Obstetrician-Gynecologist Perspectives and Counseling Practices on the U.S. Medicaid Waiting Period for Permanent Contraception

Background

Created to protect patients from coercive sterilization, the federally mandated 30-day waiting period for patients with Medicaid desiring permanent contraception is a known barrier to permanent contraception fulfillment. Existing research does not explicitly explore how physicians interpret and operationalize the consent policy, how they counsel regarding the waiting period, or whether physicians believe the policy should be revised. The purpose of this paper is to better understand obstetrician-gynecologist (OB-GYN) feelings, thoughts, and counseling practices around the waiting period as key stakeholders in counseling and provision of permanent contraception care.

Basic Procedures

We interviewed 81 postpartum people with a documented desire for permanent contraception and 61 OB-GYNs who delivered their infants at four hospitals across the United States. Interviews were audio-recorded, transcribed, and analyzed using rapid qualitative analysis and thematic content analysis.

Main Findings

Forty-seven physicians (70.2%) expressed negative feelings toward the Medicaid waiting period policy and 14 (20.9%) expressed neutral/mixed feelings. Physicians often viewed the Medicaid sterilization consent policy as inequitable and reported feeling that the waiting period hinders patient autonomy. Several physicians suggested that the waiting period needs revision. Physicians cited several barriers related to the implementation of the waiting period, including a lack of prenatal care or the conversation not being initiated. Physicians mentioned various approaches to counseling around the waiting period, either explicitly or inexplicitly explaining the policy. Last, physicians discussed differing interpretations around the waiting period policy.

Principal Conclusions

Physicians in our sample largely do not favor the current Medicaid sterilization waiting period. However, physicians report varying approaches to clinical counseling as well as beliefs regarding policy revision. Revision to the policy should be informed by the lived experience and expertise of the various stakeholders, including patients, clinicians, and policymakers.