Denying postpartum sterilization to women with Emergency Medicaid does not reduce hospital charges

Rodríguez, María I.; Edelman, Alison; Wallace, Nancy; Jensen, Jeffrey T.

doi:10.1016/j.contraception.2008.04.006

Cited by 16 publications

(19 citation statements)

References 7 publications

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“…In doing so, it underscores the economic implications of failing to increase sterilization access for low‐income and minority women, and raises questions regarding reproductive rights for these groups in the United States. Although female and male sterilization have higher up‐front costs than some of the most common methods, like birth control pills, these are ultimately more cost‐effective forms of contraception; and sterilization certainly costs less than an unwanted birth that could result from the failure to provide other methods . Finally, the inability of some women to undergo sterilization because of their immigrant status or income contradicts the long‐standing presumption that all women have the right to access their preferred method in order to achieve their reproductive goals…”

Section: Discussionmentioning

confidence: 99%

Frustrated Demand for Sterilization Among Low‐Income Latinas in El Paso, Texas

Potter¹,

White²,

Hopkins³

et al. 2012

Perspect Sexual Reproductive

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CONTEXT Sterilization is the most commonly used contraceptive in the United States, yet access to this method is limited for some. METHODS A 2006–2008 prospective study of low‐income pill users in El Paso, Texas, assessed unmet demand for sterilization among 801 women with at least one child. Multivariable logistic regression analysis identified characteristics associated with wanting sterilization. In 2010, at an 18‐month follow‐up, women who had wanted sterilization were recontacted; 120 semistructured and seven in‐depth interviews were conducted to assess motivations for undergoing the procedure and the barriers faced in trying to obtain it. RESULTS At baseline, 56% of women wanted no more children; at nine months, 65% wanted no more children, and of these, 72% wanted sterilization. Only five of the women interviewed at 18 months had undergone sterilization; two said their partners had obtained a vasectomy. Women who had not undergone sterilization were still strongly motivated to do so, mainly because they wanted no more children and were concerned about long‐term pill use. Among women's reasons for not having undergone sterilization after their last pregnancy were not having signed the Medicaid consent form in time and having been told that they were too young or there was no funding for the procedure. CONCLUSIONS Because access to a full range of contraceptive methods is limited for low‐income women, researchers and providers should not assume a woman's current method is her method of choice.

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Section: Discussionmentioning

confidence: 99%

Frustrated Demand for Sterilization Among Low‐Income Latinas in El Paso, Texas

Potter¹,

White²,

Hopkins³

et al. 2012

Perspect Sexual Reproductive

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“…Immigrants often face unique challenges accessing family planning services due to language and insurance coverage barriers 82. Further compounding these barriers, key legislative changes over the last decade have eroded immigrants’ access to health care.…”

Section: What Causes These Disparities In Family Planning Outcomes?mentioning

confidence: 99%

“…New immigrants are therefore only eligible for Emergency Medicaid, which covers acute illnesses and obstetrical deliveries, but does not cover preventative care such as contraception 83. These policies persist despite research that has shown that restricting access to contraception for immigrants is not cost effective 82, 83. Access to abortion is also limited for immigrants, for while some states use state funds to pay for abortion for low income women, most do not cover this service for non-citizens.…”

Section: What Causes These Disparities In Family Planning Outcomes?mentioning

confidence: 99%

Disparities in family planning

Dehlendorf¹,

Rodríguez²,

Levy³

et al. 2010

American Journal of Obstetrics and Gynecology

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320

242

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Prominent racial/ethnic and socioeconomic disparities in rates of unintended pregnancy, abortion, and unintended births exist in the United States. These disparities can contribute to the cycle of disadvantage experienced by specific demographic groups when women are unable to control their fertility as desired. In this review we consider three factors which contribute to disparities in family planning outcomes: patient preferences and behaviors, health care system factors, and provider related factors. Through addressing barriers to access to family planning services, including abortion and contraception, and working to ensure that all women receive patient-centered reproductive health care, health care providers and policy makers can substantially improve the ability of women from all racial/ethnic and socioeconomic backgrounds to make informed decisions about their fertility. KeywordsHealth disparities; Unintended Pregnancy; Family Planning; Contraception; Abortion The ability to plan if and when to have children is fundamental to the health of women and critical to the equal functioning of women in society. 1 In the United States, rates of unintended pregnancy (including both mistimed and undesired pregnancies), unintended birth, abortion, and adolescent pregnancy differ across racial, ethnic, and socioeconomic lines. These disparities have profound short-term and long-term consequences for women, their children, and society. Women with unintended pregnancies that are continued to term are more likely to receive inadequate or delayed prenatal care and have poorer health outcomes such as infant low birth weight, infant mortality, and maternal mortality and morbidity. 2-7 Children resulting from unplanned pregnancies have been found to be more likely to experience developmental delay and have poorer relationships with their mother.8 These risks of unintended birth are magnified in adolescent mothers, who experience increased risk for pregnancy complications and are often forced to make compromises in education and employment opportunities that

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“…The direct annual cost of unintended pregnancy to the health care system measures in billions of dollars (18). Because approximately one quarter of American women rely on female sterilization for contraception, making the availability of postpartum sterilization a priority is critical to reducing unintended pregnancy (6,10,17). Women in the postpartum period, with the added responsibility of caring for a newborn and varying insurance coverage,…”

Section: Women's Health Care Physiciansmentioning

confidence: 99%

“…This consent form must be signed at least 30 days before the procedure in order for a health care provider or health care facility to be reimbursed, and it remains valid for 180 days; if the consent form is not signed, the patient will receive a bill for services. If a woman covered by Medicaid does not receive her desired sterilization, she may not be eligible for coverage of any contraceptive method because Medicaid insurance often ends shortly after the birth (17). Although the original intent was to protect women from being sterilized against their will, the lack of a timely signature on the federal consent form now interferes with patient autonomy because it has become a common reason for lack of provision of desired postpartum sterilization (15,16,22,23).…”

Section: Consent Documentsmentioning

confidence: 99%

Committee Opinion No. 530

2012

Obstetrics & Gynecology

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Postpartum tubal sterilization is one of the safest and most effective methods of contraception. Women who desire this type of sterilization typically undergo thorough counseling and informed consent during prenatal care and reiterate their desire for postpartum sterilization at the time of their hospital admission. Not all women who desire postpartum sterilization actually undergo the surgical procedure, and women with unfulfilled requests for postpartum sterilization have a high rate of repeat pregnancy (approaching 50%) within the following year. Potentially correctable barriers to obtaining postpartum sterilization include patient and health care provider factors, as well as hospital and health care system issues. Given the consequences of a missed procedure and the limited time frame in which it may be performed, postpartum sterilization should be considered an urgent surgical procedure. In addition, women with government insurance face barriers to sterilization procedures based on cumbersome consent requirements. The differences in the requirements surrounding consent for sterilization procedures based on the type of insurance a patient has must be addressed in order to establish fair and equitable access to sterilization procedures for all women. Policies and procedures that remove barriers to and increase efficiency in performing postpartum sterilization could reduce cancellations of the procedure. Improving consistency in accomplishing desired postpartum sterilization is an important strategy to reduce high rates of unintended pregnancy in the United States.

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Denying postpartum sterilization to women with Emergency Medicaid does not reduce hospital charges

Cited by 16 publications

References 7 publications

Frustrated Demand for Sterilization Among Low‐Income Latinas in El Paso, Texas

Frustrated Demand for Sterilization Among Low‐Income Latinas in El Paso, Texas

Disparities in family planning

Committee Opinion No. 530

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