THERE has been an overall decline in the use of sterilisation (tubal ligation) among Jamaican women over the years as more women turn to the utilisation of long-acting reversible methods of contraception instead.

But it still remains one of Jamaica’s most widely chosen methods of contraception, particularly by older women with three to four children.

The use of sterilisation has declined across surveys as access to and use of other options have increased, the newest Reproductive Health Survey, Jamaica is showing. The recently released 2021 survey looks at the fertility, contraception, and reproductive health of males and females aged 15 to 49 years. Of note, the report noted that while vasectomy (male sterilisation) has fewer complications than tubal ligation, it is far less popular due to cultural perceptions, but is available at selected public sector facilities.

Sterilisation was more prevalent between 1983 and 1993 but began trending down as less invasive, long-acting, reversible, but equally effective birth control methods came on the market, the report noted. Female sterilisation declined from a high of 25 per cent in 1989 to 14 per cent in 2008, falling again in 2021 to 9.8 per cent. On the other hand, use of other non-surgical contraceptive methods increased from 25 per cent in 1983 to 56 per cent in 2008 and 61.3 per cent in 2021.

“Future research can explore whether females are self-motivated to choose other less invasive, non-permanent options, whether they are not being given the option, are being discouraged, or fail to gain the approval of medical practitioners,” the authors said.

From the survey data, sterilisation was most common among women with at least four live births and over 30. Only a small proportion of women who were sterilised expressed dissatisfaction with their procedure; fewer women compared to previous surveys.

During the survey, respondents who had done a tubal ligation were asked about their satisfaction with the procedure. In 2021, just 5.1 per cent expressed dissatisfaction with having had the procedure, the lowest reported prevalence compared to previous studies. This decrease in regret is probably due to the availability of more options for long-term fertility control and reflect readiness for the procedure when it is selected, the report noted.

Women who had the surgical procedure done when they were younger than age 30 (nine per cent) were more likely to have regrets than those who did it between the ages of 30-34 years (5.5 per cent) and 35-49 years (2.2 per cent). Moreover, women in a visiting relationship (8.8 per cent) were more dissatisfied than those in a common-law union (3.5 per cent). Women who had pre-sterilisation counselling (2.8 per cent) were more satisfied with having the procedure done than those who did not (11.1 per cent), suggesting the value of counselling in matching this method to the population for whom it is best suited.

Childless women (2.2 per cent) and those with one child (5.1 per cent) were the least likely to be sterilised, whereas close to one-half of those with four or more live births were sterilised (48.4 per cent). Women in a marriage and visiting relationship accounted for 35.6 per cent and 34.5 per cent of sterilised women respectively, compared to those in a common-law union (30 per cent). In 2021, almost three-quarters of sterilised women in Jamaica were 35 years and older, with 34.6 per cent aged 35-39 years, and 37.8 per cent aged 40-44 years.

Sterilisation is a permanent form of birth control that is highly effective in preventing pregnancy but does not protect against sexually transmitted infections. This procedure is also referred to as “tie-off”, where the Fallopian tubes are tied or closed to prevent the sperm from joining with eggs for fertilisation.

The household survey was conducted by Statistical Institute of Jamaica on behalf of National Family Planning Board. It covers fertility; contraceptive use, knowledge, attitude and practice; reproductive health; maternal and newborn care; infant and child mortality; sexually transmitted infections including HIV/AIDS; gender-based violence; and the reproductive health of respondents 15-49 years. The data also generated indicators on Jamaica’s progress towards achieving UN Sustainable Development Goal (SDG) #3 on good health and well-being, including SDG 3.7.1 on contraceptive use, and estimates for SDG #5 on gender equality. The information gleaned is used in determining programme implementation and other vital issues specific to how the country deals with matters relating to reproductive health.

There were 5,008 participants — 3,224 females and 1,784 males. Close to one-half (46.1 per cent) of respondents resided in rural areas, less than one-third (31.6 per cent) resided in other urban centres, while 22.3 per cent lived in the Kingston metropolitan area.