A Prospective Study on the Effects of Medicaid Regulation and Other Barriers to Immediate Postpartum Sterilization [14F

Abstract

INTRODUCTION: To assess the rate of and reasons for unfulfilled sterilization requests, specifically regarding issues with the Medicaid Consent for sterilization, and to determine the proportion of patients who subsequenstly receive interval sterilization by 3 months postpartum. METHODS: Prospective observational cohort study of women delivering over an 8 month period and requesting 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 and alternative contraceptive methods chosen. Bivariate analyses were performed to evaluate the relationship between unfulfilled sterilization and sociodemographic characteristics. RESULTS: 334 women delivered and requested immediate postpartum sterilization. 173 women (52%) received requested sterilization while 161 women (48%) did not. Medicaid Consent was the primary reason for unfulfilled request for 61 women (37.9%). Within this group, six women (9.8%) received interval sterilization by 3 months postpartum, while the remaining 90.2% were still awaiting interval sterilization (14.8%), had chosen an alternative contraceptive method (52.5%), or did not receive postpartum care (23.0%). Of the sociodemographic factors assessed, only advanced age was associated with increased sterilization (p=0.02). CONCLUSION: A sizable proportion of women requesting postpartum sterilization continue to have unfulfilled requests due to an issue with the Medicaid Consent and they have a low likelihood of receiving interval sterilization. This has important implications for ongoing reproductive justice efforts to protect vulnerable populations while minimizing barriers to desired sterilization.