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When do women decide to undergo sterilization? A qualitative study to evaluate the utility of the federally-mandated Medicaid waiting period

Olivia Foley, BA, Harvard Medical School, 2015

Project abstract

Women enrolled in Medicaid seeking sterilization must sign a federally mandated sterilization consent form (SCF) 30-180 days before undergoing the procedure. While this law was designed to protect women from involuntary sterilization, the required consent process and mandatory delay may create barriers to completion of patient requests for sterilization, and correspondingly increase the risk for future unintended pregnancy. Because women with private insurance do not have a mandated waiting period, the law represents a disparity in access to an effective, popular birth control method. The proposed qualitative study will explore the decision-making process of women who undergo postpartum sterilization. In particular, we will assess women’s perceptions of the value of the 30-day waiting period within their reported decision-making timeline. Postpartum women who have undergone sterilization will be invited to participate in a short individual interview, to be completed either during their postpartum hospital stay or at a scheduled appointment within 8 weeks of sterilization. Interviews will explore when and how women arrived at their decisions to undergo sterilization. Themes identified in the interviews and reported decision timelines will be assessed in the context of the 30-day waiting period, comparing women who did and did not sign the SCF. We also hope to explore whether the mandated waiting period adds value to the decision-making process for some women more than others depending on personal characteristics and beliefs.

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