Berg Kristen A, Bullington Brooke W, Gunzler Douglas D, Miller Emily S, Boozer Margaret, Serna Tania, Bailit Jennifer L, Arora Kavita S
Center for Health Care Research and Policy, Population Health Research Institute, MetroHealth Medical System, Cleveland, Ohio, USA.
School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Reprod Female Child Health. 2024 Mar;3(1). doi: 10.1002/rfc2.64. Epub 2023 Oct 30.
Research suggests neighbourhood socioeconomic vulnerability is negatively associated with women's likelihood of receiving adequate prenatal care and achieving desired postpartum permanent contraception. Receiving adequate prenatal care is linked to a greater likelihood of achieving desired permanent contraception, and access to such care may be critical for women with Medicaid insurance given that the federally mandated Medicaid sterilization consent form must be signed at least 30 days before the procedure. We examined whether adequacy of prenatal care mediates the relationship between neighbourhood socioeconomic position and postpartum permanent contraception fulfilment, and examined moderation of relationships by insurance type.
This secondary analysis of a retrospective cohort study examined 3012 Medicaid or privately insured individuals whose contraceptive plan at postpartum discharge was permanent contraception. Path analysis estimated relationships between neighbourhood socioeconomic position (economic hardship and inequality, financial strength and educational attainment) and permanent contraception fulfilment by hospital discharge, directly and indirectly through adequacy of prenatal care. Multigroup testing examined moderation by insurance type.
After adjusting for age, parity, weeks of gestation at delivery, mode of delivery, race, ethnicity, marital status and body mass index, having adequate prenatal care predicted achieving desired sterilization at discharge ( = 0.065, 95% confidence interval [CI]: 0.011, 0.117). Living in neighbourhoods with less economic hardship (indirect effect -0.007, 95% CI: -0.015, -0.001), less financial strength (indirect effect -0.016, 95% CI: -0.030, -0.002) and greater educational attainment (indirect effect 0.012, 95% CI: 0.002, 0.023) predicted adequate prenatal care, in turn predicting achievement of permanent contraception by discharge. Insurance status conditioned some of these relationships.
Contact with the healthcare system via prenatal care may be a mechanism by which neighbourhood socioeconomic disadvantage affects permanent contraception fulfilment, particularly for patients with Medicaid. To promote reproductive autonomy and healthcare equity, future inquiry and policy might closely examine how neighbourhood social and economic characteristics interact with Medicaid mandates.
研究表明，社区社会经济脆弱性与女性获得充分产前护理及实现期望的产后永久避孕的可能性呈负相关。获得充分的产前护理与实现期望的永久避孕的可能性更大相关，鉴于联邦政府规定的医疗补助绝育同意书必须在手术前至少30天签署，对于有医疗补助保险的女性来说，获得这种护理可能至关重要。我们研究了产前护理的充分性是否介导了社区社会经济地位与产后永久避孕实现之间的关系，并研究了保险类型对这些关系的调节作用。
这项对一项回顾性队列研究的二次分析，考察了3012名有医疗补助或私人保险的个体，他们产后出院时的避孕计划是永久避孕。路径分析估计了社区社会经济地位（经济困难与不平等、经济实力和教育程度）与出院时永久避孕实现之间的关系，直接以及通过产前护理的充分性间接进行估计。多组检验考察了保险类型的调节作用。
在调整了年龄、产次、分娩时的孕周、分娩方式、种族、民族、婚姻状况和体重指数后，获得充分的产前护理预示着出院时实现期望的绝育（β = 0.065，95%置信区间[CI]：0.011，0.117）。生活在经济困难较少（间接效应 -0.007，95% CI：-0.015，-0.001）、经济实力较弱（间接效应 -0.016，95% CI：-0.030，-0.002）和教育程度较高（间接效应0.012，95% CI：0.002，0.023）的社区，预示着能获得充分的产前护理，进而预示着出院时实现永久避孕。保险状况对其中一些关系有调节作用。
通过产前护理与医疗保健系统接触可能是社区社会经济劣势影响永久避孕实现的一种机制，特别是对于有医疗补助的患者。为了促进生殖自主权和医疗保健公平性，未来的研究和政策可能需要密切研究社区社会和经济特征如何与医疗补助规定相互作用。
