Sterilization as last resort in women with intellectual disabilities: protection or disservice?

Insogna, Iris G.; Fiester, Autumn

doi:10.1016/j.ajog.2014.10.016

Cited by 8 publications

(4 citation statements)

References 7 publications

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“…Up until the middle decades of the 20th century, compulsory sterilization programs existed in the United States. 3 Initially, these programs targeted intellectually disabled and mentally ill patients; however, many African American women and deaf, blind, epileptic, physically deformed, and low-income women were sterilized against their will. 4 One legacy of this history is persistent racial disparities in access to and use of contraception.…”

Section: Brief History Of Federal Legislationmentioning

confidence: 99%

Health care justice and its implications for current policy of a mandatory waiting period for elective tubal sterilization

Moaddab

McCullough

Chervenak

et al. 2015

American Journal of Obstetrics and Gynecology

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Tubal sterilization during the immediate postpartum period is 1 of the most common forms of contraception in the United States. This time of the procedure has the advantage of 1-time hospitalization, which results in ease and convenience for the woman. The US Collaborative Review of Sterilization Study indicates the high efficacy and effectiveness of postpartum tubal sterilization. Oral and written informed consent is the ethical and legal standard for the performance of elective tubal sterilization for permanent contraception for all patients, regardless of source of payment. Current health care policy and practice regarding elective tubal sterilization for Medicaid beneficiaries places a unique requirement on these patients and their obstetricians: a mandatory waiting period. This requirement originates in decades-old legislation, which we briefly describe. We then introduce the concept of health care justice in professional obstetric ethics and explain how it originates in the ethical concepts of medicine as a profession and of being a patient and its deontologic and consequentialist dimensions. We next identify the implications of health care justice for the current policy of a mandatory 30-day waiting period. We conclude that Medicaid policy allocates access to elective tubal sterilization differently, based on source of payment and gender, which violates health care justice in both its deontologic and consequentialist dimensions. Obstetricians should invoke health care justice in women's health care as the basis for advocacy for needed change in law and health policy, to eliminate health care injustice in women's access to elective tubal sterilization.

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Section: Brief History Of Federal Legislationmentioning

confidence: 99%

Health care justice and its implications for current policy of a mandatory waiting period for elective tubal sterilization

Moaddab

McCullough

Chervenak

et al. 2015

American Journal of Obstetrics and Gynecology

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show abstract

“…Some felt uncomfortable due to the forced sterilizations in the past. Nevertheless, sterilization could be the best option for some women with intellectual disability if they are unable to use other appropriate and safe contraceptive methods, as described in a previous study (Insogna & Fiester, 2015). However, if they were not able to give a clear consent, this became both an ethical dilemma and a legal barrier.…”

Section: Discussionmentioning

confidence: 94%

Ethical dilemmas and legal aspects in contraceptive counselling for women with intellectual disability—Focus group interviews among midwives in Sweden

Höglund

Larsson

2019

Research Intellect Disabil

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Background Few studies have explored ethical and legal issues in contraceptive counselling among women with intellectual disability (ID). This study aimed to gain a deeper understanding of these issues during midwifery contraceptive counselling. Method The present authors interviewed 19 midwives in five focus groups in Sweden 2016 – 2017 and analysed data with content analysis. Results The participants expressed that women with intellectual disability have equal right to relationships and sexual expressions, but feared exposure to sexual exploitation/abuse. They experienced ethical dilemmas related to principles of fairness and autonomy, but strived to provide assistance in spite of the women's cognitive impairment, presence of supporting persons and uncertainty of optimal counselling. Organizational support was insufficient. Conclusions The midwives experienced ambivalence, uncertainty and ethical dilemmas in their counselling. They were, however, aware of legal aspects and strived for the women's best interest, right to self‐determination and autonomous choices. The participants wanted better professional teamwork and support.

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“…21 However, some authors have argued that sterilization should still be considered as first-line in women with intellectual disability. 27,28 Rates of sterilization of women with intellectual disability remain higher than peers', and sterilization occurs at younger ages compared with peers. 29 No practice guidelines are available to pediatric neurologists regarding sterilization, contributing to the lack of clarity about the neurologist's role.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Neurologists’ Perspectives on Sexual and Reproductive Health Care for Adolescent and Young Adult Women With Epilepsy and Intellectual Disability

et al. 2021

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Objective: To explore perspectives of pediatric neurologists regarding sexual and reproductive health care for adolescent women with epilepsy (WWE) and intellectual disability. Methods: We interviewed pediatric neurologists regarding sexual and reproductive health for WWE with intellectual disability. We audio-recorded and transcribed interviews and conducted qualitative analysis. Results: 16 pediatric neurologists participated. Themes included the following: (1) Pediatric neurologists have differing perspectives about how intellectual disability affects WWE’s sexual and reproductive health needs, (2) pediatric neurologists provide sexual and reproductive health counseling variable in content and frequency to this population, (3) pediatric neurologists tend to recommend longer-term methods of contraception for this population, and (4) pediatric neurologists are asked to be involved in decision-making around sterilization, yet express ethico-legal reservations. Conclusion: Our findings suggest pediatric neurologists provide variable, often suboptimal, sexual and reproductive health care for WWE and intellectual disability. Themes reveal ethical concerns among neurologists about sexual and reproductive health practices including sterilization. More tailored clinical guidelines and provider training on sexual and reproductive health for this population may be beneficial.

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Sterilization as last resort in women with intellectual disabilities: protection or disservice?

Cited by 8 publications

References 7 publications

Health care justice and its implications for current policy of a mandatory waiting period for elective tubal sterilization

Health care justice and its implications for current policy of a mandatory waiting period for elective tubal sterilization

Ethical dilemmas and legal aspects in contraceptive counselling for women with intellectual disability—Focus group interviews among midwives in Sweden

Pediatric Neurologists’ Perspectives on Sexual and Reproductive Health Care for Adolescent and Young Adult Women With Epilepsy and Intellectual Disability

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