Series 23

No. 20

Surgical Sterilization

in the United States:

Prevalence and

Characteristics, 1965–95

June 1998

Vital and

Health Statistics

From the CENTERS FOR DISEASE CONTROL AND PREVENTION / National Center for Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics
Copyright Information

All material appearing in this report is in the public domain and may be

reproduced or copied without permission; citation as to source, however, is

appreciated.

Suggested citation

Chandra A. Surgical sterilization in the United States: Prevalence and

characteristics, 1965–95. National Center for Health Statistics. Vital Health Stat

23(20). 1998.

Library of Congress Catalog Card Number

Surgical sterilization in the United States : prevalence and characteristics,

1965–95.

p. cm. — (Vital and health statistics. Series 23, Data from the National

Survey of Family Growth ; no 20) (DHHS publication ; no. (PHS) 98-1996)

‘‘May 1998.’’

Includes bibliographical references.

ISBN 0-8406-0547-1

1. Sterilization of women—United States—Statistics. 2. Sterilization (Birth

control)—United States—Statistics. I. National Center for Health Statistics (U.S.)

II. National Survey of Family Growth (U.S.) III. Series. IV. Series: DHHS

publication ; no. (PHS) 98-1996.

[DNLM: 1. Sterilization, Sexual—United States statistics. W2

AN148vw no. 20 1998]

RG138.S9726 1998

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for Library of Congress 98-22554

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Printed on acid-free paper
Surgical Sterilization

in the United States:

Prevalence and

Characteristics, 1965–95

Series 23:

No. 20

Hyattsville, Maryland

June 1998

DHHS Publication No. (PHS) 98-1996

Vital and

Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics
National Center for Health Statistics

Edward J. Sondik, Ph.D., Director

Jack R. Anderson, Deputy Director

Jack R. Anderson, Acting Associate Director for

International Statistics

Lester R. Curtin, Ph.D., Acting Associate Director for

Research and Methodology

Jennifer H. Madans, Ph.D., Acting Associate Director for

Analysis, Epidemiology, and Health Promotion

P. Douglas Williams, Acting Associate Director for Data

Standards, Program Development, and Extramural Programs

Edward L. Hunter, Associate Director for Planning, Budget,

and Legislation

Jennifer H. Madans, Ph.D., Acting Associate Director for

Vital and Health Statistics Systems

Stephen E. Nieberding, Associate Director for

Management

Charles J. Rothwell, Associate Director for Data

Processing and Services

Division of Vital Statistics

Mary Anne Freedman, Director

James A. Weed, Ph.D., Deputy Director

Kenneth G. Keppel, Ph.D., Acting Chief, Reproductive

Statistics Branch

Nicholas F. Pace, Chief, Systems Programming and

Statistical Resources Branch
Contents

Abstract ............................................................................................... 1

Highlights ............................................................................................. 1

Introduction ............................................................................................ 2

Methods ............................................................................................... 3

Results ................................................................................................ 4

Women’s Age and Type of Operation: 1965–95 ............................................................. 4

Women’s Race and Hispanic Origin and Type of Operation: 1973–95 ........................................... 4

Women’s Characteristics and Surgical Sterilization: 1973 and 1995 ............................................. 5

Reasons for Sterilizing Operations: 1995 ................................................................... 8

Desire for Sterilization Reversal: 1995 .................................................................... 9

Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Overall Surgical Sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Type of Sterilizing Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Appendix I

Definition of Terms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Appendix II

Sampling Errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Appendix III

Availability of Data and Related Data Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Figure

1. Percent of ever-married women 22–44 years of age who were surgically sterile by education and race and Hispanic

origin: United States, 1995............................................................................ 7

Text Table

A. Number of sample women 15–44 years of age by survey year: 1965–95....................................... 3

Detailed Tables

1. Number of currently married women 15–44 years of age and percent who have ever had (or whose husbands have

had) sterilizing operations, by survey year, age at interview, and type of operation: United States, 1965–95 . . . . . . . . . 14

2. Number of ever-married women 15–44 years of age and percent who have ever had (or whose current husbands or

cohabiting partners have had) sterilizing operations, by survey year, race and Hispanic origin, and type of operation:

United States, 1973–95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

3. Number of ever-married women 15–44 years of age and percent who have ever had (or whose current husbands or

cohabiting partners have had) sterilizing operations, by selected characteristics: United States, 1973 and 1995 . . . . . . 16

iii
4. Number of ever-married women 15–44 years of age and percent who have ever had (or whose current husbands or

cohabiting partners have had) sterilizing operations, by race and Hispanic origin and selected characteristics:

United States, 1973 and 1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

5. Number of ever-married women 15–44 years of age and percent who have ever had (or whose husbands or

cohabiting partners have had) a sterilizing operation, by parity, age, and education: United states, 1973 and 1995 . . . . 20

6. Adjusted odds ratios for surgical sterilization among ever-married women 15–44 years of age: United States,

1973 and 1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

7. Number of ever-married women 15–44 years of age, number of sterilizing operations they reported, and percent

distribution by selected characteristics, according to type of operation: United States, 1973 and 1995 . . . . . . . . . . . . . . 22

8. Number of sterilizing operations reported by women 15–44 years of age and percent mentioning selected reasons

for the operation, by parity, race and Hispanic origin, and type of operation: United States, 1995 . . . . . . . . . . . . . . . . . 24

9. Number of sterilizing operations reported by women 15–44 years of age and percent mentioning the specified

medical reasons for the operation, by type of operation: United States, 1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

10. Number of women 15–44 years of age with unreversed tubal ligations, number of women 15–44 years of age whose

current husbands or cohabiting partners have had unreversed vasectomies, and percent distribution by desire for

reversal of these sterilizing operations, according to selected characteristics: United States, 1995 . . . . . . . . . . . . . . . . . 26

11. Number of women 15–44 years of age with unreversed tubal ligations, number of women 15–44 years of age whose

current husbands or cohabiting partners have had unreversed vasectomies, and percent distribution by desire for

reversal of these sterilizing operations, according to reasons cited for the operation: United States, 1995 . . . . . . . . . . . 28

Appendix Tables

I. Approximate standard errors expressed in percentage points of estimated percents for currently married white women

or women of all races combined: 1965 National Fertility Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

II. Approximate standard errors expressed in percentage points of estimated percents for women of all races combined:

1973 National Survey of Family Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

III. Approximate standard errors expressed in percentage points of estimated percents for women of all races combined:

1982 National Survey of Family Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

IV. Approximate standard errors expressed in percentage points of estimated percents for women of all races combined

or for other-than-black women: 1988 National Survey of Family Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

V. Generalized standard errors expressed in percentage points of estimated percents for women of all races combined

or for white women: 1995 National Survey of Family Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

iv
Objectives

This report presents national data on

the prevalence of surgical sterilization

from 1965 to 1995 among women 15–44

years of age. Data are shown by type of

sterilizing operation and demographic

characteristics of the women. For the

1995 survey data, reasons for the three

most common sterilizing operations (tubal

ligation, vasectomy, and hysterectomy)

are shown, as well as the desire for

reversal among those with potentially

reversible operations.

Methods

Data are based on nationally

representative samples of women 15–44

years of age: the 1965 National Fertility

Study (NFS), and the 1973, 1982, 1988,

and 1995 cycles of the National Survey

of Family Growth (NSFG).

Results

After rising from 16 to 42 percent

between 1965 and 1988, the prevalence

of surgical sterilization among married

women 15–44 years old remained stable

at 41 percent in 1995. Age, parity,

religious affiliation, and education

continued to be strongly associated with

overall surgical sterilization levels. Tubal

ligation and vasectomy were equally

prevalent in the 1965 and 1973 surveys,

but since 1982, tubal ligation has been

more prevalent than vasectomy.

Conclusions

Several factors contributed to the rise

in reliance upon surgical sterilization

among women 15–44 years old over the

last 3 decades: (a) aging of the

post-World War II Baby Boom women

(and their partners) through the primary

reproductive years; (b) relatively high

contraceptive failure rates, particularly

among socioeconomically less

advantaged women; and (c) higher

expectations for contraceptive

effectiveness, safety, and convenience.

Overall sterilization prevalence may be

leveling off among women 15–44 years

old, in part due to greater delay of first

and subsequent births, thus making

sterilization less of a concern while

women are in this age range.

Keywords: surgical sterilization c

population characteristics

Surgical Sterilization in the

United States: Prevalence and

Characteristics, 1965–95

by Anjani Chandra, Ph.D., Division of Vital Statistics

Highlights

+ Between the 1965 and 1988 surveys,

the prevalence of surgical

sterilization rose dramatically among

married women 15–44 years of age

in the United States from 16 to

42 percent. In 1995, the prevalence

remained about the same at

41 percent.

+ In the 1965 and 1973 surveys, tubal

ligation and vasectomy were equally

common among currently married

and ever-married women aged

15–44 (and their partners). Since the

1982 survey, tubal ligation has

become more prevalent than

vasectomy, occurring 11⁄2 to 2 times

as often. Among married women in

1995, 24 percent reported a tubal

ligation, compared with 15 percent

reporting that their husbands had a

vasectomy.

+ The profile of the typical

ever-married woman with a tubal

ligation has changed over time, as

has the profile of the typical woman

who reported that her husband or

partner had a vasectomy. From 1973

to 1995, an increasing proportion of

tubal ligations occurred among

ever-married women aged 35–44

years with 1 or 2 births (as opposed

to 3 or more births) and with

education beyond high school. Over

the same period, a similar shift

toward older age, lower parity, and

higher education occurred for

vasectomies. In addition,

vasectomies reported by Catholic

women represented a greater

proportion of all vasectomies

reported in the 1995 survey than in

the 1973 survey. Some of these

shifts reflect similar changes among

the general population of

ever-married women between the

survey years.

+ Age, parity, religious affiliation, and

education continued to be strongly

associated with overall surgical

sterilization rates. Marital status,

race and Hispanic origin, and

socioeconomic factors such as

education and income were also

strongly associated with particular

types of sterilizing operations.

+ Among ever-married women aged

15–44 years in 1995, 41 percent

were surgically sterile (15.3 million

women), 26 percent reported having

a tubal ligation, 7 percent had a

hysterectomy, and 12 percent were

currently living with a husband or

partner who had a vasectomy.

+ The most frequently cited reasons

for tubal ligation and vasectomy

among women who had any births

were that one or both partners

wanted no more children. Among

nulliparous women with tubal

The National Survey of Family Growth, Cycles 1–5, were jointly planned and funded by the National

Center for Health Statistics, the National Institute for Child Health and Human Development, and the

Office of Population Affairs. Additional support was provided for the 1988 and 1995 surveys from the

Administration for Children and Families. Other agencies and individuals also provided helpful advice

and assistance. Drs. William Mosher and Kate Brett of NCHS served as peer reviewers for this report

and made a number of helpful and insightful suggestions.

Page 1
ligation, medical reasons and

problems with their birth control

method were cited most often. As

expected, medical problems were the

most frequent reason given for

hysterectomy, cited by 90 percent.

+ Nearly 25 percent of women with an

unreversed tubal ligation in 1995

expressed a desire for reversal of the

operation, on the part of herself, her

husband or partner, or both. About

11 percent of married or cohabiting

women whose partner had a

vasectomy reported some desire for

reversal. Higher levels of desire for

tubal ligation reversal were seen

among younger women, Hispanic

women, and women with lower

levels of education and income.

Introduction

The data presented in this report

suggest that the dramatic increase

in the prevalence of surgical

sterilization that occurred in the United

States between 1965 and 1988 may have

leveled off between 1988 and 1995. In

1965, 16 percent of married women

15–44 years of age reported a sterilizing

operation undergone by either

themselves or their husbands. In 1988,

the prevalence had risen to 42 percent,

and in 1995 the prevalence remained at

about 41 percent. The data show that

tubal ligation and vasectomy were

chiefly responsible for the overall

increase in prevalence of surgical

sterilization in the 1970’s and 1980’s.

The percent of women reporting

hysterectomies, based on self-reported

national survey data, has remained

relatively stable over the period from

1965 through 1995, though analyses of

hospital discharge data suggest that

hysterectomy rates may be declining

(1,2).

Surgical sterilization has grown to

be the most common method of

contraception among women of

reproductive age in the United States. In

1995, female sterilization (primarily

tubal ligation) or male sterilization

(vasectomy) was reported by 38 percent

of all women aged 15–44 years who

were currently using a form of

contraception, compared with 19 percent

of current contraceptors in 1982 (3,4).

Nearly 70 percent of currently

contracepting women 40–44 years of

age in 1995 relied on female or male

sterilization (3).

A fairly clear portrait of who

undergoes sterilizing operations,

particularly for contraceptive reasons but

also for medical reasons, has been

established based on national survey

data and smaller-scale studies (4–16).

Age, parity, education, religious

affiliation, marital status, race, and

region of residence are among the

strongest correlates of overall surgical

sterilization, and to a lesser but

important degree, correlates of the type

of sterilizing operation chosen. Earlier

research has hypothesized that the

increased reliance on surgical

sterilization over time stems from higher

rates of contraceptive failure, rates that

are even higher among

socioeconomically disadvantaged

women (5,17). Bumpass (5) has also

argued that the oral contraceptive pill,

first introduced in the 1970’s, created

greater expectations for contraceptive

methods because of its higher theoretical

effectiveness and relative convenience.

However, there were concerns about the

pill’s long-term use and safety. Health

concerns about the intrauterine device

(IUD), most notably the Dalkon Shield,

led to the withdrawal of many types of

IUD’s from the U.S. market in the

1980’s (18). The prevalence of IUD use

fell from as high as 10 percent of

contracepting women in the 1970’s to

less than 2 percent in 1995. Thus, high

expectations for method effectiveness

and convenience combined with fears

about method safety may have led many

women (and couples) toward more

permanent contraceptive methods such

as tubal ligation and vasectomy.

In conjunction with the higher

prevalence rates of surgical sterilization

within age groups, it should be noted

that the absolute numbers of women

potentially opting for surgical

sterilization increased dramatically over

the past 30 years. As the large Baby

Boom generation of women, those born

roughly between 1946 and 1964, were

aging through their reproductive years,

the age composition of women 15–44

years of age shifted markedly toward

older ages. For example, between 1982

and 1995, the number of women aged

35–39 years increased by 42 percent, the

number aged 40–44 years increased by

59 percent, and the number aged 15–29

years decreased by 6–15 percent (3). An

older age distribution among women of

reproductive age can mean a surge in

the number and prevalence of women

achieving their desired family size and

possibly choosing sterilization as a more

permanent method of contraception. The

apparent leveling off seen in 1995 in the

overall prevalence of surgical

sterilization among women 15–44 years

of age may be due to the fact that Baby

Boom women were aging out of the

peak reproductive years, and may also

represent the impact of delayed first

births among these women.

Using the most recent national data

available, this report presents trends in

the prevalence of surgical sterilization

overall, and by type of sterilizing

operation. Several national surveys in

recent decades have also included

information on reasons for sterilizing

operations. However, the questions used

have changed enough between surveys

that it is difficult to study changes over

time in self-reported reasons for the

three most common sterilizing

operations. Therefore, in this report,

only 1995 data on reasons for operations

are shown, and can provide a starting

point for future trend analyses.a It is

expected that tubal ligations and

vasectomies were done primarily for

contraceptive reasons, while women

with hysterectomies are expected to

report medical reasons with highest

frequency.

Another topic on which this report

is limited to the most recent survey data

is the desire for reversal of tubal

ligation and vasectomy; the questions

asked across survey years were not

a

Using only the data from 1995, it is possible to

examine trends across birth cohorts by showing

reasons for the operation according to age at time

of interview, but this was deemed beyond the

scope of this report. One would need to consider

potential confounding by secular changes (if any)

in age at time of operation.

Page 2 [ Series 23, No. 20
sufficiently comparable to examine

trends. Although measures of desire for

reversal are sometimes referred to as

‘‘sterilization regret,’’ this phrase can be

misleading and is not used in this report.

Women are reporting their attitudes (and

those of their husbands or cohabiting

partners) at the time of interview, not at

the time of operation or even

postoperation. Given that one of the

chief predictors of desire for reversal

has been found to be the occurrence of

remarriage (i.e., the operation occurred

during an earlier union) (19,20), trends

in desire for reversal may be more a

reflection of changes in the incidence of

divorce and remarriage, as well as

changes in the likelihood of success of

reversal operations.

Methods

To examine changes in the

prevalence of surgical sterilization

over time, this report provides

national data from 1965 through 1995

by type of sterilizing operation. Reasons

for sterilizing operations and desire for

reversal of tubal ligation and vasectomy

are shown for 1995, the most recently

available survey year. Data are presented

by key demographic and socioeconomic

characteristics of the woman at the time

of the interview, such as age, marital

status, parity, income, education,

religion, and race and Hispanic origin.

With the exception of relatively

unchanging attributes such as

self-reported race and Hispanic origin, it

is acknowledged that many of these

characteristics may have been different

at the time of the sterilizing operation

and that some of the associations noted

in this report may be affected by using

characteristics at the time of interview

rather than at the time of operation. In

addition, it is noted that using

characteristics of the woman may not be

an adequate substitute for using her

husband’s or partner’s actual

characteristics.

Data for 1965 are obtained from the

National Fertility Study (NFS),

conducted by Princeton University. Data

for 1973, 1982, 1988, and 1995 are

from Cycles 1, 3, 4, and 5 of the

National Survey of Family Growth

(NSFG), conducted by the National

Center for Health Statistics (NCHS).

The NFS and all cycles of the NSFG

were based on multistage probability

samples of the civilian

noninstitutionalized population of

women in the United States, yielding

estimates that are representative of the

national population of women in the age

ranges covered by the surveys. Recent

cycles of the NSFG have been jointly

planned and funded by NCHS, the

Office of Population Affairs (OPA), and

the National Institute for Child Health

and Human Development (NICHD),

with additional support from the

Administration for Children and

Families. The main purpose of the

NSFG is to collect data on factors

affecting pregnancy and women’s health

in the United States. The NSFG

supplements and complements data from

the National Vital Statistics System on

births, marriage and divorce, fetal death,

and infant mortality. The NSFG is also a

significant part of the Centers for

Disease Control and Prevention’s public

health surveillance for women, infants,

and children—particularly on

contraception, infertility, unintended

pregnancy and childbearing, teenage

pregnancy, and breastfeeding.

The 1988 and 1995 NSFG surveys

drew their samples from the National

Health Interview Survey, an ongoing

household survey also conducted by

NCHS, in collaboration with the U.S.

Bureau of the Census. The 1995 NSFG

was the first in the series to be

conducted with computer-assisted

personal interviewing (CAPI), which

significantly improved the quality and

timeliness of the data. Further details on

the sample design and data collection

procedures for all of the NSFG cycles

can be found in several published

reports (21–26).

The 1995 NSFG was based on

personal, inhome interviews with a

national sample of 10,847 women 15–44

years of age. Interviews were conducted

between January and October of 1995

with 1,553 Hispanic women, 6,483

non-Hispanic white women, 2,446

non-Hispanic black women, and 365

women of other races and ethnic origins.

The 1988 NSFG consisted of personal

interviews with 8,450 women aged

15–44 years, the 1982 NSFG included

7,969 women aged 15–44 years, and the

1973 NSFG included 9,797 women aged

15–44 years. The 1965 NFS included a

wider age range of 15–54 years, but

only data for the 4,810 women aged

15–44 years were used for this report

because the NSFG surveys were limited

to women in this age range.

Table A summarizes the number of

sample cases in each survey year. The

1965 NFS was targeted at women who

were currently married at time of

interview, and the 1973 NSFG was

targeted at women who were currently

or formerly married (‘‘ever-married’’).

The 1982 NSFG was the first in this

series of surveys to include women

regardless of marital status. Therefore,

tables showing trends from 1965 to

1995 are limited to women currently

married at the time of interview and

those showing trends from 1973 through

1995 are limited to women ever married

at the time of interview.

In all five surveys, women were

asked about sterilizing operations that

they or their current husbands have had.

Beginning in 1982, women could report

more than one such operation, and

beginning in 1988, each woman

cohabiting with a partner at the time of

interview was explicitly asked whether

Table A. Number of sample women 15–44 years of age by survey year: 1965–95

Survey year

All

women

Ever-married

women

Currently

married

women

1965 . . . . . . . . . . . . . . . . . . . . . . . . . ... ... 4,810

1973 . . . . . . . . . . . . . . . . . . . . . . . . . ... 9,797 7,418

1982 ......................... 7,969 4,651 3,551

1988 ......................... 8,450 5,290 4,031

1995 ......................... 10,847 6,844 5,291

. . . Category not applicable

Series 23, No. 20 [ Page 3
her partner had ever had a vasectomy or

other operation that rendered him sterile.

Although the precise wording and flow

of questions about sterilizing operations

varied across survey years (see

appendix I), certain information

collected was comparable. For example,

for each reported operation, women

were asked to give the type of operation

and the date so that trends can readily

and reliably be examined over the

30-year period as to type of operation

and age at operation. This report is

limited to age at interview because the

primary purpose was to describe

changes over time in the prevalence of

surgical sterilization among women

15–44 years of age.

Other data collected for each

operation, such as reasons for the

operation and desire for reversal (for

tubal ligations and vasectomies), are less

amenable to trend analyses because, as

noted above, the series of questions

were substantially different from year to

year (see appendix I) and also because

there have been significant advances in

the operative techniques and success of

sterilization reversals. In this report,

reasons for sterilizing operations and the

desire for reversal are presented based

only on the most recent data (1995).

This permits the inclusion of all women

regardless of marital experience.

Results

Women’s Age and Type of

Operation: 1965–95

For each survey year from 1965 to

1995, table 1 shows the percent of

married women who were

surgically sterile at the time of interview

and the percents reporting tubal ligation,

hysterectomy, and vasectomy. Bilateral

oophorectomy (the removal of both

ovaries) is included only in the ‘‘all

operations’’ percents because this

sterilizing operation was reported too

infrequently to show separately in this

report. The overall percent surgically

sterile rose from 16 percent in 1965 to

39 percent in 1982 and appears to have

leveled off at about 41–42 percent in the

late 1980’s and 1990’s. As earlier

reports have documented, the prevalence

of surgical sterilization increases with

age, and this increase can be seen in

each survey year. In 1965, sterilizing

operations were reported by 3 percent of

married women 15–24 years of age,

14 percent of those 25–34 years old, and

25 percent of those 35–44 years old. At

their highest levels in 1988, the

age-specific proportions surgically sterile

were 6 percent among women 15–24

years old, 31 percent among those

25–34 years old, and 65 percent among

those 35–44 years old. Among older

women, there has been a downward turn

in surgical sterilization since 1988,

perhaps related to the delayed

childbearing of Baby Boom women.

Looking at the three most common

types of sterilizing operations, table 1

shows that there was little change in the

proportion of women with a

hysterectomy, but considerable change

in the proportions reporting tubal

ligation and vasectomy since 1965. Both

of these potentially reversible operations

have increased in prevalence over the

last 3 decades. The percent of all

married women aged 15–44 years

reporting tubal ligations grew sixfold,

from 4 percent in 1965 to 24 percent in

1995. The bulk of the increase seems to

have occurred between the 1973 and

1982 surveys. Similar trends were seen

for tubal ligation within age groups.

There were substantial increases in the

prevalence of vasectomy, from 4 percent

of husbands in 1965 to 15 percent in

1995. The pace of the increase appears

to have slowed after the 1982 survey.

Table 1 also shows that tubal

ligation has become far more common

than hysterectomy and vasectomy.

Prevalence rates of tubal ligation and

vasectomy were comparable in 1965 and

1973 among all women and within age

groups. In the 1982 survey, tubal

ligation began to overtake vasectomy in

prevalence, particularly among women

25 years and older. By 1995, 24 percent

of wives 15–44 years of age reported a

tubal ligation compared with 15 percent

who had husbands with vasectomies.

Women 25–34 years of age showed the

widest gap, with tubal ligation reported

twice as often as vasectomy (18

compared with 9 percent).

Women’s Race and

Hispanic Origin and Type

of Operation: 1973–95

Table 2 depicts the percent

surgically sterile among ever-married

women according to type of operation

and race and Hispanic origin over the

period 1973–95. The overall prevalence

of surgical sterilization was comparable

across racial and ethnic groups in 1973,

ranging from 20 percent among

non-Hispanic black women to 23 percent

among non-Hispanic white women.

Over time, black women experienced

the largest increase in surgical

sterilization, from 20 percent in 1973 to

nearly 50 percent in 1995. Hispanic

women have generally had the lowest

prevalence of surgical sterilization

among the three racial/ethnic groups

shown, but by 1995, their level

(37 percent) was close to the level seen

among non-Hispanic white women

(41 percent).

Tubal ligation accounted for the

bulk of the increase in surgical

sterilization since 1973 across all three

racial/ethnic groups, but this was

particularly the case among black

women, in whom the percent reporting a

tubal ligation quadrupled from 10 to

41 percent. While tubal ligation among

white women tripled from 8 to

24 percent, vasectomy among their

husbands was a significant contributor to

the overall increase in surgical

sterilization among white women, nearly

doubling from 8 to 15 percent. The rise

in the prevalence of vasectomy among

the husbands or partners of all women,

from 7 to 12 percent, was primarily

driven by its near-doubling among

husbands or partners of white women,

from 8 to 15 percent. With regard to

hysterectomy, there has been a small

decline in prevalence (about

2 percentage points) among all women

and among non-Hispanic white women

between 1982 and 1995. No significant

change over time was seen among

Hispanic and non-Hispanic black

women, but the data suggest lower rates

of hysterectomy among Hispanic women

and higher rates among black women,

relative to non-Hispanic white women in

all survey years.

Page 4 [ Series 23, No. 20
Women’s Characteristics

and Surgical Sterilization:

1973 and 1995

Percent Surgically Sterile

Table 3 compares the percent of

ever-married women reporting sterilizing

operations by selected sociodemographic

characteristics of the woman and type of

operation for 1973 and 1995. In every

group shown, there was a significant

increase in the prevalence of overall

surgical sterilization between the two

survey years. As demonstrated in earlier

NSFG reports and in other studies, when

all operations are considered together,

surgical sterilization prevalence in both

survey years increases steadily with age

(at interview) and parity, and declines

with education (at interview) and age at

first birth. The effects of age, parity, and

age at first birth are striking and

generally consistent across types of

operation, particularly for tubal ligation

(table 3). For example, nearly 60 percent

of women who had their first birth as a

teenager were surgically sterile in 1995,

with 44 percent reporting a tubal

ligation. In contrast, 25 percent of

women whose first birth occurred at 30

years or older were surgically sterile in

1995, with 14 percent reporting tubal

ligation. Compared with 1973 figures,

the prevalence of surgical sterilization

remained about the same among women

who were 30 years or older at first birth

(22–25 percent), but nearly doubled

among women who had their first births

as teenagers (30–59 percent).

The association between higher

education and lower levels of overall

surgical sterilization has been observed

in numerous surveys, including the

NSFG. For example, a proportional

hazards analysis of the 1984 Canadian

Fertility Study found that education had

a consistent predictive effect on

sterilization rates in all birth cohorts, but

showed the strongest effect in the

youngest cohort (6). Based on NSFG

data (table 3), education appears to play

opposite roles in the prevalence of tubal

ligation and vasectomy: higher

education is associated with lower

frequency of the female operation and

higher frequency of the male operation.

The 1995 data suggest that women with

education less than high school were

less likely to have husbands or partners

who have had a vasectomy. (While it

should be noted that this report shows

women’s education rather than the

men’s, tabulations not shown in this

report indicate similar patterns using

men’s education.) Comparing 1973 and

1995 figures, there was a widening of

the gap between tubal ligation and

vasectomy among less educated women.

In 1973, women with less than a high

school education reported tubal ligation

twice as often as they reported

vasectomies among their partners (14

compared with 7 percent). In 1995, such

women reported tubal ligations 6 times

more often than vasectomies (42

compared with 7 percent). High school

graduates in 1973 reported tubal ligation

and vasectomy at equal rates, but in

1995, they reported tubal ligation more

than twice as often (33 compared with

14 percent).

As seen with education, higher

income was associated with lower levels

of overall surgical sterilization and had

opposite effects on tubal ligation and

vasectomy. Higher income was linked to

lower prevalence of tubal ligation,

particularly in 1995. Between 1973 and

1995, the prevalence of tubal ligation

uniformly tripled across all income

groups. In both survey years, higher

income was associated with a narrower

gap in prevalence of female versus male

sterilization. Lower income women in

1995 were about 8 times as likely to

have undergone tubal ligation than their

husbands or partners were to have

undergone a vasectomy (41 versus

5 percent). In contrast, higher income

women were almost equally likely to

have undergone the female operation as

their husbands or partners were to have

undergone the male operation (20 versus

15 percent).

With regard to religion, table 3

shows that Protestant women in both

survey years had the highest rates of

overall sterilization and of tubal

ligations, in particular, among all

religious groups, with the exception of

the ‘‘other’’ group (in 1973) that was

small and probably more heterogeneous.

Although sample sizes were small,

Jewish women were less likely to have

undergone sterilizing operations than all

other religious groups shown. While

tubal ligations represented nearly

two-thirds of the operations reported by

Protestant and Catholic women, tubal

ligations represented about one half of

the operations reported by Jewish

women, with the other half being almost

all vasectomies. These findings are

consistent with earlier reports of

religious differences in contraceptive

choice, as well as differences in

selection of female versus male

sterilizing operations (8,9).

The pattern of surgical sterilization

by region of residence changed between

1973 and 1995. In 1973, women

residing in the West were the most

likely to report a sterilizing operation,

with 8 percent reporting tubal ligations

and 13 percent reporting vasectomies. In

1995, residence in the South was

associated with the highest proportions

surgically sterile, and tubal ligation was

3 times more common than vasectomy

(31 compared with 10 percent). The data

for 1995 also suggest that women in the

South were more likely to have

undergone hysterectomies than women

in other regions. Data not shown

indicated that Southern women’s higher

rates of tubal ligation and hysterectomy

may be related to their generally

younger age at first birth and higher

parity. These findings appear consistent

with earlier studies of female

sterilization that have found higher rates

of tubal ligation and hysterectomy in

Southern hospitals (2,16,27). Given that

nonwhite women are disproportionately

represented among all births in the

South, it should particularly be noted

that postpartum ligation rates after

vaginal delivery were found to be

20 percent higher for nonwhite women

than for white women, and after

cesarean delivery, about 40 percent

higher (27).

Race and Hispanic Origin and

Selected Characteristics

As noted above, some of the

variation in surgical sterilization

prevalence observed by race and

Hispanic origin (table 3) may be tied to

racial and ethnic differences in

characteristics such as age at first birth,

religious affiliation, and region of

Series 23, No. 20 [ Page 5
residence. Table 4 presents data for 1973

and 1995 that begin to address the

question of whether the association

between these characteristics and

surgical sterilization may vary by race

and Hispanic origin.

In both survey years, younger age

at first birth was strongly associated

with higher levels of overall sterilization

and tubal ligation in particular,

regardless of race and Hispanic origin.

In 1973, there were no significant

racial/ethnic differences (within

categories of age at first birth) in the

prevalence of overall sterilization or in

tubal ligation. The 1995 data indicate

two important shifts in the associations

among surgical sterilization, age at first

birth, and race and Hispanic origin.

First, Hispanic women in 1995 whose

first birth occurred before age 20 years

were significantly less likely than white

or black women to be surgically sterile

(45 compared with 63 percent). Second,

black women in 1995 were consistently

more likely than Hispanic or white

women to have undergone a tubal

ligation, regardless of age at first birth.

For example, over 55 percent of black

women whose first birth occurred before

age 20 years were surgically sterile

compared with 43 percent of white

women and 39 percent of Hispanic

women with first births before age 20

years.

Protestant women in both survey

years, regardless of race and Hispanic

origin, were more likely to be surgically

sterile than Catholic or Jewish women

(though the Jewish subgroup could only

be shown for non-Hispanic white

women). The prevalence of tubal

ligation was also higher for Protestant

women than for Catholic or Jewish

women in all racial/ethnic groups. The

1995 data show that black Protestant

women were significantly more likely

than white Protestant women to have

undergone tubal ligations (41 versus

27 percent). Though numbers were

small, the data suggest that black

Catholic women in 1995 were nearly

twice as likely as white Catholic women

to report tubal ligations (35 compared

with 18 percent), and also more likely

than Hispanic Catholic women to report

tubal ligations.

While overall sterilization levels in

1995 were higher for all residents of the

South compared with residents of other

regions (table 3), table 4 shows that

black women living in the South were

more likely to be surgically sterile than

their white and Hispanic counterparts

(52 compared with 45 percent). Black

women in the South were also

significantly more likely to report a

tubal ligation than Southern white

women (43 versus 27 percent).

Vasectomy was reported more often by

white women in the West than other

white women. Although numbers were

small, the data suggest that black

women in the West reported a higher

vasectomy prevalence of their husbands

or partners than among black women in

other regions.

Parity, Age, Education, and Race and

Hispanic Origin

Table 5 shows the percent surgically

sterile in 1973 and 1995 by parity, age,

and education. Figure 1 illustrates

similar percents for 1995 by education

and race and Hispanic origin. Earlier

reports, as well as this analysis, have

shown that the prevalence of surgical

sterilization increases with age and

parity and decreases with educational

attainment. It is generally recognized

that age, parity, and education are

interrelated—for example, older age is

associated with higher parity and higher

education is associated with lower

parity. It is also acknowledged that these

factors are related to age at first birth,

and that all of these factors vary by race

and Hispanic origin (28,29). Women of

higher socioeconomic status (e.g., higher

education) are more likely to have their

first birth at older ages and therefore

less likely to undergo surgical

sterilization in the age range covered by

the NSFG. Similarly, women who have

their first birth at younger ages are more

likely to reach their desired family size

earlier and choose to have a sterilizing

operation.

Table 5 shows that controlling for

parity somewhat diminishes the

association between education and the

prevalence of surgical sterilization. In

both 1973 and 1995, nulliparous women

and high-parity women (those with 3 or

more births) showed lower rates of

sterilizing operations at higher levels of

education. For example, in 1995

nulliparous women with less than a high

school education were nearly 3 times as

likely to be surgically sterile than their

counterparts with a college degree (32

versus 11 percent). However, for women

with 1–2 births, the link between

education and the prevalence of surgical

sterilization appears to be less clearcut.

Figure 1 shows that after controlling for

education, black women in 1995 had

somewhat higher levels of surgical

sterilization than Hispanic or

non-Hispanic white women. For

example, 56 percent of ever-married

black high school graduates were

surgically sterile compared with

50 percent of white women and

42 percent of Hispanic women.

In a preliminary assessment of the

net effect of factors including race and

Hispanic origin, table 6 shows the

adjusted odds of surgical sterilization in

1973 and 1995, derived from weighted

logistic regression models that control

for the variables shown in table 3. (Note

that the 1995 regression model was

obtained using SUDAAN software,

which takes into account the complex

sample design of the NSFG. However,

the 1973 regression model did not

account for the design effect, but was

weighted by the reciprocal of the mean

weight to scale down the significance

levels of the odds ratios.) In these

regression models, black race did not

show a significant net effect on surgical

sterilization in either 1973 or 1995,

although the sample sizes of nulliparous

black women and college-educated

black women in these cycles of the

NSFG may have been too small to draw

reliable inferences with respect to the

net (main) effects of parity, education,

and race or any possible interactions

among these factors. The net effects of

most of the variables in the models were

quite consistent across both survey

years: in addition to being married at

the time of interview, the characteristics

most strongly associated with reporting

any sterilizing operation were Protestant

affiliation, older age at interview,

younger age (less than 20 years) at time

of first birth, and higher parity. With

regard to education, higher levels,

particularly a college degree or higher,

Page 6 [ Series 23, No. 20
were associated in both survey years

with lower odds of having undergone a

sterilizing operation. The net effect of

region of residence has apparently

changed over time. Compared with

residents of the South, residents in the

West were more likely to have

undergone a sterilizing operation in

1973. However, in 1995 residents of all

non-South regions, including the West,

were less likely to report a sterilizing

operation.

Percent Distribution of Selected

Characteristics

Table 7 shows the data from a

different standpoint than the earlier

tables in this report. Tables 1–5 show

the percent of women in various

subgroups who reported sterilizing

operations. In contrast, table 7 gives the

percent distribution of sociodemographic

characteristics among all ever-married

women, women reporting any sterilizing

operations, and women reporting tubal

ligation, hysterectomy, or vasectomy.

This table illustrates how the profiles of

women who had undergone (or whose

partners had undergone) these operations

changed between 1973 and 1995, as

well as how the population of

ever-married women changed over this

time period. Among all ever-married

women, there was little change in the

percent distribution by region of

residence, poverty level income, and

race and Hispanic origin, though there

was a decline in the proportion of

non-Hispanic white women in 1995. For

the most part, the distributions of these

characteristics among surgically sterile

women were also the same in 1973 and

1995. As supported by the results shown

in table 3, a higher proportion of tubal

ligations were reported by Southern

women in the 1995 survey—41 percent

compared with 34 percent in the 1973

survey.

With regard to age, parity, marital

status, education, and religious

affiliation, there were more noteworthy

changes between 1973 and 1995.

Age

Ever-married women were

significantly older in 1995 than in 1973.

For example, the proportion aged 35–44

years increased from 36 to 51 percent.

Women were also older at the time of

their first birth—the percent who had

their first birth at age 30 years or older

rose from 2 to 11 percent, and the

percent whose first birth occurred before

age 20 years fell from 40 to 29 percent.

Women who reported any sterilizing

operations for themselves or their

husbands or partners were generally

older (35–44 years). The proportion of

tubal ligations reported among women

aged 35–44 years doubled from 34 to

68 percent from 1973 to 1995, and the

fraction of hysterectomies and

vasectomies reported by women aged

35–44 years more than doubled over

this period. There was no change

between 1973 and 1995 in the

distribution of hysterectomies by age at

first birth. However, for tubal ligations

and vasectomies, there was a significant

shift toward women who had their first

births at older ages—mirroring the shift

among all ever-married women.

Parity

Between 1973 and 1995, a

substantially higher percent of sterilizing

Figure 1. Percent of ever-married women 22–44 years of age who were surgically sterile by education and race and Hispanic origin:

United States, 1995

Series 23, No. 20 [ Page 7
operations, including hysterectomy,

occurred among nulliparous women and

lower parity women (those with 1 or 2

births). This may be expected given that

a smaller proportion of ever-married

women had 3 or more births (37 percent

in 1973 compared with 25 percent in

1995). In 1995, nearly 60 percent of all

operations were to women with fewer

than 3 births, while in 1973, only

35 percent were in these parity groups.

Marital Status

The percent of ever-married women

who were currently married at the time

of interview fell from 85 percent in

1973 to 79 percent in 1995. There were

corresponding shifts in the distribution

of tubal ligations and hysterectomies by

marital status over this time period. The

figures for vasectomy do not signify any

particular difference in marital status

distribution compared with the female

operations because only married or

cohabiting women were asked about

vasectomy. It can be noted, however,

that the fraction of ‘‘divorced, widowed,

or separated’’ women reporting that their

partners had vasectomies rose slightly

from less than 1 percent in 1973 to

nearly 3 percent in 1995, probably due

to the increased prevalence of

nonmarital cohabitation in the last 2

decades (3,30).

Education

As in the earlier tables, the percent

distributions for education were limited

to women aged 22–44 years at the time

of interview to maximize the chances

for women to report college attendance.

The proportion of ever-married women

who had graduated from college

doubled from 11 percent in 1973 to

23 percent in 1995, a finding

corroborated by data from the Current

Population Survey (31). This upward

shift in the educational attainment of all

ever-married women may be responsible

for the general upward shift in education

among the surgically sterile, regardless

of the type of operation. The fraction of

sterilizing operations that were reported

by women with any college attendance

also doubled, from 18 percent in 1973 to

37 percent in 1995.

Religion

Between 1973 and 1995, there was

a decrease in the percent reporting

Protestant affiliation among ever-married

women, from 64 percent to 54 percent.

Within each operation group in 1995,

there was a comparable shift away from

Protestant affiliation and apparently into

the ‘‘no religious affiliation’’ category.

While no change was seen in the

proportion reporting Catholic affiliation,

partners of Catholic women represented

a higher proportion of

vasectomies—30 percent in 1995

compared with 20 percent in 1973.

Reasons for Sterilizing

Operations: 1995

As mentioned earlier, it is not

possible to create a comparable measure

of reasons for sterilizing operations

across all surveys from 1965 through

1995 because the questions differed in

important ways. In the 1995 survey, up

to four separate female sterilizing

operations were recorded to allow for

women who may have had several

operations including tubal ligation,

hysterectomy, ovary removal, and some

other type of operation. For each female

sterilizing operation reported in the 1995

NSFG, the woman was asked a ‘‘code

all that apply’’ question:

‘‘Now please look at Card D-3

which lists some reasons that women

sometimes give for having sterilizing

operations. Which reason or reasons do

you believe are closest to your own?’’

The response categories were as

follows:

+ You had all the children you wanted.

+ Your husband or partner at the time

did not want any more children.

+ Financial reasons.

+ Medical reasons.

+ Reasons related to birth control.

+ Some other reason.

Women who reported ‘‘medical

reasons’’ were asked to report which of

the following medical reasons applied to

them, again choosing all that may apply:

+ Medical problems with your female

organs.

+ Pregnancy would be dangerous to

your health.

+ You would probably lose a

pregnancy.

+ You would probably have an

unhealthy child.

+ Some other medical reason

(SPECIFY:).

Women who reported ‘‘reasons

related to birth control’’ were asked:

‘‘Was your method of birth control

dangerous to your health, or did you not

like your method of birth control for

other reasons?’’

Women could report health reasons

only, other reasons only, or both health

and other reasons. (Appendix I gives

more details on the guidelines provided

to the interviewer and the respondent for

choosing among these reasons for

sterilizing operations.)

A similar sequence of items was

used for male sterilizing operations, with

some minor wording changes to make

the question and response categories

appropriate for male operations. For

example, the response set for ‘‘medical

reasons’’ did not include ‘‘Medical

problems with your female organs’’ but

did include ‘‘He had health problems

that required the operation.’’ It should

also be noted that the woman was only

asked to report on her husband’s or

partner’s reasons for the operation if the

operation was done during the time of

their relationship. While she may know

the reasons for his operation regardless

of when it was done, it was believed

that a woman could more accurately

report on reasons for operations that

occurred while she might potentially

have been involved in the

decisionmaking about sterilization.

In table 8, the most common

reasons given for sterilizing operations

are shown by parity and type of

operation for all women, and to the

extent possible given sample sizes, by

type of operation for white, black, and

Hispanic women. Table 9 gives the

percent of women reporting specific

medical reasons for their tubal ligations

or hysterectomies or their husbands’ or

partners’ vasectomies. The most

commonly mentioned reason for tubal

ligation was that the woman wanted no

more children (71 percent), followed by

medical problems (21 percent). Among

nulliparous women who had tubal

Page 8 [ Series 23, No. 20
ligations, medical problems (53 percent)

and problems related to birth control

(35 percent) were the most often cited

reasons, while only 6 percent reported

that either they or their partner wanted

no children. Among women with any

births, higher parity was associated with

more reporting of contraceptive

motivation and less reporting of medical

problems, but no difference in reporting

of financial barriers. No significant

differences in reported reasons for tubal

ligation were seen among white, black,

and Hispanic women.

With vasectomy as with tubal

ligation, contraception was the primary

motivation reported by women.

However, a higher percent of

nulliparous women cited contraceptive

reasons for their husbands’ vasectomies

than for their own tubal ligations

(45 percent compared with 6 percent).

Women with 1–2 births were also less

likely to report contraceptive motivation

for their tubal ligations than for their

husbands’ vasectomies. For example,

60 percent of women with one birth

cited contraceptive reasons for their

tubal ligations, compared with

89 percent of one-birth women whose

partners had vasectomies. In general,

across all parity groups, the husband or

cohabiting partner who had undergone a

vasectomy was reported as not wanting

any more children more often than the

woman herself was. Problems with birth

control were cited as reasons for

vasectomy more often than any other

operation or parity group, with the

exception of nulliparous women with

tubal ligations. Among women giving

reasons for their partners’ vasectomies,

birth control-related reasons were

reported twice as often among

nulliparous women as among women

with any births (39 percent compared

with 20–22 percent).

With regard to hysterectomy,

90 percent of all women reporting this

operation cited medical problems. As

seen in table 9, nearly 90 percent cited

medical problems with their

reproductive organs, in contrast to some

other danger to themselves or their

babies. Regardless of parity,

4–10 percent reported that when they

had these operations, they did not want

to have any (more) children.

Desire for Sterilization

Reversal: 1995

In the 1995 NSFG, women who

reported an unreversed tubal ligation or

an unreversed vasectomy as their only

sterilizing operation(s) were asked about

their desire for sterilization reversal.

Women were also asked to report on

their current husband’s or cohabiting

partner’s desire for reversal of her tubal

ligation and/or his vasectomy. These

questions on desire for reversal were

limited to women who reported no

sterilizing operations other than tubal

ligation or vasectomy. This permitted a

focus on only those women who could

potentially regain their fecundity, that is,

their physical capacity to have a child.

As with reasons for sterilizing

operations, trends across survey years

cannot readily be examined because the

questions related to desire for reversal

were modified significantly from year to

year. Also, the probable success of

sterilization reversal operations has

increased over time.

It should be noted that neither tubal

ligation nor vasectomy is necessarily

reversible, and these operations should

be considered as permanent

contraception. Not only does reversal

require major surgery that is costly and

technically difficult (18), but also this

surgery is generally not covered by

health insurance, unlike the original

sterilizing operation. NSFG data

presented here on desire for reversal do

not address socioeconomic barriers that

may affect the likelihood of women or

their partners undergoing reversal

surgery, nor can they address clinical

attributes that influence the success of

reversal surgery (e.g., age, tubal length

remaining, operative technique used in

the first operation) (18,32).

While these limitations should be

considered when interpreting data on

desire for reversal, these data have

intrinsic value as an important indicator

of dissatisfaction with sterilization as a

method of contraception. Desire for

reversal may also represent a marker for

‘‘sterilization regret.’’ As mentioned

earlier, this report does not equate the

two terms because ‘‘regret’’ is a

complex psychological process that may

or may not manifest itself in an actual

desire for reversal (19,20). Just as

‘‘regretting’’ one’s sterilizing operation

does not necessarily mean that the

individual wants it reversed, expressing

a desire to have the operation reversed

is not equivalent to being sorry that the

operation took place, nor is it equivalent

to saying that one would not make the

same choice again if given another

chance to decide about undergoing

surgical sterilization. In conjunction with

reasons for sterilizing operations, data

on desire for reversal have implications

for those who provide counseling for

family planning, particularly as

sterilization has become the most

prevalent form of contraception among

women 15–44 years of age. These data

also have research implications for those

who develop and investigate permanent

and nonpermanent methods of

contraception.

In earlier studies of the predictors

of poststerilization regret, couple

agreement about the sterilization

decision was a key factor (19).

Extending this idea to the desire for

sterilization reversal, table 10 shows

couple agreement separately for tubal

ligation and vasectomy according to

selected characteristics of the woman.

Note that the partner’s desire for tubal

ligation reversal was only asked of

married and cohabiting women.

Questions on desire for vasectomy

reversal were only asked of married or

cohabiting women whose partners had

their vasectomies during the time of

their relationship. Therefore, it is not

possible with these data to explore the

hypothesis that women may report

greater desire for reversal of

vasectomies that occurred in their

partners’ previous unions. Other studies

have identified younger age and the

acquisition of a new partner (for

example, following divorce) as

significant predictors of sterilization

regret and desire for reversal, along with

ambivalence about future childbearing

and about the sterilization decision itself

(19,20).

Among 9.2 million women with

unreversed and potentially reversible

tubal ligations at the time of the

interview in 1995, 76 percent expressed

no desire for reversal on the part of

either partner, 10 percent said that she

Series 23, No. 20 [ Page 9
alone wanted reversal,b 6 percent said

that her partner alone wanted reversal,

and 8 percent reported that both she and

her partner desired reversal (table 10).

Among 3.7 million married or

cohabiting women reporting unreversed

and potentially reversible vasectomies,

89 percent expressed no desire for

reversal on either partner’s part, and

3 percent shared a desire for vasectomy

reversal with their partners. This lower

level of desire for reversal of vasectomy

compared with tubal ligation has been

found in other studies (33). Desire for

reversal by at least one partner was

more common among younger women,

as noted in other studies (19). Future

studies with the NSFG data might

investigate the role of age at operation

(rather than at interview) and duration

since the operation in the reporting of

desire for reversal.

Table 10 also shows several other

factors associated with desire for

sterilization reversal. Women of

Hispanic origin and those with

education less than high school, lower

income, and residence in the South or

West were more likely to express some

desire for reversal of tubal ligation.

Hispanic origin, education, income, and

region of residence were not associated

with desire for vasectomy reversal, but

to some extent this may be related to

the very small numbers of vasectomies

in these groups. Though the number of

nulliparous women with potentially

reversible tubal ligations was also quite

small, it appeared that women with no

births were no more likely to desire

reversal than women who have had

children. This absence of a relationship

may be related to the higher prevalence

of medical problems (53 percent) and

birth control method problems

(35 percent) among reasons cited for

tubal ligation by women with no births

(table 8).

Reasons cited for having a

potentially reversible sterilizing

operation such as tubal ligation may be

related to women’s reports of a desire

for reversal, perhaps as a result of

women’s perceptions of the ‘‘true’’

reversibility of their operations. For

example, women who have undergone

tubal ligations for medical reasons may

not express a desire for reversal because

they would consider themselves

realistically unable or ill-advised to have

children, due to their health problems,

even after reversal of their ligations. To

begin to explore this hypothesis, table 11

shows the percent distribution of desire

for reversal according to selected

reasons cited for tubal ligation and

vasectomy. The data suggest that

financial or medical reasons were more

often associated with some degree of

desire for tubal ligation reversal than

women’s wanting no more children.

Discussion

Overall Surgical

Sterilization

The most recent national data

indicate that after dramatic

increases between 1965 and 1982,

the prevalence of surgical sterilization

among women in the primary

reproductive years appears to have

stabilized at about 40 percent of

currently married and ever-married

women. This report has largely been

restricted to ever-married women

because the occurrence of sterilization

among never-married women in 1995,

while higher than in previous survey

years, was markedly lower than among

currently and formerly married women

(5 percent compared with 40–41 percent

in 1995) (3). The increased overall

prevalence of surgical sterilization

among women 15–44 years of age

between the 1965 and 1988 surveys can

largely be attributed to the following

factors:

+ Aging of the Baby Boomers—The

large post-World War II birth

cohorts were passing through their

reproductive years, and the age

composition of Baby Boom women

was shifting upward throughout the

1970’s and 1980’s toward the ages

when family sizes might be

completed and permanent forms of

contraception might be chosen.

+ Higher expectations for

contraception—With the

introduction of more contraceptive

options, in particular the oral

contraceptive pill, women had

higher expectations for the

effectiveness, convenience, and

safety of their birth control methods.

Reduced fear and stigma associated

with permanent sterilization, coupled

with greater health concerns about

nonpermanent methods such as the

pill and the IUD, may have pushed

more women and their partners to

opt for surgical sterilization.

+ Contraceptive failure—Women with

prior histories of contraceptive

failure and unintended births were

more likely to undergo surgical

sterilization (5). Because higher

contraceptive failure rates were

experienced disproportionately by

women of lower socioeconomic

status (17), nonwhite women and

women with lesser education and

income were disproportionately

represented among the increasing

number of surgically sterile women

over time, particularly those

reporting tubal ligations.

Similarly, several hypotheses may

be suggested for the apparent leveling

off in the prevalence of surgical

sterilization among women 15–44 years

of age in the 1988 and 1995 surveys:

+ Delayed childbearing—Baby

Boomers, and the birth cohorts that

followed them, were more likely

than their predecessors to delay their

first births until older ages, as

evidenced by the 1973–95 increase

from 2 to 11 percent in the percent

of women who had their first birth

at 30 years or older (table 6), as

well as increasing birth rates of all

orders among older women (34). As

a result, older women, especially

those 35–44 years old, were and

perhaps will continue to be less

likely to have completed their

families and less inclined to undergo

b

Some of this group includes women who were

not married or cohabiting at time of interview but

who desired reversal of their tubal ligations. In

contrast, because vasectomy reversal questions

were only asked of married or cohabiting women,

the ‘‘only R wants’’ group does indeed indicate

women who alone desired reversal of vasectomies.

Page 10 [ Series 23, No. 20
permanent sterilization. Because

more women were still trying in

their late 30’s and 40’s to have their

desired number of children, fewer

women in this age group were

candidates for any form of

contraception.

+ Diminished health concerns about

nonpermanent methods—Although

trend data from the NSFG do not

indicate that pill use among women

35–44 years old has increased in the

past 10–15 years (4,35), it may be

that women are returning to the

nonpermanent methods of birth

control as health and safety concerns

about the pill and other methods are

allayed. For example, women over

age 35 years are no longer advised

against using the pill unless they

have other contraindicating risk

factors such as cigarette smoking or

cardiovascular problems (18).

+ Uncertainity of relationships—

Women and men may be more

reluctant to adopt permanent forms

of contraception in the face of

greater uncertainty in their

relationships—for example, as a

result of higher rates of divorce in

the last 2 decades (36). Several

studies suggest that entering a new

relationship, or at least the

possibility of doing so, may lead

women or their partners to avoid

sterilization or to desire reversal of

sterilizing operations they underwent

in previous relationships

(11,19,20,37).

+ Greater concern about disease

risk—Though perhaps not as salient

among married women or women in

long-term monogamous

relationships, heightened concerns

about HIV and other sexually

transmitted diseases (STD’s) may

deter reliance on sterilization. Given

that only latex condoms and certain

spermicidal jellies protect against

STD’s, it would not be sufficient for

sexually active women to protect

themselves only against pregnancy.

Some studies have found that

surgically sterile women are less

likely to use condoms for HIV/STD

prevention and may have less access

to information, education, and

preventive gynecologic care (38).

Type of Sterilizing

Operation

The factors associated with overall

surgical sterilization were generally

those associated with the most prevalent

operation, which has been tubal ligation

since roughly the 1982 survey. Over

time, higher levels of overall

sterilization were consistently seen

among women who were older at time

of interview, were younger at time of

first birth, had more births, were

married, were less educated, and had

lower income. The patterns of

sterilization by region of residence

changed between the 1970’s and 1990’s.

In 1973, prevalence rates were highest

in the West, driven largely by

vasectomy. By 1995, they were highest

in the South, driven largely by tubal

ligation and hysterectomy—a finding

observed in other studies (16). Higher

prevalence of tubal ligation and

hysterectomy in the South may be

related to the higher proportion of black

women than in other regions. Some

studies have reported that hospitals in

the South performed postpartum tubal

ligations more frequently, particularly

among nonwhite women, than hospitals

in other regions. Also, nonwhite women

(primarily black women) represented a

disproportionately higher proportion of

all deliveries in the South compared

with other regions (27). Furthermore,

Brett and colleagues (1) have suggested

that higher hysterectomy rates among

black women may be related to their

higher incidence of uterine fibroids.

These authors also found that

hysterectomy was associated with low

education and high parity, characteristics

that are on average more common

among black women than among white

women in the United States.

Beginning with the 1982 survey, the

prevalence of tubal ligation exceeded

that of vasectomy. Despite that

vasectomies are generally less expensive

to perform and carry lower risks of side

effects and complications, the majority

of couples in the United States and

other countries opt for the female

operation (18,38,39). Although it should

be noted that the NSFG cannot capture

the full universe of men who have had

vasectomies because the survey only

learns about men who are married to or

cohabiting with women 15–44 years of

age, more research is needed into the

reasons why tubal ligation surpassed

vasectomy among surgically sterile

married couples. Some studies have

pointed to advances in operative (and

often out-patient) procedures that have

improved the safety and convenience of

tubal ligation, as well as societal and

attitudinal changes that made

sterilization more acceptable (5,7,11,40).

It may also be that contraception has

become more the domain and

responsibility of women, particularly

because of greater uncertainty of

relationships. It can be difficult for a

woman to control whether her partner

uses a condom, and just as difficult and

impractical, if not impossible, for her to

expect or rely on her partner(s) to have

a vasectomy.

More study is also needed to

explain the significantly higher rates of

tubal ligation among black women

compared with nonblack women and the

lower prevalence of vasectomy among

the husbands and partners of Hispanic

and black women in comparison with

white women (3,16). Hispanic women

are less likely to choose surgical

sterilization of any type compared with

other women. Black women are equally

likely, if not more likely than white

women, to report surgical sterilization,

but they report a higher proportion of

female operations than white women

report. The higher prevalence of tubal

ligation among black women may be

tied to the fact that black women are, on

average, younger when they have their

first child (29). Younger age at first birth

often means earlier completion of

families and longer premenopausal

intervals at risk of contraceptive failure

and unintended pregnancy. As this report

and other studies have shown, tubal

ligation is less common among women

of higher socioeconomic status (e.g.,

higher education and income). These

women tend to have their first birth at

older ages, making surgical sterilization

less likely when they are between 15

and 44 years of age. Lower vasectomy

rates among partners of black women

(who are primarily black men) may also

be related to racial differences in

socioeconomic status. From the

Series 23, No. 20 [ Page 11
perspective of NSFG, which interviews

only women, vasectomy is more

common among partners of women with

higher education and income. These

characteristics are usually less common

among nonwhite individuals than among

white individuals. In addition, black and

Hispanic men are more likely to be

uninsured or underinsured and may not

be able to afford vasectomies (28).

Conclusion

This report presents national data on

the prevalence of surgical sterilization

from 1965 through 1995 by type of

operation and key demographic and

socioeconomic characteristics. After a

dramatic rise in popularity between the

1960’s and early 1980’s, the prevalence

of surgical sterilization among currently

married and ever-married women 15–44

years of age appears to have leveled off

at about 40 percent in the last 15 years.

Among women reporting potentially

reversible tubal ligations and

vasectomies in the 1995 NSFG, nearly

25 percent of those with ligations and

11 percent of those whose partners had

vasectomies expressed some desire for

reversal of the operations. These data on

desire for reversal, along with reported

reasons for sterilizing operations, are

included in this report as important

descriptors of the surgically sterile

population, and may suggest levels of

dissatisfaction with permanent and

nonpermanent forms of contraception.

This information should not only prove

relevant for providers of family planning

and medical services, but also

underscore the need for improving

contraceptive options for individuals of

all ages and fertility intentions.

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Series 23, No. 20 [ Page 13
Table 1. Number of currently married women 15–44 years of age and percent who have ever had (or whose husbands have had) sterilizing

operations, by survey year, age at interview and type of operation: United States, 1965–95

Age and type of sterilizing operation 1965 1973 1982 1988 1995

Number in thousands

All ages ......................... 26,454 26,240 28,231 29,147 29,673

15–24 years ...................... 5,429 5,780 4,741 3,337 2,805

25–34 years ...................... 10,027 11,186 12,924 13,646 12,242

35–44 years ...................... 10,998 9,274 10,566 12,163 14,625

All ages Percent

All operations ..................... 15.9 23.1 38.9 42.4 41.1

Tubal ligation . . . . . . . . . . . . . . . . . . . . . . 3.9 7.8 19.4 23.1 23.8

Hysterectomy . . . . . . . . . . . . . . . . . . . . . 7.1 6.8 8.8 7.7 6.8

Vasectomy . . . . . . . . . . . . . . . . . . . . . . . 3.6 8.2 13.0 14.5 14.9

15–24 years

All operations . . . . . . . . . . . . . . . . . . . . . 2.6 4.3 7.2 6.0 5.9

Tubal ligation . . . . . . . . . . . . . . . . . . . . . . 0.9 2.6 4.0 4.4 3.9

Hysterectomy . . . . . . . . . . . . . . . . . . . . . 0.4 0.1 0.0 0.0 0.3

Vasectomy . . . . . . . . . . . . . . . . . . . . . . . 1.1 1.6 3.1 1.6 1.7

25–34 years

All operations ..................... 13.6 19.9 31.6 31.1 27.2

Tubal ligation . . . . . . . . . . . . . . . . . . . . . . 4.3 7.7 17.6 18.1 17.6

Hysterectomy . . . . . . . . . . . . . . . . . . . . . 4.7 3.4 4.7 3.5 1.9

Vasectomy . . . . . . . . . . . . . . . . . . . . . . . 4.0 8.6 10.6 10.3 8.9

35–44 years

All operations ..................... 24.9 38.7 62.0 65.1 59.5

Tubal ligation . . . . . . . . . . . . . . . . . . . . . . 5.1 11.1 28.5 33.8 32.9

Hysterectomy ..................... 12.9 15.1 17.7 14.6 12.2

Vasectomy . . . . . . . . . . . . . . . . . . . . . . . 4.6 11.9 20.4 22.7 22.4

0.0 Quantity more than zero but less than 0.05.

NOTES: The percents with each separate operation may not add to the percent with ‘‘all operations.’’ Since 1982, women were allowed to report more than one sterilizing operation. Also, in all survey

years ‘‘all operations’’ include other operations not shown separately (for example, oophorectomy).

Page 14 [ Series 23, No. 20
Table 2. Number of ever-married women 15–44 years of age and percent who have ever had (or whose current husbands or cohabiting

partners have had) sterilizing operations, by survey year, race and Hispanic origin, and type of operation: United States, 1973–95

Race and Hispanic origin and type of sterilizing

operation 1973 1982 1988 1995

Number of women in thousands

All women1 ....................... 31,018 34,935 36,842 37,521

Hispanic ......................... 2,104 2,914 3,452 4,116

Non-Hispanic white .................. 25,001 27,684 28,579 28,250

Non-Hispanic black .................. 3,604 3,341 3,458 3,536

All women1 Percent

All operations ..................... 22.4 38.0 41.9 40.9

Tubal ligation . . . . . . . . . . . . . . . . . . . . . . 8.1 20.2 24.2 25.8

Hysterectomy . . . . . . . . . . . . . . . . . . . . . 7.0 9.5 8.5 7.4

Vasectomy . . . . . . . . . . . . . . . . . . . . . . . 7.0 10.6 11.7 12.1

Hispanic

All operations ..................... 20.7 26.7 33.4 37.4

Tubal ligation . . . . . . . . . . . . . . . . . . . . . . 11.6 16.7 25.8 30.6

Hysterectomy . . . . . . . . . . . . . . . . . . . . . 5.1 6.1 4.7 5.1

Vasectomy . . . . . . . . . . . . . . . . . . . . . . . 4.0 5.1 3.2 4.5

Non-Hispanic white

All operations ..................... 23.0 39.0 43.1 41.1

Tubal ligation . . . . . . . . . . . . . . . . . . . . . . 7.6 19.7 23.0 23.8

Hysterectomy . . . . . . . . . . . . . . . . . . . . . 7.0 9.7 9.0 7.5

Vasectomy . . . . . . . . . . . . . . . . . . . . . . . 8.1 12.2 14.3 14.7

Non-Hispanic black

All operations ..................... 19.8 37.6 45.2 49.0

Tubal ligation ...................... 10.2 25.6 34.9 40.5

Hysterectomy . . . . . . . . . . . . . . . . . . . . . 8.8 11.3 10.5 10.4

Vasectomy . . . . . . . . . . . . . . . . . . . . . . . 0.6 1.4 0.9 2.6

1Includes women of other race and origin groups not shown separately.

NOTES: The percents with each separate operation may not add to the percent with ‘‘all operations.’’ Since 1982, women were allowed to report more than one sterilizing operation. Also, in all survey

years ‘‘all operations’’ include other operations not shown separately (for example, oophorectomy).

Series 23, No. 20 [ Page 15
men 15–44 years of age and percent who have ever had (or whose current husbands or cohabiting partners have had) sterilizing operations,

States, 1973 and 1995

1973 1995

Number in

thousands

Any

sterilizing

operation1

Tubal

ligation Hysterectomy Vasectomy

Number in

thousands

Any

sterilizing

operation1 Tubal ligation Hysterectomy Vasectomy

Percent reporting Percent reporting

... 31,018 22.4 8.1 7.0 7.0 37,521 40.9 25.8 7.4 12.1

... 7,059 4.5 3.0 0.1 1.3 3,501 6.4 4.8 0.2 1.4

... 12,959 19.7 8.2 3.9 7.5 15,074 28.1 19.7 2.2 7.5

... 11,000 37.1 11.4 15.2 10.0 18,931 57.4 34.6 12.9 17.8

... 5,216 5.2 0.8 2.9 1.4 7,154 12.9 2.9 4.8 6.5

... 6,297 7.0 1.5 3.3 2.0 8,223 19.6 9.2 6.6 6.4

... 8,154 21.2 7.1 5.9 7.9 12,665 51.9 32.9 8.0 16.6

... 11,352 39.7 15.9 11.8 11.7 9,463 65.7 48.1 9.3 15.4... 10,213 30.2 12.4 9.3 8.2 8,737 59.3 44.2 13.0 10.4

... 11,694 24.4 8.0 7.3 8.9 11,387 49.9 32.7 8.2 14.2... 3,268 18.5 7.9 5.0 5.3 6,992 39.3 20.6 4.3 17.7

. . . 629 22.4 4.1 10.1 7.3 3,237 24.7 13.9 2.1 9.7

... 26,240 23.1 7.8 6.8 8.2 29,660 41.1 23.8 6.8 14.9

... 4,779 18.5 10.0 8.2 0.1 7,846 40.0 33.3 9.6 1.7

... 19,948 25.0 8.9 7.8 8.0 20,139 45.5 29.1 9.5 12.9

... 8,809 18.1 7.1 5.9 4.8 11,398 34.4 20.9 4.4 11.8

. . . 487 16.5 3.8 5.3 7.4 540 23.1 12.0 2.6 11.2

. . . 716 24.3 7.0 6.8 9.4 1,620 34.8 18.5 5.7 11.8

... 1,058 11.4 5.3 2.6 3.5 3,809 40.6 28.1 7.0 9.2

... 6,457 17.0 7.9 5.3 3.5 6,776 37.5 25.0 4.1 10.9

... 8,011 21.6 8.1 5.0 8.1 8,886 40.2 24.5 6.7 14.1

... 10,399 22.0 8.2 9.1 4.6 12,952 45.4 30.7 10.1 10.1

. . . 6,151 29.7 8.4 8.0 13.3 8,892 37.5 20.6 6.7 14.0

... 7,791 32.5 13.8 11.7 6.5 4,168 52.9 42.0 8.8 6.6

... 13,019 23.9 8.0 7.3 8.3 14,881 49.7 32.5 9.8 13.5

... 3,826 21.5 7.0 6.0 8.4 9,016 38.9 23.7 7.4 12.8

... 3,140 13.9 3.3 2.9 7.5 8,282 26.7 11.4 3.5 13.3

Page 16 [ Series 23, No. 20
men 15–44 years of age and percent who have ever had (or whose current husbands or cohabiting partners have had) sterilizing operations,

States, 1973 and 1995—Con.

1973 1995

Number in

thousands

Any

sterilizing

operation1

Tubal

ligation Hysterectomy Vasectomy

Number in

thousands

Any

sterilizing

operation1 Tubal ligation Hysterectomy Vasectomy

Percent reporting Percent reporting

... 5,453 27.8 13.7 9.5 4.2 6,788 48.3 40.8 6.6 4.6

... 9,801 24.7 10.0 7.1 7.3 11,463 45.2 29.3 8.4 12.7

... 12,521 23.7 6.0 7.7 9.7 18,096 37.9 19.5 7.5 15.3

... 2,104 20.7 11.6 5.1 4.0 4,109 37.4 30.6 5.1 4.5

... 25,001 23.0 7.6 7.0 8.1 28,245 41.1 23.7 7.5 14.7

... 3,604 19.8 10.2 8.8 0.6 3,534 48.9 40.5 10.4 2.6

. . . 309 18.8 6.2 5.4 7.2 1,619 28.2 17.7 4.7 8.0

or example, oophorectomy).

.

Series 23, No. 20 [ Page 17
men 15–44 years of age and percent who have ever had (or whose current husbands or cohabiting partners have had) sterilizing operations,

ected characteristics: United States, 1973 and 1995

1973 1995

Number in

thousands

Any

sterilizing

operation1

Tubal

ligation Hysterectomy Vasectomy

Number in

thousands

Any

sterilizing

operation1

Tubal

ligation Hysterectomy Vasectomy

Percent reporting Percent reporting

... 31,018 22.4 8.1 7.0 7.0 37,521 40.9 25.8 7.4 12.1

... 25,001 23.0 7.6 6.9 8.1 28,250 41.1 23.7 7.5 14.7

... 7,196 32.5 11.8 9.2 11.0 5,558 62.9 43.1 15.0 14.6

... 9,935 25.5 7.8 7.8 9.7 8,532 51.5 31.2 8.8 17.4... 2,802 19.2 7.9 5.2 5.9 5,769 39.8 19.2 4.4 19.8

. . . 473 22.6 2.4 10.4 8.8 2,638 25.2 13.5 1.5 11.1

... 16,292 26.1 8.6 7.7 9.5 15,890 44.9 26.6 9.5 15.1

... 6,804 17.2 5.5 6.0 5.3 7,828 34.2 17.5 4.1 15.4

. . . 482 16.6 3.7 5.3 7.5 506 22.6 10.7 2.7 11.9

. . . 584 28.0 8.4 6.5 11.5 958 41.5 19.7 6.4 15.8

. . . 839 10.8 5.5 1.5 3.8 3,069 41.7 28.5 7.2 10.4

... 4,984 15.8 6.4 4.7 4.3 5,497 38.6 24.4 4.0 13.0

... 7,092 21.7 7.3 4.9 9.0 7,771 40.0 23.2 6.3 15.7

... 7,856 23.4 8.2 9.4 5.5 9,219 44.5 27.3 10.7 12.5

. . . 5,069 31.3 8.2 8.3 14.8 5,763 39.6 18.2 7.4 18.3

... 3,604 19.8 10.2 8.8 0.6 3,536 48.9 40.5 10.4 2.6

... 2,098 23.2 12.3 10.4 0.4 1,459 63.4 55.5 13.3 1.8

. . . 928 16.4 9.4 5.6 1.1 936 51.8 45.8 8.2 3.0

. . . 248 17.2 7.6 7.9 1.5 560 41.2 33.1 5.1 4.9

... 3,194 20.0 10.5 8.7 0.6 2,897 49.8 41.3 10.7 2.6

. . . 237 19.9 8.4 10.6 0.9 243 41.7 35.2 11.8 –

. . . 173 15.4 6.3 8.7 – 397 47.0 37.9 7.6 4.6

. . . 840 20.9 10.0 10.5 0.2 492 42.0 35.7 6.8 0.9

. . . 709 22.3 14.7 6.8 0.8 667 48.4 39.2 12.2 2.6

... 1,829 18.0 8.0 9.1 0.7 2,028 52.2 43.2 10.8 2.8

. . . 226 21.4 13.9 6.1 1.2 350 40.6 34.2 10.2 4.4

... 2,104 20.7 11.6 5.1 4.0 4,116 37.3 30.6 5.1 4.5

. . . 884 28.6 17.8 7.4 3.4 1,456 44.8 39.4 6.2 3.8

. . . 753 18.8 8.6 4.3 5.9 1,456 42.1 34.9 5.2 4.9

. . . 262 13.6 8.1 2.0 3.5 721 32.4 22.3 4.5 7.0

Page 18 [ Series 23, No. 20
men 15–44 years of age and percent who have ever had (or whose current husbands or cohabiting partners have had) sterilizing operations,

ected characteristics: United States, 1973 and 1995—Con.

1973 1995

Number in

thousands

Any

sterilizing

operation1

Tubal

ligation Hysterectomy Vasectomy

Number in

thousands

Any

sterilizing

operation1

Tubal

ligation Hysterectomy Vasectomy

Percent reporting Percent reporting

. . . 379 20.3 7.1 3.9 9.2 888 45.5 36.8 7.3 6.7... 1,639 21.3 13.2 5.3 2.7 2,862 34.9 29.3 4.3 3.7

. . . 86 11.5 – 6.1 5.5 366 35.8 25.3 6.4 5.2

. . . 582 23.1 18.0 3.5 1.6 548 34.4 29.8 4.5 1.9

. . . 169 23.3 15.5 5.4 2.4 253 39.0 30.5 7.8 6.3

. . . 635 15.1 7.3 5.1 2.8 1,295 44.8 37.9 6.0 4.4

. . . 718 22.9 9.2 6.4 7.4 2,020 33.1 26.1 4.4 5.0

or example, oophorectomy).

ot shown separately.

Series 23, No. 20 [ Page 19
Table 5. Number of ever-married women 15–44 years of age and percent who have ever had (or whose husbands or cohabiting partners

have had) a sterilizing operation, by parity, age, and education: United States, 1973 and 1995

Parity, age at interview, and

education at interview1

1973 1995

Number in

thousands

Percent

surgically

sterile

Number in

thousands

Percent

surgically

sterile

All women ............................. 31,018 22.4 37,521 40.9

0 births .............................. 5,216 5.2 7,154 12.9

Age:

15–24 years ........................ 2,685 0.7 1,372 1.5

25–34 years ........................ 1,844 4.6 3,383 6.4

35–44 years . . . . . . . . . . . . . . . . . . . . . . . . 676 24.7 2,399 28.6

Education:

No high school diploma or GED2 . . . . . . . . . . . . 422 14.9 208 31.7

High school diploma or GED2 .............. 1,643 8.7 2,153 16.0

Some college, no bachelor’s degree . . . . . . . . . . 725 2.5 1,788 12.6

Bachelor’s degree or higher ............... 1,000 4.2 2,530 11.3

1 birth ............................... 6,297 7.0 8,223 19.6

Age:

15–24 years ........................ 2,688 0.5 1,239 1.5

25–34 years ........................ 2,587 6.4 3,383 6.4

35–44 years ........................ 1,022 25.9 3,236 39.6

Education:

No high school diploma or GED2 . . . . . . . . . . . . 999 15.8 590 18.3

High school diploma or GED2 .............. 2,530 8.1 3,124 28.5

Some college, no bachelor’s degree . . . . . . . . . . 731 7.2 2,124 18.8

Bachelor’s degree or higher . . . . . . . . . . . . . . . 657 4.1 1,890 11.2

2 births .............................. 8,154 21.2 12,665 51.9

Age:

15–24 years ........................ 1,263 12.8 630 16.1

25–34 years ........................ 4,214 16.7 4,732 39.6

35–44 years ........................ 2,677 32.1 7,313 63.0

Education:

No high school diploma or GED2 ............ 1,881 24.6 1,209 50.0

High school diploma or GED2 .............. 3,890 20.9 5,441 58.5

Some college, no bachelor’s degree .......... 1,192 20.8 3,212 51.9

Bachelor’s degree or higher . . . . . . . . . . . . . . . 816 20.9 2,656 42.1

3 births or more ......................... 11,352 39.7 9,463 65.7

Age:

15–24 years . . . . . . . . . . . . . . . . . . . . . . . . 424 28.8 261 37.8

25–34 years ........................ 4,303 37.1 3,212 57.0

35–44 years ........................ 6,625 42.1 5,990 71.7

Education:

No high school diploma or GED2 ............ 4,488 41.1 2,162 66.0

High school diploma or GED2 .............. 4,956 39.4 4,163 71.4

Some college, no bachelor’s degree .......... 1,178 42.8 1,901 64.2

Bachelor’s degree or higher . . . . . . . . . . . . . . . 666 29.5 1,212 49.3

1Education figures are limited to women 22–44 years of age at interview.

2GED is general equivalency diploma.

Page 20 [ Series 23, No. 20
Table 6. Adjusted odds ratios for surgical sterilization among ever-married women 15–44 years of age: United States, 1973 and 1995

Characteristic

Odds ratio (95 percent confidence interval)

1973 1995

Age at interview

15–24 years1 . . . . . . . . . . . . . . . . . . . . . . 1.0 1.0

25–34 years . . . . . . . . . . . . . . . . . . . . . . 3.3 (2.6–4.1)*** 5.4 (3.7–7.8)***

35–44 years . . . . . . . . . . . . . . . . . . . . . . 6.0 (4.7–7.6)* 20.2 (13.8–29.5)***

Parity

0 births1 . . . . . . . . . . . . . . . . . . . . . . . . . 1.0 1.0

1 birth . . . . . . . . . . . . . . . . . . . . . . . . . . 1.6 (1.2–2.2)* 3.0 (2.2–4.0)***

2 births . . . . . . . . . . . . . . . . . . . . . . . . . 4.0 (3.1–5.2)*** 10.0 (7.6–13.3)***

3 births or more . . . . . . . . . . . . . . . . . . . . 7.7 (6.0–10.0)*** 15.0 (11.5–19.5)***

Age at first live birth

Under 20 years1 . . . . . . . . . . . . . . . . . . . . 1.0 1.0

20–24 years . . . . . . . . . . . . . . . . . . . . . . 0.7 (0.7–0.8)*** 0.7 (0.5–0.8)***

25–29 years . . . . . . . . . . . . . . . . . . . . . . 0.6 (0.5–0.8)*** 0.5 (0.4–0.6)***

30 years or more . . . . . . . . . . . . . . . . . . . 0.8 (0.6–1.2) 0.2 (0.2–0.3)***

Marital status at interview

Married . . . . . . . . . . . . . . . . . . . . . . . . . 1.4 (1.2–1.6) 1.4 (1.2–1.6)***

Divorced, widowed, or separated1 . . . . . . . . . 1.0 1.0

Religion

Protestant1 . . . . . . . . . . . . . . . . . . . . . . . 1.0 1.0

Catholic . . . . . . . . . . . . . . . . . . . . . . . . . 0.7 (0.6–0.7)*** 0.6 (0.5–0.7)***

Jewish/other/none . . . . . . . . . . . . . . . . . . . 0.7 (0.6–0.9)* 0.9 (0.8–1.1)

Region of residence at interview

South1 . . . . . . . . . . . . . . . . . . . . . . . . . . 1.0 1.0

Northeast . . . . . . . . . . . . . . . . . . . . . . . . 0.8 (0.6–0.9)** 0.7 (0.6–0.8)***

Midwest . . . . . . . . . . . . . . . . . . . . . . . . . 0.9 (0.8–1.0) 0.7 (0.6–0.8)***

West . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.5 (1.3–1.8)*** 0.7 (0.6–0.8)***

Education at interview

No high school diploma or GED1,2 . . . . . . . . . 1.0 1.0

High school diploma or GED2 . . . . . . . . . . . 0.9 (0.8–1.0)* 1.2 (0.9–1.4)

Some college, no bachelor’s degree . . . . . . . 0.8 (0.6–0.9)* 0.8 (0.7–1.1)

Bachelor’s degree or higher . . . . . . . . . . . . . 0.6 (0.4–0.7)*** 0.5 (0.4–0.7)***

Poverty level income at interview

0–149 percent1 . . . . . . . . . . . . . . . . . . . . 1.0 1.0

150–299 percent . . . . . . . . . . . . . . . . . . . 0.9 (0.8–1.1) 1.1 (0.9–1.3)

300 percent or higher . . . . . . . . . . . . . . . . . 1.2 (1.0–1.4)^ 1.3 (1.1–1.6)***

Race and Hispanic origin

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . 0.8 (0.6–1.0)^ 0.8 (0.7–1.0)

Non-Hispanic white or other1 . . . . . . . . . . . . 1.0 1.0

Non-Hispanic black . . . . . . . . . . . . . . . . . . 0.8 (0.6–0.9)* 0.9 (0.8–1.1)

^ p < 0.10

* p < 0.05

** p < 0.001

*** p < 0.0001

1Reference category.

2GED is general equivalency diploma.

NOTE: Based on weighted logistic regression. See Methods section for further details.

Series 23, No. 20 [ Page 21
men 15–44 years of age, number of sterilizing operations they reported, and percent distribution by selected characteristics, according to type

nd 1995

1973 1995

All

ever-married

women

Women reporting

All

ever-married

women

Women reporting

Any sterilizing

operations1

Tubal

ligation Hysterectomy Vasectomy

Any sterilizing

operations1

Tubal

ligation Hysterectomy Vasectomy

Number in thousands

... 31,018 6,950 2,524 2,179 2,164 37,521 15,331 9,685 2,779 4,546

Percent distribution

... 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

... 22.8 4.5 8.4 0.4 4.4 9.3 1.5 1.7 0.3 1.1

... 41.8 36.7 42.1 23.2 44.8 40.2 27.7 30.7 11.7 24.9... 35.5 58.8 49.6 76.5 50.9 50.5 70.9 67.6 88.0 74.0

... 16.8 3.9 1.7 6.9 3.3 19.1 6.0 2.1 12.2 10.2

... 20.3 6.4 3.7 9.5 5.7 21.9 10.5 7.8 19.6 11.6

... 26.3 24.8 22.8 22.2 29.9 33.8 42.9 43.0 36.5 46.2

... 36.6 64.9 71.7 61.4 61.1 25.2 40.6 47.0 31.7 32.0... 39.6 46.1 51.0 46.7 39.8 28.8 36.0 40.8 46.4 22.3

... 45.3 42.7 37.5 42.1 49.8 37.5 39.4 39.3 38.5 39.7

... 12.7 9.1 10.5 8.1 8.3 23.1 19.1 15.2 12.4 30.3. . . 2.4 2.1 1.1 3.1 2.2 10.7 5.6 4.7 2.7 7.7

... 84.6 87.3 81.0 82.1 99.8 79.1 79.5 73.0 72.8 97.1

... 15.4 12.7 19.0 17.9 0.2 20.9 20.5 27.0 27.2 2.9

... 64.3 71.7 70.4 71.4 74.0 53.7 59.8 60.6 68.7 57.1

... 28.4 22.9 24.7 23.9 19.5 30.4 25.6 24.6 17.9 29.7

. . . 1.6 1.2 0.7 1.2 1.7 1.4 0.8 0.7 0.5 1.3

. . . 2.4 2.5 2.0 2.2 3.1 4.3 3.7 3.1 3.3 4.2

. . . 3.4 1.7 2.2 1.2 1.7 10.2 10.1 11.0 9.6 7.7

... 20.8 15.8 20.2 15.7 10.4 18.1 16.6 17.5 10.0 16.2

... 25.8 25.0 25.6 18.4 29.9 23.7 23.3 22.5 21.5 27.6

... 33.5 33.0 33.8 43.3 21.9 34.5 38.4 41.1 46.9 28.7

. . . 19.8 26.3 20.5 22.7 37.8 23.7 21.7 18.9 21.6 27.5

Page 22 [ Series 23, No. 20
men 15–44 years of age, number of sterilizing operations they reported, and percent distribution by selected characteristics, according to type

nd 1995—Con.

1973 1995

All

ever-married

women

Women reporting

All

ever-married

women

Women reporting

Any sterilizing

operations1

Tubal

ligation Hysterectomy Vasectomy

Any sterilizing

operations1

Tubal

ligation Hysterectomy Vasectomy

Percent distribution

... 28.0 36.7 43.1 41.8 23.7 11.5 14.4 18.1 13.2 6.1

... 46.9 45.1 41.9 43.5 50.5 40.9 48.2 50.0 52.3 44.3

... 13.8 11.9 10.8 10.5 14.9 24.8 22.9 22.1 24.1 25.3

. . . 11.3 6.3 4.2 4.2 11.0 22.8 14.4 9.8 10.4 24.3

... 19.6 22.0 30.1 23.8 10.5 18.7 21.4 28.7 16.1 6.8

... 35.3 35.0 39.4 31.9 33.1 31.6 33.8 34.8 34.8 32.1

... 45.1 43.0 30.4 44.3 56.4 49.8 44.8 36.6 49.1 61.1

. . . 6.8 6.3 9.7 4.9 3.9 11.0 10.0 13.0 7.6 4.1

... 80.6 82.7 75.1 79.8 94.1 75.3 75.7 69.3 76.4 91.1

. . . 11.6 10.3 14.5 14.5 1.0 9.4 11.3 14.8 13.3 2.0

. . . 1.0 0.8 0.8 0.8 1.0 4.3 3.0 3.0 2.8 2.8

or example, oophorectomy).

.

ng.

Series 23, No. 20 [ Page 23
Table 8. Number of sterilizing operations reported by women 15–44 years of age and percent mentioning selected reasons for the

operation, by parity, race and Hispanic origin, and type of operation: United States, 1995

Characteristic

Number in

thousands

Woman wanted

no more

children

Husband or

partner

wanted no

more children

Either partner

wanted no

more children

Could not

afford more

children

Medical

problems2

Problems with

birth control

method1

All women2 Percent mentioning

All parities:

Tubal ligation .................... 10,659 70.6 12.2 75.6 14.3 21.1 8.2

Hysterectomy .................... 3,023 6.4 0.9 7.1 0.9 89.5 0.7

Vasectomy ...................... 3,927 40.1 77.8 86.0 13.1 7.2 21.6

0 births:

Tubal ligation . . . . . . . . . . . . . . . . . . . . 278 5.9 1.9 5.9 1.9 52.8 35.3

Hysterectomy . . . . . . . . . . . . . . . . . . . . 422 3.6 1.6 5.2 – 91.6 –

Vasectomy . . . . . . . . . . . . . . . . . . . . . . 196 26.1 38.6 44.9 – 6.0 39.1

1 birth:

Tubal ligation . . . . . . . . . . . . . . . . . . . . 840 55.1 8.7 60.2 10.0 36.7 9.4

Hysterectomy . . . . . . . . . . . . . . . . . . . . 568 4.2 0.9 4.2 2.9 93.8 2.4

Vasectomy . . . . . . . . . . . . . . . . . . . . . . 390 43.5 77.9 88.5 9.3 9.1 6.8

2 births:

Tubal ligation .................... 4,491 69.5 13.8 75.3 14.9 22.9 7.8

Hysterectomy .................... 1,090 5.5 1.3 6.9 0.5 89.5 –

Vasectomy ...................... 1,987 43.0 79.2 88.7 11.6 6.4 22.3

3 births or more:

Tubal ligation .................... 5,050 77.8 12.0 82.2 15.2 15.1 6.9

Hysterectomy . . . . . . . . . . . . . . . . . . . . 944 9.9 – 9.9 0.7 86.0 0.8

Vasectomy ...................... 1,354 31.8 81.5 87.4 18.3 8.1 20.2

Non-Hispanic white

All parities:

Tubal ligation .................... 6,929 69.3 13.7 74.6 14.6 23.0 8.9

Hysterectomy .................... 2,225 6.6 0.9 7.2 1.1 89.2 0.8

Vasectomy ...................... 3,604 39.8 78.9 86.3 13.0 7.4 21.7

Non-Hispanic black3

All parities:

Tubal ligation .................... 2,016 79.2 6.8 81.7 11.8 16.2 5.0

Hysterectomy . . . . . . . . . . . . . . . . . . . . 483 6.8 – 6.8 0.6 88.7 –

Hispanic4

All parities:

Tubal ligation .................... 1,400 67.2 12.7 73.0 16.7 20.0 7.7

Hysterectomy . . . . . . . . . . . . . . . . . . . . 238 3.1 – 3.1 – 90.8 –

– Quantity zero

1See Methods section and appendix I for further explanation of terms.

2Includes women of other race and origin groups not shown separately.

3There were not enough vasectomies among husbands/partners of non-Hispanic black women and Hispanic women to show this operation separately.

NOTES: Percents will not add to 100 because women could mention multiple reasons and not all reasons are included here. Women were only asked about reasons for vasectomy if they were with

this husband or partner at the time of his operation.

Page 24 [ Series 23, No. 20
Table 9. Number of sterilizing operations reported by women 15–44 years of age and percent mentioning the specified medical reasons for

the operation, by type of operation: United States, 1995

Reason Tubal ligation Hysterectomy Vasectomy

All women Number in thousands

Sterilizing operations ...................... 10,659 3,023 3,927

Percent mentioning

Any medical reasons ...................... 21.1 89.5 7.2

Medical problems with female reproductive organs . . . 7.4 86.4 . . .

Pregnancy would be dangerous to woman’s health . . . 10.9 4.8 5.8

Woman would probably lose the baby . . . . . . . . . . . 3.9 3.6 1.3

Woman would probably have an unhealthy baby . . . . . 2.5 1.1 1.4

Husband or partner had a health problem . . . . . . . . . . . . . . . 0.4

Women with 0 births Number in thousands

Sterilizing operations . . . . . . . . . . . . . . . . . . . . . . 278 422 196

Percent mentioning

Any medical reasons ...................... 52.8 91.6 6.0

Medical problems with female reproductive organs . . . 30.9 88.0 . . .

Pregnancy would be dangerous to woman’s health . . . 13.7 3.8 3.4

Woman would probably lose the baby ........... 17.2 5.2 6.0

Woman would probably have an unhealthy baby . . . . . 1.9 – –

Husband or partner had a health problem . . . . . . . . . ... ... –

. . . Category not applicable

– Zero quantity

NOTES: Women could report more than one medical reason for each sterilizing operation, so the percents mentioning individual reasons may not add to the percent mentioning ‘‘any medical

reasons.’’ See the Methods section and appendix I for further explanation about these medical reasons for sterilizing operations.

Series 23, No. 20 [ Page 25
years of age with unreversed tubal ligations, number of women 15–44 years of age whose current husbands or cohabiting partners have had

nt distribution by desire for reversal of these sterilizing operations, according to selected characteristics: United States, 1995

Tubal ligation Vasectomy

Number in

thousands Total

Neither

wants

Only

woman

wants1

Only

husband or

partner wants

Both

want

Number in

thousands Total

Neither

wants

Only

woman

wants1

Only

husband or

partner wants

Both

want

Percent distribution Percent distribution

. 9,249 100.0 75.7 10.2 6.5 7.7 3,672 100.0 88.8 5.7 2.6 2.9

. 226 100.0 66.7 26.3 – 7.0 25 100.0 33.7 – – 66.3. 3,288 100.0 68.4 13.4 6.9 11.3 978 100.0 83.0 9.3 3.9 3.8. 5,736 100.0 80.2 7.6 6.5 5.7 2,669 100.0 91.4 4.4 2.2 2.0

. 190 100.0 77.5 15.1 – 7.4 182 100.0 85.0 8.5 3.2 3.3

. 693 100.0 82.9 6.6 6.4 4.2 354 100.0 88.0 5.9 0.6 5.5

. 3,926 100.0 74.5 10.5 6.4 8.6 1,888 100.0 89.3 5.2 2.3 3.3

. 4,440 100.0 75.5 10.2 6.8 7.5 1,249 100.0 88.9 6.0 3.6 1.6

. 5,576 100.0 75.5 10.3 7.1 7.2 2,007 100.0 88.6 6.1 2.6 2.7

. 2,289 100.0 75.2 9.6 5.9 9.4 1,155 100.0 90.0 5.5 1.8 2.7

. 57 100.0 76.1 9.8 14.0 – 48 100.0 100.0 – – –

. 269 100.0 82.0 3.8 7.7 6.5 192 100.0 80.1 – 11.4 8.5

. 1,058 100.0 76.2 12.5 4.0 7.3 270 100.0 89.1 8.1 0.8 1.9

. 1,709 100.0 79.3 9.9 4.9 6.0 678 100.0 89.3 5.9 1.9 2.9

. 2,069 100.0 80.9 7.7 5.0 6.3 1,021 100.0 87.3 6.5 2.3 3.9

. 3,778 100.0 72.9 12.6 6.8 7.7 960 100.0 88.2 7.8 2.7 1.2

. 1,693 100.0 71.9 8.1 9.0 11.0 1,013 100.0 90.5 2.7 3.3 3.5

. 1,928 100.0 69.6 15.1 6.3 9.1 193 100.0 81.9 9.9 5.1 3.1

. 4,536 100.0 76.2 9.2 6.7 7.9 1,629 100.0 92.2 4.6 1.4 1.9

. 1,895 100.0 77.9 9.3 6.2 6.7 952 100.0 81.9 9.4 2.5 6.2

. 873 100.0 81.3 6.3 6.4 6.0 898 100.0 91.4 2.9 4.4 1.3

. 3,135 100.0 71.8 14.9 4.9 8.4 247 100.0 87.3 6.9 1.8 4.0

. 3,075 100.0 74.8 9.3 8.3 7.7 1,259 100.0 88.3 6.5 2.4 2.7

. 3,022 100.0 80.5 6.2 6.3 7.0 2,166 100.0 89.2 5.1 2.8 2.9

Page 26 [ Series 23, No. 20
years of age with unreversed tubal ligations, number of women 15–44 years of age whose current husbands or cohabiting partners have had

nt distribution by desire for reversal of these sterilizing operations, according to selected characteristics: United States, 1995—Con.

Tubal ligation Vasectomy

Number in

thousands Total

Neither

wants

Only

woman

wants1

Only

husband or

partner wants

Both

want

Number in

thousands Total

Neither

wants

Only

woman

wants1

Only

husband or

partner wants

Both

want

Percent distribution Percent distribution

. 1,261 100.0 64.4 14.3 8.5 12.8 147 100.0 85.0 11.9 3.1 –

. 5,886 100.0 79.0 8.7 6.1 6.3 3,360 100.0 89.0 5.6 2.6 2.9

. 1,802 100.0 72.5 13.4 6.5 7.7 76 100.0 86.8 6.1 7.0 –

. 300 100.0 77.6 2.3 5.1 15.0 89 100.0 87.9 – – 12.1

r cohabiting.

desire for reversal, and whether woman was with husband or partner at time of his operation. Desire for reversal was only asked if woman (or couple) reported no sterilizing operations other than ligation or

e asked about their husband’s or partner’s desire for reversal.

.

answered ‘‘definitely yes’’ or ‘‘probably yes.’’ Percents may not add to 100 due to rounding.

Series 23, No. 20 [ Page 27
years of age with unreversed tubal ligations, number of women 15–44 years of age whose current husbands or cohabiting partners have had

nt distribution by desire for reversal of these sterilizing operations, according to reasons cited for the operation: United States, 1995

on

Number in

thousands Total

Neither

wants

Only

woman

wants1

Only

husband or

partner wants

Both

want

Percent distribution

......................... 9,249 100.0 75.7 10.2 6.5 7.7

......................... 6,847 100.0 79.4 7.4 7.5 5.8

ion) wanted no more children3 ...... 1,204 100.0 73.3 13.5 4.6 8.7

......................... 1,403 100.0 70.8 9.8 7.5 11.9

......................... 1,638 100.0 71.6 12.9 4.6 10.9

. . . . . . . . . . . . . . . . . . . . . . . . . 777 100.0 76.4 10.8 4.7 8.3

ners who have had

......................... 3,672 100.0 88.8 5.7 2.6 2.9

......................... 1,508 100.0 91.1 2.8 4.6 1.5

dren ...................... 2,835 100.0 90.2 5.8 2.1 1.9

. . . . . . . . . . . . . . . . . . . . . . . . . 492 100.0 85.3 8.1 4.6 2.0

. . . . . . . . . . . . . . . . . . . . . . . . . 266 100.0 89.3 1.8 3.1 5.8

. . . . . . . . . . . . . . . . . . . . . . . . . 803 100.0 89.3 4.3 2.4 4.0

r cohabiting.

desire for reversal or reasons for the operation. Desire for reversal was only asked if woman (or couple) reported no sterilizing operations other than tubal ligation or vasectomy. Only married or cohabiting

partners’ desire for reversal. Reasons for vasectomy were only asked if the woman was currently married or cohabiting and the vasectomy occurred during the time of their relationship.

arriage or cohabitation, the woman was asked whether her husband or partner at the time of the operation had wanted no more children.

answered ‘‘definitely yes’’ or ‘‘probably yes.’’ Percents may not add to 100 due to rounding.

Page 28 [ Series 23, No. 20
Appendix I

Definition of Terms

Sterilization-related Terms

Sterilizing operations—were any

operations reported by women that

would make it impossible for them to

have a baby—that is, operations that

rendered them surgically sterile. Married

women, and in the later surveys also

cohabiting women, were asked to report

on sterilizing operations that their

partners ever had. This report presents

data separately for the three most

commonly mentioned sterilizing

operations—tubal ligation, hysterectomy,

and vasectomy. Tubal ligation refers to

all surgical procedures that result in the

removal, tying off, or cutting of both

fallopian tubes. Hysterectomy refers to

the surgical removal of all or part of the

woman’s uterus (or womb). Vasectomy

refers to surgical procedures that result

in both of the man’s vas deferens being

cut or tied off.

Since the 1982 NSFG, respondents

were allowed to report more than one

sterilizing operation, and as a result, the

percents reporting ‘‘any sterilizing

operations’’ or ‘‘all operations’’ may be

less than the sum of the percents

reporting individual operations. Also,

‘‘all operations’’ include other operations

not shown separately, such as

oophorectomy (ovary removal).

Reasons for sterilizing operations—

were asked in different ways in each

survey year. Therefore, this report

presents data only for 1995. The

primary differences across survey years

were in the way that ‘‘contraceptive

intent’’ was determined and in the range

of reasons explicitly offered to the

respondent.

In the 1965, 1973, and 1982

surveys, women were only asked about

contraceptive intent, and no other

motivations for the operation were

included. For example in 1973, women

were asked: ‘‘Was the operation done at

least partly so that you would not have

any (more) children?’’ In 1982, women

were asked a somewhat similar

question: ‘‘Was one reason for having

(OPERATION) because (you had all the

children you wanted/did not want to

have any children)?’’

In the 1988 and 1995 surveys,

women were asked about a range of

reasons and could report as many as

they wished. In 1988, women were first

given the chance to answer an openended question about why they or their

husbands or partners had the operation.

Then they were offered the following

list of ‘‘reasons people often give for

having sterilizing operations’’ and asked

‘‘Which reason or reasons do you

believe come closest to your own?’’:

+ I had all the children I wanted or

I did not want any children.

+ My husband wanted no more

children.

+ A pregnancy would be dangerous

to my health.

+ I would probably lose a(nother)

pregnancy or have an unhealthy

child.

+ I could not afford or take care of

more children.

+ The method of birth control I was

using was dangerous to my health.

+ I didn’t like the method of birth

control I was using for other

reasons.

+ Medical problems with my female

organs (such as infections, cancer,

etc.).

+ None of the above.

In the 1995 NSFG, women were

not offered the open-ended question

about their reasons for the operation. As

described in the Methods section,

women were asked the following ‘‘code

all that apply’’ question for each female

sterilizing operation: ‘‘Now please look

at Card D-3 which lists some reasons

that women sometimes give for having

sterilizing operations. Which reason or

reasons do you believe are closest to

your own?’’ The response categories

were as follows:

+ You had all the children you wanted.

+ Your husband or partner at the time

did not want any more children.

+ Financial reasons.

+ Medical reasons.

+ Reasons related to birth control.

+ Some other reason.

Women who reported that they had

medical reasons were asked to report

which of the following medical reasons

applied to them, again choosing all that

applied:

+ Medical problems with your female

organs.

+ Pregnancy would be dangerous to

your health.

+ You would probably lose a

pregnancy.

+ You would probably have an

unhealthy child.

+ Some other medical reason

(SPECIFY:).

Respondents and interviewers were

provided with the following guidance

both on-screen and in a separate booklet

to help them choose among the specific

medical reasons:

+ Medical problems with your female

organs include such things as

infections, cancer, fibroids,

endometriosis, and so on.

+ Some possible reasons for having an

unhealthy child include incompatible

Rh factor (between mother and

baby) and family history of diseases

such as Tay-Sachs, hemophilia, and

sickle-cell anemia.

Women who reported ‘‘reasons

related to birth control’’ were asked:

‘‘Was your method of birth control

dangerous to your health, or did you not

like your method of birth control for

other reasons?’’ Women could report

health reasons only, other reasons only,

or both health and other reasons. The

interviewer and respondent were offered

the following on-screen and in-print

guidelines:

+ Health reasons might include pain,

side effects or complications, and so

on.

+ Other reasons might include

inconvenience, messiness, and so on.

A similar sequence of items was

used for male sterilizing operations, with

some minor changes in wording to make

the question and response categories

appropriate for male operations. For

example, the response set for ‘‘medical

reasons’’ did not include ‘‘Medical

problems with your female organs’’ but

did include ‘‘He had health problems

Series 23, No. 20 [ Page 29
that required the operation.’’ It should

also be noted that the woman was only

asked to report on her husband’s or

partner’s reasons for the operation if the

operation was done during the time of

their relationship. While she may know

the reasons for his operation regardless

of when it was done, it was believed

that she could more accurately report on

reasons for operations that occurred

while she might potentially have been

involved in the decisionmaking about

sterilization.

Selected Demographic Terms

Further details on these terms have

been published elsewhere (3).

Age at interview—is based on the

woman’s age (as of her last birthday) at

the midpoint of the interviewing period

for each survey year. This date was used

to determine whether each respondent

was in the eligible age range for the

survey.

Education at interview—is based on the

woman’s educational attainment at the

time of interview. Results shown by

education in this report are limited to

women 22–44 years of age to allow all

women to report college attendance. For

the 1973 survey, educational attainment

was based on a recoded variable

(EDUCAT) that gives the completed

years of school attended. Those who

completed 16 or more years of

education are considered as having a

‘‘bachelor’s degree or higher.’’ Those

with 13–15 years of school are

considered as having ‘‘some college,’’

those with 12 years as having a high

school diploma, and those with less than

12 years as having no high school

diploma.

In the 1995 survey, which obtained

greater detail about each respondent’s

school attendance and educational

attainment, a somewhat different recode

was used (HIEDUC). This recode is

based on the specific degrees earned, but

still takes into account the number of

years of school attended (EDUCAT).

For example, women who earned a

bachelor’s degree in less than 16 years

would be classified appropriately as

having a ‘‘bachelor’s degree or higher,’’

rather than as having ‘‘some college.’’ In

general, priority is given to the actual

degree earned, rather than the length of

time taken to earn it. In the 1995

survey, women are considered high

school graduates if they report either a

regular high school diploma or a general

equivalency diploma (GED) or

certificate, regardless of the number of

years of high school they attended. It

should be noted that the tabulations

shown in this report were also run with

EDUCAT for 1995, as opposed to

HIEDUC, but the differences were not

substantial. It was considered preferable

to use HIEDUC for 1995 because these

data are more comparable with other

data sources, such as the Current

Population Surveys of the U.S. Census

Bureau.

Marital status at interview—indicates

the woman’s formal (legal) marital

status at time of interview. In this

report, women who were widowed,

divorced, or separated are grouped

together.

Parity—is defined as the total number

of live births ever had by the woman.

This number is distinguished from

gravidity, which is the total number of

times she has been pregnant.

Nulliparous women are those who have

had no live births, and parous women

are those who have given birth to at

least one baby. The term ‘‘nulliparous’’

is used in this report instead of

‘‘childless’’ because (a) women may be

‘‘childless’’ even though they have given

birth (e.g., they relinquished their babies

for adoption or their children died), and

(b) women may have children although

they have never given birth (e.g.,

nulliparous women who adopted a

child).

Poverty level income at interview—is

based on the poverty index ratio

calculated for the given survey year.

Poverty status, measured in this way,

adjusts the total family income for the

number of persons in the family and

accounts for the current poverty levels

defined by the U.S. Census Bureau. In

this report, poverty level income at

interview is shown for 1973 and 1995.

Race and Hispanic origin—can be

defined in all of the NSFG surveys, but

Hispanic origin was not obtained in the

1965 NFS. Women who reported any

Hispanic or Spanish ancestry were

classified as Hispanic. All other women

were classified according to race,

yielding groups for ‘‘non-Hispanic

white,’’ ‘‘non-Hispanic black,’’ and

‘‘non-Hispanic other’’ women.

Region of residence at interview— is

classified into the four major census

regions: Northeast, Midwest, South, and

West for the 1973 and 1995 NSFG.

These regions, which correspond to

those used by the U.S. Census Bureau,

are as follows:

Region States included

Northeast Maine, New Hampshire,

Vermont, Massachusetts,

Rhode Island, Connecticut,

New York, New Jersey, and

Pennsylvania

Midwest Ohio, Indiana, Illinois,

Michigan, Wisconsin,

Minnesota, Iowa, Missouri,

North Dakota, South Dakota,

Nebraska, and Kansas

South Delaware, Maryland, District

of Columbia, Virginia, West

Virginia, North Carolina,

South Carolina, Georgia,

Florida, Kentucky, Tennessee,

Alabama, Mississippi,

Arkansas, Louisiana,

Oklahoma, and Texas

West Montana, Idaho, Wyoming,

Colorado, New Mexico,

Arizona, Utah, Nevada,

Washington, Oregon,

California, Alaska, and

Hawaii

Appendix II

Sampling Errors

Because the statistics presented in

this report are based on sample surveys,

they may differ from the statistics that

would have resulted if all of the

millions of women represented by the

surveys had been interviewed. The

standard error of an estimate is a

measure of such differences.

Page 30 [ Series 23, No. 20
It was not possible (at the time of

this writing) to use the same statistical

software and techniques to estimate

standard errors across all survey years

from 1965 to 1995. Standard errors for

the percents based on the 1965 National

Fertility Study and the 1973 NSFG were

estimated based on the approximations

shown in tables I and II. Although

standard error approximation tables are

also presented for the 1982, 1988, and

1995 NSFG rounds (tables III–V), an

alternate approach was used in this

report for these 3 survey years. This

approach uses the design effect of each

survey round.

The design effect indicates the

factor by which variances for a given

estimate are elevated—or sometimes

diminished—because simple random

sampling (SRS) was not used. The

overall design effect for 1982 was 3.01;

for 1988, it was 1.55; and for 1995, it

was 1.46. For example, the 1982 design

effect means that because the 1982

NSFG relied upon multistage probability

sampling, variances are on average 3

times higher than if SRS had been used.

The standard error of a percent is the

square root of its variance, and the

variance of a percent can be

approximated using the design effect by

the following formula:

D c (p c q / n)

where D = design effect for the given

survey round or subgroup

p = percent

q = 100 – percent

n = sample size on which the

percent is based

Statistical significance of differences

was assessed by constructing confidence

intervals around each estimated percent.

Confidence intervals can be considered

to be the range of acceptable null

hypotheses for the statistic in question.

A difference between percents was

considered significant at the 5-percent

level if the 95-percent confidence

intervals did not overlap.

Nonoverlapping 90-percent confidence

intervals indicated statistical significance

at the 10-percent level. The formula for

defining confidence intervals for a

percent is as follows:

percent ± [C c (standard error

of the percent)]

= percent ±[C c √ ( D c ( p c q / n))]

where D = Design effect for a given

survey round or subgroup,

and C is based on the

standard normal distribution:

C = 1.96 for constructing

95-percent confidence

intervals, and

C = 1.64 for constructing

90-percent confidence

intervals.

In this report, terms such as

‘‘higher,’’ ‘‘lower,’’ ‘‘increase,’’ and

‘‘decrease’’ indicate that the observed

differences were statistically significant

at the 5-percent level. Statements using

phrases such as ‘‘the data suggest’’

indicate that the difference was

significant at the 10-percent level. Lack

of comment about any two statistics

does not mean that statistical

significance of the difference was ruled

out—that is, overlap between 90-percent

or 95-percent confidence intervals was

not examined for all possible pairs of

statistics.

Statistics in this report may also be

subject to nonsampling error, that is,

errors or omissions in responding to the

interview, recording answers, and

processing data. The NSFG data for

each survey year have been adjusted for

nonresponse by adjustment to the

sample weights assigned to each case.

Other types of nonsampling error were

minimized by a series of quality control

measures that have been described

elsewhere (21–26).

Table I. Approximate standard errors expressed in percentage points of estimated

percents for currently married white women or women of all races combined: 1965

National Fertility Study

Size of sample

Estimated percent

5 or 95 10 or 90 15 or 85 20 or 80 25 or 75 30 or 70 40 or 60 50

Standard error in percentage points

50 . . . . . . . . . . . . . . 3.1 4.3 5.1 5.7 6.2 6.6 7.0 7.2

75 . . . . . . . . . . . . . . 2.6 3.5 4.2 4.7 5.1 5.4 5.8 5.9

100 . . . . . . . . . . . . . . 2.2 3.1 3.7 4.1 4.4 4.7 5.0 5.1

150 . . . . . . . . . . . . . . 1.8 2.5 3.0 3.4 3.7 3.9 4.2 4.2

200 . . . . . . . . . . . . . . 1.6 2.2 2.6 3.0 3.2 3.4 3.6 3.7

250 . . . . . . . . . . . . . . 1.5 2.0 2.4 2.7 2.0 3.1 3.3 3.3

300 . . . . . . . . . . . . . . 1.3 1.9 2.2 2.5 2.7 2.8 3.0 3.1

400 . . . . . . . . . . . . . . 1.2 1.6 1.9 2.2 2.4 2.5 2.7 2.7

500 . . . . . . . . . . . . . . 1.1 1.5 1.8 2.0 2.2 2.3 2.4 2.5

600 . . . . . . . . . . . . . . 1.0 1.4 1.7 1.9 2.0 2.1 2.3 2.3

800 . . . . . . . . . . . . . . 0.9 1.3 1.5 1.6 1.8 1.9 2.0 2.1

1,000 . . . . . . . . . . . . . 0.8 1.1 1.4 1.5 1.7 1.8 1.9 1.9

1,500 . . . . . . . . . . . . . 0.7 1.0 1.2 1.3 1.4 1.5 1.6 1.7

2,000 . . . . . . . . . . . . . 0.7 0.9 1.1 1.2 1.3 1.4 1.5 1.5

2,500 . . . . . . . . . . . . . 0.6 0.9 1.0 1.2 1.2 1.3 1.4 1.4

3,000 . . . . . . . . . . . . . 0.6 0.8 1.0 1.1 1.2 1.3 1.3 1.4

3,500 . . . . . . . . . . . . . 0.6 0.8 0.9 1.1 1.1 1.2 1.3 1.3

Table II. Approximate standard errors expressed in percentage points of estimated

percents for women of all races combined: 1973 National Survey of Family Growth

Base of percent

Estimated percent

2 or 98 5 or 95 10 or 90 20 or 80 30 or 70 40 or 60 50

Standard error in percentage points

100,000 . . . . . . . . . . . 3.0 4.6 6.4 8.5 9.7 10.4 10.6

500,000 . . . . . . . . . . . 1.3 2.1 2.8 3.8 4.3 4.6 4.7

1,000,000 . . . . . . . . . . 0.9 1.5 2.0 2.7 3.1 3.3 3.3

3,000,000 . . . . . . . . . . 0.5 0.8 1.2 1.5 1.8 1.9 1.9

5,000,000 . . . . . . . . . . 0.4 0.6 0.9 1.2 1.4 1.5 1.5

7,000,000 . . . . . . . . . . 0.3 0.5 0.8 1.0 1.2 1.2 1.3

10,000,000 . . . . . . . . . 0.3 0.5 0.6 0.8 1.0 1.0 1.1

Series 23, No. 20 [ Page 31
Unlike the NSFG, the 1965

National Fertility Study did not include

procedures to obtain weighted numbers.

Therefore, approximate numbers of

currently married women for 1965 were

obtained from population estimates

made by the U.S. Bureau of the Census.

Further details of this estimation

procedure have been published

elsewhere (41–43).

Appendix III

Availability of Data and

Related Data Sources

Public-use data files containing data

from all surveys used in this report are

available from the National Technical

Information Service. Ordering

information for data and selected reports

based on the data can be found on the

NCHS homepage at http://www.cdc.gov/

nchswww/nchshome.htm. One can also

order paper copies of NCHS reports

based on the NSFG by contacting the

Data Dissemination Branch at

301–436-8500 or the U.S. Government

Printing Office at 202–512-1800.

In addition to the NSFG, other

sources of data on surgical sterilization

include several provider-based surveys

conducted by NCHS, including the

National Hospital Discharge Survey and

the National Ambulatory Medical Care

Survey. The Association for Voluntary

Surgical Contraception (AVSC) has also

conducted provider-based surveys that

yield annual incidence rates for tubal

ligation and vasectomy. The AVSC

surveys include primarily clinical

descriptors, but do provide limited

demographic data on persons

undergoing these operations. The NSFG

remains the only nationally

representative dataset that includes

information on type of operation,

reasons for operation, and desire for

reversal of potentially reversible

operations, in conjunction with key

demographic and socioeconomic

characteristics.

Table III. Approximate standard errors expressed in percentage points of estimated

percents for women of all races combined: 1982 National Survey of Family Growth

Base of percent

Estimated percent

2 or 98 5 or 95 10 or 90 20 or 80 30 or 70 40 or 60 50

Standard error of percentage points

100,000 . . . . . . . . . . . 6.4 10.1 13.8 18.5 21.2 22.6 23.1

500,000 . . . . . . . . . . . 2.9 4.5 6.2 8.2 9.4 10.1 10.3

1,000,000 . . . . . . . . . . 2.0 3.2 4.4 5.8 6.7 7.1 7.3

5,000,000 . . . . . . . . . . 0.9 1.4 2.0 2.6 3.0 3.2 3.3

10,000,000 . . . . . . . . . 0.6 1.0 1.4 1.8 2.1 2.3 2.3

30,000,000 . . . . . . . . . 0.4 0.6 0.8 1.1 1.2 1.3 1.3

50,000,000 . . . . . . . . . 0.3 0.4 0.6 0.8 0.9 1.0 1.0

Table IV. Approximate standard errors expressed in percentage points of estimated

percents for women of all races combined or for other-than-black women: 1988 National

Survey of Family Growth

Base of percent

Estimated percent

2 or 98 5 or 95 10 or 90 20 or 80 30 or 70 40 or 60 50

Standard error in percentage points

100,000 . . . . . . . . . . . 4.6 7.1 9.8 13.1 15.0 16.1 16.4

500,000 . . . . . . . . . . . 2.1 3.2 4.4 5.9 6.7 7.2 7.3

1,000,000 . . . . . . . . . . 1.5 2.3 3.1 4.1 4.7 5.1 5.2

5,000,000 . . . . . . . . . . 0.6 1.0 1.4 1.9 2.1 2.3 2.3

10,000,000 . . . . . . . . . 0.5 0.7 1.0 1.3 1.5 1.6 1.6

30,000,000 . . . . . . . . . 0.3 0.4 0.6 0.8 0.9 0.9 0.9

50,000,000 . . . . . . . . . 0.2 0.3 0.4 0.6 0.7 0.7 0.7

58,000,000 . . . . . . . . . 0.2 0.3 0.4 0.5 0.6 0.7 0.7

Page 32 [ Series 23, No. 20
Table V. Generalized standard errors expressed in percentage points of estimated percents for women of all races combined or for white

women: 1995 National Survey of Family Growth

Sample

size

Weighted

size

(thousands)

Estimated percent

50 45 or 55 40 or 60 35 or 65 30 or 70 25 or 75 20 or 80 15 or 85 10 or 90 5 or 95

100 . . . . . . . . . . . . . . . . . . . . 555 4.95 4.93 4.86 4.73 4.54 4.28 3.94 3.51 2.92 2.09

200 . . . . . . . . . . . . . . . . . . . . 1,110 3.61 3.60 3.54 3.45 3.31 3.13 2.88 2.56 2.13 1.53

300 . . . . . . . . . . . . . . . . . . . . 1,665 3.00 2.99 2.95 2.87 2.76 2.60 2.39 2.13 1.77 1.27

400 . . . . . . . . . . . . . . . . . . . . 2,220 2.64 2.63 2.59 2.52 2.42 2.28 2.10 1.87 1.56 1.11

500 . . . . . . . . . . . . . . . . . . . . 2,775 2.38 2.37 2.34 2.28 2.18 2.06 1.90 1.69 1.41 1.01

600 . . . . . . . . . . . . . . . . . . . . 3,330 2.19 2.18 2.15 2.09 2.01 1.90 1.75 1.55 1.29 0.93

700 . . . . . . . . . . . . . . . . . . . . 3,885 2.04 2.04 2.01 1.95 1.87 1.77 1.63 1.45 1.21 0.86

800 . . . . . . . . . . . . . . . . . . . . 4,440 1.92 1.92 1.89 1.84 1.76 1.66 1.53 1.36 1.14 0.81

900 . . . . . . . . . . . . . . . . . . . . 4,995 1.82 1.82 1.79 1.74 1.67 1.58 1.45 1.29 1.08 0.77

1,000 .................... 5,550 1.74 1.73 1.71 1.66 1.59 1.50 1.38 1.23 1.03 0.73

1,200 .................... 6,660 1.60 1.59 1.57 1.53 1.47 1.38 1.27 1.13 0.94 0.68

1,600 .................... 8,880 1.40 1.40 1.38 1.34 1.29 1.21 1.12 0.99 0.83 0.59

2,000 .................... 11,100 1.27 1.26 1.24 1.21 1.16 1.10 1.01 0.90 0.75 0.54

3,000 .................... 16,650 1.05 1.05 1.04 1.01 0.97 0.91 0.84 0.75 0.62 0.45

4,000 .................... 22,200 0.93 0.92 0.91 0.88 0.85 0.80 0.74 0.66 0.55 0.39

5,000 .................... 27,750 0.84 0.83 0.82 0.80 0.77 0.72 0.67 0.59 0.49 0.35

6,000 .................... 33,300 0.77 0.77 0.76 0.74 0.71 0.67 0.61 0.54 0.45 0.33

8,000 .................... 44,400 0.68 0.67 0.66 0.65 0.62 0.58 0.54 0.48 0.40 0.29

10,000 ................... 55,500 0.61 0.61 0.60 0.58 0.56 0.53 0.49 0.43 0.36 0.26

10,847 ................... 60,201 0.59 0.59 0.58 0.56 0.54 0.51 0.47 0.42 0.35 0.25

Series 23, No. 20 [ Page 33
Vital and Health Statistics

series descriptions

SERIES 1. Programs and Collection Procedures—These reports

describe the data collection programs of the National Center

for Health Statistics. They include descriptions of the methods

used to collect and process the data, definitions, and other

material necessary for understanding the data.

SERIES 2. Data Evaluation and Methods Research—These reports

are studies of new statistical methods and include analytical

techniques, objective evaluations of reliability of collected

data, and contributions to statistical theory. These studies also

include experimental tests of new survey methods and

comparisons of U.S. methodology with those of other

countries.

SERIES 3. Analytical and Epidemiological Studies—These reports

present analytical or interpretive studies based on vital and

health statistics. These reports carry the analyses further than

the expository types of reports in the other series.

SERIES 4. Documents and Committee Reports—These are final

reports of major committees concerned with vital and health

statistics and documents such as recommended model vital

registration laws and revised birth and death certificates.

SERIES 5. International Vital and Health Statistics Reports—These

reports are analytical or descriptive reports that compare U.S.

vital and health statistics with those of other countries or

present other international data of relevance to the health

statistics system of the United States.

SERIES 6. Cognition and Survey Measurement—These reports are

from the National Laboratory for Collaborative Research in

Cognition and Survey Measurement. They use methods of

cognitive science to design, evaluate, and test survey

instruments.

SERIES 10. Data From the National Health Interview Survey—These

reports contain statistics on illness; unintentional injuries;

disability; use of hospital, medical, and other health services;

and a wide range of special current health topics covering

many aspects of health behaviors, health status, and health

care utilization. They are based on data collected in a

continuing national household interview survey.

SERIES 11. Data From the National Health Examination Survey, the

National Health and Nutrition Examination Surveys, and

the Hispanic Health and Nutrition Examination Survey—

Data from direct examination, testing, and measurement on

representative samples of the civilian noninstitutionalized

population provide the basis for (1) medically defined total

prevalence of specific diseases or conditions in the United

States and the distributions of the population with respect to

physical, physiological, and psychological characteristics, and

(2) analyses of trends and relationships among various

measurements and between survey periods.

SERIES 12. Data From the Institutionalized Population Surveys—

Discontinued in 1975. Reports from these surveys are

included in Series 13.

SERIES 13. Data From the National Health Care Survey—These

reports contain statistics on health resources and the public’s

use of health care resources including ambulatory, hospital,

and long-term care services based on data collected directly

from health care providers and provider records.

SERIES 14. Data on Health Resources: Manpower and Facilities—

Discontinued in 1990. Reports on the numbers, geographic

distribution, and characteristics of health resources are now

included in Series 13.

SERIES 15. Data From Special Surveys—These reports contain

statistics on health and health-related topics collected in

special surveys that are not part of the continuing data

systems of the National Center for Health Statistics.

SERIES 16. Compilations of Advance Data From Vital and Health

Statistics—Advance Data Reports provide early release of

information from the National Center for Health Statistics’

health and demographic surveys. They are compiled in the

order in which they are published. Some of these releases

may be followed by detailed reports in Series 10–13.

SERIES 20. Data on Mortality—These reports contain statistics on

mortality that are not included in regular, annual, or monthly

reports. Special analyses by cause of death, age, other

demographic variables, and geographic and trend analyses

are included.

SERIES 21. Data on Natality, Marriage, and Divorce—These reports

contain statistics on natality, marriage, and divorce that are

not included in regular, annual, or monthly reports. Special

analyses by health and demographic variables and

geographic and trend analyses are included.

SERIES 22. Data From the National Mortality and Natality Surveys—

Discontinued in 1975. Reports from these sample surveys,

based on vital records, are now published in Series 20 or 21.

SERIES 23. Data From the National Survey of Family Growth—

These reports contain statistics on factors that affect birth

rates, including contraception, infertility, cohabitation,

marriage, divorce, and remarriage; adoption; use of medical

care for family planning and infertility; and related maternal

and infant health topics. These statistics are based on

national surveys of women of childbearing age.

SERIES 24. Compilations of Data on Natality, Mortality, Marriage,

Divorce, and Induced Terminations of Pregnancy—

These include advance reports of births, deaths, marriages,

and divorces based on final data from the National Vital

Statistics System that were published as supplements to the

Monthly Vital Statistics Report (MVSR). These reports provide

highlights and summaries of detailed data subsequently

published in Vital Statistics of the United States. Other

supplements to the MVSR published here provide selected

findings based on final data from the National Vital Statistics

System and may be followed by detailed reports in Series 20

or 21.

For answers to questions about this report or for a list of reports published

in these series, contact:

Data Dissemination Branch

National Center for Health Statistics

Centers for Disease Control and Prevention

6525 Belcrest Road, Room 1064

Hyattsville, MD 20782-2003

(301) 436–8500

E-mail: nchsquery@cdc.gov

Internet: www.cdc.gov/nchswww/
DHHS Publication No. (PHS) 98-1996, Series 23, No. 20

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