Multi-level factors affecting postpartum sterilization

摘要 怀孕或产后的人经历监禁（PPEI）代表了一个关键的U3人口， 由于监狱机构内部的障碍，研究不足， 制度化的个人从研究，并低估，因为他们构成了少数人在 被监禁的人。PPEI在NIH指定的健康差异中的代表性高于平均水平， 实现所需产后绝育的差异对于PPEI来说特别复杂，因为 影响健康结果的独特多层次障碍。不幸的是，许多PPEI已经灭菌， 同意.因此，鉴于面临的挑战，制定了政策和法律，限制PPEI接受绝育手术 涉及获得真正的知情同意，胁迫的可能性，以及监禁后后悔的风险。 然而，其他具有良好配方的、长期渴望获得产后绝育的人， 在几个领域遇到了障碍，包括恶劣的建筑环境，惩罚性的社会文化 环境和卫生保健系统。因此，需要进行细致的考虑，以平衡这些因素。 保护，但却产生了意想不到的不平等后果。产后影响因素调查 PPEI中的灭菌愿望和实现代表了关键的知识差距。本行政 补充，我们寻求从我们的母公司R 01（1 R 01 HD 098127 H）扩展努力，以满足总体目标 更好地了解PPEI的目标，经验和健康结果，希望产后绝育 以及他们的医疗团队这一目标与ORWH的战略目标1.3直接相关， 直接响应NOSI在评估结构方面的研究兴趣的具体领域 健康的决定因素，利用预防性保健，并探讨影响这一点的交叉污名 U3人口通过多维研究框架。利用我们在生物伦理学方面的广泛专业知识 和观察分析以及与北卡罗来纳州监狱系统的长期合作， 快速实现我们的目标。因此，我们的目标是：1）纵向评估 PPEI的避孕目标，通过回顾性提取的病历资料，从孕妇， 从2016年至2021年被监禁（n=850），以了解产后绝育决策， 通过父母补助金创建的类似数据集与普通人群进行比较。2)识别 PPEI及其产科医生对产后绝育的态度、信念和做法， 进行和分析PPEI要求产后绝育的半结构化访谈， 分娩产科医生（n=15对）; 3）制定符合伦理的产后绝育临床指南， PPEI通过从以患者为中心和健康公平透镜进行强大的伦理分析。我们的结果将 提供一个重要的框架，为长期拖延，以证据为基础的政策建议，以改善临床护理， 促进公共卫生，减少PPEI之间的差距。

ABSTRACT Pregnant or postpartum people experiencing incarceration (PPEI) represent a critical U3 population that is understudied due to barriers within carceral institutions, underrepresented due to the exclusion of institutionalized individuals from research, and underreported because they comprise a minority within incarcerated people. PPEI have higher than average representation of NIH-designated health disparities, and disparities in the fulfillment of desired postpartum sterilization are particularly complex for PPEI because of the unique multilevel barriers that influence health outcomes. Tragically, many PPEI have been sterilized without consent. Thus, policies and laws are in place to limit access of PPEI to sterilization given the challenges involved in obtaining true informed consent, potential of coercion, and risk of regret after incarceration. However, others with well-formulated, long-standing desires to obtain postpartum sterilization have encountered barriers over several domains, including harsh built environments, punitive sociocultural environments, and health care systems. Therefore, nuanced consideration is required to balance these protections with the unintended consequence of disparities. Investigation of factors that influence postpartum sterilization desire and fulfillment in PPEI represents a critical knowledge gap. In this Administrative Supplement, we seek to extend efforts from our parent R01 (1R01HD098127H) to meet an overall objective of better understanding the goals, experiences, and health outcomes of PPEI desiring postpartum sterilization and their delivering medical team. This objective is directly related to Strategic Goal 1.3 of the ORWH and directly responsive to the NOSI’s specific areas of research interest in terms of assessing structural determinants of health, utilizing preventive health care and exploring the intersectional stigma impacting this U3 population through a multidimensional research framework. Leveraging our extensive expertise in bioethics and observational analysis and long-term collaboration with the North Carolina state prison system, we have the infrastructure to rapidly meet our objective. Consistently, our Aims are to 1) Longitudinally assess the contraceptive goals of PPEI by retrospectively abstracting medical record data from pregnant women who were incarcerated from 2016-2021 (n=850) to understand postpartum sterilization decision-making and compare with the general population via a similar dataset created through the parent grant. 2) Identify the attitudes, beliefs, and practices of PPEI and their obstetricians regarding postpartum sterilization by performing and analyzing semi-structured interviews of PPEI requesting postpartum sterilization and their delivering obstetrician (n=15 dyads); 3) Develop clinical guidance for ethical postpartum sterilization for PPEI by performing robust ethical analysis from a patient-centered and health-equity lens. Our results will provide a critical framework for long overdue, evidence-based policy recommendations to improve clinical care, advance public health, and mitigate disparities among PPEI.