Princeton expert: Medicaid rules keep poor women from getting sterilized – NJ.com

File this one under the category of “It seemed like a good idea at the time.”

That time was 1976, when public health officials worried about poor women being permanently sterilized without their consent. The fix was a 72-hour waiting period between when a Medicaid patient consented to a tubal ligation and when the operation was done. Two years later, that waiting period was extended to 30 days.

But that has created its own problem, according to researchers at Princeton University’s Woodrow Wilson School. Medicaid patients who want to have their tubes tied immediately after having a baby can’t do that because of the 30-day rule.

If they wait 30 days, some may no longer have Medicaid coverage, since pregnancy-related eligibility ends shortly after delivery.

“While we certainly don’t want to return to the days when low-income women were coerced into agreeing to sterilization, we feel that the current rule – while well-meaning – goes too far in the other direction,” said James Trussell, one of the authors of the paper submitted to the New England Journal of Medicine, and a professor of public and international affairs.

In addition, the consent form is too complicated for many patients to understand. An earlier study found that more than a third of the women didn’t fully understand the long-term consequences of sterilization after they read the form. Switching to a form set to a lower literacy level helped patients grasp both the waiting period details and the availability of other, reversible, forms of contraception.

Nearly half the women who requested – but did not receive — a tubal ligation procedure be done right after childbirth were pregnant within the following year. That is twice the pregnancy rate of the women who didn’t request sterilization.

Many of those women didn’t get the sterilization they sought because of timing. They either put in a request too close to their delivery date, delivered a baby too early to meet the 30-day waiting period, or else didn’t have the form with them when they delivered.

Reducing the waiting time and making the consent form easier to understand could help in “making a dent in this stubbornly high rate of unintended pregnancy and the high costs associated with it,” Trussell said.

Studies done elsewhere estimate there are 62,000 unfulfilled requests for tubal ligation annually. Those, in turn, resulted in 29,000 unintended pregnancies, of which 10,000 were termination by abortion and 19,000 led to a birth. The public cost: $215 million.

Those numbers – both the number of women impacted and the resulting cost – are likely to expand as more working poor join Medicaid under provisions of Obamacare, the research report stated.