Factors Influencing Uptake Of Bilateral Tubal Ligation Among Women Who Have Completed Family Size In Central And Eastern Provinces.

Abstract

Background: Bilateral tubal ligation is a terminal event in a woman’s life. The decision to undergo bilateral tubal ligation is a major one that affects the family and the community as a whole. While attainment of desired family size is an easy decision to reach for a couple, bilateral tubal ligation is not the first choice contraceptive to many such couples. As per KDHS 2008-2009, 49% of women interviewed expressed attainment of desired family size, yet only 5% took up BTL. Different factors may affect the decision to undergo BTL such as spousal refusal, level of communication among the couple, socioeconomic standing and even fear of child mortality. The purpose of this study was to elucidate the factors that affect couples that have attained the desired family size in choosing BTL. Objective: To determine the factors that will influence uptake of bilateral tubal ligation among women who have attained desired family size. Setting: The study was carried out in health centers in Central and Eastern provinces. Study design:Cross sectional comparative study. Sample size:A sample size of 710 was used. Methods:Patients were recruited after obtaining informed consent. The entry point for the study was expression of attainment of desired family size. All participants in the study had achieved desired family size and were counseled on available contraceptive methods. A structuredquestionnaire was then administered and analyzed to determine the factors that influenced uptake or not of BTL. Data analysis was done using Statistical Package Social Scientist (SPSS) version 19.0. Results:Socio-economic factors did not appear to influence uptake of BTL. Of women who took up BTL, 54.3% were earning more than Ksh.10,000 compared to 59% who declined to take it up (p=0.586).However, who were in gainful employment were more likely to take up BTL than those who were unemployed (66.9% and 33.1% respectively p=0.019). At the same time those aged above 30years were more likely to take up BTL than those who were below 30years (84% and 16% respectively p=0.003) It was also found that women who had been married for more than 5 years took up BTL more than those who had not (88.4% and 15.1% respectively p=0.836). Communication amongst the couple was vital and 80% of respondents who took up BTL reported that they had agreed on the number of children to get with their husbands, compared to 12.9% who had not agreed and did not take up BTL (p=0.024). Most couples considered more 4 children and above to be enough in order to consider BTL while some who did not take up BTL considered 3 children to be enough (66.4% and 25.1% respectively p=0.07). Women who had previously used long acting contraception were more likely to take up BTL. Amongst IUD users 12% took up BTL compared to 2.7% who declined (p<0.001).Amongst implant users, 14.9% took up BTL compared to 9.8% who declined (p=0.069).At the end of the study, 28% of respondents who had attained desired family size took up BTL. Conclusion: While socioeconomic factors do not seem to have a causal relationship with decision to take up BTL, factors such as increasing age and parity, good communication amongst couples, previous use of long term contraception and knowledge of other women who had taken up BTL, were associated with uptake of BTL. Recommendations: It is recommended that counseling on FP involve the husband, peer counseling be encouraged and women be empowered economically in order to increase uptake of BTL.