BACKGROUND: African-American women have had higher rates of female sterilization compared to white women since its emergence as a contraceptive method. The reasons underlying this observed racial difference are unknown. OBJECTIVES: The goals of this study were to (1) explore what factors shape black and white women's decisions about tubal sterilization as a contraceptive method and (2) generate hypotheses about the relationship of race to the decision-making process. DESIGN: We conducted six focus groups stratified by tubal sterilization status and race. During each of the audio-recorded sessions, participants were asked to discuss reasons that women choose sterilization as a contraceptive method. PARTICIPANTS: The participants of the study were 24 African-American women and 14 white women. APPROACH: Transcripts of the sessions were qualitatively analyzed with particular attention to factors that might be unique to each of the two racial groups. RESULTS: Personal factors shaped black and white women's decisions regarding tubal sterilization. Preference for a convenient, highly effective contraceptive method was the main reason to get a tubal sterilization for women of both racial groups. We also identified socio-cultural differences that might explain why black women are more likely than white women to choose tubal sterilization over other contraceptive methods. An unanticipated, but clinically important, finding was that women often reported feeling that their doctors and the health-care system served as barriers to obtaining the desired procedure. CONCLUSION: Socio-cultural differences may help explain why black and white women choose different contraceptive methods.
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