Multi-level factors affecting postpartum sterilization

影响产后绝育的多层次因素

基本信息

批准号：
10792263
负责人：
Kavita Shah Arora
金额：
$ 19.67万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-08-07 至 2025-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10792263
关键词：
Address Administrative Supplement Affect Attitude Bioethics Caring Clinical Coercion Communities Complex Consent Forms Contraceptive methods Couples Data Decision Making Demographic Factors Disparity Ensure Equilibrium Equity Ethics Exercise Freedom Future Goals Health Policy Hospitals Infrastructure Insurance Involuntary Sterilization Justice Knowledge Length Light Link Low income Maternal Health Medicaid Methodology Methods Michigan Modeling Operative Surgical Procedures Parents Participant Patients Persons Policies Population Positioning Attribute Postpartum Period Postpartum Sterility Pregnancy Privatization Procedures Public Health Published Comment Recording of previous events Reproductive Health Research Sterilization Structural Racism United States United States National Institutes of Health Visit Woman Work clinical care community based participatory research community engagement disparity reduction evidence base experience federal policy health disparity health disparity populations implicit bias improved infant morbidity/mortality insight low socioeconomic status maternal morbidity maternal risk multidisciplinary parent grant patient engagement patient oriented patient population policy recommendation pregnant pressure reproductive response social health determinants success unintended pregnancy women of color

项目摘要

Title: Deliberative Bioethics to Inform Policy Surrounding the Medicaid Sterilization Waiting Period ABSTRACT Approximately 30-50% of patients with Medicaid requesting sterilization for contraception after delivery do not obtain their desired surgery. Disparities in fulfilment of sterilization requests have been linked to the federal Medicaid sterilization policy, which does not apply to patients with private insurance. This policy requires a 30- day waiting period between when a specific consent form is signed and when sterilization can occur. However, the bioethical considerations of the 30-day waiting period in the Medicaid sterilization policy are complex. While data exist regarding the barriers to autonomously-desired care presented by the policy, less is known regarding the present-day need for the historical basis for the policy’s inception – to protect against coercion. Ongoing disparities in maternal health are attributed to structural racism, implicit bias, and social determinants of health factors, but little is known regarding the patient viewpoint on how to achieve this necessary balance between ensuring women covered by Medicaid, like women with other insurance, have their autonomous decisions for sterilization respected, while ensuring freedom from coercion or undue pressure – thus representing a critical knowledge gap. While our parent R01 (1R01HD098127H) characterizes the multi-level barriers to equitable postpartum sterilization – this Administrative Supplement’s overall objective, extends these efforts to better understand the goals and priorities of patients themselves regarding revision of the 30-day Medicaid sterilization waiting period. This objective is directly responsive to the NOSI as it has tremendous potential to exert an influence on bioethics-related policy and provide evidence to inform future policy directions; addresses a persistent, compelling bioethics question about reproductive decision making; and engages communities as partners in the research and, in so doing, sustains and adds capacity for community-partnered bioethics research. Leveraging our expertise in bioethics and long-standing community-academic partnerships, we have the infrastructure to rapidly meet our objective. Our Aims are to 1) Engage patients and couples with Medicaid insurance in informed deliberations about the 30-day Medicaid sterilization waiting period by conducting deliberation exercises with 10 groups of 9-15 groups of Medicaid enrollees in Michigan who have experienced pregnancy and some that include couples. 2) Prepare preliminary policy briefs that describe the views of patients as the stakeholders in potential Medicaid sterilization policy revision to set the stage for future, broader community-based participatory research and deliberative bioethics work in other states with distinct reproductive health policies as well as for eventual, federal health policy change. Our results will provide a critical framework for long overdue, evidence-based, and patient-centered policy recommendations to mitigate disparities surrounding sterilization.

标题：慎重的生物伦理学为围绕医疗补助绝育等待期的政策提供信息抽象的大约 30-50% 的医疗补助患者在产后要求绝育避孕，但他们没有这样做获得所需手术的差异与联邦有关。医疗补助绝育政策，不适用于拥有私人保险的患者。该政策要求 30-。从签署特定同意书到可以进行绝育之间有一天的等待期。医疗补助绝育政策中 30 天等待期的生物伦理考虑是虽然存在有关政策对自主所需护理的障碍的数据，但较少。众所周知，当前需要为该政策的启动提供历史基础——以防止孕产妇健康方面持续存在的差异归因于结构性种族主义、隐性偏见和社会。健康因素的决定因素，但对于患者如何实现这一目标的观点知之甚少确保医疗补助覆盖的女性与拥有其他保险的女性一样，在尊重她们绝育的自主决定，同时确保她们免受胁迫或不当行为压力 - 因此代表了一个关键的知识差距，而我们的母公司 R01 (1R01HD098127H)。描述了公平产后绝育的多层次障碍——本行政补充总体目标，扩展这些努力以更好地了解患者本身的目标和优先事项关于 30 天医疗补助绝育等待期的修订该目标直接响应。 NOSI，因为它具有对生物伦理学相关政策产生影响并提供证据的巨大潜力为未来的政策方向提供信息；解决有关生殖的持续存在的、引人注目的生物伦理问题决策；并让社区作为研究的合作伙伴，并在此过程中维持和增加利用我们在生物伦理学方面的专业知识和长期的经验进行社区合作的生物伦理学研究的能力。社区与学术伙伴关系，我们拥有快速实现我们目标的基础设施：1) 让拥有 Medicaid 保险的患者和夫妇参与有关 30 天的知情审议医疗补助绝育等待期，通过 10 组 9-15 组进行深思熟虑练习密歇根州怀孕过的医疗补助参与者，其中包括夫妇 2) 做好准备。初步政策简报，描述患者作为潜在医疗补助利益相关者的观点绝育政策修订为未来更广泛的基于社区的参与性研究和审议生物伦理学在其他具有不同生殖健康政策的国家中发挥作用，并最终实现，我们的结果将为期待已久的基于证据的联邦卫生政策变革提供一个关键框架。以患者为中心的政策建议，以减少绝育方面的差异。