Women's decision making for postpartum sterilization: does the Medicaid waiting period add value?

Currently, patients with federally funded insurance are required to sign a sterilization consent form (SCF) at least 30 days prior to sterilization, while privately insured patients are not. Although this policy was designed to protect the reproductive rights of vulnerable populations, it has had the unintended effect of creating a disparity in access to an effective contraceptive method. Our qualitative study aims to clarify the decision-making process surrounding postpartum sterilization and assess if patients perceive that the SCF adds value.

We interviewed 25 women who underwent postpartum sterilization procedures, 10 with private insurance and 15 with Medicaid. Topics discussed included reproductive history, reason for choosing sterilization, decision-making timeline and value of the SCF. We transcribed and coded the interviews and identified themes.

Participant responses indicated that decision-making processes were similar between patients with private insurance and those with Medicaid. For most women, the decision to undergo sterilization took place over the course of their reproductive lives. Participants expressed that nonbiased provider counseling, autonomy and information from other women were helpful to their decision making. Most subjects felt that the SCF might benefit other women but did not/would not affect their own decision making.

We did not find evidence suggesting that women with private insurance and women with Medicaid should be subjected to disparate restrictions on sterilization based on differences in decision-making processes. Characteristics of the decision-making process that women value, which in this population did not include the SCF, should be prioritized.

Given the potential negative consequences associated with the SCF including its disproportionate burden on women of low socioeconomic status, the lack of value added to the decision-making process for postpartum sterilization reported by our participants provides further evidence for reevaluation of the policy.