Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, United States; Department of Bioethics, Case Western Reserve University, Cleveland, OH, United States.
Department of Bioethics, Case Western Reserve University, Cleveland, OH, United States.
Contraception. 2020 Nov;102(5):376-382. doi: 10.1016/j.contraception.2020.08.009. Epub 2020 Aug 25.
To explore the attitudes and beliefs of obstetrician-gynecologists in the United States (US) regarding the Medicaid postpartum sterilization policy.
We recruited obstetrician-gynecologists practicing in ten geographically diverse US states for a qualitative study using the American College of Obstetricians and Gynecologists directory. We conducted semi-structured interviews via telephone, professionally transcribed, and analyzed using the constant comparative method and principles of grounded theory.
We interviewed thirty obstetrician-gynecologists (63.3% women, 76.7% non-subspecialized, and 53.3% academic setting). Participants largely described the consent form as unnecessary, paternalistic, an administrative hassle, a barrier to desired patient care, and associated with worse health outcomes. Views on the waiting period's utility and impact were mixed. Many participants felt the sterilization policy was discriminatory. However, some participants noted the policy's importance in terms of the historical basis, used the form as a counseling tool to remind patients of the permanence of sterilization, felt the policy prompted them to counsel regarding sterilization, and protected patients in contemporary medical practice.
Many physicians shared concerns about the ethics and clinical impact of the Medicaid sterilization policy. Future revisions to the Medicaid sterilization policy must balance prevention of coercion with reduction in barriers to those desiring sterilization in order to maximize reproductive autonomy.
Obstetrician-gynecologists are key stakeholders of the Medicaid sterilization policy. Obstetrician-gynecologists largely believe that revision to the Medicaid sterilization policy is warranted to balance reduction of external barriers to desired care with a process that enforces the need for counseling regarding contraception and reviewing patient preference for sterilization throughout pregnancy in order to minimize regret.
探讨美国妇产科医生对医疗补助产后绝育政策的态度和信念。
我们使用美国妇产科医师学会名录，招募了在美国十个地理上不同的州行医的妇产科医生，进行了一项定性研究。我们通过电话进行了半结构化访谈，专业转录，并使用常数比较法和扎根理论原则进行了分析。
我们采访了 30 名妇产科医生（63.3%为女性，76.7%为非专科医生，53.3%为学术环境）。参与者主要将同意书描述为不必要的、家长式的、行政上的麻烦、对所需患者护理的障碍，以及与更糟糕的健康结果有关。对等待期效用和影响的看法不一。许多参与者认为绝育政策具有歧视性。然而，一些参与者指出该政策在历史基础方面的重要性，将该表格用作咨询工具，以提醒患者绝育的永久性，认为该政策促使他们咨询绝育问题，并在当代医疗实践中保护患者。
许多医生对医疗补助绝育政策的伦理和临床影响表示担忧。未来修订医疗补助绝育政策必须在防止强制与减少那些希望绝育的人面临的障碍之间取得平衡，以最大限度地实现生殖自主权。
妇产科医生是医疗补助绝育政策的主要利益相关者。妇产科医生普遍认为，需要对医疗补助绝育政策进行修订，以平衡减少对所需护理的外部障碍与在整个怀孕期间强制进行避孕咨询和审查患者对绝育的偏好的过程，以尽量减少遗憾。
