A Prospective Study on the Effects of Medicaid Regulation and Other Barriers to Obtaining Postpartum Sterilization. (8th November 2018)

• Record Type: Journal Article
• Authors: Hahn, Taylor A.; McKenzie, Fatima; Hoffman, Shelley M.; Daggy, Joanne; Tucker Edmonds, Brownsyne
• Is Part Of: Journal of midwifery & women's health. Volume 64:Number 2(2019)
• Page Start: 186
• Page End: 193
• Publication Date: 2018-11-08
• Subjects: postpartum sterilization -- Medicaid -- long‐acting reversible contraception -- postpartum contraception -- reproductive justice; Midwives -- Periodicals; Obstetrics -- Periodicals; Women's health services -- Periodicals; 618.2
• DOI: 10.1111/jmwh.12909
• Languages: English
• ISSNs: 1526-9523

Abstract

Abstract : Introduction: This study aimed to assess unfulfilled sterilization requests, specifically regarding issues with the Medicaid consent for sterilization, and determine the proportion of women who subsequently received interval sterilization by 3 months postpartum. Methods: The authors conducted a prospective observational cohort study of women who gave birth over an 8‐month period and requested immediate postpartum sterilization. Records of women with unfulfilled requests were reviewed up to 3 months postpartum to determine rates of postpartum follow‐up and interval sterilization. Primary analysis examined unfulfilled sterilization requests associated with the Medicaid consent form and, secondarily, all other reasons for unfulfilled requests, as well as alternative contraceptive methods chosen. Results: Of the 334 women who requested immediate postpartum sterilization, 173 (52%) received the requested sterilization and 161 (48%) did not. Among those whose request was unfulfilled, 91 (56.5%) still wanted the procedure, and of those women, more than two‐thirds were unable to receive it because of Medicaid consent issues. Within this group, only 6 received interval sterilization by 3 months postpartum; more than one‐third received a form of long‐acting reversible contraception, and 24.6% did not receive postpartum care. Discussion: A sizable proportion of women requesting postpartum sterilization have unfulfilled requests because of an issue with the Medicaid consent and also have a low likelihood of receiving interval sterilization by 3 months postpartum. The Medicaid consent may create barriers for women requesting postpartum sterilization, the vast majority of whom face subsequent barriers obtaining interval sterilization, thereby increasing the risk for unintended pregnancy in an at‐risk population. This has important implications for reproductive justice efforts to protect vulnerable populations while minimizing barriers to desired care.