Exploring Factors in the Decision to Choose Sterilization vs Alternatives in Rural El Salvador

Miriam L. Cremer, MD, MPH; Erica Holland, BA; Maritza Monterroza, MA; Sonia Duran, MPH; Rameet Singh, MD, MPH; Heather Terbell, MD; Alison Edelman, MD, MPH


Medscape J Med. 2008;10(8):183 

In This Article

Materials and Methods

We explored factors influencing women to undergo tubal sterilization in addition to their knowledge about the procedure in 11 focus groups in January 2005. The study was approved by the Institutional Review Board of The University of Southern California as well as a committee representing the community in El Salvador. Women verbally consented to participate in the study.

All focus groups were conducted during a week-long health fair in the rural community of San Pedro Perulapan, a municipality in the Cuscatlan department of El Salvador (Figure 1). Local healthcare workers advertised the health fair. Women between the ages of 20 and 45 years with a history of tubal sterilization were offered to participate in the study. Study participation did not affect the ability to receive healthcare. Women were sequentially recruited to fill 11 focus groups of 5 to 10 individuals each (Figure 2).

San Pedro Perulapan is in the Department of Cuscatlan in El Salvador. Image courtesy of Miriam Cremer, MD, MPH.

Women in San Pedro Perulapan wait to participate in focus groups and to be screened for cervical cancer. Image courtesy of Miriam Cremer, MD, MPH.

A moderator fluent in Spanish and English who had experience in conducting focus groups facilitated eleven 90-minute focus groups. All sessions were held behind closed doors to ensure privacy and confidentiality. The demographic information of each participant was obtained (current age, age at tubal sterilization, number of children, education level, and occupation). Validated discussion questions were used with permission from EngenderHealth (New York, NY; Attitudes towards tubal ligation among users, potential users, and husbands in Jordan. October 2003 site email). The questions, listed in the Table , were used to guide the discussions.

Each session was tape-recorded, and additional information was collected through detailed notes. Separate transcriptions in Spanish were created for each of the 11 focus groups. All transcriptions were coded manually using grounded theory coding procedures.[16] Primary endpoints to each question were identified, and key words were coded to represent common thematic categories. Subthemes were also collected and summarized.


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