STERILIZATION, CESAREANS AND CONTRACEPTIVE CHOICE

描述：在巴西，甚至比美国还要多 手术避孕和分娩的使用都出现了激增。这个 调查人员的目标是区分和权衡 带领巴西医生表演，巴西妇女要求， 剖宫产分娩过程中的绝育。这些问题与以下方面有关： 医生的便利程度和报酬；女性对外科手术的偏好 分娩和避孕；以及重复剖腹产的发生率， 这可能会使女性在分娩期间子宫破裂的风险很高 未来怀孕并导致选择一种不可逆转的方法。至 评估这些替代影响，他们将采用一种研究设计 结合了服务的提供者和使用者，并深入到 在生育率和生育率的常规调查中没有发现的对象 如国土安全部已经实施的避孕措施。 调查人员将约谈产科医生关于他们的培训和 他们应用于关于交付类型和类型的决定的标准 绝育；采访妇女关于她们的经验，知识， 和喜好。他们还将进行一项前瞻性研究， 母亲们会在怀孕早期接受采访，然后在她们的 接生和约谈资深医生，了解 在他们的医疗界进行外科避孕和分娩。这个 研究将在巴西选择的四个州进行，以捕捉 巴西国内存在的剖腹产率差异， 女性绝育占所有避孕措施的比例，以及 剖宫产中绝育手术的比例 横断面。这个项目将有助于当前关于自然界的争论 在生育率快速下降期间采用避孕措施的过程 并且，第一次强调这样的过程可能会出错，导致 一个被既不安全也不安全的技术所束缚的社会 性价比高。

DESCRIPTION: In Brazil, even more so than in the United States there has been an upsurge in use of both surgical contraception and delivery. The investigators' aim is to distinguish among and weigh the influences that lead Brazilian doctors to perform, and Brazilian women to demand, sterilizations during a cesarean section delivery. These have to do with: the doctor's convenience and remuneration; women's preferences for surgical delivery and contraception; and the incidence of repeat cesarean sections, which supposedly place women at high risk of rupturing their uterus during a future pregnancy and lead to the choice of an irreversible method. To assess these alternative influences, they will employ a research design that incorporates both the providers and consumers of services, and delves into subjects that are not found in regular surveys of fertility and contraceptive practice such as have been carried out by DHS. The investigators will interview obstetricians regarding their training and the criteria they apply to decisions regarding type of delivery and sterilization; and interview women regarding their experience, knowledge, and preferences. They will also carry out a prospective study in which mothers would be interviewed early in pregnancy and then after their delivery and interview senior medical practitioners regarding the history of surgical contraception and delivery in their medical community. The research will be carried out in four states of Brazil chosen to capture the variation that exists within Brazil in the rate of cesarean sections, the proportion of all contraception accounted for by female sterilization, and the proportion of sterilizations that are performed during cesarean sections. This project will contribute to current debates about the nature of the process of contraceptive adoption during a rapid fertility decline and, for the first time, highlight how such a process can go wrong, leading a society to become locked-in to technologies that are neither safe nor cost-effective.