Kavita Shah Arora1, Barbara Wilkinson2, Emily Verbus2, Mary Montague2, Jane Morris3, Mustafa Ascha4, Brian M Mercer3. 1. Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH. Electronic address: Kavita.Shah.Arora@gmail.com. 2. School of Medicine, Case Western Reserve University, Cleveland, OH. 3. Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH. 4. Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH.
Abstract
OBJECTIVE: We sought to assess fulfillment of sterilization requests while accounting for the complex interplay between insurance, clinical and social factors in a contemporary context that included both inpatient and outpatient postpartum sterilization procedures. STUDY DESIGN: This is a retrospective single-center cohort chart review study of 1331 women with a documented contraceptive plan at time of postpartum discharge of sterilization. We compared sterilization fulfillment within 90days of delivery, time to sterilization and rate of subsequent pregnancy after nonfulfillment between women with Medicaid and women with private insurance. RESULTS: A total of 475 of 1030 Medicaid-insured and 100 of 154 privately insured women received postpartum sterilization (46.1% vs. 64.9%, p<.001). Women with Medicaid had a longer time from delivery to completion of the sterilization request (p<.001). After adjusting for age, parity, gestational age, mode of delivery, adequacy of prenatal care, race/ethnicity, marital status and education level, private insurance status was not associated with either sterilization fulfillment [odds ratio 0.94, 95% confidence interval (CI) 0.54-1.64] or time to sterilization (hazard ratio 1.03, 95% C.I. 0.73-1.34). Of the 555 Medicaid-insured women who did not receive a postpartum sterilization, 267 (48.1%) had valid Title XIX sterilization consent forms at time of delivery. Of women who did not receive sterilization, 132 of 555 Medicaid patients and 5 of 54 privately insured patients became pregnant within 1 year (23.8% vs. 9.3%, p=.023). CONCLUSION: Differences in fulfillment rates of postpartum sterilization and time to sterilization between women with Medicaid versus private insurance are similar after adjusting for relevant clinical and demographic factors. Women with Medicaid are more likely than women with private insurance to have a short interval repeat pregnancy after an unfulfilled sterilization request. IMPLICATIONS: Efforts are needed to ensure that Medicaid recipients who desire sterilization receive timely services.
OBJECTIVE: We sought to assess fulfillment of sterilization requests while accounting for the complex interplay between insurance, clinical and social factors in a contemporary context that included both inpatient and outpatient postpartum sterilization procedures. STUDY DESIGN: This is a retrospective single-center cohort chart review study of 1331 women with a documented contraceptive plan at time of postpartum discharge of sterilization. We compared sterilization fulfillment within 90days of delivery, time to sterilization and rate of subsequent pregnancy after nonfulfillment between women with Medicaid and women with private insurance. RESULTS: A total of 475 of 1030 Medicaid-insured and 100 of 154 privately insured women received postpartum sterilization (46.1% vs. 64.9%, p<.001). Women with Medicaid had a longer time from delivery to completion of the sterilization request (p<.001). After adjusting for age, parity, gestational age, mode of delivery, adequacy of prenatal care, race/ethnicity, marital status and education level, private insurance status was not associated with either sterilization fulfillment [odds ratio 0.94, 95% confidence interval (CI) 0.54-1.64] or time to sterilization (hazard ratio 1.03, 95% C.I. 0.73-1.34). Of the 555 Medicaid-insured women who did not receive a postpartum sterilization, 267 (48.1%) had valid Title XIX sterilization consent forms at time of delivery. Of women who did not receive sterilization, 132 of 555 Medicaid patients and 5 of 54 privately insured patients became pregnant within 1 year (23.8% vs. 9.3%, p=.023). CONCLUSION: Differences in fulfillment rates of postpartum sterilization and time to sterilization between women with Medicaid versus private insurance are similar after adjusting for relevant clinical and demographic factors. Women with Medicaid are more likely than women with private insurance to have a short interval repeat pregnancy after an unfulfilled sterilization request. IMPLICATIONS: Efforts are needed to ensure that Medicaid recipients who desire sterilization receive timely services.
Authors: Joseph E Potter; Kristine Hopkins; Abigail R A Aiken; Celia Hubert; Amanda J Stevenson; Kari White; Daniel Grossman Journal: Contraception Date: 2014-07-03 Impact factor: 3.051
Authors: Jane Morris; Mustafa Ascha; Barbara Wilkinson; Emily Verbus; Mary Montague; Brian M Mercer; Kavita Shah Arora Journal: Obstet Gynecol Date: 2019-12 Impact factor: 7.661
Authors: Barbara Wilkinson; Mustafa Ascha; Emily Verbus; Mary Montague; Jane Morris; Brian Mercer; Kavita Shah Arora Journal: Contraception Date: 2018-09-05 Impact factor: 3.375
Authors: Mary Montague; Mustafa Ascha; Barbara Wilkinson; Emily Verbus; Jane Morris; Brian M Mercer; Kavita Shah Arora Journal: Obstet Gynecol Date: 2018-09 Impact factor: 7.661
Authors: Kavita Shah Arora; Roselle Ponsaran; Laura Morello; Leila Katabi; Rosemary T Behmer Hansen; Nikki Zite; Kari White Journal: Contraception Date: 2020-08-25 Impact factor: 3.375
Authors: Sayuli Bhide; Mustafa Ascha; Barbara Wilkinson; Emily Verbus; Mary Montague; Jane Morris; Kavita Shah Arora Journal: Contraception Date: 2020-06-12 Impact factor: 3.375