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Developing patient-centered approaches to sterilization under Medicaid: a community-based participatory approach

Priya Batra, University of California, Riverside–Center for Healthy Communities, School of Medicine

Project abstract

Background: One-quarter of U.S. women use sterilization for contraception; Medicaid-insured women prefer sterilization over other birth control methods. Approximately half of U.S. sterilization requests go unfulfilled; federally mandated consent regulations and waiting periods governing sterilization under Medicaid serve as structural barriers among low-income women. Despite calls to improve the process for publicly reimbursed sterilization, no efforts have engaged Medicaid-insured women to develop proposed revisions.

Aims: This study will explore the experiences of a sample of recently sterilized, Medicaid-insured women in: 1) selecting sterilization; 2) completing sterilization counseling and consent; and 3) undergoing the sterilization procedure. Process improvement suggestions will be elicited at each decision point.

Methods: Participants will include 25-30 Medicaid-insured women who have undergone sterilization within the last 6 months. Using purposive sampling, eligible participants will be identified among beneficiaries of the Inland Empire Health Plan (IEHP)—a regional Medicaid plan. Qualitative, in-depth interviews will be employed. Findings will be inductively analyzed (theme identification). Interviews and analysis will be informed by the social ecological model, recognizing intersections between structural factors and individual health outcomes. Women’s process improvement suggestions will be rapidly analyzed and deliberated using planning cells, where stakeholders will evaluate women’s policy recommendations.

Implications: Community and academic partners collaboratively conceived this study. IEHP is a non-profit Medicaid plan serving 1.2 million beneficiaries. The Center for Healthy Communities (CHC) at the University of California, Riverside has extensive regional experience in community engagement and participatory research. Findings grounded in patient experiences will shape a critical reproductive health policy change.

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