Disparities in postpartum sterilization found based on Medicaid insurance

According to a recent study published in American Journal of Obstetrics and Gynecology.

Food to take home

1. Medicaid patients face significant barriers to accessing postpartum sterilization, as revealed by a recent study in the American Journal of Obstetrics & Gynecology.
2. Although female sterilization is a common contraceptive choice, only half of patients seeking sterilization at their initial prenatal visit actually receive the procedure after delivery.
3. Medicaid patients are required to sign a Sterilization Consent Form (Title XIX) between 30 and 180 days before sterilization, creating an additional bureaucratic hurdle.
4. The study, based on a retrospective cohort analysis using data from the National Survey of Family Growth, found that Medicaid-insured individuals were 56 percent less likely to achieve postpartum sterilization than those with private insurance.
5. These findings underscore the urgent need for equitable access to reproductive health care regardless of insurance status, emphasizing the importance of implementing safeguards and decision-making tools for all patients.

Female sterilization is the most common contraceptive method among Americans ages 15 to 49. It is used by 27.7% of women, and half of the sterilizations are in patients after childbirth. However, many patients face barriers to accessing desired permanent contraception.

Of patients desiring sterilization at the initial prenatal visit, only half receive the procedure after birth. Barriers differ between private and public contraception patients, with Medicaid patients required to sign the Sterilization Consent Form (Title XIX) between 30 and 180 days prior to sterilization.

Approximately 43% of births in the US are covered by Medicaid, making identification of barriers to sterilization among Medicaid patients vital. To determine whether there was a relationship between insurance type and postpartum sterilization outcomes, the researchers conducted a retrospective cohort analysis.

Data were obtained from the National Survey of Family Growth (NSFG), which includes personal interviews discussing topics about family life. Participants from the 2013 to 2015 cohort were included in the analysis.

Participants included US individuals aged 15 to 44 years with a pregnancy that resulted in a live birth, Medicaid, or private insurance and reporting their last pregnancy as “unintended.” NSFG intended pregnancy answers include planned, untimed, unwanted, and more.

Exclusion criteria included never being pregnant, being pregnant during the study period, not having a live birth before the current pregnancy, and marking the last birth as planned, unplanned, or other. Patients with missing data on time of sterilization, body mass index (BMI) and mode of delivery were also excluded.

Completion of postpartum sterilization within 2 months of delivery was reported as the primary outcome of the analysis. The types of sterilization procedures are not distinguished by the NSFG.

Insurance status was the primary analysis exposure, reported as either Medicaid or private insurance. Respondents were assumed to be insured by Medicaid if they reported that Medicaid covered the index delivery. Those who cite private insurance as their primary payment method are considered privately insured.

The final analysis included 416 respondents with a mean age of 28.6 years. Of the participants, 55.1% were insured by Medicaid, 47.6% had a college degree or higher, 81.1% were born in the United States, and 89.6% spoke English. A BMI of 25 kg/m2 or more was reported by 68.3%, vaginal delivery by 68%, and term delivery by 86.6%.

Postpartum sterilization after unwanted birth was reported by 26.4% of patients. Different factors among these patients compared with those without postpartum sterilization included race and ethnicity, educational attainment, work history, religious affiliation, insurance status, parity, mode of delivery, and term.

After adjusting for variables, the odds of achieving postpartum sterilization were reduced by 56% among women with unwanted births who had Medicaid insurance. This relationship was maintained when the sterilization interval was extended from 2 to 3 months.

These results indicate an association between Medicaid insurance and reduced odds of achieving postpartum sterilization. The researchers concluded that safeguards such as postpartum contraceptive decision-making tools should be available to patients regardless of insurance status.

reference

Chesnokova A, Christensen T, Streaty T, et al. Medicaid, compared with private insurance, is associated with lower rates of sterilization among people with unwanted births. Am J Obstet Gynecol. 2024;230:347.e1-11. doi:10.1016/j.ajog.2023.10.039