Abstract
Objectives
Currently, patients with federally funded insurance are required to sign a sterilization
consent form (SCF) at least 30 days prior to sterilization, while privately insured
patients are not. Although this policy was designed to protect the reproductive rights
of vulnerable populations, it has had the unintended effect of creating a disparity
in access to an effective contraceptive method. Our qualitative study aims to clarify
the decision-making process surrounding postpartum sterilization and assess if patients
perceive that the SCF adds value.
Study design
We interviewed 25 women who underwent postpartum sterilization procedures, 10 with
private insurance and 15 with Medicaid. Topics discussed included reproductive history,
reason for choosing sterilization, decision-making timeline and value of the SCF.
We transcribed and coded the interviews and identified themes.
Results
Participant responses indicated that decision-making processes were similar between
patients with private insurance and those with Medicaid. For most women, the decision
to undergo sterilization took place over the course of their reproductive lives. Participants
expressed that nonbiased provider counseling, autonomy and information from other
women were helpful to their decision making. Most subjects felt that the SCF might
benefit other women but did not/would not affect their own decision making.
Conclusions
We did not find evidence suggesting that women with private insurance and women with
Medicaid should be subjected to disparate restrictions on sterilization based on differences
in decision-making processes. Characteristics of the decision-making process that
women value, which in this population did not include the SCF, should be prioritized.
Implications
Given the potential negative consequences associated with the SCF including its disproportionate
burden on women of low socioeconomic status, the lack of value added to the decision-making
process for postpartum sterilization reported by our participants provides further
evidence for reevaluation of the policy.
Keywords
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References
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Article info
Publication history
Published online: July 19, 2018
Accepted:
July 11,
2018
Received in revised form:
July 6,
2018
Received:
January 5,
2018
Footnotes
☆Funding: This work was supported by the Society of Family Planning Research Fund (Grant No. SFPRF9-T4).
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
