Obstacles Underserved Women Face to Access Postpartum Sterilization: Ethical Obligation for Modification

Abstract

Postpartum tubal ligation is an effective, safe method of sterilization. Underserved women face many barriers in their attempt to access this time sensitive postpartum contraception. A major barrier for many of these women who are without the means of availing themselves of this procedure is the Federal policy regarding Medicaid sterilization funding. The two main barriers are a) The Medicaid form must be signed 30-180 days prior to the procedure and brought to the hospital on the procedure day and b) The reading level and design of the consent form is not patient friendly. Barriers enacted by Federal regulations may prevent disenfranchised women from exercising the same degree of reproductive healthcare autonomy as their more socio-economically advantaged counterparts. In addition to the consent form that needs to be signed and verified before the procedure, other barriers include the age of the woman, in which some hospitals restrict sterilization procedures on woman younger than 30, even though Medicaid funds sterilization for woman over 21, restrictions from Catholic affiliated hospitals where sterilization is not permitted, and the shortage of operating rooms and resources. We suggest change in clinical and legal practice fostered by revised Federal regulations is urgently needed to adhere to ethical standards of medical practice.