COVID-19 highlights the policy barriers and complexities of postpartum sterilization.
COVID-19 highlights the policy barriers and complexities of postpartum sterilization.
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DOI：
10.1016/j.contraception.2020.10.006
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发表时间：
2021-01
期刊：
影响因子：
2.9
通讯作者：
Shah Arora K
中科院分区：
文献类型：
--
作者：
Evans ML;Qasba N;Shah Arora K
产后期间绝育存在多种障碍。其中一个障碍，医疗补助第十九条绝育政策，要求公共保险的病人完成绝育同意书至少30天前，他们的预定程序。虽然这项政策是在1970年代制定的，以解决边缘化妇女被迫绝育的做法，但在当代，它已成为获得绝育手术的重大障碍。COVID-19大流行凸显了产后绝育的特殊复杂性，并为希望使用这种避孕方法的女性制造了额外的障碍。尽管进行产后绝育的时间有限，但一些医院管理人员、选举官员和州医疗补助办公室认为绝育是“可选择的”。此外，随着医疗保险和医疗补助服务中心（CMS）修订了远程医疗报销并鼓励其增加使用，它没有提供关于绝育同意书，口头同意书的使用以及绝育同意书有效期变更的指导。这使得各州可以制定可能不被CMS接受或认可的政策和推荐程序。这些障碍给试图进行产后绝育的患者带来了巨大的压力，特别是对低收入患者和有色人种妇女。CMS可以通过向州医疗补助办公室提供明确的指导、延长大流行前签署的绝育同意书的180天有效期以及允许有证人或电子签名的远程医疗口头同意来支持弱势群体的生殖健康。
Multiple barriers exist to sterilization in the postpartum period. One such barrier, the Medicaid Title XIX sterilization policy, requires publicly insured patients to complete a sterilization consent form at least 30 days prior to their scheduled procedure. While this policy was set in place in the 1970s to address the practice of coerced sterilization among marginalized women, it has served as a significant barrier to obtaining the procedure in the contemporary period. The COVID-19 pandemic has highlighted specific complexities surrounding postpartum sterilization and created additional barriers for women desiring this contraceptive method. Despite the time constraints to perform postpartum sterilization, some hospital administrators, elective officials, and state Medicaid offices deemed sterilization as “elective.” Additionally, as the Center for Medicare and Medicaid Services (CMS) has revised telemedicine reimbursement and encouraged its increased use, it has provided no guidance for the sterilization consent form, use of oral consents, and change to the sterilization consent form expiration date. This leaves individual states to create policies and recommended procedures that may not be accepted or recognized by CMS. These barriers put significant strain on patients attempting to obtain postpartum sterilization, specifically for patients with lower incomes and women of color. CMS can support reproductive health for vulnerable populations by providing clear guidance to state Medicaid offices, extending the 180-day expiration of a sterilization consent form signed prior to the pandemic, and allowing for telemedicine oral consents with witnesses or electronic signatures.
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影响因子：
2.9
作者：
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通讯作者：
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DOI：
10.1056/nejmp1313325
发表时间：
2014-01-09
期刊：
The New England journal of medicine
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作者：
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作者：
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