Women's decision making for postpartum sterilization: does the Medicaid waiting period add value?
Women's decision making for postpartum sterilization: does the Medicaid waiting period add value?
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DOI：
10.1016/j.contraception.2018.07.004
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发表时间：
2018-10-01
期刊：
影响因子：
2.9
通讯作者：
Dutton, Caryn
中科院分区：
文献类型：
--
作者：
Foley, Olivia;Janiak, Elizabeth;Dutton, Caryn
目的：目前，拥有联邦基金保险的患者需要在绝育前至少30天签署绝育同意书(SCF)，而私人保险的患者则不需要。虽然这项政策旨在保护弱势人口的生育权，但它产生了意外的影响，造成了获得有效避孕方法的机会差距。我们的定性研究旨在澄清围绕产后绝育的决策过程，并评估患者是否认为SCF增加了价值。研究设计：我们采访了25名接受产后绝育手术的女性，10名接受私人保险的女性，15名接受医疗补助的女性。讨论的主题包括生育史、选择绝育的原因、决策时间表和SCF的价值。我们对访谈进行了转录和编码，并确定了主题。结果：参与者的回答表明，私人保险患者和医疗补助患者的决策过程相似。对于大多数女性来说，接受绝育手术的决定发生在她们的生殖生命过程中。参与者表示，无偏见的提供者咨询、自主性和来自其他女性的信息有助于他们的决策。大多数受试者认为SCF可能会使其他女性受益，但不会/不会影响她们自己的决策。结论：我们没有发现证据表明，根据决策过程的不同，有私人保险的女性和有医疗补助的女性应该受到不同的绝育限制。妇女重视的决策过程的特点，在这一人群中不包括SCF，应该优先考虑。影响：鉴于与SCF相关的潜在负面后果，包括其对社会经济地位较低的妇女不成比例的负担，我们的参与者报告的产后绝育决策过程缺乏附加值，为重新评估该政策提供了进一步的证据。(C)2018 Elsevier Inc.保留所有权利。
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. (C) 2018 Elsevier Inc. All rights reserved.