Attitudes and beliefs of obstetricians–gynecologists regarding Medicaid postpartum sterilization – A qualitative study

Arora, Kavita Shah; Ponsaran, Roselle; Morello, Laura; Katabi, Leila; Hansen, Rosemary T. Behmer; Zite, Nikki B.; White, Kari

doi:10.1016/j.contraception.2020.08.009

Cited by 12 publications

(9 citation statements)

References 30 publications

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“…[12][13][14] In a previous analysis, we assessed ob-gyns' attitudes, beliefs, and perspectives regarding postpartum sterilization. 15 In the present study, we describe the reasons ob-gyns do or do not follow the policy when the form may not be considered legally valid.…”

Section: Methodsmentioning

confidence: 99%

“…Full study methodology has been previously published. 15 Briefly, we conducted a qualitative study consisting of semi-structured, open-ended interviews with board-certified ob-gyns in 10 states. We selected two states within each of the four U.S. Census macro regions with the highest percentage of Medicaid-paid births in 2016 given the desire to select a geographically diverse sample of physicians who likely had familiarity with the Medicaid sterilization policy.…”

Section: Methodsmentioning

confidence: 99%

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Obstetrician–Gynecologists' Practices in Postpartum Sterilization Without a Valid Medicaid Consent Form

Arora

Ponsaran

Morello

et al. 2021

Obstetrics &Amp; Gynecology

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OBJECTIVE: To explore the practices of obstetrician–gynecologists (ob-gyns) in the United States surrounding postpartum sterilization when the Medicaid consent form was not valid. METHODS: Using the American College of Obstetricians and Gynecologists' online directory, we conducted a qualitative study where we recruited ob-gyns practicing in 10 geographically diverse U.S. states for a qualitative study using semi-structured interviews conducted by telephone. We analyzed interview transcripts using the constant comparative method and principles of grounded theory. RESULTS: Thirty ob-gyns (63% women, 77% nonsubspecialized, and 53% academic setting) were interviewed. Although most physicians stated that they did not perform sterilizations without a valid Medicaid sterilization form, others noted that they sometimes did due to a sense of ethical obligation toward their patient's health, being in a role with more authority or seniority, interpreting the emergency justification section of the form more broadly, or backdating the form. The physicians who said that they never went ahead without a signed form tended to work at large institutions and were concerned with losing funding and engaging in potentially illegal or fraudulent behavior. CONCLUSION: Physicians' varied behaviors related to providing postpartum sterilization without a valid Medicaid consent form demonstrate that the policy is in need of revision. Unclear terminology and ramifications of the Medicaid sterilization policy need to be addressed to ensure equitable care.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Obstetrician–Gynecologists' Practices in Postpartum Sterilization Without a Valid Medicaid Consent Form

Arora

Ponsaran

Morello

et al. 2021

Obstetrics &Amp; Gynecology

Self Cite

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“…The goal of permanent contraception counseling-and counseling more generally-is to adopt a patient-centered approach in which decision making is shared between a patient and their physician. However, when patients consider an irreversible decision such as permanent contraception, it is possible that a physician may feel a protective impulse to help a patient avoid regret (16). However, this beneficent desire to "protect" a patient from the consequences of a permanent decision is a form of medical paternalism and should be avoided because it overrides or undermines patient autonomy.…”

Section: Counseling Processmentioning

confidence: 99%

Permanent Contraception: Ethical Issues and Considerations

2024

Obstetrics &Amp; Gynecology

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Permanent contraception is the most used method of contraception among women aged 15–49 years and is one of the most straightforward surgical procedures an obstetrician–gynecologist can perform. At the same time, this therapeutic option is enormously complex when considered from a historical, sociological, or ethical perspective. This Committee Statement reviews ethical issues related to permanent contraception using a reproductive justice framework. Ethical counseling and shared decision making for permanent contraception should adopt a nonjudgmental, patient-centered approach, using up-to-date information about permanent contraception procedures and alternatives. Obstetrician–gynecologists should strive to avoid bringing into the clinical encounter biases around gender, race, age, and class that affect thoughts on who should or should not become a parent. Obstetrician–gynecologists should also ensure that permanent contraception requests reflect each patient's wishes, come from a desire to permanently end childbearing, and come from a preference for permanent contraception over all reversible methods as well as permanent contraception for the male partner. When difficulties in meeting a postpartum permanent contraception request are anticipated and permanent contraception is desired by the patient, transfer of care for the remainder of pregnancy should be offered. ACOG recognizes the right of all patients to unimpeded access to permanent contraception as a way of ensuring health equity, but it is unclear how to craft policies that protect from coercion but also do not create barriers to autonomously desired care. Determining the ethical balance between access and safeguards will require a collaborative interdisciplinary approach that involves a variety of stakeholders with varying perspectives.

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“…In addition, 1 in 11 obstetricians responding to this survey said they would decline to perform a sterilizing procedure if the patients’ husbands were not in agreement. In qualitative interviews performed with 30 obstetricians regarding the sterilization consent process, male physicians more commonly supported waiting periods than female physicians [21 ▪▪ ].…”

Section: Hospital-level Barriersmentioning

confidence: 99%

“…One recent study reported on interviews of 30 obstetrician-gynecologists practicing in diverse locations across the country, with respondents describing the consent form as unnecessary, paternalistic, and bureaucratic, with one provider remarking: ‘I really don’t think the form serves much of a purpose other than preventing patients from accessing contraception’ [21 ▪▪ ]. A survey of Medicaid representatives from 15 states identified similar themes, with respondents referring to the informed consent document as ‘antiquated’ and ‘not updated or changed in 40 years’ [29 ▪ ].…”

Section: Insurance-level Barriersmentioning

confidence: 99%

Postpartum permanent contraception: updates on policy and access

Henkel

Beshar²,

Goldthwaite³

2021

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewTo describe barriers to provision of postpartum permanent contraception at patient, hospital, and insurance levels. Recent findingsPermanent contraception remains the most commonly used form of contraception in the United States with the majority of procedures performed during birth-hospitalization. Many people live in regions with a high Catholic hospital market share where individual contraceptive plans may be refused based on religious doctrine. Obesity should not preclude an individual from receiving a postpartum tubal ligation as recent studies find that operative time is clinically similar with no increased risk of complications in obese compared with nonobese people. The largest barrier to provision of permanent contraception remains the federally mandated consent for sterilization for those with Medicaid insurance. State variation in enforcement of the Medicaid policy additionally contributes to unequal access and physician reimbursement. Although significant barriers exist in policy that will take time to improve, hospital-based interventions, such as listing postpartum tubal ligation as an 'urgent' procedure or scheduling interval laparoscopic salpingectomy prior to birth-hospitalization discharge can make a significant impact in actualization of desired permanent contraception for patients. SummaryUnfulfilled requests for permanent contraception result in higher rates of unintended pregnancies, loss of self-efficacy, and higher costs. Hospital and federal policy should protect vulnerable populations while not preventing provision of desired contraception.

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Attitudes and beliefs of obstetricians–gynecologists regarding Medicaid postpartum sterilization – A qualitative study

Cited by 12 publications

References 30 publications

Obstetrician–Gynecologists' Practices in Postpartum Sterilization Without a Valid Medicaid Consent Form

Obstetrician–Gynecologists' Practices in Postpartum Sterilization Without a Valid Medicaid Consent Form

Permanent Contraception: Ethical Issues and Considerations

Postpartum permanent contraception: updates on policy and access

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