The New England Journal of Medicine published a perspectives piece in its January 9 issue co-authored by Nikki Zite, MD, Associate Professor and Residency Program Director in Obstetrics and Gynecology, featuring research on women's access to sterilization based on current Medicaid policy and whether that policy is still relevant.
Current policy, established in the 1970s, prohibits persons younger than 21 years old from being sterilized as well as those who are mentally incompetent or institutionalized. The focus of the perspectives piece was related to the mandatory 30-day waiting period from the date of written informed consent that is required. In addition, a signed copy of the consent form must be available or verified at the time of the procedure. The only exception is if the patient is undergoing emergency abdominal surgery or a premature delivery, then the 30-day waiting period may be waived, however, there must be 72 hours between signed consent and the procedure.
The Medicaid policy was originally established to protect minority women's rights, however research by Zite and her collaborators, some completed in the University of Tennessee OB/GYN clinic indicates the consent process may not be capable of protecting vulnerable women by ensuring that truly informed consent is obtained. A previous study by Dr. Zite on the comprehension of women who sign the consent form for tubal sterilization shows the form is written at a reading level too difficult for most patients to understand. Beyond concerns about the consent form, the waiting period and the need for the completed form to be transferred to the delivery unit pose logistic barriers for women who wish to undergo tubal ligation immediately after giving birth.
The authors of the perspectives piece recommend that the Medicaid policy and consent form concerning sterilization should be thoughtfully modified.
James Neutens, PhD, Dean of the UT Graduate School of Medicine noted, "This is a great contribution to the diversity and inclusion efforts being made in healthcare today."
Posted March 18, 2014
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