Obstetricians' experiences caring for pregnant people experiencing incarceration who request permanent contraception

Given the historic and contemporary legacy of non-consensual sterilization and concern for coercion among incarcerated populations, routine provision of permanent contraception is discouraged. However, as with non-incarcerated patients, the 58,000 pregnant people who are incarcerated every year have diverse contraceptive goals, including the desire for permanent contraception. Clinicians caring for incarcerated patients must navigate this ethical tension. The perspectives and experiences of obstetricians who perform surgical permanent contraception procedures and who care for incarcerated patients requesting permanent contraception are unknown.

To explore the knowledge, beliefs, and experiences of obstetricians who provide care to pregnant patients experiencing incarceration who request postpartum permanent contraception.

Qualitative study of obstetricians with experience providing care to pregnant people seeking postpartum permanent contraception during incarceration in North Carolina.

Semi-structured interviews were conducted via Zoom or phone and transcribed, coded, and analyzed using a Framework Analysis methodology. Interviews explored domains of carceral policy, contraceptive decision-making and counseling, hospital availability of permanent contraception, and the Medicaid sterilization policy.

Eight obstetricians were interviewed. The major themes identified from the interviews were physician support for patient autonomy, physician desire for certainty, and the implications of incarceration on the universal challenges of providing postpartum permanent contraception. Physicians described striving to honor patient autonomy while working within a system that inherently limits liberties and imparts coercive influence. Physicians highlighted the struggle between treating all patients equally while acknowledging that pregnant people experiencing incarceration are a unique population that necessitates individualized care and considerations.

Physicians in our sample were supportive of requests for permanent contraception by pregnant people experiencing incarceration, when evidence of long-standing, autonomous decision-making was available, especially given the inherently coercive system in which these decisions are made. Our findings highlight the need for well-developed ethical guidance for physicians approaching the care of pregnant people experiencing incarceration who request permanent contraception.