Introduction: Sterilization is more common in rural areas than in urban areas. We assessed whether desire for sterilization reversal also differs by rural/urban areas and by aspects of the sterilization care visit-specifically, method of payment and type of facility.

Methods: We used data from 469 female 2015-2019 National Survey of Family Growth respondents who received a tubal ligation in the last 5 years. Multivariate logistic regression tested associations between wanting a sterilization reversal and residence, method of payment, and facility type, controlling for sociodemographic factors.

Results: Overall, roughly one-quarter of respondents living in rural and urban areas wanted a reversal. Receiving a tubal ligation at a public facility was associated with lower odds of desire for reversal (adjusted odds ratio [aOR] = 0.48, p = 0.04, confidence intervals [CIs]: 0.24-0.97). Additionally, using Medicaid/receiving a tubal ligation for free was associated with marginally higher odds of desire for reversal (aOR = 1.92, p = 0.070, CIs: 0.95-3.91). Consistent with prior research, we found higher odds in the desire for reversal among those who received a tubal ligation for reasons other than ending childbearing and for non-Hispanic Black respondents, and lower odds for those with a history of unwanted pregnancy.

Conclusions: The desire for sterilization reversal is similarly high among rural and urban women. However, aspects of the care visit did matter. To prevent sterilization procedures, people later want reversed; improvements in counseling are warranted across sites. At the same time, attention is needed to address structural barriers that limit contraceptive options.