Population Research Center, University of Texas, Austin, TX, United States.
Population Research Center, University of Texas, Austin, TX, United States.
Contraception. 2021 Nov;104(5):518-523. doi: 10.1016/j.contraception.2021.05.009. Epub 2021 May 25.
To assess an alternative method for estimating demand for postpartum tubal ligation and evaluate reproductive trajectories of low-income women who did not obtain a desired procedure.
In a 2-year cohort study of 1700 publicly insured women who delivered at 8 hospitals in Texas, we identified those who had an unmet demand for tubal ligation prior to discharge from the hospital. We classified unmet demand as explicit or prompted based on survey questions that included a prompt regarding whether the respondent would like to have had a tubal ligation at the time of delivery. We assessed persistence of demand for permanent contraception, contraceptive use, and repeat pregnancies among all study participants who wanted but did not get a postpartum procedure.
Some 426 women desired a postpartum tubal ligation; 219 (51%) obtained one prior to discharge. Among the 207 participants with unmet demand, 62 (30%) expressed an explicit preference for the procedure, while 145 (70%) were identified from the prompt. Most with unmet demand still wanted permanent contraception 3 months after delivery (156/184), but only 23 had obtained interval procedures. By 18 months, the probability of a woman with unmet demand conceiving a pregnancy that she would likely carry to term was 12.5% (95% CI: 8.3%-18.5%).
The majority of unmet demand for postpartum tubal ligation among publicly insured women in Texas was uncovered via a prompt and would not have been evident in clinical records or from consent forms. Women unable to obtain a desired procedure had a substantial chance of pregnancy within 18 months after delivery.
Estimates of unmet demand for postpartum tubal ligation based on clinical records and consent forms likely underestimate desire for permanent contraception. Among low-income women in Texas, those with unmet demand for postpartum tubal ligation require improved access to effective contraception.
评估一种估计产后输卵管结扎需求的替代方法，并评估未获得所需手术的低收入妇女的生殖轨迹。
在一项为期 2 年的队列研究中，我们对德克萨斯州 8 家医院分娩的 1700 名有公共保险的女性进行了研究，确定了那些在出院前对输卵管结扎有未满足需求的女性。我们根据包括在分娩时是否希望进行输卵管结扎的提示的调查问题，将未满足的需求分为明确或提示。我们评估了所有想要但未获得产后手术的研究参与者对永久性避孕、避孕使用和重复怀孕的需求持续情况。
大约有 426 名女性希望进行产后输卵管结扎术；其中 219 名（51%）在出院前进行了手术。在 207 名有未满足需求的参与者中，62 名（30%）明确表示对该手术有偏好，而 145 名（70%）是从提示中确定的。大多数有未满足需求的人在分娩后 3 个月仍然想要永久性避孕（156/184），但只有 23 人获得了间隔手术。到 18 个月时，有未满足需求的女性怀孕的可能性为 12.5%（95%CI：8.3%-18.5%），且她可能会将其分娩。
德克萨斯州公共保险女性产后输卵管结扎术未满足需求的大多数是通过提示发现的，而在临床记录或同意书中不会发现。无法获得所需手术的女性在分娩后 18 个月内怀孕的可能性很大。
基于临床记录和同意书的产后输卵管结扎术未满足需求的估计数可能低估了对永久性避孕的需求。在德克萨斯州的低收入女性中，那些对产后输卵管结扎术有未满足需求的人需要更好地获得有效的避孕措施。
