Abstract
Objectives
Evidence shows many misconceptions exist around permanent contraception, and there
are numerous barriers to accessing the procedure. This qualitative study explored
physician perspectives regarding patients’ informational and decision-support needs,
the complexities and challenges of counseling and access, and how these factors may
differ for people living on lower incomes.
Study design
We conducted 15 semistructured, telephone interviews with obstetrician-gynecologists
in three geographic regions of the United States to explore their perspectives on
providing permanent contraception counseling and care. We analyzed the interviews
using content analysis.
Results
Physicians discussed a tension between respecting individual reproductive autonomy
and concern for future regret; they wanted to support patients’ desire for permanent
contraception but were frequently concerned patients did not have the information
they needed or the foresight to make high-quality decisions. Physicians also identified
barriers to counseling including lack of time, lack of continuity over the course
of prenatal care, and baseline misinformation among patients. Physicians identified
additional barriers in providing a postpartum procedure even after thedecision was
made including lack of personnel and operating room availability. Finally, physicians
felt that people living on lower incomes faced more challenges in access primarily
due to the sterilization consent regulations required by Medicaid.
Conclusions
Physicians report numerous challenges surrounding permanent contraception provision
and access. Strategies are needed to support physicians and patients to enhance high-quality,
patient-centered sterilization decision making and ensure that patients are able to
access a permanent contraceptive procedure when desired.
Implications
This qualitative study demonstrates the various challenges faced by physicians to
support permanent contraception decision making. These challenges may limit patients’
access to the care they desire. This study supports the need to transform care delivery
models and improve the federal sterilization policy to ensure equitable patient-centered
access to desired permanent contraception.
Disclaimer
Although the term permanent contraception has increasingly replaced the word sterilization
in clinical settings, we use sterilization in some places throughout this paper as
that was the standard terminology at the time the interviews were conducted and the
language the interviewed physicians used.
Keywords
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Article info
Publication history
Published online: January 11, 2023
Accepted:
December 12,
2022
Received in revised form:
December 7,
2022
Received:
February 25,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
