COVID-19 highlights the policy barriers and complexities of postpartum sterilization

Abstract

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Declines in contraceptive visits in the United States during the COVID-19 pandemic

“…Tubal ligation may have seen the largest declines because the service is typically provided in a hospital setting and requires an operating room and personal protective equipment. [17] . Some state Medicaid offices, hospitals, and clinicians determined that tubal ligation was an elective procedure that could be delayed while the pandemic was most severe [17] .…”

Improving assessment of demand for postpartum tubal ligation among publicly insured women in Texas

“…Moreover, we can only speculate as to what may have happened to unmet demand for tubal ligation following the onset of the COVID-19 pandemic. We suspect that it increased as a result of restrictions on elective procedures [24], and that the mandated extension of postpartum Medicaid coverage did little to offset this decline since so few interval procedures are performed in this population.…”

The impact of the COVID-19 pandemic on postpartum contraception planning

“…It is suspected that changes in the obstetrical service models indirectly deprioritized the most effective forms of postpartum contraception because sterilization requires a signed consent before birthhospitalization and postplacental intrauterine devices require consent before delivery. 4,5 Current state legislation requiring in-person signature to consent for federally funded sterilization remains a barrier. We found that fewer individuals left with top-tier contraception than with plan on admission, especially within the COVID cohort.…”