Multi-level factors affecting postpartum sterilization

女性绝育是美国第二大常用的避孕方法， 通常在产后期间进行。然而，有医疗补助保险的女性只有一半 有可能像那些有私人保险的人一样获得所需的产后绝育。加剧了这种差距， 与白色相比，有医疗补助保险的有色人种妇女实现绝育的可能性较小 有医疗保险的女性绝育不履行使妇女处于随后的意外风险高 怀孕的解释间隔时间短，并对孕产妇和婴儿健康的相关风险。那里 是公平的产后绝育的重大政策障碍，影响那些有医疗补助的人， 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- 1976年，由于对有色人种和低收入妇女的强迫绝育， 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 需要在保护弱势群体与不平等的意外后果之间取得平衡， 灭菌完成。此外，还注意到患者、提供者和医院层面的障碍， 尽管这些障碍相互作用的程度尚不清楚。主张完全消除 医疗补助绝育过程，然后，忽视了复杂的历史以及额外的，非政策 公平产后绝育的障碍。本提案的总体目标是确定离散 不同分析层次的障碍（患者、提供者、医院和政策）。核心假设是， 单独和共同的障碍分层导致产后绝育实现的差异 医疗补助人群。该项目的基本原理是，识别和理解潜在的障碍 是消除产后绝育差异的关键下一步。以强为导 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）建立医疗补助保险和绝育实现之间的关联模型 在调整合并的多机构样本（患者和政策）中的临床和人口统计学差异后， 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影响（针对医院和政策一级的障碍）。 这种方法是创新的，因为它通过将重点从学习上转移而脱离了现状 这些障碍包括单独的障碍和识别和评估各种障碍。这一贡献 将是重要的，因为它预计将告知以证据为基础和以患者为中心的卫生政策， 消除由于绝育未实现和由此产生的健康差距，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.