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Commentary|Articles in Press, 109995

Reproductive justice in post-Roe America: Impact of restricted abortion access on patients seeking permanent contraception

      On June 24, 2022, the United States Supreme Court issued its decision in Dobbs v. Jackson Women’s Health Organization (Dobbs), thereby eliminating the almost 50-year-long federal constitutional right to an abortion. Healthcare clinicians across the country have anecdotally reported an increased demand for permanent contraception procedures following the Dobbs decision. This increased demand may reflect patients’ fear of losing reproductive autonomy [

      Bolton A, Julhin E.More people are opting to get sterilized—and some are being turned away. NPR. Published online July 29, 2022. 〈https://www.npr.org/sections/health-shots/2022/07/29/1113573995/more-people-are-opting-to-get-sterilized-and-some-are-being-turned-away〉 (accessed August 14, 2022).

      ,

      Browne G. Permanent birth control is in demand in the US—but hard to get. Wired. Published online July 6, 2022. 〈https://www.wired.com/story/permanent-birth-control-iuds-post-roe/〉 (accessed August 14, 2022).

      ]. As more patients seek permanent contraception procedures following the Dobbs decision, several ethical issues emerge regarding (1) disparities in impact, (2) bias and discrimination in accessing permanent contraception, and (3) the practice of obtaining informed consent via shared decision-making in the setting of political restrictions to autonomous decision-making.

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      References

      1. Bolton A, Julhin E.More people are opting to get sterilized—and some are being turned away. NPR. Published online July 29, 2022. 〈https://www.npr.org/sections/health-shots/2022/07/29/1113573995/more-people-are-opting-to-get-sterilized-and-some-are-being-turned-away〉 (accessed August 14, 2022).

      2. Browne G. Permanent birth control is in demand in the US—but hard to get. Wired. Published online July 6, 2022. 〈https://www.wired.com/story/permanent-birth-control-iuds-post-roe/〉 (accessed August 14, 2022).

        • Mosley E.
        • Monaco A.
        • Zite N.
        • Rosenfeld E.
        • Schablik J.
        • Rangnekar N.
        • et al.
        "How do you balance individual autonomy with also people making decisions in a world of constrained choices?”: U.S. physicians’ perspectives on the complexities and challenges of permanent contraception provision.
        Contraception. 2022;
        • Kimport K.
        More than a physical burden: women’s mental and emotional work in preventing pregnancy.
        J Sex Res. 2018; 55: 1096-1105https://doi.org/10.1080/00224499.2017.1311834
        • Fennell J.L.
        Men bring condoms, women take pills: men’s and women’s roles in contraceptive decision making.
        Gend Soc. 2011; 25: 496-521https://doi.org/10.1177/0891243211416113
        • Fields J.
        Risky lessons: sex education and social inequality.
        Rutgers University Press, New Brunswick NJ2008
        • Luker K.
        Dubious conceptions: the politics of teenage pregnancy.
        Harvard University Press, Cambridge, MA1996
        • Weber J.
        Becoming teen fathers: stories of teen pregnancy, responsibility, and masculinity.
        Gend Soc. 2012; 26: 900-921https://doi.org/10.1177/089124321245907
        • Littlejohn K.E.
        Just get on the pill: the uneven burden of reproductive politics.
        University of California Press, Oakland, CA2021
        • Campo-Engelstein L.
        Contraceptive justice: why we need a male pill.
        AMA J Ethics. 2012; 14: 146-151https://doi.org/10.1001/virtualmentor.2012.14.2.msoc1-1202
        • Borrero S.
        • Abebe K.
        • Dehlendorf C.
        Racial variation in tubal sterilization rates: role of patient-level factors.
        Fertil Steril. 2011; 95: 17-22https://doi.org/10.1016/j.fertnstert.2010.05.031
        • Block-Abraham D.
        • Arora K.S.
        • Tate D.
        • Gee R.E.
        Medicaid consent to sterilization forms: historical, practical, ethical, and advocacy considerations.
        Clin Obstet Gynecol. 2015; 58: 409-417https://doi.org/10.1097/GRF.0000000000000110
        • Morris J.
        • Ascha M.
        • Wilkinson B.
        • Verbus E.
        • Montague M.
        • Mercer B.M.
        • et al.
        Desired sterilization procedure at the time of cesarean delivery according to insurance status.
        Obstet Gynecol. 2019; 134: 1171-1177https://doi.org/10.1097/AOG.0000000000003552
        • Amalraj J.
        • Arora K.S.
        Ethics of a mandatory waiting period for female sterilization.
        Hastings Cent Rep. 2022; 52: 17-25https://doi.org/10.1002/hast.1405
        • Thorne N.B.
        • Soderborg T.K.
        • Glover J.J.
        • Hoffecker L.
        • Guiahi M.
        Reproductive health care in catholic facilities: a scoping review.
        Obstet Gynecol. 2019; 133: 105-115https://doi.org/10.1097/AOG.0000000000003029
      3. U.S. Conference of Catholic Bishops. Ethical and religious directives for Catholic health care services. 〈https://www.usccb.org/about/doctrine/ethical-and-religious-directives/upload/ethical-religious-directives-catholic-health-service-sixth-edition-2016–06.pdf〉 (accessed August 18, 2022).

        • Grady C.D.
        • Dehlendorf C.
        • Cohen E.D.
        • Schwarz E.B.
        • Borrero S.
        Racial and ethnic differences in contraceptive use among women who desire no future children, 2006–2010 National Survey of Family Growth.
        Contraception. 2015; 92: 62-70https://doi.org/10.1016/j.contraception.2015.03.017
        • Smaw E.D.
        Uterus collectors: the case for reproductive justice for African American, Native American, and Hispanic American female victims of eugenics programs in the United States.
        Bioethics. 2022; 36: 318-327https://doi.org/10.1111/bioe.12977
        • Kathawa C.A.
        • Arora K.S.
        Implicit bias in counseling for permanent contraception: historical context and recommendations for counseling.
        Health Equity. 2020; 4: 326-329https://doi.org/10.1089/heq.2020.0025
        • Arora K.
        • Castleberry N.
        • Schulkin J.
        Obstetrician-gynecologists’ counseling regarding postpartum sterilization.
        Int J Womens Health. 2018; 10: 425-429https://doi.org/10.2147/IJWH.S169674
        • Solo J.
        • Festin M.
        Provider bias in family planning services: a review of its meaning and manifestations.
        Glob Health Sci Pract. 2019; 7: 371-385https://doi.org/10.9745/GHSP-D-19-00130
        • Manzer J.L.
        • Bell A.V.
        “We’re a Little Biased”: medicine and the management of bias through the case of contraception.
        J Health Soc Behav. 2021; 62: 120-135https://doi.org/10.1177/00221465211003232
        • Dehlendorf C.
        • Ruskin R.
        • Grumbach K.
        • Vittinghoff E.
        • Bibbins-Domingo K.
        • Schillinger D.
        • et al.
        Recommendations for intrauterine contraception: a randomized trial of the effects of patients’ race/ethnicity and socioeconomic status.
        Am J Obstet Gynecol. 2010; 203: 319.e1-319.e8https://doi.org/10.1016/j.ajog.2010.05.009
        • American College of Obstetricians and Gynecologists
        Sterilization of women: ethical issues and considerations.
        Obstet Gynecol. 2017; 129 (Committee Opinion No. 695): e109-e116https://doi.org/10.1097/AOG.0000000000002023
        • Harrison D.
        • Cooke C.
        An elucidation of factors influencing physicians’ willingness to perform elective female sterilization.
        Obstet Gynecol. 1988; 72: 565-570
        • Metzl J.M.
        • Hansen H.
        Structural competency: theorizing a new medical engagement with stigma and inequality.
        Soc Sci Med. 2014; 103: 126-133https://doi.org/10.1016/j.socscimed.2013.06.032
        • Downey M.M.
        • Gomez A.M.
        Structural competency and reproductive health.
        AMA J Ethics. 2018; 20: 211-223https://doi.org/10.1001/journalofethics.2018.20.3.peer1-1803
        • Mann E.S.
        • Chen A.M.
        • Johnson C.L.
        Doctor knows best? Provider bias in the context of contraceptive counseling in the United States.
        Contraception. 2022; 110: 66-70https://doi.org/10.1016/j.contraception.2021.11.009