Multi-level factors affecting postpartum sterilization

标题：深思熟虑的生物伦理学，以告知围绕医疗补助绝育等待期的政策 摘要 大约30-50%的医疗补助患者在分娩后要求绝育避孕，但没有 做他们想要的手术。在满足绝育要求方面存在的差异与联邦政府有关。 医疗补助绝育政策，不适用于有私人保险的病人。这项政策需要30- 从签署具体同意书到可以进行绝育手术之间的一天等待期。然而，在这方面， 医疗补助绝育政策中30天等待期的生物伦理学考虑是 复杂.虽然有数据表明，该政策阻碍了人们获得理想的护理， 众所周知，当今需要的历史基础的政策的开端-以防止 胁迫孕产妇健康方面持续存在的差距归因于结构性种族主义、隐性偏见和社会歧视。 健康因素的决定因素，但很少有人知道关于如何实现这一点的病人的观点 确保医疗补助覆盖的妇女与其他保险的妇女一样， 她们关于绝育的自主决定得到尊重，同时确保她们不受胁迫或不适当的 压力-因此代表着一个关键的知识差距。而我们的母体R 01（1 R 01 HD 098127 H） 描述了公平的产后绝育的多层次障碍-本行政补充文件的 总体目标，将这些努力扩展到更好地了解患者本身的目标和优先事项 关于修改30天医疗补助绝育等待期。这一目标直接响应 NOSI，因为它具有对生物伦理学相关政策施加影响并提供证据的巨大潜力 为未来的政策方向提供信息;解决了一个持续存在的、令人信服的关于生殖健康的生物伦理学问题。 决策;并使社区作为研究的伙伴参与，并在这样做的过程中，维持和增加 社区合作开展生物伦理学研究的能力。利用我们在生物伦理学方面的专业知识和 社区学术伙伴关系，我们有基础设施，以迅速实现我们的目标。我们的目标是（1） 让有医疗补助保险的患者和夫妇参与关于30天 医疗补助绝育等待期进行审议演习与10组9-15组 密歇根州有怀孕经历的医疗补助注册者，其中一些包括夫妇。2)准备 初步政策简报，描述患者作为潜在医疗补助利益相关者的观点 * 修订绝育政策，为今后更广泛的社区参与性研究奠定基础， 在其他具有不同生殖健康政策的国家开展审议性生物伦理学工作， 联邦卫生政策改变。我们的研究结果将提供一个重要的框架， 以及以患者为中心的政策建议，以减轻围绕绝育的差异。

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.