Multi-level factors affecting postpartum sterilization

影响产后绝育的多层次因素

• 批准号: 10557980
• 负责人: Kavita Shah Arora
• 金额: $ 21.43万
• 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 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10557980
• 关键词: Administrative Supplement; Affect; Area; Attitude; Belief; Bioethics; Clinic; Clinical; Coercion; Collaborations; Complex; Consent; Contraceptive Agents; Contraceptive methods; Data; Data Set; Decision Making; Deltastab; Demographic Factors; Ensure; Environment; Equilibrium; Ethical Analysis; Ethics; Exclusion; Face; General Population; Goals; Guidelines; Health; Health Insurance; Healthcare Systems; Hospitals; Imprisonment; Individual; Informed Consent; Infrastructure; Institution; Intake; Interview; Investigation; Justice; Knowledge; Laws; Link; Logistics; Medical; Medical Records; Methods; Minority; Modeling; North Carolina; Outcome; Parents; Patients; Personal Satisfaction; Persons; Policies; Population; Positioning Attribute; Postpartum Period; Pregnant Women; Prenatal care; Preventive care; Preventive healthcare; Prisons; Procedures; Provider; Public Health; Recommendation; Regrets; Research; Risk; Safety; Sterilization; Structure; System; Testing; United States; United States National Institutes of Health; abstracting; base; built environment; clinical care; disparity reduction; evidence base; experience; health disparity; health disparity populations; health equity; health inequalities; improved; infant morbidity/mortality; insight; interest; lens; maternal morbidity; maternal risk; mindfulness; parent grant; patient oriented; policy recommendation; postpartum contraception; postpartum outcome; preference; pregnant; prospective; reproductive; social culture; social stigma; socioeconomics; sound; unintended pregnancy

ABSTRACT Pregnant or postpartum people experiencing incarceration (PPEI) represent a critical U3 population that is understudied due to barriers within carceral institutions, underrepresented due to the exclusion of institutionalized individuals from research, and underreported because they comprise a minority within incarcerated people. PPEI have higher than average representation of NIH-designated health disparities, and disparities in the fulfillment of desired postpartum sterilization are particularly complex for PPEI because of the unique multilevel barriers that influence health outcomes. Tragically, many PPEI have been sterilized without consent. Thus, policies and laws are in place to limit access of PPEI to sterilization given the challenges involved in obtaining true informed consent, potential of coercion, and risk of regret after incarceration. However, others with well-formulated, long-standing desires to obtain postpartum sterilization have encountered barriers over several domains, including harsh built environments, punitive sociocultural environments, and health care systems. Therefore, nuanced consideration is required to balance these protections with the unintended consequence of disparities. Investigation of factors that influence postpartum sterilization desire and fulfillment in PPEI represents a critical knowledge gap. In this Administrative Supplement, we seek to extend efforts from our parent R01 (1R01HD098127H) to meet an overall objective of better understanding the goals, experiences, and health outcomes of PPEI desiring postpartum sterilization and their delivering medical team. This objective is directly related to Strategic Goal 1.3 of the ORWH and directly responsive to the NOSI’s specific areas of research interest in terms of assessing structural determinants of health, utilizing preventive health care and exploring the intersectional stigma impacting this U3 population through a multidimensional research framework. Leveraging our extensive expertise in bioethics and observational analysis and long-term collaboration with the North Carolina state prison system, we have the infrastructure to rapidly meet our objective. Consistently, our Aims are to 1) Longitudinally assess the contraceptive goals of PPEI by retrospectively abstracting medical record data from pregnant women who were incarcerated from 2016-2021 (n=850) to understand postpartum sterilization decision-making and compare with the general population via a similar dataset created through the parent grant. 2) Identify the attitudes, beliefs, and practices of PPEI and their obstetricians regarding postpartum sterilization by performing and analyzing semi-structured interviews of PPEI requesting postpartum sterilization and their delivering obstetrician (n=15 dyads); 3) Develop clinical guidance for ethical postpartum sterilization for PPEI by performing robust ethical analysis from a patient-centered and health-equity lens. Our results will provide a critical framework for long overdue, evidence-based policy recommendations to improve clinical care, advance public health, and mitigate disparities among PPEI.

抽象的 经历监禁的孕妇或产后人群 (PPEI) 代表了关键的 U3 人群， 由于监狱机构内部的障碍而研究不足，由于排除 研究中将个人制度化，但由于他们在研究中只占少数而被低估 PPEI 的健康差异高于平均水平，并且 对于 PPEI 来说，在实现所需的产后绝育方面的差异尤其复杂，因为 影响健康结果的独特多层次障碍 不幸的是，许多 PPEI 未经消毒就被消毒。 因此，鉴于面临的挑战，已制定政策和法律来限制 PPEI 进行绝育。 涉及获得真正的知情同意、强迫的可能性以及入狱后后悔的风险。 然而，其他长期渴望进行产后绝育的人却 多个领域的障碍，包括恶劣的建筑环境、遇到的惩罚性社会文化障碍 因此，需要细致入微地考虑来平衡这些因素。 调查影响产后的因素。 PPEI 中的绝育愿望和实现代表了本行政部门的一个关键知识差距。 补充，我们寻求扩大母公司 R01 (1R01HD098127H) 的努力，以实现总体目标 更好地了解希望产后绝育的 PPEI 的目标、经验和健康结果 及其提供医疗团队的目标与 ORWH 和的战略目标 1.3 直接相关。 直接响应 NOSI 在结构评估方面的具体研究兴趣领域 健康的决定因素，利用预防性医疗保健并探索影响这一点的交叉耻辱 通过多维研究框架利用我们在生物伦理学方面的广泛专业知识。 和观察分析以及与北卡罗来纳州监狱系统的长期合作，我们有 快速实现我们目标的基础设施始终如一，我们的目标是 1) 纵向评估 通过回顾性地提取孕妇的医疗记录数据来确定 PPEI 的避孕目标 2016 年至 2021 年期间被监禁 (n=850)，以了解产后绝育决策和 通过家长资助创建的类似数据集与一般人群进行比较 2) 识别。 PPEI 及其产科医生对产后绝育的态度、信念和做法 对要求产后绝育的 PPEI 进行半结构化访谈及其分析 接生的产科医生（n=15 组）； 3) 制定道德产后绝育的临床指南 PPEI 通过从以患者为中心和健康公平的角度进行稳健的伦理分析，我们的结果将。 为早就该提出的基于证据的政策建议提供一个关键框架，以改善临床护理， 促进公共卫生，并缩小 PPEI 之间的差距。