Medicaid and fulfillment of desired postpartum sterilization

Arora, Kavita Shah; Wilkinson, Barbara; Verbus, Emily; Montague, Mary‐Louise; Morris, Jane; Ascha, Mustafa; Mercer, Brian M.

doi:10.1016/j.contraception.2018.02.012

Cited by 43 publications

(49 citation statements)

References 21 publications

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“…Full study methodology has been published previously [ 10 ]. Briefly, we reviewed each patient’s linked outpatient and inpatient electronic medical record for demographic and clinical characteristics, postpartum contraceptive plan choice, and plan achievement for up to 365 days from date of delivery.…”

Section: Methodsmentioning

confidence: 99%

“…In fact, after controlling for patient and physician level factors, we have found that the disparity in sterilization completion between patients with Medicaid and private insurance desiring postpartum sterilization is no longer significant [ 7 ]. Rather, Medicaid insurance status may be simply a proxy for other demographic and clinical factors such as adequacy of prenatal care and route of delivery that account for the difference in sterilization for patients with private versus Medicaid insurance [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Association between neighborhood disadvantage and fulfillment of desired postpartum sterilization

et al. 2020

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Background Adequacy of prenatal care is associated with fulfillment of postpartum sterilization requests, though it is unclear whether this relationship is indicative of broader social and structural determinants of health or reflects the mandatory Medicaid waiting period required before sterilization can occur. We evaluated the relationship between neighborhood disadvantage (operationalized by the Area Deprivation Index; ADI) and the likelihood of undergoing postpartum sterilization. Methods Secondary analysis of a single-center retrospective cohort study examining 8654 postpartum patients from 2012 to 2014, of whom 1332 (15.4%) desired postpartum sterilization (as abstracted from the medical record at time of delivery hospitalization discharge) and for whom ADI could be calculated via geocoding their home address. We determined the association between ADI and sterilization completion, postpartum visit attendance, and subsequent pregnancy within 365 days of delivery via logistic regression and time to sterilization via Cox proportional hazards regression. Results Of the 1332 patients included in the analysis, patients living in more disadvantaged neighborhoods were more likely to be younger, more parous, delivered vaginally, Black, unmarried, not college educated, and insured via Medicaid. Compared to patients living in less disadvantaged areas, patients living in more disadvantaged areas were less likely to obtain sterilization (44.8% vs. 53.5%, OR 0.84, 95% CI 0.75–0.93), experienced greater delays in the time to sterilization (HR 1.23, 95% CI 1.06–1.44), were less likely to attend postpartum care (58.9% vs 68.9%, OR 0.86, CI 0.79–0.93), and were more likely to have a subsequent pregnancy within a year of delivery (15.1% vs 10.4%, OR 1.56, 95% CI 1.10–1.94). In insurance-stratified analysis, for patients with Medicaid, but not private insurance, as neighborhood disadvantage increased, the rate of postpartum sterilization decreased. The rate of subsequent pregnancy was positively associated with neighborhood disadvantage for both Medicaid as well as privately insured patients. Conclusion Living in an area with increased neighborhood disadvantage is associated with worse outcomes in terms of desired postpartum sterilization, especially for patients with Medicaid insurance. While revising the Medicaid sterilization policy is important, addressing social determinants of health may also play a powerful role in reducing inequities in fulfillment of postpartum sterilization.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between neighborhood disadvantage and fulfillment of desired postpartum sterilization

et al. 2020

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“…This is a secondary analysis of a subset of all 8,654 women who delivered at 20 weeks or beyond from January 1, 2012 through December 31, 2014. The primary analysis investigated the subset desiring postpartum sterilization [12]. For the purposes of this secondary analysis, the cohort was restricted to patients who indicated interest in LARC.…”

Section: Methodsmentioning

confidence: 99%

“…For the purposes of this secondary analysis, the cohort was restricted to patients who indicated interest in LARC. Full methodological details have been presented previously [12]. …”

Section: Methodsmentioning

confidence: 99%

Medicaid and receipt of interval postpartum long-acting reversible contraception

et al. 2019

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“…This policy was enacted in 1974 in response to the unacceptable instances of coerced sterilization of marginalized women [2]. However, in several studies with clinical samples, as few as half of women on Medicaid who desire a postpartum sterilization actually have the procedure, and greater than 20% who do not obtain their desired postpartum sterilization will have a subsequent unintended pregnancy within the following year [3][4][5][6][7]. These unplanned and unintended pregnancies disproportionally impact low-income women of color, adding to the morbidity and mortality of this population [2,8].…”

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confidence: 99%

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

2021

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Medicaid and fulfillment of desired postpartum sterilization

Abstract: Efforts are needed to ensure that Medicaid recipients who desire sterilization receive timely services.

Cited by 43 publications

References 21 publications

Association between neighborhood disadvantage and fulfillment of desired postpartum sterilization

Association between neighborhood disadvantage and fulfillment of desired postpartum sterilization

Medicaid and receipt of interval postpartum long-acting reversible contraception

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

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