Journal
REPRODUCTIVE SCIENCES
Volume 29, Issue 9, Pages 2620-2624Publisher
SPRINGER HEIDELBERG
DOI: 10.1007/s43032-022-00912-3
Keywords
Permanent contraception; Postpartum contraception; Health disparities
Categories
Funding
- National Institute of Child Health and Human Development (NICHD) [T32HD52468]
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) branch of the National Institutes of Health (NIH) [1R01HD098127]
- Carolina Population Center at University of North Carolina at Chapel Hill [P2CHD050924]
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Women of color face disparities in fulfilling desired postpartum permanent contraception. The disparities cannot be completely explained by policies, as racial and ethnic disparities persist within different insurance types. We propose addressing postpartum permanent contraception as a health disparities issue and highlight barriers at the patient, physician, hospital, and policy levels that interact and affect individuals differently.
Women of color experience marked disparities in fulfillment of desired postpartum permanent contraception. While many attribute the disparity to the required Medicaid sterilization consent form and 30-day waiting period established in response to forced and coerced sterilizations, the policy does not entirely explain the disparity; racial and ethnic disparities persist even within strata of insurance type. We therefore propose framing postpartum permanent contraception as a health disparities issue that requires multi-level interventions to address. Based on the literature, we identify discrete levels of barriers to postpartum permanent contraception fulfillment at the patient, physician, hospital, and policy levels that interact and compound within and between individual levels, affecting each individual patient differently. At the patient level, sociodemographic characteristics such as age, race and ethnicity, and parity impact desire for and fulfillment of permanent contraception. At the physician level, implicit bias and paternalistic counseling contribute to barriers in permanent contraception fulfillment. At the hospital level, Medicaid reimbursement, operating room availability, and religious affiliation influence fulfillment of permanent contraception. Lastly, at the policy level, the Medicaid consent form and waiting period pose a known barrier to fulfillment of desired postpartum permanent contraception. Unpacking each of these discrete barriers and untangling their collective impact is necessary to eliminate racial and ethnic disparities in permanent contraception fulfillment.
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