Tubal Ligation, Cesarean Sections, and Insurance Status: A Community-Based Study in Barrero, Dominican Republic

INTRODUCTION: In the Dominican Republic (DR), more than half of those using contraception choose permanent or long-acting contraception. At 30.6%, the DR has the highest reported prevalence of permanent sterilization worldwide. Similarly, they have one of the highest cesarean-section rates in the world, reported at 62.9%. The Barrero community is a semi-rural, semi-urban community in the DR. Most studies about contraception and cesarean sections in the Dominican focus on urban or rural regions; thus, this study provides insight into the tubal ligation and cesarean-section usage of this unique community. OBJECTIVE: This study aimed to evaluate any correlation between cesarean sections and tubal ligation, as well as explore potential factors associated with tubal ligation, including insurance status at time of birth. METHODS: Using a cross-sectional design, 121 women living in Barrero, DR, with children aged 0–12 years were interviewed via house-to-house sampling. This survey included questions regarding prenatal care, pregnancies, deliveries, and contraception use after birth. Data collection took place in February 2025. Categorical data is represented using frequency counts and percentages. Data was analyzed using generalized estimating equations due to the inherent correlation of mothers providing responses for more than one pregnancy. RESULTS: Of the 92 women in the survey who use contraception, 43% chose tubal ligation as their primary method. Of women who delivered via cesarean section for their final child, 45.9 (95% CI, 33.6.5–58.7) underwent tubal ligation at an unknown time after their last birth. For those delivering their last child vaginally, 37.9 (95% CI, 22.1–56.9) underwent tubal ligation at an unknown time after the birth. There was no statistically significant difference in tubal ligation rates between those delivering their last child vaginally versus cesarean section (p = 0.483) (Table 1). Additionally, of the women who underwent tubal ligation, 16 (44.4%) had private insurance, 7 (19.4%) had public insurance, and 13 (36.1%) had no insurance. For women using no contraception, tubal ligation, or another form of contraception, there was no statistically significant difference in type of insurance (p = 0.687) (Table 2). CONCLUSIONS: In Barrero, 43% of all women using contraception and 45.9% of women delivering their final child via c-section underwent tubal ligation. History of cesarean-section delivery and type of insurance were not significantly associated with the choice of tubal ligation for contraception. Additional studies should investigate factors that influence women to undergo tubal ligation at high rates in the Dominican Republic.Table 1Table 2