Multi-level factors affecting postpartum sterilization

摘要 孕妇或产后监禁者(PPEI)代表关键的U3人群，即 由于监狱内部的障碍而未得到充分研究，由于被排除在监狱之外而代表不足 将个人从研究中制度化，并未得到充分报告，因为他们在 被监禁的人。PPEI比NIH指定的健康差距的平均水平更高，并且 对于PPEI来说，在实现期望的产后绝育方面的差异尤其复杂，因为 影响健康结果的独特的多层次障碍。可悲的是，许多PPEI在没有 同意。因此，考虑到挑战，已经制定了政策和法律来限制PPEI获得绝育的机会 涉及获得真正的知情同意、可能的胁迫和监禁后后悔的风险。 然而，其他长期渴望获得产后绝育手术的人 在几个领域遇到障碍，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，需要细致入微的考虑来平衡这些 保护与不平等的意外后果。产后影响因素的调查分析 PPEI中的绝育欲望和成就感代表着一个关键的知识鸿沟。在此管理中 作为补充，我们寻求扩展母公司R01(1R01HD098127H)的努力，以实现总体目标 更好地了解希望产后绝育的PPEI的目标、经验和健康结果 以及他们的接送医疗队。这一目标与世界卫生组织的战略目标1.3直接相关 直接响应国家统计局在评估结构方面的具体研究兴趣领域 健康的决定因素，利用预防性保健和探索影响健康的跨部门污名 U3人群通过多维度的研究框架。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，我们有 基础设施，以迅速达到我们的目标。一以贯之，我们的目标是纵向评估 通过回顾提取孕妇的病历数据实现PPEI的避孕目标 2016-2021年入狱(n=850)，以了解产后绝育决策和 通过通过父母拨款创建的类似数据集与一般人口进行比较。2)确定 PPEI及其产科医生对产后绝育的态度、信念和做法 产后绝育PPEI患者的半结构化访谈与分析 接生产科医生(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的视角进行强有力的伦理分析。我们的结果将 为早就应该提出的、基于证据的政策建议提供一个关键框架，以改善临床护理； 促进公共卫生，缓解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.