Predictors of Female Sterilization in Bihar

Purpose Female sterilization is the most emphasized and utilized method of family planning in India. According to the National Family Health Survey 2005-2005 (NFHS-3), of the women in the state of Bihar between the ages of 15 and 49 who report using some method of contraception, 68% report female sterilization. Of these women, 68% report being sterilized prior to age 30. Given the well-documented backdrop of hierarchical gender norms in India that has rationalized the limited bargaining power of women and lack of informed choice (Pradhan 2009), this study examines the determinants of female sterilization in the state of Bihar using the Social Relations Framework.

Methods Data for 3, 818 women aged 15-49 years in Bihar were abstracted from the third National Family Health Survey (NFHS-3). Analyses were restricted to women from Bihar age 15-49 years (N=806) who reported using some form of contraception. A logistic regression model was developed to understand the determinants of female sterilization, including religion, place of residence, wealth index, age at first birth, total children ever born and knowledge of other forms of contraception. Respondents’ current age and educational attainment were controlled for. The strength of the association was estimated by calculating the odds ratios (OR) with 95% confidence intervals (CI).

Results Descriptive statistics revealed women’s general lack of knowledge prior to being sterilized: 34 percent of women indicated that they were not told that they would not be able to have more children after getting sterilized and 86 percent of women indicated that they were not warned about the side effects they would experience following the sterilization. However, an overwhelming majority of sterilized women report not regretting their decision to get sterilized (95%). Logistic regression results suggest that being Muslim, delaying child birth and having knowledge about other forms of contraception are significantly associated with a decreased likelihood of being sterilized. Muslim women were 90 percent less likely to be sterilized than Hindu women (OR=0.10; CI=0.04-0.23). A one year increase in age at first birth reduced the likelihood of being sterilized by 12 percent (OR=0.88; CI=0.79-0.98). Women who were aware of other forms of contraception were 62 percent less likely to be sterilized than women who were not aware of other forms of contraception (OR=0.38; CI=0.21-0.69). Educational attainment (control) was significantly associated with a decreased likelihood of sterilization (OR=0.91; CI=0.84-0.99). Place of residence, wealth index and number of children born were not significantly associated with female sterilization.

Conclusions and Implications The findings of this study suggest that religion, age at first birth, educational attainment and knowledge of other forms of contraception are associated with a decreased likelihood of sterilization. Although women reported a general lack of knowledge regarding sterilization and other forms of contraception, they overwhelmingly reported no regrets regarding their decision to become sterilized. Future research should examine how knowledge of sterilization and other forms of contraception affect women’s decision to become sterilized and ultimately, their satisfaction with their decision.