AT ACOG 2017

SAN DIEGO (FRONTLINE MEDICAL NEWS) – Just over half of women who requested immediate postpartum sterilization received it in a prospective study of 334 women, with Medicaid paperwork serving as a barrier for many of the unfulfilled requests.

All of the women in the study delivered a baby and had requested immediate postpartum sterilization at some point before delivery, but just 173 women (52%) received the procedure, Taylor Hahn, MD, reported at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists. A total of 161 women (48%) did not receive the procedure.

The biggest barrier was completion of the Medicaid Consent to Sterilization form, which must be completed 30 days before the procedure is performed in a term pregnancy. Among women with unfulfilled requests for sterilization, an issue with the Medicaid consent form was the primary reason in 38% of cases.

Dr. Hahn, a fourth-year resident at Indiana University, Indianapolis, and her colleagues followed these women for up to 3 months post partum and found that, within the group that didn’t receive immediate postpartum sterilization, just six women – less than 10% – had received sterilization by the end of the follow-up period. The remaining women had chosen an alternative contraceptive method, were still awaiting interval sterilization, or did not receive postpartum care.

This is concerning, Dr. Hahn said, because Medicaid coverage for sterilization typically expires after 60 days post partum.

The consent form was developed in the 1970s to protect women in vulnerable populations from being coerced into sterilization, but Dr. Hahn said that, today, “it really has created such a barrier to these women getting the care that they want and desire.” She contrasted the Medicaid procedure with what is typical in private insurance, which generally covers immediate postpartum sterilization, and the decision can be made the same day.

The researchers reported having no relevant financial disclosures.

On Twitter @maryellenny


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