Medicaid compared to private insurance is associated with lower rates of sterilization in US women with unwanted births

Background Medicaid, unlike any other insurance mechanism, imposes a consent requirement on female patients desiring sterilization that must be completed at least 30 days, but no more than 180 days, prior to sterilization. Desired sterilization cannot be completed in the Medicaid population without this consent. Large scale national evidence is lacking on the impact of this requirement. Objective The aim of this study was to explore the influence of insurance status on the achievement of postpartum sterilization following a self-reported unwanted birth in a nationally representative sample. Study Design We performed a retrospective cohort analysis using data from the 2013-2015 National Survey of Family Growth (NSFG). The NSFG uses a stratified, multistage clustered sample to make nationally representative estimates for men and women aged 15-44 years in the household population of the U.S. The analysis was limited to a cohort of birthing people who reported their last birth as unwanted and who were insured by either Medicaid or private insurance. The survey was analyzed with application of inverse probability of treatment weights (IPW) to balance those insured by Medicaid and private insurance in addition to the survey weight. The association between completion of postpartum sterilization and insurance type was evaluated using weighted logistic regression, adjusting for demographic and clinical characteristics. Results In an adjusted and IPW balanced analysis of a weighted national sample representing 4,164,304 people (respondent n=416), Medicaid insured birthing people with a history of unwanted birth were found to have 56% lower odds of obtaining postpartum sterilization (OR 0.44; 95%CI 0.22, 0.87; p=0.019) compared to those with private insurance. Conclusions This study adds to mounting evidence that insurance type plays a significant role in the achievement of desired postpartum sterilization, with individuals who are insured by Medicaid less likely to undergo the procedure. The findings call for policy reforms around sterilization policy in the United States, emphasizing the need for uniform consent procedures that do not discriminate based on insurance status.