Patients with Medicaid are less likely to undergo postpartum sterilization, according to a recent study published in the American Journal of Obstetrics & Gynecology.
Takeaways
- Medicaid-insured patients face significant barriers to accessing postpartum sterilization, as revealed by a recent study in the American Journal of Obstetrics & Gynecology.
- Despite female sterilization being a common contraceptive choice, only half of patients desiring sterilization at their initial prenatal visit actually receive the procedure after delivery.
- Medicaid patients are required to sign a Consent for Sterilization (Title XIX) Form between 30 and 180 days prior to sterilization, creating an additional bureaucratic hurdle.
- The study, based on a retrospective cohort analysis using data from the National Survey for Family Growth, found that Medicaid-insured individuals were 56% less likely to achieve postpartum sterilization compared to those with private insurance.
- These findings highlight the pressing need for equitable access to reproductive healthcare, irrespective of insurance status, emphasizing the importance of implementing safeguards and decision-making tools for all patients.
Female sterilization is the most common contraceptive method among US individuals aged 15 to 49 years. It is utilized by 27.7% of female individuals, with half of sterilizations occurring among postpartum patients. However, many patients face barriers to accessing desired permanent contraception.
Of patients desiring sterilization at the initial prenatal visit, only half receive the procedure after delivery. Barriers differ between patients with private and public contraception, with Medicaid patients required to sign the Consent for Sterilization (Title XIX) Form between 30 and 180 days prior to sterilization.
Approximately 43% of US births are covered by Medicaid, making it vital to determine barriers to sterilization among Medicaid patients. To determine if there is an association between insurance type and postpartum sterilization achievement, investigators conducted a retrospective cohort analysis.
Data was obtained from the National Survey for Family Growth (NSFG), which involved in-person interviews discussing topics about family life. Participants from the 2013 to 2015 cohort were included in the analysis.
Participants included US individuals aged 15 to 44 years with a pregnancy resulting in live delivery, Medicaid or private insurance, and reporting their last pregnancy as “unwanted.” Responses for pregnancy intendedness on the NSFG included intended, mistimed, unwanted, and other.
Exclusion criteria included never being pregnant, being pregnant during the survey period, not having a live birth before current pregnancy, and marking the last delivery as intended, mistimed, or others. Patients with missing data about timing of sterilization, body mass index (BMI), and mode of delivery were also excluded.
The completion of postpartum sterilization within 2 months of delivery was reported as the primary outcome of the analysis. Sterilization procedure types were not distinguished by the NSFG.
Insurance status was the primary exposure of the analysis, reported as either Medicaid or private insurance. Respondents were assumed as insured by Medicaid if they reported Medicaid as covering the index delivery. Those citing private insurance as their primary method of payment were considered private insured.
There were 416 respondents included in the final analysis, aged an average 28.6 years. Of participants, 55.1% were insured by Medicaid, 47.6% had a college level education or higher, 81.1% were born in the United States, and 89.6% spoke English. A BMI of 25 kg/m2 or greater was reported by 68.3%, vaginal birth by 68%, and term birth by 86.6%.
Postpartum sterilization following an unwanted birth was reported by 26.4% of patients. Differing factors among these patients compared to those without postpartum sterilization include race and ethnicity, educational attainment, employment history, religious affiliation, insurance status, parity, mode of delivery, and term status.
After weighing variables, the odds of achieving postpartum sterilization were reduced by 56% among women with unwanted births who had Medicaid insurance. This relationship remained when extending the sterilization interval from 2 to 3 months.
These results indicated an association between Medicaid insurance and reduced odds of achieving postpartum sterilization. Investigators concluded safeguards such as postpartum contraception decision-making tools should be available for patients regardless of insurer payer status.
Reference
Chesnokova A, Christensen T, Streaty T, et al. Medicaid compared with private insurance is associated with lower rates of sterilization in people with unwanted births. Am J Obstet Gynecol. 2024;230:347.e1-11. doi:10.1016/j.ajog.2023.10.039
