Trends and Disparities in Postpartum Sterilization after Cesarean Section, 2000 through 2008

Garcia, Ginny; Richardson, Dawn M.; Gonzales, Kelly; Cuevas, Adolfo G.

doi:10.1016/j.whi.2015.07.006

Cited by 18 publications

(11 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Other recent studies suggest that female sterilization varies by payer, but LARC utilization does not. 9,18–20, 24 Our findings could represent patient preferences; many Medicaid beneficiaries lose coverage 60 days post-delivery and may be particularly motivated to initiate highly effective contraception before hospital discharge. Alternatively, findings could result from biased counseling and care, with clinicians disproportionately promoting LARC and sterilization to women with non-private insurance.…”

Section: Discussionmentioning

confidence: 90%

Inpatient Postpartum Long-Acting Reversible Contraception and Sterilization in the United States, 2008–2013

Moniz

Chang

Heisler

et al. 2017

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

Objective To measure rates of long-acting reversible contraception (LARC), including intrauterine devices and contraceptive implants, and tubal sterilization during delivery hospitalizations, and correlates of their use. Methods This retrospective cohort study used the 2008–2013 National Inpatient Sample, a publicly-available all-payer database. We identified delivery hospitalizations with the International Classification of Diseases, 9th Revision, Clinical Modification codes for intrauterine device insertion, contraceptive implant insertion, and tubal sterilization. We used weighted multivariable logistic regression to examine associations between predictors, (age, delivery mode, medical comorbidity, payer, hospital type, geographic region, and year), and likelihood of LARC and sterilization, and to compare characteristics of LARC and sterilization users. Results Our sample included 4,691,683 discharges, representing 22,667,204 delivery hospitalizations. LARC insertion increased from 1.86 per 10,000 deliveries (2008–2009) to 13.5 per 10,000 deliveries (2012–2013; p<0.001); tubal sterilization remained stable (711 to 683 per 10,000 deliveries; p=0.24). In multivariable analysis adjusting for all predictors, compared to neither LARC nor sterilization, LARC use was highest among women with medical comorbidity (count per 10,000 deliveries: 15.04, standard error [SE]= 2.11; adjusted odds ratio [aOR]=1.92; 95% confidence interval 1.72–2.13), non-private payer (13.50, SE=2.14; aOR=5.23; 3.82–7.16), and at urban teaching hospitals (14.92, SE=2.25; aOR=20.85, 12.73–34.15). Sterilization was least likely among women age ≤24 years (251.04, SE=4.88; aOR=0.12, 0.12–0.13, versus ≥35 years) and most likely with cesarean delivery (1568.74, SE=20.81; aOR=6.25, 5.88–6.63). Comparing only LARC and sterilization users, LARC users tended to have non-private insurance (84.95% vs. 57.17%, aOR=1.90; 1.38–2.63) and deliver at urban teaching hospitals (94.65% vs. 45.47%, aOR=38.39; 23.52–62.64) in later study years (2012–2013; 55.72% vs. 32.18%, aOR=8.26; 4.42–15.44, versus 2008–2009). Conclusion LARC insertion increased from 1.86 to 13.5 per 10,000 deliveries but remained less than 2% of the sterilization rate. Inpatient postpartum LARC insertion is more likely among sicker, poorer women delivering at urban teaching hospitals.

show abstract

Section: Discussionmentioning

confidence: 90%

Inpatient Postpartum Long-Acting Reversible Contraception and Sterilization in the United States, 2008–2013

Moniz

Chang

Heisler

et al. 2017

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

show abstract

“…Our analyses indicated that women receiving individual prenatal care were more likely to undergo permanent contraception. Women in the individual care group were older, higher parity, and more likely to have had a cesarean delivery or a medical condition that makes pregnancy or childbearing difficult, all of which are factors that influence decisions to undergo permanent contraception [31,32]. While we matched on observable characteristics, propensity score methods cannot fully compensate for underlying group differences.…”

Section: Discussionmentioning

confidence: 99%

The effects of CenteringPregnancy group prenatal care on postpartum visit attendance and contraception use

et al. 2020

View full text Add to dashboard Cite

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

show abstract

“…Variations in sterilization rates by demographic and clinical characteristics such as age, race, and parity are well documented in the literature. 18 , 19 For example, women of color request permanent contraception more often than white women. 20 Fulfilling a patient's autonomous preference for permanent contraception is important; however, recommendations toward these procedures based on demographic and clinical characteristics due to subconscious notions of what a “good mother” looks like are unethical.…”

Section: Permanent Contraceptionmentioning

confidence: 99%

Implicit Bias in Counseling for Permanent Contraception: Historical Context and Recommendations for Counseling

Kathawa

Arora

2020

Health Equity

View full text Add to dashboard Cite

We provide an overview of the causes, manifestations, and potential mitigating steps regarding implicit bias in counseling for permanent contraception. The historical context of sterilization abuses and the implications of these on society's notions of fitness for parenthood are reviewed. We present contemporary examples of contraceptive coercion and discuss the impact of implicit bias from health care providers. Finally, we outline steps for ensuring a patient-centered shared decision-making ethical approach to permanent contraceptive counseling.

show abstract

Trends and Disparities in Postpartum Sterilization after Cesarean Section, 2000 through 2008

Cited by 18 publications

References 18 publications

Inpatient Postpartum Long-Acting Reversible Contraception and Sterilization in the United States, 2008–2013

Inpatient Postpartum Long-Acting Reversible Contraception and Sterilization in the United States, 2008–2013

The effects of CenteringPregnancy group prenatal care on postpartum visit attendance and contraception use

Implicit Bias in Counseling for Permanent Contraception: Historical Context and Recommendations for Counseling

Contact Info

Product

Resources

About