Women's Decision-Making for Postpartum Sterilization: Does the Medicaid Waiting Period Add Value?

Abstract

Purpose: Currently, patients with federally-funded insurance are required to sign a sterilization consent form (SCF) at least 30 days prior to sterilization, while privately insured patients are not. This policy creates a disparity in access to an effective birth control method. Our qualitative study aims to clarify the decision-making process surrounding postpartum sterilization to better understand if the SCF adds value to this process. Methods: We enrolled 25 women who underwent desired postpartum sterilization procedures, ten with private insurance and fifteen with Medicaid. We interviewed them using a semistructured guide that explored topics such as reproductive history, reason for choosing sterilization, and decision-making timeline. We transcribed and coded the interviews and identified themes. Results: Emergent themes were comparable between patients with private insurance and those with Medicaid. For most women, the decision to undergo sterilization took place over the course of their reproductive lives. Participants expressed that non-biased provider counseling, autonomy, and information from other women were helpful to their decision-making. Most subjects felt that the SCF might benefit other women, but did not/would not affect their own decision-making. Conclusions: We found no evidence that decision-making processes differ between women with Medicaid and those with private insurance, suggesting that these groups should not be subjected to disparate restrictions on sterilization. The timeline surrounding this decision appears to be much longer term than the mandated 30-day waiting period. Characteristics of the decision-making process that women personally value, which in this population did not include the SCF, should be prioritized.