Permanent Contraception: Ethical Issues and Considerations

Abstract

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.

A Decision Aid to Support Tubal Sterilization Decision-Making Among Pregnant Women

“… 15 While the intention of the mandatory 30-day waiting period was to ensure voluntary consent, it has inadvertently created a reproductive injustice: patients with Medicaid face numerous barriers to desired sterilization services, with nearly 50% of sterilization requests going unfulfilled. 37 Thus, numerous advocacy groups and practitioners, including the American Medical Association 38 and the American College of Obstetricians and Gynecologists, 39 , 40 have called for an overhaul of the Medicaid sterilization consent process to better meet the concurrent goals of ensuring informed consent and facilitating equitable access. Specific recommendations include a plain language and simplified consent form 41 as well as shortening or eliminating the mandatory waiting period.…”