%) coupleswithout

anyfemalechildinthefamilyand59(8.7%)couples

withoutanymalechildindicating91%ofthecouple

hadatleastonemalechild. Only15%ofthecouples

underwentpermanentmethodofcontraceptionafter

2livingchildrenwhilemajority(65%)ofthecouples

decideditafterhaving3livingchildren.Only1couple

underwentTLoperationeveniftheydidn'thaveany

childandthereasonforthesamewasnotmentioned

intherecords.

Agegroup(years)

11-20

21-30

31-40

41-50

Educationalstatus

Illiterate

Primaryeducation

Secondaryeducation

Graduate

Religionofcouple

Hindu

Muslim

Sikh

Notmentionedinrecord

1(0.1)

502(74.4)

171(25.3)

1(0.1)

No.ofwomen(%)

74(10.8)

509(75.5)

88(13.05)

4(0.6)

No

187

484

1

3

0(0)

246(36.4)

403(59.7)

26(3.9)

39(5.8)

441(65.3)

188(27.9)

7(1)

Percent

27.7

71.7

0.1

0.4

No.ofmen(%)

No.ofmen(%)No.ofwomen(%)

Table1:Socio-demographicinformationofcouplesselectingTubalLigation(n=675)

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Majorityi.e.,518(76.7%)ofthecouplespreferred

thesterilizationoperationwhentheageoflastliving

child was less than one month. Out of total 675

couples,thelastlivingchildwasmalein375(55.6%)

andfemalein300(44.4%)couples.(Table2)

Majority (62.7%) of couples selected TL along

withLowersectioncaesarean,94(13.9%)ofcouples

preferred TL after normal vaginal delivery while

114(16.9%) females underwent sterilization after

MedicallyTerminatedPregnancy (MTP)procedure.

(Figure1)

Outof675,74(11%)wereilliterateandamong

these 71(96%) had more than 2 children while

among literate females, 501(83%) out of 601 had

more than 2 children and this difference was also

statisticallysignificant(pvalue0.003andOddsRatio

(OR)4.72).Outof675males,39(5.8%)wereilliterate

Table2:Totalnumberoflivingchildren,genderandageoflastlivingchildincouplesatthetimeofdoingTubalLigation(n=675)

Numberoflivingchildren

0

1

2

3

Morethan3

Numberofchildren

0

1

2

Morethan2

Ageoflastlivingchild

<1month

1monthto12months

1yearto5years

5yearsto10years

Morethan10years

Genderofthelastlivingchild

Female

Male

No.ofcouples

1

1

101

440

132

No.ofcouples

(malechildren)

59(8.7%)

275(40.7%)

253(37.5%)

88(13.1%)

No.ofcouples

518

10

97

41

9

No.

300

375

percentage

0.1

0.1

15

65.1

19.7

No.ofcouples

(femalechildren)

92(13.6%)

261(38.7%)

215(31.9%)

107(15.8%)

percentage

76.7

1.5

14.4

6.1

1.3

percentage

44.4

55.6

Figure1:SelectionoftimingforTL

and among these couples, 95%were havingmore

than 2 living children. However, male educational

statuswasnotsignificantlyassociatedwiththetotal

number of living children in family(p value0.1134

and Odds Ratio (OR) 3.49). Out of 484 Muslims

couples,429(88%)hadmorethan2childrenwhile

amongHinducouples139(74%)outof187hadmore

than2 childrenand thisdifferencewasalsohighly

significant(pvalue0.0001andOddsRatio(OR)2.69).

Genderof last livingchildwhethermaleor female,

wasnotsignificantlyrelatedtothetotalnumberof

livingchildren(pvalue0.9618andOddsRatio(OR)

0.98).Outof a total 675 couples, 59(8.7%)hadno

male child, andamong these couples53(90%)had

more than two living children. However, this

association was insignificant(p value 0.3428 and

OddsRatio(OR)1.65).(Table3)

Discussion:

The study was conducted at Vadilal Sarabhai

GeneralHospitalwhichissituatedinthewestzoneof

Ahmedabadcity.Themeanageoffemalesundergoing

TLwas 28 years and their husbandwas 33 years.

Puwaretal.,hadalsoreported28yearsasmedianage[4]infemalesand31yearsasmedianageinmales. This

showsthatcouplesarechoosingpermanentmethod

ofcontraceptionatayoungerage.74.4%femaleswho

underwentTLinourstudywereintheagegroupof

21-30 years. While a study by Benjamin et al.,

reported that 40.1% of female who underwent

sterilizationoperationwereintheagegroupof30-35

HealthlineJournalVolume12Issue2(April-June2021)

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Panchaletal Socio-demographicFactorsaffectingFemaleSterilization...

Table3:Associationbetweensociodemographicvariableandtotallivingchildren(n=675)

[8]years. Wefoundinourstudythat75%femalesand

65%ofmaleshadcompletededucationuptoprimary

level,whereasinastudybyAthavaleAetal.,showed

that 23% of women were illiterate, 11% were

educateduptoprimaryleveland66%hadcompleted[9]educationbeyondprimarylevel. Amongstilliterate

females,96%hadmorethan2childreninourstudy.It

was seen in an ICMR studybyRBaveja et al., that

illiterate women in their study had more children[10]

compared to literate women. A significant

relationship was seen between female education

withnumberoflivingchildren(Oddsratio4.72andP

value0.003) inourstudy.Educationof femalewas

alsofoundsignificantlyrelatedtothetotalnumberof

children (chi square22.4, p=0.001) in a studyby[4]

PuwarBetal. Thisshowsthatfemaleeducationplay

a major role in limiting the family size. Male

education had no significant relationship with the

number of living children (p value 0.1134) in our

study.AstudybyPalamuleniMEetal.,showedthat

with higherwomen empowerment the use of long[11]

actingcontraceptiveshasincreased. Whileastudy

conducted from thedataofNationalFamilyHealth

Survey(NFHS) inUttarPradeshin1992–1993by

Totalnumberoflivingchildren

Morethan2(%) Upto2(%)Total

Oddsratioand95%Confidence

Intervalp-valueVariable

FemaleEducation

Illiterate 71(95.95) 3(4.05) 74

Literate 501(83.36) 100(16.64) 601

Total 572(84.7) 103(15.2) 675

4.72(1.46to5.301) 0.0030

MaleEducation

Illiterate

Literate

Total

Religion

Muslims

Hindu

Total

Genderoflastlivingchild

Female

Male

Total

Atleastonemalechild

No

Yes

Total

37(94.8)

535(84.1)

572(84.7)

429(88.6)

139(74.3)

568(84.6)

254(84.6)

318(84.8)

572(84.7)

53(89.8)

519(84.2)

572(84.7)

2(5.1)

101(15.8)

103(15.2)

55(11.3)

48(25.6)

103(15.3)

46(15.3)

57(15.2)

103(15.2)

6(10.2)

97(15.7)

103(15.2)

39

636

675

484

187

671

300

375

675

59

616

675

3.49(0.82to14.72)

2.69(1.74to4.14)

0.98(0.64to1.51)

1.65(0.69to3.94)

0.1134

0.0001

0.9618

0.3428

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HealthlineJournalVolume12Issue2(April-June2021)

DwivediSNetal.,showedthatwhosehusband'swere

literateweremorelikelytoadoptcontraception(OR=[12]1.7, 95% CI : 1.4-2.1). Thus, improving the

educationallevelmayprovebeneficialincontrolling

thepopulationgrowth.Themeannumberofchildren

inthefamilywas3inourstudy.Similarly,PuwarBet[4]

al.,reported2.84asthemeannumberofchildren.

Outofall,91%of thecouplehadat leastonemale

childand55%oftotalcoupleshadthelastlivingchild

asmaleindicatingthathavingatleastonemalechild

inthefamilybeforeundergoingpermanentmethodof

contraception does have an influence. Similarly,

AthavaleAetal.,reportedthat89%ofthecoupleshad[9]

atleastonemalechild. PuwarBetal.,alsoobserved

that98.9%coupleshadatleastonemalechildinthe[4]

family before selecting permanent method.

EdmeadesJetal.,alsoshowedthat29%womendid[13]sterilizationiftheyhadatleastoneson. Agooddeal

ofdocumentedresearchhadshownthesameresults[7,14-17]

forsexpreference.

Whenanalyzed,thegenderoflastlivingchildwith

the total number of living children, no significant

relationshipwasseen(P=0.9618).Instead,anequal

distributionwasnoted.Alsohavingatleastonemale

childdidnot showasignificant relationship inour

studywithtotalnumberofchildren(P=0.3428).We

alsonotedthat62%ofthecouplespreferredTLsoon

after Lower section caesarean delivery and 76%

couplespreferredTLwhentheageoftheirlastchild

waslessthanamonth.Puwaretal.,statedthat28%

femalespreferredtoundergosterilizationwhenthe[4]ageof last living childwas less than1month. TL

afterlowersectioncaesareandeliverymakesitacost-

effectivestrategy.Itwasalsoseenthatabout16.9%

couplesdidsterilizationafterundergoingMedically

Terminatedpregnancy,indicatinganunmetneedfor

contraception.

ItwasseenthatoutofMuslimscouples,88%had

more than 2 children before selecting TL while in

Hindusitwas74%ofcoupleswhohadmorethat2

children,thisrelationshipwasalsofoundtobehighly

significant(P=0.0001).AstudydonebyHayatHetal.,

in rural Kashmir valley particularly Muslim

dominatedalsoshowed17%ofcouplesdidnotuse

[18]contraceptionduetoreligiousreasons. Inastudy

byKansalAetal.,theystatedthatthemostcommon

reasonfornotusingcontraceptionwasthedesirefor

more children in21%couplesorparticularlymale

child (5.4%) followed by religious reasons also[19]

(5.8%). SimilarlyinastudybyPatraSetal.,in2015,

about 9% Muslim women in India do not use

contraception due to religious reasons, and non-

Muslim women were more likely to use a family[20]planningmethodinthefuturethanMuslimwomen,

thus religious and cultural beliefs regarding the

familysizeplayadefiniteroleinlimitingthesizeof

thefamily.

Limitations:

Thiswasarecordbasedstudyso,onlythefactors

mentionedintherecordscouldbestudied.Moresuch

studiesarerequiredhavingalargersamplesizeanda

populationconsistingofdifferentethnicgroupsand

religion.

Conclusion:

Inpresentstudy,womendidsterilizationat the

ageof28yearsafterhavingapproximately3children.

Majorityofthefamilieshadatleastonemalechild.

Educationofmotherwassignificantlyrelatedtothe

totalnumberofchildren,indicatingwomen'srolein

deciding the time of sterilization. Religion of the

couple also showed a significant association with

totalnumberofchildreninthefamily.Mostcommon

time selected for TLwas soon after Lower section

caesarean delivery and majority of the couples

preferredTLwhentheageoftheirlastchildwasless

than amonth. So wewould like to recommend to

increaseliteracyamongfemales.

Declaration:

Funding:Nil

Conflictsofinterest:Nil

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Panchaletal Socio-demographicFactorsaffectingFemaleSterilization...