Multi-level factors affecting postpartum sterilization

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Title: Deliberative Bioethics to Inform Policy Surrounding the Medicaid Sterilization Waiting Period ABSTRACT Approximately 30-50% of patients with Medicaid requesting sterilization for contraception after delivery do not obtain their desired surgery. Disparities in fulfilment of sterilization requests have been linked to the federal Medicaid sterilization policy, which does not apply to patients with private insurance. This policy requires a 30- day waiting period between when a specific consent form is signed and when sterilization can occur. However, the bioethical considerations of the 30-day waiting period in the Medicaid sterilization policy are complex. While data exist regarding the barriers to autonomously-desired care presented by the policy, less is known regarding the present-day need for the historical basis for the policy’s inception – to protect against coercion. Ongoing disparities in maternal health are attributed to structural racism, implicit bias, and social determinants of health factors, but little is known regarding the patient viewpoint on how to achieve this necessary balance between ensuring women covered by Medicaid, like women with other insurance, have their autonomous decisions for sterilization respected, while ensuring freedom from coercion or undue pressure – thus representing a critical knowledge gap. While our parent R01 (1R01HD098127H) characterizes the multi-level barriers to equitable postpartum sterilization – this Administrative Supplement’s overall objective, extends these efforts to better understand the goals and priorities of patients themselves regarding revision of the 30-day Medicaid sterilization waiting period. This objective is directly responsive to the NOSI as it has tremendous potential to exert an influence on bioethics-related policy and provide evidence to inform future policy directions; addresses a persistent, compelling bioethics question about reproductive decision making; and engages communities as partners in the research and, in so doing, sustains and adds capacity for community-partnered bioethics research. Leveraging our expertise in bioethics and long-standing community-academic partnerships, we have the infrastructure to rapidly meet our objective. Our Aims are to 1) Engage patients and couples with Medicaid insurance in informed deliberations about the 30-day Medicaid sterilization waiting period by conducting deliberation exercises with 10 groups of 9-15 groups of Medicaid enrollees in Michigan who have experienced pregnancy and some that include couples. 2) Prepare preliminary policy briefs that describe the views of patients as the stakeholders in potential Medicaid sterilization policy revision to set the stage for future, broader community-based participatory research and deliberative bioethics work in other states with distinct reproductive health policies as well as for eventual, federal health policy change. Our results will provide a critical framework for long overdue, evidence-based, and patient-centered policy recommendations to mitigate disparities surrounding sterilization.