Multi-level factors affecting postpartum sterilization

影响产后绝育的多层次因素

• 批准号: 10792263
• 负责人: Kavita Shah Arora
• 金额: $ 19.67万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-07 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10792263
• 关键词: Address; Administrative Supplement; Affect; Attitude; Bioethics; Caring; Clinical; Coercion; Communities; Complex; Consent Forms; Contraceptive methods; Couples; Data; Decision Making; Demographic Factors; Disparity; Ensure; Equilibrium; Equity; Ethics; Exercise; Freedom; Future; Goals; Health Policy; Hospitals; Infrastructure; Insurance; Involuntary Sterilization; Justice; Knowledge; Length; Light; Link; Low income; Maternal Health; Medicaid; Methodology; Methods; Michigan; Modeling; Operative Surgical Procedures; Parents; Participant; Patients; Persons; Policies; Population; Positioning Attribute; Postpartum Period; Postpartum Sterility; Pregnancy; Privatization; Procedures; Public Health; Published Comment; Recording of previous events; Reproductive Health; Research; Sterilization; Structural Racism; United States; United States National Institutes of Health; Visit; Woman; Work; clinical care; community based participatory research; community engagement; disparity reduction; evidence base; experience; federal policy; health disparity; health disparity populations; implicit bias; improved; infant morbidity/mortality; insight; low socioeconomic status; maternal morbidity; maternal risk; multidisciplinary; parent grant; patient engagement; patient oriented; patient population; policy recommendation; pregnant; pressure; reproductive; response; social health determinants; success; unintended pregnancy; women of color

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.

标题：审议生物伦理学，以告知围绕医疗补助灭菌等待期的政策 抽象的 大约30-50％的医疗补助患者要求避孕后，分娩后不进行灭菌 获得所需的手术。实现灭菌请求的差异已与联邦 医疗补助灭菌政策不适用于有私人保险的患者。该政策需要30- 在签署特定同意书以及何时发生灭菌之间的日期等待期。然而， 医疗补助灭菌政策中30天等待期的生物伦理考虑是 复杂的。虽然存在有关该政策提出的自主性护理障碍的数据，但较少的是 关于当今对政策开始的历史依据的需求已知 - 防止 强迫。物物健康中持续的分布归因于结构性种族主义，隐性偏见和社会 确定健康因素，但关于如何实现这一目标的患者观点知之甚少 在确保医疗补助覆盖的妇女（例如拥有其他保险的妇女）之间的必要平衡 他们尊重灭菌的自主决定，同时确保免于胁迫或撤消 压力 - 因此代表关键的知识差距。而我们的父母R01（1R01HD098127H） 表征公平产后灭菌的多层次障碍 - 这种行政补充 总体目标，扩展了这些努力，以更好地了解患者本身的目标和优先事项 考虑修订30天的医疗补助灭菌等待期。这个目标直接响应 NOSI具有对与生物伦理相关的政策产生影响并提供证据的巨大潜力 告知未来政策指示；解决有关复制性的持久，引人入胜的生物伦理问题 决策;并以合作伙伴的身份与社区参与研究，并在这样做的过程中维持和添加 社区合作生物伦理学研究的能力。利用我们在生物伦理学和长期存在方面的专业知识 社区学术伙伴关系，我们拥有迅速实现我们目标的基础设施。我们的目标是1） 让患者和夫妻在医疗补助保险中与有关30天的知情审议 医疗补助灭菌等待期通过与10组9-15组进行审议练习 医疗补助在密歇根州招收，他们经历了怀孕，其中一些包括夫妇。 2）准备 初步政策摘要将患者视为潜在医疗补助的利益相关者的观点 灭菌政策修订为未来，更广泛的社区参与研究奠定了基础， 审议性生物伦理学在其他州具有独特的生殖健康政策以及最终的生殖健康政策的工作 联邦卫生政策变更。我们的结果将为长期逾期，基于证据的， 以及以患者为中心的政策建议，以减轻围绕灭菌的分布。

项目成果

Ethics of a Mandatory Waiting Period for Female Sterilization.

• DOI: 10.1002/hast.1405
• 发表时间: 2022-07
• 期刊: HASTINGS CENTER REPORT
• 影响因子: 3.3
• 作者: Amalraj, Jessica;Arora, Kavita Shah
• 通讯作者: Arora, Kavita Shah

Reproductive justice in post-Roe America: Impact of restricted abortion access on patients seeking permanent contraception.

后罗伊时代美国的生殖正义：限制堕胎对寻求永久避孕的患者的影响。

• DOI: 10.1016/j.contraception.2023.109995
• 发表时间: 2023
• 期刊: Contraception
• 影响因子: 2.9
• 作者: Thornton,Madeline;Arora,KavitaShah
• 通讯作者: Arora,KavitaShah

Characteristics of Patients Requiring Surgical Removal of Subdermal Contraceptive Implants: A Case-Control Study.

• DOI: 10.2147/oajc.s368250
• 发表时间: 2022
• 期刊: Open access journal of contraception
• 影响因子: 2.1