Multi-level factors affecting postpartum sterilization
影响产后绝育的多层次因素
基本信息
- 批准号:10455329
- 负责人:
- 金额:$ 34.23万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2020
- 资助国家:美国
- 起止时间:2020-05-05 至 2024-01-31
- 项目状态:已结题
- 来源:
- 关键词:AchievementAdvocateAffectAlabamaAttitudeBeliefBirthCaliforniaClinicalColorComplexConsent FormsContraceptive UsageContraceptive methodsDataDatabasesDiscipline of obstetricsEnsureEquilibriumExcisionFemale SterilizationGeographyGoalsHealth PolicyHigh Risk WomanHospitalsIndividualInfant HealthInstitutionInsuranceInterviewKnowledgeLeadLiteratureLow Birth Weight InfantMaternal HealthMedicaidMedical centerMethodsMissionModelingOperating RoomsOutcomePaternalismPatientsPatternPhysiciansPoliciesPolicy DevelopmentsPopulationPostpartum PeriodPostpartum WomenPre-EclampsiaPregnancy IntervalPremature BirthPrenatal carePrivatizationProcessProviderProxyPublic HealthRecommendationRecording of previous eventsReproductive HealthResearchRiskRouteSamplingSan FranciscoSiteState HospitalsSterilizationStructureSurveysTestingUnited StatesUnited States National Institutes of HealthUniversitiesVulnerable PopulationsWomanWorkclinical carecohortdesigndisparity reductioneffective interventionevidence baseexperiencefederal policyhealth disparityimprovedindividual patientinfant morbidity/mortalityinnovationinsightlow socioeconomic statusmaternal morbiditypatient orientedpatient populationpostpartum contraceptionpreferencepregnantprovider factorssocialunintended pregnancy
项目摘要
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.
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
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
数据更新时间:{{ journalArticles.updateTime }}
{{
item.title }}
{{ item.translation_title }}
- DOI:
{{ item.doi }} - 发表时间:
{{ item.publish_year }} - 期刊:
- 影响因子:{{ item.factor }}
- 作者:
{{ item.authors }} - 通讯作者:
{{ item.author }}
数据更新时间:{{ journalArticles.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ monograph.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ sciAawards.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ conferencePapers.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ patent.updateTime }}
Kavita Shah Arora其他文献
Improving Rates of Post-Essure Hysterosalpingography in an Urban Population Using Electronic Tracking Reminders
- DOI:
10.1016/j.jmig.2016.10.019 - 发表时间:
2017-02-01 - 期刊:
- 影响因子:
- 作者:
Yu-Han Virginia Hu;Kavita Shah Arora - 通讯作者:
Kavita Shah Arora
Correction to: Changes in Rates of Inpatient Postpartum Long‑Acting Reversible Contraception and Sterilization in the USA, 2012–2016
- DOI:
10.1007/s10995-021-03202-7 - 发表时间:
2021-08-25 - 期刊:
- 影响因子:1.700
- 作者:
David Sheyn;Kavita Shah Arora - 通讯作者:
Kavita Shah Arora
Uncertainty in Postpartum Permanent Contraception Decision-Making: Physician and Patient Perspectives
- DOI:
10.1016/j.whi.2024.06.005 - 发表时间:
2024-11-01 - 期刊:
- 影响因子:
- 作者:
Brooke W. Bullington;Madeline Thornton;Madison Lyleroehr;Kristen A. Berg;Kari White;Margaret Boozer;Tania Serna;Emily S. Miller;Jennifer L. Bailit;Kavita Shah Arora - 通讯作者:
Kavita Shah Arora
Consistency of antenatal contraceptive plan and postpartum fulfillment in patients with opioid use disorder
- DOI:
10.1007/s00737-023-01388-z - 发表时间:
2023-11-03 - 期刊:
- 影响因子:2.700
- 作者:
Tani Malhotra;Kathryn Thomas;David Ngendahimana;Kelly S Gibson;Kavita Shah Arora - 通讯作者:
Kavita Shah Arora
Transfer of embryos affected by monogenic conditions: an Ethics Committee Opinion
单基因疾病影响的胚胎移植:伦理委员会的意见
- DOI:
10.1016/j.fertnstert.2025.02.001 - 发表时间:
2025-05-01 - 期刊:
- 影响因子:7.000
- 作者:
Sigal Klipstein;Sina Abhari;Deborah Anderson;Aishwarya Arjunan;Kavita Shah Arora;Tolulope Bakare;Zeki Beyhan;Katherine Cameron;Susan Crockin;Ruth Farrell;Catherine Hammack-Aviran;Mandy Katz-Jaffe;Jennifer Kawwass;Louise King;Edward Martinez;Joshua Morris;Torie Comeaux Plowden;Robert Rebar;Chevis N. Shannon;Hugh Taylor;Julianne Zweifel - 通讯作者:
Julianne Zweifel
Kavita Shah Arora的其他文献
{{
item.title }}
{{ item.translation_title }}
- DOI:
{{ item.doi }} - 发表时间:
{{ item.publish_year }} - 期刊:
- 影响因子:{{ item.factor }}
- 作者:
{{ item.authors }} - 通讯作者:
{{ item.author }}
{{ truncateString('Kavita Shah Arora', 18)}}的其他基金
Multi-level factors affecting postpartum sterilization
影响产后绝育的多层次因素
- 批准号:
10792263 - 财政年份:2023
- 资助金额:
$ 34.23万 - 项目类别:
Multi-level factors affecting postpartum sterilization
影响产后绝育的多层次因素
- 批准号:
10159298 - 财政年份:2020
- 资助金额:
$ 34.23万 - 项目类别:
Multi-level factors affecting postpartum sterilization
影响产后绝育的多层次因素
- 批准号:
10557980 - 财政年份:2020
- 资助金额:
$ 34.23万 - 项目类别:
Multi-level factors affecting postpartum sterilization
影响产后绝育的多层次因素
- 批准号:
10557170 - 财政年份:2020
- 资助金额:
$ 34.23万 - 项目类别:
Multi-level factors affecting postpartum sterilization
影响产后绝育的多层次因素
- 批准号:
10360685 - 财政年份:2020
- 资助金额:
$ 34.23万 - 项目类别:
Multi-level factors affecting postpartum sterilization
影响产后绝育的多层次因素
- 批准号:
9883068 - 财政年份:2020
- 资助金额:
$ 34.23万 - 项目类别:
相似海外基金
Optimizing Health and Well-Being of Diverse Mothers with IDD and Their Infants During the Perinatal Period: A Virtual Advocate Tool for Data-Driven Supports
优化患有 IDD 的不同母亲及其婴儿在围产期的健康和福祉:用于数据驱动支持的虚拟倡导工具
- 批准号:
10760051 - 财政年份:2023
- 资助金额:
$ 34.23万 - 项目类别:
POSE: Phase II: Advocate Led Long-term Gameplan for Open OnDemand (ALL GOOD)
POSE:第二阶段:倡导者主导 Open OnDemand 的长期游戏计划(一切顺利)
- 批准号:
2303692 - 财政年份:2023
- 资助金额:
$ 34.23万 - 项目类别:
Standard Grant
Capitalising on our differences: A gathering to better understand and advocate for Early Career Health Researchers in Canada
利用我们的差异:更好地理解和倡导加拿大早期职业健康研究人员的聚会
- 批准号:
468168 - 财政年份:2022
- 资助金额:
$ 34.23万 - 项目类别:
Miscellaneous Programs
Addressing social adversity to improve outcomes among children undergoing liver transplant: the role for a health advocate on the transplant team
解决社会逆境以改善接受肝移植的儿童的预后:移植团队中健康倡导者的作用
- 批准号:
10427960 - 财政年份:2022
- 资助金额:
$ 34.23万 - 项目类别:
Evaluating an ACEs-Targeting Advocate Model of a Substance Use Prevention Program
评估药物使用预防计划的针对 ACE 的倡导者模型
- 批准号:
10577074 - 财政年份:2022
- 资助金额:
$ 34.23万 - 项目类别:
The Art of Creation: Using Art-Based Knowledge Translation to Promote and Advocate for a Healthy Start to Life
创造的艺术:利用基于艺术的知识转化来促进和倡导健康的生命开端
- 批准号:
486588 - 财政年份:2022
- 资助金额:
$ 34.23万 - 项目类别:
Studentship Programs
When I am Old, I shall Wear Purple Nail Varnish: Utilising performance art to construct queer spaces that celebrate and advocate for ageing bodies
当我老了,我要涂紫色指甲油:利用行为艺术构建酷儿空间,庆祝和倡导衰老的身体
- 批准号:
2760091 - 财政年份:2022
- 资助金额:
$ 34.23万 - 项目类别:
Studentship
Addressing social adversity to improve outcomes among children undergoing liver transplant: the role for a health advocate on the transplant team
解决社会逆境以改善接受肝移植的儿童的预后:移植团队中健康倡导者的作用
- 批准号:
10621188 - 财政年份:2022
- 资助金额:
$ 34.23万 - 项目类别:
Techquity by FAITH!: A cluster randomized controlled trial to assess the efficacy of a community-informed, cardiovascular health promotion mobile hlth intervention with digital health advocate support
Techquity by FAITH!:一项整群随机对照试验,旨在评估社区知情、心血管健康促进移动 hlth 干预措施在数字健康倡导者支持下的效果
- 批准号:
10891016 - 财政年份:2021
- 资助金额:
$ 34.23万 - 项目类别:
CMV responses in autoantibody positive subjects advocate antiviral treatments for prevention of T1D
自身抗体阳性受试者的 CMV 反应主张抗病毒治疗以预防 T1D
- 批准号:
10230365 - 财政年份:2020
- 资助金额:
$ 34.23万 - 项目类别: