Postpartum permanent contraception: updates on policy and access.
Journal
Current opinion in obstetrics & gynecology
ISSN: 1473-656X
Titre abrégé: Curr Opin Obstet Gynecol
Pays: England
ID NLM: 9007264
Informations de publication
Date de publication:
01 12 2021
01 12 2021
Historique:
pubmed:
18
9
2021
medline:
15
12
2021
entrez:
17
9
2021
Statut:
ppublish
Résumé
To describe barriers to provision of postpartum permanent contraception at patient, hospital, and insurance levels. Permanent contraception remains the most commonly used form of contraception in the United States with the majority of procedures performed during birth-hospitalization. Many people live in regions with a high Catholic hospital market share where individual contraceptive plans may be refused based on religious doctrine. Obesity should not preclude an individual from receiving a postpartum tubal ligation as recent studies find that operative time is clinically similar with no increased risk of complications in obese compared with nonobese people. The largest barrier to provision of permanent contraception remains the federally mandated consent for sterilization for those with Medicaid insurance. State variation in enforcement of the Medicaid policy additionally contributes to unequal access and physician reimbursement. Although significant barriers exist in policy that will take time to improve, hospital-based interventions, such as listing postpartum tubal ligation as an 'urgent' procedure or scheduling interval laparoscopic salpingectomy prior to birth-hospitalization discharge can make a significant impact in actualization of desired permanent contraception for patients. Unfulfilled requests for permanent contraception result in higher rates of unintended pregnancies, loss of self-efficacy, and higher costs. Hospital and federal policy should protect vulnerable populations while not preventing provision of desired contraception.
Identifiants
pubmed: 34534995
doi: 10.1097/GCO.0000000000000750
pii: 00001703-202112000-00005
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
445-452Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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