Sterilization racism: A quantitative study of pan-ethnic and other ethnic disparities in sterilization, sterilization regret, and long-acting contraceptive use

Date of Completion

January 2009

Keywords

Sociology, Ethnic and Racial Studies

Degree

Ph.D.

Abstract

In the late 1960s and 1970s there were widespread reports of coercive and deceptive sterilizations of women of color in the United States. The women impacted were African American, American Indian, Mexican-origin, and of Puerto Rican descent. These cases painted a troubling picture of reproductive healthcare in the United States that was suggestive of racism. Although a significant scholarship on historical case studies has emerged in recent years, there has been little quantitative study of disparities in sterilization. In this dissertation, I use historical case studies of racially-targeted sterilization abuse to frame a quantitative study of pan-ethnic and other ethnic disparities in the sterilization of women. ^ First, I review the history of efforts to control the reproductive activities of women of color going back to the colonization of the Americas and through the 1970s. Second, I review and critique quantitative studies of sterilization. Noting the presence of racial disparities uncovered in some studies and given the historical pretext of racist sterilization abuse, I argue that a racism theory of quantitative sterilization outcomes is necessary. Third, I review several racism theories and develop a concept I call "sterilization racism." I then discuss the methodological limitations of doing a racism study when quantitative data on racism do not exist. In so doing, I argue that my analysis can make a "strong-conceptual/weak-data" case for sterilization racism. ^ In the data analysis portion of the dissertation, I analyze three outcomes indicative of racist sterilization abuse: tubal sterilization, sterilization regret, and the use of long-acting hormonal contraception (Norplant and Depo-Provera). The analysis of dependent variables proceeds as I partition the sample (drawn from the 1982, 1988, 1995, and 2002 National Survey of Family Growth). To study tubal sterilization (1), I use a sample of all women using contraception (full sample), to study sterilization regret (2) I limit the sample to sterilized women, and to analyze the use of long-acting hormonal contraception (3), I limit the sample to non-sterile women. ^ After controlling for a host of confounding factors and using European American women as a reference group, I find pan-ethnic and other ethnic disparities in tubal sterilization. Of special significance is my finding of growing disparities over time for African American and Mexican-origin women compared to European American women. American Indian women are found to have consistently higher rates of sterilization across time. In my analysis of sterilization regret, I find that Latinas (Mexican-origin and Puerto Ricans and Other Latinas) have higher rates of sterilization regret than European American women. When the sample is restricted to women who first gave birth at age twenty or older, African American, American Indian, and Mexican-origin women are all more likely to regret the surgery than European American women, net of confounding factors. Finally, I find that among non-sterile women, African American and Mexican-origin women are most likely to have ever used Depo-Provera, whereas American Indian women are more likely than European American women to have ever or currently be using Norplant. Furthermore, African American women are more likely than European American women to be current users of Depo-Provera. I conclude with a discussion of the limitations of the analysis and how future researchers can collect racism-specific data to provide stronger tests for the concept of sterilization racism. ^

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