Multi-level factors affecting postpartum sterilization

影响产后绝育的多层次因素

• 批准号: 10557170
• 负责人: Kavita Shah Arora
• 金额: $ 48.97万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-05 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10557170
• 关键词: Achievement; Advocate; Affect; Alabama; Attitude; Belief; Birth; California; Clinical; Complex; Consent Forms; Contraceptive Usage; Contraceptive methods; Data; Databases; Discipline of obstetrics; Disparity; Ensure; Equilibrium; Equity; Excision; Female Sterilization; Geography; Goals; Health Policy; High Risk Woman; Hospitals; Individual; Infant Health; Institution; Insurance; Interview; Knowledge; Lead; Literature; Low Birth Weight Infant; Maternal Health; Medicaid; Medical center; Methods; Mission; Modeling; Operating Rooms; Outcome; Paternalism; Patients; Pattern; Physicians; Policies; Policy Developments; Population; Postpartum Period; Postpartum Sterility; Postpartum Women; Pre-Eclampsia; Pregnancy Interval; Premature Birth; Prenatal care; Privatization; Process; Provider; Proxy; Public Health; Recording of previous events; Reproductive Health; Research; Risk; Route; Sampling; San Francisco; Site; Sterilization; Structure; Surveys; Testing; United States; United States National Institutes of Health; Universities; Vulnerable Populations; Woman; Work; clinical care; cohort; design; disparity reduction; effective intervention; evidence base; experience; federal policy; health disparity; improved; individual patient; infant morbidity/mortality; innovation; insight; low socioeconomic status; maternal morbidity; patient oriented; patient population; permissiveness; policy recommendation; postpartum contraception; preference; pregnant; provider factors; social; unintended pregnancy; women of color

Female sterilization, the second most commonly used contraceptive method in the United States, is commonly performed during the postpartum period. However, women with Medicaid insurance are half as likely to obtain a desired postpartum sterilization as those with private insurance. Compounding this disparity, women of color with Medicaid insurance are less likely to achieve sterilization fulfillment compared to white women with Medicaid insurance. Sterilization non-fulfillment puts women at high risk of subsequent unintended pregnancy with a short interpregnancy interval and the associated risks to maternal and infant health. There are significant policy barriers to equitable postpartum sterilization that impact those with Medicaid but not private insurance. However, the federal Medicaid policy (including specific consent form and subsequent thirty- day waiting period) was established in 1976 due to coerced sterilizations on women of color and low socioeconomic status. Therefore, sensitive consideration of the complex social and cultural backdrop is required to balance protection of a vulnerable population with the unintended consequence of disparities in sterilization fulfillment. Furthermore, barriers at the patient, provider, and hospital level have also been noted, though it is unclear the extent to which these barriers interact. Advocating for the complete removal of the Medicaid sterilization process, then, ignores both the complex history as well as the additional, non-policy barriers to equitable postpartum sterilization. The overall objective for this proposal is to determine the discrete barriers at various levels of analysis (patient, provider, hospital, and policy). The central hypothesis is that the layering of barriers individually and collectively contributes to disparities in postpartum sterilization fulfillment for the Medicaid population. The rationale for the project is that identifying and understanding potential barriers is the critical next step to eradicating the disparities surrounding postpartum sterilization. Guided by strong preliminary data, this hypothesis will be tested through an explanatory sequential mixed methods design by pursuing three specific aims: 1) Model the association between Medicaid insurance and sterilization fulfillment after adjusting for clinical and demographic differences in a pooled multi-institution sample (patient- and policy- level barriers aim); 2) Identify the attitudes, beliefs, and practices of postpartum women and their obstetricians regarding postpartum sterilization (patient-, provider-, hospital-, and policy-level barriers aim); 3) Assess the impact of hospital and state policy barriers on postpartum sterilization (hospital- and policy-level barriers aim). The approach is innovative because it departs from the status quo by shifting focus away from studying barriers individually and toward the identification and assessment of various layers of barriers. This contribution will be significant because it is expected to inform an evidence-based and patient-centered health policy to eradicate health disparities and improve clinical outcomes due to sterilization non-fulfillment and resultant unintended pregnancies.

女性灭菌是美国第二常用的避孕方法，是 通常在产后进行。但是，拥有医疗补助保险的妇女为 可能会获得所需的产后灭菌作为具有私人保险的人。使这种差异更加复杂， 与白人相比 拥有医疗补助保险的妇女。灭菌不实现，使妇女处于后来意外的高风险 怀孕时间较短，妊娠间隔时间很短，并且对母亲和婴儿健康的风险相关。那里 是公平产后灭菌的重大政策障碍，影响医疗补助的人，但不会影响那些 私人保险。但是，联邦医疗补助政策（包括具体的同意书以及随后的三十三个 由于对有色妇女的强制灭菌而建立了日期等待期） 社会经济地位。因此，对复杂的社会和文化背景的敏感考虑是 需要平衡对弱势人口的保护与差距差异的意想不到的结果 灭菌履行。此外，还注意到患者，提供者和医院级别的障碍， 尽管目前尚不清楚这些障碍相互作用的程度。提倡完全删除 然后，医疗补助灭菌过程忽略了复杂的历史以及其他非政策 公平产后灭菌的障碍。该提案的总体目标是确定离散 各种分析级别的障碍（患者，提供者，医院和政策）。中心假设是 分层单独和集体促进产后灭菌的差异 对于医疗补助人群。该项目的理由是确定和理解潜在的障碍 是消除产后灭菌的差异的关键下一步。在强者的指导下 初步数据，该假设将通过解释性顺序混合方法设计进行检验 追求三个具体目标：1）建模医疗补助保险与灭菌履行之间的关联 在调整了合并的多机构样本（患者和政策）中的临床和人口差异之后 水平障碍目标）； 2）确定产后妇女及其产科医生的态度，信念和实践 关于产后绝育（患者，提供者，医院和政策级别的障碍目标）； 3）评估 医院和国家政策障碍对产后灭菌的影响（医院和政策级别的障碍目标）。 这种方法具有创新性，因为它通过将重点转移而不是学习而偏离了现状 障碍单独，朝着识别和评估各个障碍层。这个贡献 之所以重要，是因为有望告知基于证据和以患者为中心的健康政策 消除健康差异并改善由于未实现的灭菌而改善临床结果 意外怀孕。