Multi-level factors affecting postpartum sterilization

女性绝育是美国第二大最常用的避孕方法， 通常在产后期间进行。然而，有医疗补助保险的女性是 像那些有私人保险的人一样，有可能获得理想的产后绝育。加剧了这种差异， 与白人相比，拥有医疗补助保险的有色人种女性实现绝育的可能性较小 有医疗补助保险的女性。绝育失败使女性处于随后意外的高风险中 解释间隔时间短的妊娠及其对母婴健康的相关风险。那里 是公平产后绝育的重大政策障碍，影响到那些接受医疗补助的人，但不是 私人保险。然而，联邦医疗补助政策(包括具体的同意书和随后的30- 日间等待期)是1976年建立的，因为对肤色和低肤色的妇女进行了强制绝育 社会经济地位。因此，对复杂的社会和文化背景的敏感考虑是 需要平衡对弱势群体的保护和社会性别差异的意外后果 完成灭菌任务。此外，患者、提供者和医院层面的障碍也已被注意到， 尽管目前还不清楚这些障碍相互作用的程度。倡导彻底废除 因此，医疗补助绝育过程既忽略了复杂的历史，也忽略了额外的非政策因素 公平产后绝育的障碍。该提案的总体目标是确定离散的 不同分析级别(患者、提供者、医院和政策)的障碍。中心假设是 个别和集体障碍的分层导致产后绝育完成情况的差异 对于医疗补助计划的人群。该项目的基本原理是识别和理解潜在的障碍 是消除围绕产后绝育的差异的关键下一步。以Strong为指导 初步数据，这一假设将通过解释性序贯混合方法设计进行检验。 追求三个具体目标：1)建立医疗补助保险与绝育实施之间的关联模型 在合并的多机构样本中调整了临床和人口统计学差异后(患者和政策- 水平障碍目标)；2)确定产后妇女及其产科医生的态度、信念和做法 关于产后绝育(患者、提供者、医院和政策层面的障碍目标)；3)评估 医院和国家政策障碍对产后绝育的影响(目标是医院和政策层面的障碍)。 这种方法是创新的，因为它改变了现状，把重点从学习转移到了 在确定和评估不同层面的障碍方面，有必要单独设置障碍。这一贡献 将具有重大意义，因为预计它将为以证据为基础和以患者为中心的卫生政策提供信息 消除因灭菌未履行和结果而导致的健康差距和改善临床结果 意外怀孕。

Female sterilization, the second most commonly used contraceptive method in the United States, is commonly performed during the postpartum period. However, women with Medicaid insurance are half as likely to obtain a desired postpartum sterilization as those with private insurance. Compounding this disparity, women of color with Medicaid insurance are less likely to achieve sterilization fulfillment compared to white women with Medicaid insurance. Sterilization non-fulfillment puts women at high risk of subsequent unintended pregnancy with a short interpregnancy interval and the associated risks to maternal and infant health. There are significant policy barriers to equitable postpartum sterilization that impact those with Medicaid but not private insurance. However, the federal Medicaid policy (including specific consent form and subsequent thirty- day waiting period) was established in 1976 due to coerced sterilizations on women of color and low socioeconomic status. Therefore, sensitive consideration of the complex social and cultural backdrop is required to balance protection of a vulnerable population with the unintended consequence of disparities in sterilization fulfillment. Furthermore, barriers at the patient, provider, and hospital level have also been noted, though it is unclear the extent to which these barriers interact. Advocating for the complete removal of the Medicaid sterilization process, then, ignores both the complex history as well as the additional, non-policy barriers to equitable postpartum sterilization. The overall objective for this proposal is to determine the discrete barriers at various levels of analysis (patient, provider, hospital, and policy). The central hypothesis is that the layering of barriers individually and collectively contributes to disparities in postpartum sterilization fulfillment for the Medicaid population. The rationale for the project is that identifying and understanding potential barriers is the critical next step to eradicating the disparities surrounding postpartum sterilization. Guided by strong preliminary data, this hypothesis will be tested through an explanatory sequential mixed methods design by pursuing three specific aims: 1) Model the association between Medicaid insurance and sterilization fulfillment after adjusting for clinical and demographic differences in a pooled multi-institution sample (patient- and policy- level barriers aim); 2) Identify the attitudes, beliefs, and practices of postpartum women and their obstetricians regarding postpartum sterilization (patient-, provider-, hospital-, and policy-level barriers aim); 3) Assess the impact of hospital and state policy barriers on postpartum sterilization (hospital- and policy-level barriers aim). The approach is innovative because it departs from the status quo by shifting focus away from studying barriers individually and toward the identification and assessment of various layers of barriers. This contribution will be significant because it is expected to inform an evidence-based and patient-centered health policy to eradicate health disparities and improve clinical outcomes due to sterilization non-fulfillment and resultant unintended pregnancies.