Department of Social Medicine, Population, and Public Health, University of California, Riverside, Riverside, California; Inland Empire Health Plan, Rancho Cucamonga, California.
Department of Anthropology, University of California, Riverside, Riverside, California.
Womens Health Issues. 2020 Jul-Aug;30(4):260-267. doi: 10.1016/j.whi.2020.04.001. Epub 2020 May 11.
Sterilization is used by one-quarter of women in the United States for contraception and is a preferred birth control method among women with Medicaid. A history of coercive sterilization practices in the United States led to federal regulation of consent for Medicaid sterilization (including a mandated waiting period); this regulation can be a barrier to sterilization in Medicaid-insured women. This study aimed to develop a revised model of Medicaid sterilization policy grounded in the experiences of women impacted by current regulations.
This prospective study used in-depth interviews with 32 Medicaid-insured women who had obtained or tried to obtain sterilization to elicit recommendations regarding the Medicaid waiting period. Deliberative methods (a planning cell including 20 key community stakeholders) were used to evaluate women's recommendations and propose a revised policy for sterilization under Medicaid.
In-depth interview data demonstrated that women were often not made aware of the 30-day waiting period during informed consent before sterilization. Once informed about the policy, women described the Medicaid waiting period as "unfair," because it did not apply to all women. After deliberating women's recommendations to change the policy, key stakeholders came to a consensus around replacing the current waiting period policy with an improved consent process that would acknowledge the problematic history of coercive sterilization. Participants could not endorse removing the waiting period altogether without evidence that the health system had shifted away from coercive sterilization practices.
Using deliberative methods and the recommendations of women with Medicaid insurance, community stakeholders recommended developing a revised Medicaid sterilization consent policy that acknowledged the historical context of this procedure.
美国有四分之一的女性选择绝育来避孕，而在拥有医疗补助保险的女性中，绝育是首选的避孕方法。美国曾有过强制绝育的历史，这导致了联邦政府对医疗补助保险绝育（包括强制性等待期）的同意规定；这一规定可能成为医疗补助保险女性绝育的障碍。本研究旨在制定一个基于受当前法规影响的女性经历的修订后的医疗补助绝育政策模型。
本前瞻性研究使用深入访谈的方法，对 32 名获得或试图获得绝育的医疗补助保险女性进行了访谈，以征求她们对医疗补助等待期的建议。使用审议方法（包括 20 名主要社区利益相关者的规划小组）来评估女性的建议，并提出一项修订后的医疗补助绝育政策。
深入访谈数据表明，在绝育前的知情同意过程中，女性通常没有被告知 30 天的等待期。一旦了解了该政策，女性就将医疗补助等待期描述为“不公平”，因为它不适用于所有女性。在审议了女性改变政策的建议后，主要利益相关者就用一个承认强制绝育历史问题的改良同意程序取代现行等待期政策达成了共识。如果没有证据表明医疗体系已经不再采用强制绝育做法，参与者不能完全取消等待期。
通过使用审议方法和有医疗补助保险的女性的建议，社区利益相关者建议制定一项修订后的医疗补助绝育同意政策，承认该程序的历史背景。
