Women on Medicaid Face Unfair Barriers to Sterilization Requests

June 21, 2012

Washington, DC -- Women covered by Medicaid experience unfair barriers to their requests for postpartum sterilization compared with women who have commercial or private insurance, according to The American College of Obstetricians and Gynecologists (The College). The federal consent rules for sterilization procedures place an undue burden on women and effectively creates a two-tier system of access.

Medicaid regulations require women to sign a consent form 30 days prior to all sterilization procedures. If the form is not signed, filled out incorrectly, deemed illegible by the insurance company, or not with a woman at the time of her procedure, her request will be denied. [Women with unmet requests for postpartum sterilization have a high rate of repeat pregnancy (approaching 50%) within the following year.] In contrast, women with private insurance do not face such cumbersome consent requirements. To create fair and equitable access to postpartum sterilization, The College says that regulations for women enrolled in Medicaid or covered by other government insurance must be revised. Until this is accomplished, ob-gyns and hospital systems should develop policies and procedures to ensure all women who desire postpartum sterilization can receive it. 

Postpartum sterilization is one of the safest and most effective forms of contraception in the US, but only 50% of women who request the procedure actually have it performed. In addition to unfair sterilization consent regulations, women also are prevented from postpartum sterilization if a physician feels a younger patient may have long-term regret and declines to provide the procedure, or they give birth in a hospital with limited resources or in a religiously affiliated hospital that prohibits sterilization procedures altogether.  

Improving consistency in providing desired postpartum sterilization is an important strategy in reducing the high rates of unintended pregnancy. Given the consequences of a missed procedure and the limited time frame in which it may be performed, The College says that postpartum sterilization should be considered an urgent surgical procedure. 

Committee Opinion #530 “Access to Postpartum Sterilization” is published in the July issue of Obstetrics & Gynecology

Other recommendations issued in this month’s Obstetrics & Gynecology:

Committee Opinion #529 “Placenta Accreta (New!)

Abstract: Placenta accreta is a potentially life-threatening obstetric condition that requires a multidis­ciplinary approach to management. The incidence of placenta accreta has increased and seems to parallel the increasing cesarean delivery rate. Women at greatest risk of placenta accreta are those who have myometrial damage caused by a previous cesarean delivery with a placenta previa that overlies the uterine scar. Diagnosis of placenta accreta before delivery allows multidisciplinary planning in an attempt to mini­mize potential maternal or neonatal morbidity and mortality. Grayscale ultrasonography is sensitive enough and specific enough for the diagnosis of placenta accreta; magnetic resonance imaging may be helpful in ambiguous cases. Although recognized obstetric risk factors allow the identification of most cases during the antepartum period, the diagnosis is occasionally discovered at the time of delivery. In general, the recommended management of suspected placenta accreta is planned preterm cesarean hysterectomy with the placenta left in situ because attempts at removal of the placenta are associated with significant hemorrhagic morbidity. However, surgical man­agement of placenta accreta may be individualized. Although a planned delivery is the goal, a contingency plan for an emergency delivery should be developed for each patient, which may include following an institutional protocol for maternal hemorrhage management.

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 56,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization.


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