Enhancing autonomy, improving access, and reducing disparities for postpartum sterilization
Awarded 2017
Small Research Grants
Kavita Arora, MD, MBE
Case Western Reserve University

A healthcare system in which 37-51% of women who desire postpartum sterilization are unable to obtain one due to a lack of a valid signed Medicaid consent form is not delivering patient-centered, medically-appropriate, nor ethically-sound care. Sensitive, thoughtful, and careful considerations are required when approaching this topic due to its complex social and cultural backdrop. This proposal has two components. First, we aim to conduct a normative analysis of the only empirical study of sterilization fulfillment rates since the Affordable Care Act. We have previously developed a database of 8,655 women who delivered at an urban, tertiary- care hospital that primarily serves the underserved. We hope to expand on the empirical analysis currently in progress in three key areas. This normative analysis will identify clinical and public health ramifications of the current federal policy, offer recommendations for further study of patient-centered outcomes, and suggest health policy revisions to improve access and diminish disparities. In the second component, we strive to better understand the attitudes, beliefs, and practice patterns of obstetricians nationwide regarding postpartum sterilization access and fulfillment. Prior research has identified physician-level barriers disproportionately affecting the Medicaid population for women desiring postpartum sterilization. We propose to conduct semi- structured qualitative interviews with obstetricians around the country to gain a deeper understanding of the attitudes, beliefs, and practice patterns surrounding postpartum sterilization. Therefore, by combining both normative analyses with qualitative methodology, we will better understand the impact of patient-level, physician-level, health system-level, and policy-level barriers to achieving reproductive justice surrounding postpartum sterilization.