Obstetricians Call for Shortening ‘Discriminatory’ Postpartum Sterilization Waiting Period

WASHINGTON — Members of the Society for Maternal-Fetal Medicine’s Health Policy and Advocacy Committee are now calling for lawmakers to revise current Medicaid policy dictating patients who desire postpartum sterilization wait 30 days.

The pregnancy experts published their contentions to the policy in the peer-reviewed publication The Lancet Regional Health, characterizing the current regulations for Medicaid recipients as discriminatory and a contributor to health inequities. In their warning to Washington, the experts maintain postpartum sterilization is a safe and effective form of contraception, and current policy disproportionately impacts Black, Latinx, American Indian and Alaskan Native communities’ access to the procedure.

“Physicians may propose alternatives when immediate sterilization is not possible, such as interval sterilization or long-acting reversible contraception,” authors Melanie Maykin, Rachel Pilliod and Erika Werner wrote in the analysis. “However, these options are not equivalent as they burden patients with additional appointments and don’t account for the fact that pregnancy-related Medicaid coverage ends 60 days postpartum. Furthermore, interval sterilization is performed no sooner than 6 weeks postpartum, requires additional anesthesia, [frequently general], and may increase perioperative risks for the patient, who also incurs the social and economic impact of a delayed procedure.”

Consequently, a significant portion of women who desire postpartum sterilization have their requests go unfulfilled. In a prospective study on publicly insured participants, 56% of requests for immediate postpartum sterilization went unfulfilled and problems with Medicaid consent requirements were cited as the reason in more than two-thirds of those cases.

In addition, the authors cite a previous study from researchers at the University of Texas at San Antonio that found almost half of individuals with unfulfilled sterilization requests became pregnant within one year. Regulatory policies including a 72-hour waiting period were originally instituted in 1970 by the now-defunct Department of Health, Education, and Welfare to shield vulnerable patients from abusive sterilization practices common throughout previous decades.

Regulations were enacted to extend the waiting period to 30 days in 1978, limiting forced or coerced sterilizations at the cost of limiting women’s reproductive autonomy. Because these regulatory barriers developed as a result of reproductive injustices, the authors contend that policymakers should gather input on potential solutions from individuals impacted by forced sterilizations and denied sterilizations due to Medicaid regulations.

“Medicaid consent regulations have created a barrier to equal access, a major principle of reproductive justice, which is a concept coined by Black women advocates,” the authors wrote. “The reproductive justice framework describes how systemic discrimination can limit one’s ability to exercise the same degrees of reproductive autonomy as others based on race, gender, class, ability, and sexuality. Additionally, the reproductive justice framework incorporates the economic, social, and health factors that impact decision-making ability.” 

Reece can be reached at [email protected]