Desire for Sterilization Reversal in Delaware, US: The Roles of LARC Use, Personal Abortion Acceptability, and Economic Disadvantage.

Objective: To investigate the pathways that may elevate risks of desire for sterilization reversal, specifically through nonuse of long-acting reversible contraception (LARC), viewing abortion as unacceptable for oneself, and being economically disadvantaged.

Methods: We used chi-squared tests and binary logistic models to analyze data on 3422 women, including 299 sterilized women, from a population-representative sample of Delaware women aged 18-44 in 2021. We estimated models for female sterilization use and for desire for sterilization reversal.

Results: Among sterilized Delaware women aged 18-44, 28% report desiring sterilization reversal. In multivariate models, those who had never used LARC were more likely to have been sterilized (OR = 1.62; 95% CI = 1.09-2.40), although not more likely to desire sterilization reversal if sterilized. Women who viewed abortion as unacceptable for themselves were not more likely to be sterilized, but they were more likely to desire sterilization reversal if sterilized (OR = 2.42; 95% CI = 1.09-5.36). Economically disadvantaged women were both more likely to be sterilized (OR = 7.56; 95% CI = 4.51-12.68) and more likely, if sterilized, to desire sterilization reversal (OR = 3.88; 95% CI = 1.18-12.74).

Conclusion: We find varied pathways linking a woman's nonuse of LARC, her personal nonacceptability of abortion, and her economic disadvantage to increased risk of desiring sterilization reversal. Economic disadvantage is easily the greatest risk factor. We interpret these findings through a conceptual framework of constrained choice.