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Zhang Y, Wilson ML, Glass S, Godfrey EM. Reproductive Planning: Contraceptive Counseling and Nonhormonal Methods. FP Essent 2024; 538:7-12. [PMID: 38498324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
More than 65% of US women ages 15 to 49 years use contraception every year, many of whom seek care with family medicine. Family physicians are well equipped to provide comprehensive contraceptive counseling to patients in the primary care setting. When discussing options and providing education to patients, clinicians should consider patient preferences, patient autonomy, and adverse effect concerns, and should use a patient-centered approach that upholds the principles of reproductive justice. Nonhormonal methods of contraception include barrier methods and spermicides, fertility awareness-based methods, and (in postpartum individuals) lactational amenorrhea. With barrier methods, spermicides, and fertility awareness-based methods, 13 to 29 out of 100 women may become pregnant. Permanent forms of contraception include female and male sterilization procedures, which are some of the most effective (more than 99% effective) and most commonly used methods in the United States.
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Affiliation(s)
- Ying Zhang
- Reproductive Health and Advocacy Fellowship - Department of Family Medicine - University of Washington, Seattle
| | - Megan L Wilson
- Department of Family Medicine - University of Washington, Seattle
| | - Samantha Glass
- Department of Family Medicine and Community Health - Institute for Family Health-Harlem Family Medicine Residency, New York
| | - Emily M Godfrey
- Departments of Family Medicine and Obstetrics and Gynecology - University of Washington, Seattle
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2
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Balestrino F, Bimbilé Somda NS, Samuel M, Meletiou S, Bueno O, Wallner T, Yamada H, Mamai W, Vreysen MJB, Bouyer J. Mass irradiation of adult Aedes mosquitoes using a coolable 3D printed canister. Sci Rep 2024; 14:4358. [PMID: 38388700 PMCID: PMC10884024 DOI: 10.1038/s41598-024-55036-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/19/2024] [Indexed: 02/24/2024] Open
Abstract
In the last decade, the use of the sterile insect technique (SIT) to suppress mosquito vectors have rapidly expanded in many countries facing the complexities of scaling up production and procedures to sustain large-scale operational programs. While many solutions have been proposed to improve mass production, sex separation and field release procedures, relatively little attention has been devoted to effective mass sterilization of mosquitoes. Since irradiation of pupae en masse has proven difficult to standardise with several variables affecting dose response uniformity, the manipulation of adult mosquitoes appears to be the most promising method to achieve effective and reliable sterilization of large quantities of mosquitoes. A 3D-printed phase change material based coolable canister was developed which can compact, immobilize and hold around 100,000 adult mosquitoes during mass radio sterilization procedures. The mass irradiation and compaction treatments affected the survival and the flight ability of Aedes albopictus and Aedes aegypti adult males but the use of the proposed irradiation canister under chilled conditions (6.7-11.3 °C) significantly improved their quality and performance. The use of this cooled canister will facilitate adult mass irradiation procedures in self-contained irradiators in operational mosquito SIT programmes.
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Affiliation(s)
- F Balestrino
- Insect Pest Control Laboratory, Joint FAO/IAEA Centre of Nuclear Techniques in Food and Agriculture, IAEA, 1400, Vienna, Austria.
| | - N S Bimbilé Somda
- Insect Pest Control Laboratory, Joint FAO/IAEA Centre of Nuclear Techniques in Food and Agriculture, IAEA, 1400, Vienna, Austria
- Unité de Formation et de Recherche en Science et Technologie (UFR/ST), Université Norbert ZONGO (UNZ), BP 376, Koudougou, Burkina Faso
| | - M Samuel
- Insect Pest Control Laboratory, Joint FAO/IAEA Centre of Nuclear Techniques in Food and Agriculture, IAEA, 1400, Vienna, Austria
- National Institute for Communicable Diseases, Centre for Emerging Zoonotic and Parasitic Diseases, Johannesburg, 2131, South Africa
| | - S Meletiou
- Insect Pest Control Laboratory, Joint FAO/IAEA Centre of Nuclear Techniques in Food and Agriculture, IAEA, 1400, Vienna, Austria
- Department of Chemical Engineering, Cyprus University of Technology, 3020, Limassol, Cyprus
| | - O Bueno
- Insect Pest Control Laboratory, Joint FAO/IAEA Centre of Nuclear Techniques in Food and Agriculture, IAEA, 1400, Vienna, Austria
| | - T Wallner
- Insect Pest Control Laboratory, Joint FAO/IAEA Centre of Nuclear Techniques in Food and Agriculture, IAEA, 1400, Vienna, Austria
| | - H Yamada
- Insect Pest Control Laboratory, Joint FAO/IAEA Centre of Nuclear Techniques in Food and Agriculture, IAEA, 1400, Vienna, Austria
| | - W Mamai
- Insect Pest Control Laboratory, Joint FAO/IAEA Centre of Nuclear Techniques in Food and Agriculture, IAEA, 1400, Vienna, Austria
| | - M J B Vreysen
- Insect Pest Control Laboratory, Joint FAO/IAEA Centre of Nuclear Techniques in Food and Agriculture, IAEA, 1400, Vienna, Austria
| | - J Bouyer
- Insect Pest Control Laboratory, Joint FAO/IAEA Centre of Nuclear Techniques in Food and Agriculture, IAEA, 1400, Vienna, Austria
- UMR ASTRE, CIRAD, 34398, Montpellier, France
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Rodrigues MM, Fontoura CP, Garcia CSC, Martins ST, Henriques JAP, Figueroa CA, Ely MR, Aguzzoli C. Letter to editor - Reply to concerns on Rodrigues et al., "Investigation of plasma treatment on UHMWPE surfaces: Impact on physicochemical properties, sterilization and fibroblastic adhesion", Mater. Sci. Eng. C 102 (2019) 264-275, DOI: 10.1016/j.msec.2019.04.048. Biomater Adv 2024; 156:213704. [PMID: 38000337 DOI: 10.1016/j.bioadv.2023.213704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023]
Affiliation(s)
- Melissa Machado Rodrigues
- Área do Conhecimento de Ciências Exatas e Engenharias, Universidade de Caxias do Sul, Caxias do Sul, RS 95070-560, Brazil.
| | - Cristian Padilha Fontoura
- Área do Conhecimento de Ciências Exatas e Engenharias, Universidade de Caxias do Sul, Caxias do Sul, RS 95070-560, Brazil.
| | | | - Sandro Tomaz Martins
- Área do Conhecimento de Ciências Exatas e Engenharias, Universidade de Caxias do Sul, Caxias do Sul, RS 95070-560, Brazil
| | | | - Carlos Alejandro Figueroa
- Área do Conhecimento de Ciências Exatas e Engenharias, Universidade de Caxias do Sul, Caxias do Sul, RS 95070-560, Brazil
| | - Mariana Roesch Ely
- Instituto de Biotecnologia, Universidade de Caxias do Sul, Caxias do Sul, RS 95070-560, Brazil
| | - Cesar Aguzzoli
- Área do Conhecimento de Ciências Exatas e Engenharias, Universidade de Caxias do Sul, Caxias do Sul, RS 95070-560, Brazil
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Mangindaan D, Danil D, Purwondho R, Maulana S, Rombot O, Zuraida R. Comments on Rodrigues et al., "Investigation of plasma treatment on UHMWPE surfaces: Impact on physicochemical properties, sterilization and fibroblastic adhesion", Mater. Sci. Eng. C 102 (2019) 264-275, DOI: 10.1016/j.msec.2019.04.048. Biomater Adv 2024; 156:213703. [PMID: 37995387 DOI: 10.1016/j.bioadv.2023.213703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Dave Mangindaan
- Civil Engineering Department, Faculty of Engineering, Bina Nusantara University, K.H. Syahdan No. 9, Jakarta 11480, Indonesia; Waste-Food-Environmental Nexus Research Interest Group, Bina Nusantara University, K.H. Syahdan No. 9, Jakarta 11480, Indonesia.
| | - Daliansyah Danil
- Professional Engineer Program Department, Faculty of Engineering, Bina Nusantara University, K.H. Syahdan No. 9, Jakarta 11480, Indonesia
| | - Rudy Purwondho
- Professional Engineer Program Department, Faculty of Engineering, Bina Nusantara University, K.H. Syahdan No. 9, Jakarta 11480, Indonesia
| | - Suhenra Maulana
- Professional Engineer Program Department, Faculty of Engineering, Bina Nusantara University, K.H. Syahdan No. 9, Jakarta 11480, Indonesia
| | - Olifia Rombot
- Lecturer Resource Center, Bina Nusantara University, K.H. Syahdan No. 9, Jakarta 11480, Indonesia
| | - Rida Zuraida
- Waste-Food-Environmental Nexus Research Interest Group, Bina Nusantara University, K.H. Syahdan No. 9, Jakarta 11480, Indonesia; Industrial Engineering Department, Faculty of Engineering, Bina Nusantara University, K.H. Syahdan No. 9, Jakarta 11480, Indonesia
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5
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Ndayishimye S, Olorunfemi G, Nahayo B. Prevalence and factors associated with female sterilization in Rwanda: evidence from the demographic and health survey data (2019-2020). BMC Public Health 2023; 23:2446. [PMID: 38062388 PMCID: PMC10701991 DOI: 10.1186/s12889-023-17334-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Female sterilization is a safe and effective surgical procedure of achieving contraception. There is disparity in the prevalence of female sterilization globally, with high income countries having higher rates than low- and middle-income countries. However, current evidence of the uptake of female sterilization in Rwanda is not known. We therefore evaluated the prevalence and factors associated with female sterilization among women of reproductive age in Rwanda. METHODOLOGY This was a secondary data analysis of 14,634 women of reproductive age (15-49) in Rwanda. The data utilized was from the Rwanda Demographic Health and Survey (RDHS) 2019/2020. The predictors of female sterilization were determined using multivariable binary logistic regression analysis. RESULTS We found that the prevalence of female sterilization was 1.1% among women of reproductive age in Rwanda. Women older than 35 years had about 8 times higher chance of being sterilized as compared to younger women (aOR: 7.87, 95% CI: 4.77-12.99). Women living with their partners had higher odds of being sterilized as compared to never married women (aOR: 19.23, 95% CI: 4.57-80.82), while women from minority religion are more likely to be sterilized as compared to those of the catholic religion (aOR: 2.12, 95% CI: 1.03-4.37). Women from rich household had a higher chance to be sterilized as compared to their counterparts from poor households (aOR: 3.13, 95% CI: 1.94-5.03). Women from the Western region were more likely to accept sterilization compared to women from Kigali (aOR: 2.025, 95% CI: 1.17-3.49) and women who had more than 5 children had higher odds when compared to women who had 5 or less children (aOR: 1.49, 95% CI: 1.06-2.10). CONCLUSION The overall prevalence of sterilization among Rwandan women of reproductive age was 1.1%, which was very low as compared to India (29%), China (14.1%) and United States of America (13.7%). The age, marital status, religion, household wealth quintile, region and children ever born were associated with the uptake of female sterilization among Rwandan women. Public awareness campaign on the advantages of female sterilization should be done to improve uptake.
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Affiliation(s)
- Samuel Ndayishimye
- Reproductive Health Programme, Pan African University Life and Earth Sciences Institutes, University of Ibadan, Ibadan, Nigeria.
- University of Ibadan, Ibadan, Oyo State, Nigeria.
| | - Gbenga Olorunfemi
- Division of Epidemiology and Biostatistics, University of Witwatersrand, Johannesburg, South Africa
| | - Bonfils Nahayo
- Reproductive Health Programme, Pan African University Life and Earth Sciences Institutes, University of Ibadan, Ibadan, Nigeria
- University of Ibadan, Ibadan, Oyo State, Nigeria
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Hoover AT, Shattuck D, Andes KL. Vasectomy provider decision-making balancing autonomy and non-maleficence: qualitative interviews with providers. Gates Open Res 2023; 7:132. [PMID: 38352125 PMCID: PMC10861492 DOI: 10.12688/gatesopenres.15036.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 02/16/2024] Open
Abstract
Background Male sterilization, or vasectomy, is 99.9% effective at preventing pregnancy with less than a 2% risk of complications. Despite the high efficacy, low risk, low cost, and gender equity benefits of vasectomy, just 2% of women reported that they and their partners relied on vasectomy as their contraceptive method globally in 2019. Health care providers can be both a facilitator and a barrier in men's health generally, and may be in vasectomy provision as well. This study sought to describe the decision-making rationales of experienced vasectomy providers when evaluating patient candidacy in complex cases. Methods Fifteen vasectomy providers belonging to the global Vasectomy Network google group from seven countries participated in online interviews using a semi-structured in-depth interview guide. Providers were asked about their vasectomy training, their reasons for vasectomy provision, challenging cases they have faced, and approaches used to manage challenging cases. Vignettes were used to further elicit decision-making rationale. Thematic analysis was conducted using MAXQDA20. Results Provider decision-making was predicated on ensuring patients were well-informed, able to consent, and certain about their choice to have a vasectomy. Once those foundational conditions were met, providers filtered patient characteristics through their training, laws and policies, sociocultural norms, experience, and peer influence to produce a cost-benefit breakdown. Based on the cost-benefit analysis, providers determined whether to weigh autonomy or non-maleficence more heavily when determining vasectomy patient candidacy. Conclusions Despite clinical best practices that promote prioritizing patient autonomy over non-maleficence, some providers continued to weigh non-maleficence over autonomy in vasectomy patient candidacy evaluations. Non-maleficence was particularly prioritized in cases providers deemed to be at higher risk of regret. The findings of this study suggest vasectomy provider training should emphasize evidence-based best practices in shared decision-making and patient-centered care to facilitate vasectomy provision that honors patient autonomy and rights.
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Affiliation(s)
- Alison T. Hoover
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, 30322, USA
| | - Dominick Shattuck
- Center for Communication, and Department of Health Behavior and Society at the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, 21205, USA
| | - Karen L. Andes
- Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island, 02903, USA
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Vienot S, Skowron O, Valignat C, Xardel V, Ngo L, Arnoux V. [Vasectomy under local anesthesia, retrospective evaluation of patient satisfaction in CH Annecy Genevois]. Prog Urol 2023; 33:1002-1007. [PMID: 37777434 DOI: 10.1016/j.purol.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/03/2023] [Accepted: 09/07/2023] [Indexed: 10/02/2023]
Abstract
Contraceptive vasectomy is a male sterilization technique by interrupting the continuity of the vas deferens. The primary endpoint of our study was to evaluate patients' feelings of vasectomy under local anesthesia. We collected responses from 108 patients who had a vasectomy under local anesthesia at the Center Hospitalier Annecy Genevois between January 1, 2020 and April 30, 2022. The average age of patients at the time of the vasectomy was 40years old. Patients were satisfied with the level of information before vasectomy for 104 of them (96%). The level of pain felt during the intervention evaluated by Visual Analog Scale had an average of 3.4/10 (standard deviation 2.4). The degree of satisfaction during the procedure was excellent/good for 103 patients (95%). In the follow-up, we reported 10 patients (10%) with a complication (hematoma, infection or healing problem). The retrospective evaluation found 103 patients (95%) who would repeat the procedure under the same modalities and 106 patients (98%) who would recommend vasectomy under local anesthesia to a relative/friend. Vasectomy under local anesthesia is increasingly common, so it is important to assess the feelings of patients with this modality. Our study had the advantage of bringing together a large number of patients over a short period with several different operators. Overall satisfaction with the hospitalization process and the procedure was very satisfactory. The patient journey was significantly simplified with local anesthesia instead of general anesthesia. LEVEL OF EVIDENCE: 4.
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Affiliation(s)
- S Vienot
- Service d'Urologie et Transplantation rénale, CHU Grenoble Alpes , France.
| | - O Skowron
- Service d'Urologie, CH Annecy Genevois, France.
| | - C Valignat
- Service d'Urologie, CH Annecy Genevois, France.
| | - V Xardel
- Service d'Urologie, CH Annecy Genevois, France.
| | - L Ngo
- Service d'Urologie, CH Annecy Genevois, France.
| | - V Arnoux
- Service d'Urologie, CH Annecy Genevois, France.
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Joonè CJ, Konovalov DA. The effect of neuter status on longevity in the Rottweiler dog. Sci Rep 2023; 13:17845. [PMID: 37857755 PMCID: PMC10587138 DOI: 10.1038/s41598-023-45128-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023] Open
Abstract
Surgical sterilization or neutering of dogs is a commonly performed procedure in veterinary practices in many countries. In recent decades, concerns have been raised regarding possible side effects of neutering, including increased risk of certain neoplastic, musculoskeletal and endocrinological conditions. Considering that age serves as a significant confounding factor for some of these conditions, evaluating longevity statistics could provide valuable insights into the impact of neutering. The aim of this study was to compare longevity between neutered and sexually intact male and female Rottweilers, using electronic patient records collected by the VetCompass Australia database. Male and female Rottweilers neutered before 1 year of age (n = 207) demonstrated an expected lifespan 1.5 years and 1 year shorter, respectively, than their intact counterparts (n = 3085; p < 0.05). Broadening this analysis to include animals neutered before the age of 4.5 years (n = 357) produced similar results.
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Affiliation(s)
- Carolynne J Joonè
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, 4811, Australia.
| | - Dmitry A Konovalov
- College of Science and Engineering, James Cook University, Townsville, Queensland, 4811, Australia
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Mock KO, Moyer A, Lobel M. Explaining sex discrepancies in sterilization rates in the United States: An evidence-informed commentary. Perspect Sex Reprod Health 2023; 55:116-121. [PMID: 37594046 DOI: 10.1363/psrh.12243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
CONTEXT With abortion no longer deemed a constitutional right in the United States (US), the importance of effective contraceptive methods cannot be overstated. Both male sterilization (vasectomy) and female sterilization (tubal ligation) have the lowest failure rates of available means of contraception. Despite the less invasive and reversible nature of vasectomy compared to tubal ligation procedures and even though some healthcare professionals dissuade certain women, especially those who are white and/or economically advantaged, from undergoing a sterilization procedure, female sterilization is approximately three times more prevalent than male sterilization in the US. PURPOSE We suggest that the discrepancy in sterilization rates is attributable to the burdens of pregnancy and birth experienced by women, beliefs that pregnancy prevention is a woman's responsibility, a dearth of sex education that results in lack of knowledge and poor understanding of contraception, perceptions of masculinity in which contraception is viewed as feminizing, and the increase in long-term singlehood that shapes the desire of individuals to avoid unwanted pregnancy that may result in single parenting. IMPLICATIONS Recent reports suggest that court rulings restricting abortion access and looming threats to contraceptive legality and accessibility may be prompting a national increase in male sterilization.
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Affiliation(s)
- K Olivia Mock
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Anne Moyer
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA
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Jana A, Shekhar C. Female sterilisation in India: Examining the role of women's own decision making and information given to client. J Biosoc Sci 2023; 55:960-979. [PMID: 36330846 DOI: 10.1017/s0021932022000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
India has a very high prevalence of female sterilisation compared to other countries in the world, with a prevailing situation of very low level of information about contraceptive options given to women. It is well established in demographic research that, there exists a strong association between knowledge of contraceptive methods and type of contraception chosen. Present study uses data from 3 consecutive rounds of National Family Health Survey (3, 4 & 5). The sample contains currently married women who started using the current method 5 years prior to each round of survey. Multilevel Logistic Regression and Fairlie Decomposition Model are used to analyse the effect of information given to respondents and decision-making power regarding contraceptive methods on choice of female sterilisation. Women, who are informed about available methods, have lower chance (45.8%, 37.5% & 40% for NFHS 3, 4 & 5 respectively) to opt for sterilisation after controlling all other factors. If woman is the sole decision maker for contraceptive choice, the chance of sterilisation reduces than cases where decision is taken only by husband or jointly. Information about other methods also contributes towards reducing the chance of female sterilisation over the time. Information about contraceptive methods is found to be a major factor in controlling choice of temporary or permanent method. Thus, major focus for the policy makers should be to make information regarding contraceptives more accessible for women.
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Affiliation(s)
- Arjun Jana
- PhD Scholar, International Institute for Population Sciences, Mumbai, India
| | - Chander Shekhar
- Professor, Department of Fertility and Social Demography, International Institute for Population Sciences, Mumbai, India
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Homma T, Uehara H, Saji H. Factors affecting insulation failure in reusable surgical devices. Sci Rep 2023; 13:13719. [PMID: 37608091 PMCID: PMC10444886 DOI: 10.1038/s41598-023-41059-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 08/21/2023] [Indexed: 08/24/2023] Open
Abstract
The purpose of this study was to investigate the associated factors of insulation failure (IF) in reusable endoscopic instruments. The insulation coating of reusable endoscopic instruments underwent routine visual checks, hand washing to remove visible stains, and mechanized sterilization. We recorded the cleaning number and usage period of all instruments. The instruments were tested for IF using a detector. IF was found in eight of 69 devices (11.6%). Examining by clinical specialty, we found IF in 4 of 28 gastrointestinal (14.3%), 3 of 20 gynecological (15.0%), 1 of 12 urological (8.3%), and none of the nine thoracic devices. The median distance from the tip to the damaged part was 5 cm (3-5 cm). In the IF and the intact groups, the period of use [7 years (6-8) versus 7 years (4-8), P = 0.90] and the number of cleanings [281 (261-323) versus 261 (179-320), P = 0.27] were not significantly different. The IF group included products of three different companies; however, six of the eight (75.0%) were from the same company. Cleaning methods and usage period have a lower impact on IF. The use of reusable forceps as a monopolar device was found to pose a higher risk, requiring regular assessments.
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Affiliation(s)
- Takahiro Homma
- Division of Thoracic Surgery, Kurobe City Hospital, Toyama, Japan.
- Division of Thoracic Surgery, University of Toyama, Toyama, Japan.
- Department of Chest Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Hirofumi Uehara
- Central Sterile Supply Department, Toyama University Hospital, Toyama, Japan
| | - Hisashi Saji
- Department of Chest Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Kawasaki, Kanagawa, 216-8511, Japan
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12
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Yusuf F, Leeder SR. Trends in female sterilisations in New South Wales, 2010-2019. Aust N Z J Obstet Gynaecol 2023; 63:571-576. [PMID: 37254784 DOI: 10.1111/ajo.13698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 04/24/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Female sterilisation remains a common contraceptive method in many countries. AIMS The aim is to analyse the recent changes in the incidence of female sterilisation in New South Wales (NSW). METHODS Data were obtained from the NSW Admitted Patients Data Collection for all female patients who had undergone one of the five sterilisation procedures in a public or private hospitals in NSW during 2010 and 2019. Denominators for calculating sterilisation rates were estimated using census and other population data. RESULTS The number of sterilisation cases dropped from 3407 in 2010 to 2561 in 2019, and the sterilisation rate declined from 22.6 per 10 000 females aged 20-49 in 2010 to 15.4 in 2019. Incidence was at its peak in the 35-39 age group in both years. Indigenous females had higher sterilisation rates than non-Indigenous females born in Australia or overseas. While some foreign-born females had higher sterilisation rates than for those who were in Australia or overseas on average their rates were lower than those who were born in Australia or overseas. There was a clear socio-economic gradient such that females living in the most disadvantaged areas had much higher sterilisation rates than those living in the least disadvantaged areas. The Indigenous, ethnic and socio-economic differences in sterilisation rates persisted in both years of this study. CONCLUSION Although fertility rates in NSW changed little over the 10-year interval a steady decline in sterilisation occurred, consistent with other forms of contraception (particularly long-acting reversible types) increasing concurrently in popularity.
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Affiliation(s)
- Farhat Yusuf
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Management, Macquarie Business School, Macquarie University, Sydney, New South Wales, Australia
| | - Stephen Ross Leeder
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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White J, Rahman F, Petrella F, Rivero MJ, Deebel N, Arbeleaz MCS, Ledesma B, Kohn T, Ramasamy R. Telehealth Sterilization Consultation Does Not Impact Likelihood of Vasectomy: A Retrospective Institutional Analysis. Urology 2023; 176:79-81. [PMID: 37001823 DOI: 10.1016/j.urology.2023.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/08/2023] [Accepted: 03/18/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To evaluate if telehealth consultations would impact the likelihood of patients following through with vasectomies. METHODS We utilized electronic medical records from the past 5 years to retrospectively evaluate male patients undergoing a sterilization consult. Telehealth consultations have been offered since March 2020 due to the COVID-19 pandemic. Patients were stratified to in-office or telehealth consultation. We then utilized billing codes to determine if patients underwent a vasectomy. Percentages of patients who subsequently underwent vasectomy were compared using Chi-square analysis. Logistic regression was performed to identify factors associated with completing vasectomy. RESULTS There were a total of 369 patients who underwent a telehealth male sterilization consultation and 1664 patients who were seen in the office. We found that 66.9% of telehealth patients ultimately underwent a vasectomy (n.ß=.ß247) compared to 64.3% of patients who were seen via office assessment (n.ß=.ß1070) (X2 =.ß0.646, p.ß=.ß.724). Younger age was the only variable on univariate logistic regression that was associated with completing vasectomy (p.ß=.ß.002) via either an in-person or televisit, while body mass index, race, and ethnicity were not significant. CONCLUSION Only 2/3 of the men completing a vasectomy consult receive a subsequent vasectomy. Both in-office and telehealth consultations resulted in comparable rates of vasectomy. This is the first study to report on the likelihood of following through with a surgical procedure comparing in-office vs.ßtelehealth assessment in male sexual and reproductive medicine. As vasectomy consultations continue to rise, clinicians can be reassured by the effectiveness of telehealth consultations prior to vasectomy.
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Affiliation(s)
- Joshua White
- Desai Sethi Urology Institute, University of Miami, Miami, FL.
| | - Farah Rahman
- Desai Sethi Urology Institute, University of Miami, Miami, FL
| | - Francis Petrella
- Department of Urology, McGill University, Montreal, Quebec, Canada
| | | | - Nicholas Deebel
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC
| | | | - Braian Ledesma
- Desai Sethi Urology Institute, University of Miami, Miami, FL
| | - Taylor Kohn
- Department of Urology, John Hopkins University, Baltimore, MD
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14
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Thornton M, Arora KS. Reproductive justice in post-Roe America: Impact of restricted abortion access on patients seeking permanent contraception. Contraception 2023; 121:109995. [PMID: 36842605 PMCID: PMC10659109 DOI: 10.1016/j.contraception.2023.109995] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 02/28/2023]
Abstract
Anecdotally, clinicians have reported an increase in demand for permanent contraception procedures since the Dobbs v. Jackson Women’s Health Organization (Dobbs) decision, which may reflect patients’ fear of losing reproductive autonomy. In this commentary we rely upon the history of bias and discrimination in permanent contraception access in the United States to interpret and predict potential outcomes following the Dobbs decision. These findings can shape clinical practice as clinicians aim to balance meeting a patient’s contraceptive goals while upholding a commitment to avoid reproductive coercion. We provide recommendations for clinicians’ contraceptive counseling to ensure equitable access to permanent contraception for all patients.
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Affiliation(s)
- Madeline Thornton
- School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Kavita Shah Arora
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, United States.
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15
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Arora KS, Chua A, Miller E, Boozer M, Serna T, Bullington BW, White K, Gunzler DD, Bailit JL, Berg K. Medicaid and Fulfillment of Postpartum Permanent Contraception Requests. Obstet Gynecol 2023; 141:918-925. [PMID: 37103533 PMCID: PMC10154035 DOI: 10.1097/aog.0000000000005130] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/12/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE To evaluate the association between Medicaid insurance and fulfillment of postpartum permanent contraception requests. METHODS We conducted a retrospective cohort study of 43,915 patients across four study sites in four states, of whom 3,013 (7.1%) had a documented contraceptive plan of permanent contraception at the time of postpartum discharge and either Medicaid insurance or private insurance. Our primary outcome was permanent contraception fulfillment before hospital discharge; we compared individuals with private insurance with individuals with Medicaid insurance. Secondary outcomes were permanent contraception fulfillment within 42 and 365 days of delivery, as well as the rate of subsequent pregnancy after nonfulfillment. Bivariable and multivariable logistic regression analyses were used. RESULTS Patients with Medicaid insurance (1,096/2,076, 52.8%), compared with those with private insurance (663/937, 70.8%), were less likely to receive desired permanent contraception before hospital discharge (P≤.001). After adjustment for age, parity, weeks of gestation, mode of delivery, adequacy of prenatal care, race, ethnicity, marital status, and body mass index, private insurance status was associated with higher odds of fulfillment at discharge (adjusted odds ratio [aOR] 1.48, 95% CI 1.17-1.87) and 42 days (aOR 1.43, 95% CI 1.13-1.80) and 365 days (aOR 1.36, 95% CI 1.08-1.71) postpartum. Of the 980 patients with Medicaid insurance who did not receive postpartum permanent contraception, 42.2% had valid Medicaid sterilization consent forms at the time of delivery. CONCLUSION Differences in fulfillment rates of postpartum permanent contraception are observable between patients with Medicaid insurance and patients with private insurance after adjustment for clinical and demographic factors. The disparities associated with the federally mandated Medicaid sterilization consent form and waiting period necessitate policy reassessment to promote reproductive autonomy and to ensure equity.
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Affiliation(s)
- Kavita Shah Arora
- Department of Obstetrics and Gynecology, the Department of Epidemiology, Gillings School of Global Public Health, and the Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; the Department of Obstetrics and Gynecology and the Center for Health Care Research and Policy, Population Health Research Institute, MetroHealth Medical System, Cleveland, Ohio; the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island; the Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; the Department of Obstetrics and Gynecology, University of California, San Francisco, San Francisco, California; and the Department of Sociology, Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas
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16
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Mosley EA, Monaco A, Zite N, Rosenfeld E, Schablik J, Rangnekar N, Hamm M, Borrero S. U.S. physicians' perspectives on the complexities and challenges of permanent contraception provision. Contraception 2023; 121:109948. [PMID: 36641099 PMCID: PMC10159903 DOI: 10.1016/j.contraception.2023.109948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Evidence shows many misconceptions exist around permanent contraception, and there are numerous barriers to accessing the procedure. This qualitative study explored physician perspectives regarding patients' informational and decision-support needs, the complexities and challenges of counseling and access, and how these factors may differ for people living on lower incomes. STUDY DESIGN We conducted 15 semistructured, telephone interviews with obstetrician-gynecologists in three geographic regions of the United States to explore their perspectives on providing permanent contraception counseling and care. We analyzed the interviews using content analysis. RESULTS Physicians discussed a tension between respecting individual reproductive autonomy and concern for future regret; they wanted to support patients' desire for permanent contraception but were frequently concerned patients did not have the information they needed or the foresight to make high-quality decisions. Physicians also identified barriers to counseling including lack of time, lack of continuity over the course of prenatal care, and baseline misinformation among patients. Physicians identified additional barriers in providing a postpartum procedure even after thedecision was made including lack of personnel and operating room availability. Finally, physicians felt that people living on lower incomes faced more challenges in access primarily due to the sterilization consent regulations required by Medicaid. CONCLUSIONS Physicians report numerous challenges surrounding permanent contraception provision and access. Strategies are needed to support physicians and patients to enhance high-quality, patient-centered sterilization decision making and ensure that patients are able to access a permanent contraceptive procedure when desired. IMPLICATIONS This qualitative study demonstrates the various challenges faced by physicians to support permanent contraception decision making. These challenges may limit patients' access to the care they desire. This study supports the need to transform care delivery models and improve the federal sterilization policy to ensure equitable patient-centered access to desired permanent contraception. DISCLAIMER Although the term permanent contraception has increasingly replaced the word sterilization in clinical settings, we use sterilization in some places throughout this paper as that was the standard terminology at the time the interviews were conducted and the language the interviewed physicians used.
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Affiliation(s)
- Elizabeth A Mosley
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA, United States.
| | - Alexandra Monaco
- University of Florida College of Medicine Department of Obstetrics and Gynecology in Gainesville, FL
| | - Nikki Zite
- University of Tennessee Graduate School of Medicine
| | - Elian Rosenfeld
- Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA, United States
| | - Jennifer Schablik
- University of Tennessee Medical Center, Knoxville, TN, United States
| | | | - Megan Hamm
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA, United States
| | - Sonya Borrero
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA, United States
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17
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Friedman N, Hashiloni-Dolev Y. Sedated masculinity: the use of anaesthesia during vasectomy in Israel. Cult Health Sex 2023; 25:398-412. [PMID: 35290162 DOI: 10.1080/13691058.2022.2048893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
Vasectomy is considered a permanent form of contraception for men that can help reduce reproductive inequality. Its underutilisation in the context of the threats it may pose to perceptions of traditional masculinity has been closely investigated, but the lived experience of the procedure itself has been largely overlooked. This paper examines the experience of having a vasectomy in Israel, focusing on the recommended form of anaesthesia. Drawing on 15 semi-structured interviews with Israeli men who have experienced vasectomy, we found that the choice of anaesthesia has a significant impact on the meaning and experience of vasectomy. Unlike the widespread use of local anaesthesia during vasectomy in other countries, vasectomy in Israel is performed almost exclusively under twilight sedation administered intravenously. Based on our findings, we argue that framing vasectomy as an operation that requires sedation is related to views of masculinity and reproduction. Our data suggest that vasectomy in Israel is constituted as a potentially traumatic event, and anaesthesia is employed to protect patients from feelings of embarrassment and discomfort. We conclude that the prevailing method of sedation perpetuates the silencing and marginalisation of vasectomy as a contraceptive method, and consequently, its very limited accessibility in Israel.
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Affiliation(s)
- Noga Friedman
- Gender Studies Program, Tel Aviv University, Tel Aviv, Israel
| | - Yael Hashiloni-Dolev
- Department of Sociology and Anthropology, Ben-Gurion University of the Negev, Beersheba, Israel
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18
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Hennessey C, Johnson C, McLaren H, Bhardwaj N, Rivlin K, Chor J. Permanent Sterilization in Nulliparous Patients: Is Legislative Anxiety an Indication for Surgery? J Clin Ethics 2023; 34:320-327. [PMID: 37991729 DOI: 10.1086/727435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
AbstractThe Supreme Court's Dobbs v. Jackson Women's Health Organization decision, first leaked to the public on 2 May 2022 and officially released on 24 June 2022, overturned Roe v. Wade and thereby determined that abortion is no longer a federally protected right under the Constitution. Instead, the decision gives individual states the right to regulate abortion. Since the Dobbs decision first leaked, our institution has received numerous requests for permanent contraception from individuals stating that their motivation to pursue permanent contraception was influenced by the Dobbs decision and concerns about their reproductive autonomy. Discussions with patients seeking permanent contraception since the Supreme Court's leaked decision have led us to ask ourselves, is legislative anxiety an indication for surgery? This article presents a case series consisting of a convenience sample of 17 young, nulliparous individuals who sought out permanent contraception in the six months following the leak of the Dobbs decision. Healthcare professionals often feel discomfort in offering permanent contraception to young and nulliparous individuals. Accordingly, we discuss pertinent legal issues, review relevant ethical considerations, and offer a framework for these discussions intended to empower the consulting healthcare professional to center the bodily autonomy of every patient regardless of age, parity, or indication for permanent contraception.
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19
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Herczeg CK, Song J. Sterilization of Polymeric Implants: Challenges and Opportunities. ACS Appl Bio Mater 2022; 5:5077-5088. [PMID: 36318175 PMCID: PMC9691608 DOI: 10.1021/acsabm.2c00793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Degradable and environmentally responsive polymers have been actively developed for drug delivery and regenerative medicine applications, yet inadequate consideration of their compatibility with terminal sterilization presents notable barriers to clinical translation. This Review discusses industry-established terminal sterilization methods and aseptic processing and contrasts them with innovative approaches aimed at preserving the integrity of polymeric implants. Regulatory guidelines, fiscal considerations, and potential pitfalls are discussed to encourage early integration of sterility regulatory considerations in material designs.
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Affiliation(s)
- Chloe K Herczeg
- Department of Orthopedics and Physical Rehabilitation, Department of Biochemistry and Molecular Biotechnology, UMass Chan Medical School, 55 Lake Avenue North, Worcester, Massachusetts 01655, United States
| | - Jie Song
- Department of Orthopedics and Physical Rehabilitation, Department of Biochemistry and Molecular Biotechnology, UMass Chan Medical School, 55 Lake Avenue North, Worcester, Massachusetts 01655, United States
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20
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Abstract
The recently reported cases of coerced sterilisation of women at a privately operated immigration detention facility in the USA are egregious in their disregard for human dignity and professional ethics, but sadly not surprising. These abuses represent a continuation of efforts to control the reproductive capacity of women, fueled by racist and xenophobic motives. Physicians helped create and legitimise the pseudoscientific framework for the eugenics movement, which would implement forceful sterilisation as its tool of choice to eliminate undesirable traits that were thought to be biologically inherited and predominant among racial and ethnic minorities. Although state-endorsed forcible sterilisation programs have ended, incarcerated women have remained particularly vulnerable to sterilisation abuse. The intersectional vulnerabilities of racism, xenophobia and carcerality must be addressed to prevent such abuses from recurring.
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Affiliation(s)
- Mariam O Fofana
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
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21
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Marchand GJ, Masoud AT, King AK, Brazil GM, Ulibarri HM, Parise JE, Arroyo AL, Coriell CL, Goetz SP, Moir CJ, Govindan ML. Salpingectomy, tubal ligation and hysteroscopic occlusion for sterilization. Minerva Obstet Gynecol 2022; 74:452-461. [PMID: 35912465 DOI: 10.23736/s2724-606x.22.05134-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Sterilization of females is considered one of the most prevalent contraceptive techniques among women in the United States. There are many surgical sterilization procedures including salpingectomy, tubal ligation, and hysteroscopic occlusion of the fallopian tubes. We provide an overview of these methods from the clinical data and latest studies available on this topic. EVIDENCE ACQUISITION In order to review the latest literature on the topic, we searched electronic databases including PubMed, Web of Science, Scopus, and Cochrane library for all eligible studies from May 1st 2018 until May 1st 2022 using the following strategy: ("fallopian tube removal" OR Salpingectomy OR "fallopian tube excision" OR "tubal sterilization") AND ("tubal ligation" OR "bipolar coagulation" OR "tubal clip" OR "tubal ring" OR fimbriectomy). We reviewed every study that met our criteria and subjectively considered their results and methodology into this narrative review. EVIDENCE SYNTHESIS In addition to reviewing major guidelines in the United States, 19 recent studies met our eligibility criteria and were included in this review. We grouped the findings under the following headings: anatomical and physiological considerations, sterilization, salpingectomy, tubal ligation, and hysteroscopic tubal occlusion. CONCLUSIONS Bilateral salpingectomy and techniques of tubal ligation or occlusion continue to be effective procedures with good safety profiles. All techniques have similar surgical outcomes and long-term success rates. As salpingectomy has the advantage of reducing the risk of occurrence of ovarian cancer, this is preferential when feasible. Hysteroscopic occlusion techniques may be more minimally invasive but have the disadvantages of delayed efficacy, the need for a second invasive diagnostic procedure, and limited availability.
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Affiliation(s)
- Greg J Marchand
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA -
| | - Ahmed T Masoud
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
- Faculty of Medicine, University of Fayoum, Fayoum, Egypt
| | - Alexa K King
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Giovanna M Brazil
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Hollie M Ulibarri
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Julia E Parise
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Amanda L Arroyo
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Catherine L Coriell
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Sydnee P Goetz
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Carmen J Moir
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Malini L Govindan
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
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22
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Jacobs JC, Stanfors M. Heterogamy and contraceptive use among married and cohabiting women. Adv Life Course Res 2022; 53:100492. [PMID: 36652210 DOI: 10.1016/j.alcr.2022.100492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 06/17/2023]
Abstract
Decisions about which contraceptives to use are a key component of a couple's "fertility work," and these decisions can be made in homogamous or heterogamous couple contexts. Relative resource theory and the strain perspective suggest that heterogamy may lead to differences in bargaining power or higher levels of discordance within couples, thereby affecting the distribution of fertility work and decisions about which contraceptives a couple will use. While heterogamy has been linked to less effective contraceptive use amongst teenagers, its role in the contraceptive behavior of married and cohabiting women has been less widely studied. This study examines the association between relationship context in terms of education, age, and race/ethnicity heterogamy and partnered women's use of contraceptives. We used data on partnered women aged 20-45 who were trying to avoid pregnancy from the 2006-2015 National Survey of Family Growth (n = 8097). We used multinomial logistic regressions to determine whether education, age, or race/ethnicity heterogamy was associated with the use of male or female sterilization, long-acting reversible contraceptives (LARCs), other hormonal contraceptives, or other non-hormonal methods. We did not find consistent evidence that relative bargaining power due to higher education, more advanced age, or racial/ethnic privilege resulted in the use of methods requiring lower levels of fertility work. We found some evidence supporting the strain perspective. Younger women (20-34) who differed from their partners along two or more dimensions were less likely to use contraceptive methods requiring ongoing effort and coordination (i.e., LARCs, other hormonal methods, and non-hormonal methods). This association was not observed among women aged 35-45. Despite the more permanent nature of marriage/cohabitation, differences between partners in heterogamous relationships may factor into the contraceptive decision-making process, especially among younger adults at earlier stages of their relationships.
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Affiliation(s)
- Josephine C Jacobs
- Health Economics Resource Center, Palo Alto Veterans Health Administration, United States
| | - Maria Stanfors
- Centre for Economic Demography, Lund University, Sweden.
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23
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Abstract
Women of color experience marked disparities in fulfillment of desired postpartum permanent contraception. While many attribute the disparity to the required Medicaid sterilization consent form and 30-day waiting period established in response to forced and coerced sterilizations, the policy does not entirely explain the disparity; racial and ethnic disparities persist even within strata of insurance type. We therefore propose framing postpartum permanent contraception as a health disparities issue that requires multi-level interventions to address. Based on the literature, we identify discrete levels of barriers to postpartum permanent contraception fulfillment at the patient, physician, hospital, and policy levels that interact and compound within and between individual levels, affecting each individual patient differently. At the patient level, sociodemographic characteristics such as age, race and ethnicity, and parity impact desire for and fulfillment of permanent contraception. At the physician level, implicit bias and paternalistic counseling contribute to barriers in permanent contraception fulfillment. At the hospital level, Medicaid reimbursement, operating room availability, and religious affiliation influence fulfillment of permanent contraception. Lastly, at the policy level, the Medicaid consent form and waiting period pose a known barrier to fulfillment of desired postpartum permanent contraception. Unpacking each of these discrete barriers and untangling their collective impact is necessary to eliminate racial and ethnic disparities in permanent contraception fulfillment.
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Affiliation(s)
- Brooke W Bullington
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kavita Shah Arora
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, 3031 Old Clinic Building, CB 7570, Chapel Hill, NC, 27599, USA.
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24
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Ela EJ, Broussard K, Hansen K, Burke KL, Thaxton L, Potter JE. Satisfaction, Resignation, and Dissatisfaction with Long-Acting Reversible Contraception among Low-Income Postpartum Texans. Womens Health Issues 2022; 32:334-342. [PMID: 35459591 PMCID: PMC9283300 DOI: 10.1016/j.whi.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 02/01/2022] [Accepted: 02/24/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Prior longitudinal studies of long-acting reversible contraception (LARC) satisfaction and continuation guaranteed their participants access to LARC removal. Under real-world conditions, LARC users who wish to discontinue may experience barriers to LARC removal. METHODS A prospective cohort study recruited 1,700 postpartum Texans without private insurance from 8 hospitals in 6 cities. Our analysis included the 418 respondents who initiated LARC in the 24 months after childbirth. A content analysis of open-ended survey responses identified three categories of LARC users: satisfied, resigned, and dissatisfied. Satisfied LARC users were using their method of choice. Resigned users were using LARC as an alternative method when their preferred method was inaccessible. Dissatisfied users were unhappy with LARC. Multinomial logistic regression models identified risk factors for resignation and dissatisfaction. Cox proportional hazards models assessed differences in LARC discontinuation by satisfaction and sociodemographic characteristics. RESULTS Participants completed 1,505 surveys while using LARC. LARC users were satisfied in 83.46% of survey responses, resigned in 5.25%, and dissatisfied in 11.30%. Resignation was more likely if respondents were uninsured or wanted sterilization at the time of childbirth. The risk of dissatisfaction increased with time using LARC and was higher among uninsured respondents. U.S.-born Hispanic LARC users were more likely than foreign-born Hispanic LARC users to be dissatisfied and less likely to discontinue when dissatisfied. Dissatisfaction-but not resignation-predicted discontinuation. Cost, lack of insurance, and difficulty obtaining an appointment were frequent barriers to LARC removal. CONCLUSIONS Most postpartum LARC users were satisfied, but users who wished to discontinue frequently encountered barriers.
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Affiliation(s)
- Elizabeth J Ela
- Population Research Center, The University of Texas at Austin, Austin, Texas.
| | - Kathleen Broussard
- Population Research Center, The University of Texas at Austin, Austin, Texas; Department of Sociology, The University of Texas at Austin, Austin, Texas
| | - Katie Hansen
- Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Kristen L Burke
- Population Research Center, The University of Texas at Austin, Austin, Texas; Department of Sociology, The University of Texas at Austin, Austin, Texas
| | - Lauren Thaxton
- Population Research Center, The University of Texas at Austin, Austin, Texas; Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Joseph E Potter
- Population Research Center, The University of Texas at Austin, Austin, Texas; Department of Sociology, The University of Texas at Austin, Austin, Texas; Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, Texas
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25
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Picard M, Duforestel T. [Vaginal tubal sterilization: About a series of 158 patients from 2005 to 2021]. Gynecol Obstet Fertil Senol 2022; 50:470-474. [PMID: 35121173 DOI: 10.1016/j.gofs.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The latest recommendations of 2006 on tubal sterilization reported an infectious risk of 1.5 to 2.5% for the vaginal approach. There is, however, limited literature on this approach. The primary objective of our study was to investigate the feasibility of tubal sterilization via posterior colpotomy. The secondary objectives were to study the reproducibility of this approach, the postoperative infection rate after tubal sterilization via posterior colpotomy, to evaluate its peroperative and postoperative morbidity. METHODS This retrospective study, conducted at the Antibes's Hospital, included patients over 18 years of age who underwent tubal ligation with clips or bilateral vaginal salpingectomy from 2005 to 2021. RESULTS We included a total of 158 patients: 88% by clips and 12% by bilateral salpingectomy. The average operative duration was of 27 minutes. There were no infectious or postoperative complications directly related to the sterilization. There were two failures of the technique, requiring conversion to laparoscopy (1.3%) and four subsequent pregnancies (2.5%). CONCLUSIONS We were able to show low morbidity and failure rates with this surgical technique. It, therefore, does not appear to be inferior to the laparoscopic approach. Moreover, it is reproducible technique.
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Affiliation(s)
- M Picard
- Service de gynécologie-obstétrique, centre hospitalier d'Antibes Juan-les-Pins, 107, avenue de Nice, 06600 Antibes cedex, France.
| | - T Duforestel
- Service de gynécologie-obstétrique, centre hospitalier d'Antibes Juan-les-Pins, 107, avenue de Nice, 06600 Antibes cedex, France
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Russell CB, Qasba N, Evans ML, Frankel A, Arora KS. Variation in the interpretation and application of the Medicaid sterilization consent form among Medicaid officials. Contraception 2022; 109:57-61. [PMID: 35038447 PMCID: PMC9403908 DOI: 10.1016/j.contraception.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/01/2022] [Accepted: 01/07/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The Medicaid consent policy has been identified as a major barrier to desired permanent contraception, particularly for low-income communities and communities of color. As each state may modify their state Medicaid sterilization consent form, variation in the form has been reported. This study aims to characterize state-level variation in Medicaid Title XIX consent form interpretation and application. STUDY DESIGN We aimed to collect primary data from Medicaid officials in all 50 United States from January to May 2020 via a 25-question electronic survey regarding state-level consent form implementation. Questions targeted consent form details and definitions, insurance and billing, clinician correspondence, and administrative processes. We used Qualtrics XM to collect survey responses. We performed descriptive statistics on the survey responses. There were no exclusion criteria. RESULTS We had 41 responses from 36/50 states (72% participation rate). Heterogeneity existed in the key definitions of "Premature Delivery" and "Emergency Abdominal Surgery." One in five respondents reported the consent form was only available in English. Variation among Current Procedural Terminology codes covered in each state's sterilization policy were noted. Nearly a quarter of respondents did not know how Medicaid informed healthcare providers of consent form denials. Most participants (90%) were unaware of differences between state sterilization policies. CONCLUSION This study demonstrates variation in terms of consent form definitions, procedures covered, correspondence with clinicians, and administrative review processes among state Medicaid offices regarding the sterilization consent form. Greater transparency is necessary in order to reduce administrative barriers to desired permanent contraception. IMPLICATIONS Inconsistent interpretation poses an administrative barrier to care, raises concern regarding appropriate clinician reimbursement, and can potentially lead to unnecessarily denying patients the contraceptive option of their choice. Permanent contraception policies should be equitable no matter insurance status, preserve reproductive autonomy and effectively protect vulnerable populations.
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Affiliation(s)
- Colin B Russell
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, United States; Tufts University School of Medicine, Boston, MA, United States.
| | - Neena Qasba
- University of Massachusetts Medical School-Baystate Medical Center, Department of Obstetrics and Gynecology, Springfield, MA, United States
| | - Megan L Evans
- Tufts Medical Center, Department of Obstetrics and Gynecology, Boston, MA, United States
| | - Angela Frankel
- Tufts University School of Medicine, Boston, MA, United States
| | - Kavita Shah Arora
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland OH, United States; Department of Bioethics - Case Western Reserve University, Biomedical Research Building, Cleveland, OH, United States
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Kovell LC, Meyerovitz CV, Skaritanov E, Ayturk D, Person SD, Kumaraswami T, Juraschek SP, Moore Simas TA. Hypertension and contraceptive use among women of child-bearing age in the United States from 2001 to 2018. J Hypertens 2022; 40:776-784. [PMID: 35081582 PMCID: PMC10122757 DOI: 10.1097/hjh.0000000000003077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hypertension (HTN) in pregnancy is a leading cause of maternal mortality in the United States. Contraception is widely used, and estrogen-based combined hormonal forms are known to increase blood pressure (BP). With nearly half of pregnancies unplanned and many antihypertensive medications teratogenic, appropriate contraception is critical in child-bearing age women with HTN. METHODS Using the National Health and Nutrition Examination Surveys (NHANES) from 2001 to 2018, we evaluated contraception and antihypertensive medication use in women of child-bearing age (20-50 years). Women who had undergone sterilization or menopause were excluded. HTN was defined based on a self-reported provider diagnosis and BP ≥130/80 mm Hg or antihypertensive medication use. Contraception included non-barrier methods (pills/patch/ring, injections, long-acting reversible contraceptives) or consistent condom use. Multivariable logistic regression was used to model the odds of contraception use. Temporal trends in contraception use were reported. RESULTS Of the 8726 women, 12.4% had HTN with mean age (standard error) 36.0 (0.3) years. In women with HTN, 9.2% used non-barrier contraception and 10.4% used condoms only. Over half (52.7%) of women with HTN on antihypertensive medications were taking medications contraindicated in pregnancy, with no difference seen by contraceptive status. In logistic regression models, contraceptive use was lower in the older-aged women. In women with HTN on non-barrier contraception, combined hormonal contraceptive use declined, from 100% (2001-2006) to 81.4% (2013-2018, P < 0.001). CONCLUSIONS Many women with self-reported HTN are not using adequate contraception. Of the small proportion on non-barrier contraceptives, the majority are using estrogen-based, BP-raising methods.
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Affiliation(s)
- Lara C. Kovell
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School
| | | | | | - Didem Ayturk
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School
| | - Sharina D. Person
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School
| | - Tara Kumaraswami
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester
| | - Stephen P. Juraschek
- Division of General Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston
| | - Tiffany A. Moore Simas
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester
- Departments of Pediatrics and Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
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Moniz MH, Peahl AF, Zinsser D, Kolenic GE, Stout MJ, Morgan DM. Social vulnerability and use of postpartum long-acting reversible contraception and sterilization. Am J Obstet Gynecol 2022; 227:111-113.e2. [PMID: 35314136 DOI: 10.1016/j.ajog.2022.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/25/2022] [Accepted: 03/14/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Michelle H Moniz
- Department of Obstetrics and Gynecology, University of Michigan, 2800 Plymouth Rd., Bldg. 10, Rm G016, Ann Arbor, MI 48109-5276; Program on Women's Healthcare Effectiveness Research, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
| | - Alex F Peahl
- Department of Obstetrics and Gynecology, University of Michigan, 2800 Plymouth Rd., Bldg. 10, Rm G016, Ann Arbor, MI 48109-5276; Program on Women's Healthcare Effectiveness Research, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Dawn Zinsser
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Giselle E Kolenic
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Molly J Stout
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Daniel M Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
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Neves Pinto G, Grasselli Freitas FM. [Not Available]. J Int Bioethique Ethique Sci 2022; Vol. 32:127-149. [PMID: 35485044 DOI: 10.3917/jibes.324.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
One of the biggest issues faced by lawmakers in the news revolves around the question of how to deal with the scientific discoveries uncovered by new technologies. Scientific developments in the field of health awaken, in human beings, the desire to try to go beyond nature, and developments in the field of sexual and reproductive health not only challenge the laws of nature itself, but also the laws put in place by humanity. Among the advances in the field of human contraception, we highlight voluntary sterilization, used throughout the world as a 99% effective contraceptive measure. In Brazil, voluntary sterilization was formalized by the Family Planning Law which imposed, among other restrictions, the need for the consent of another person for its realization. It is a violent imposition, in the service of control over the bodies, on the part of the State. This control is notably imposed on the woman’s body, thus reducing her autonomy, which is the basis of her dignity. That said, the purpose of this article is to question the foundations on which the adoption of such a limitation of bodily self-determination is based and justified. For this, the legal-philosophical contributions of authors Ronald Dworkin and Jürgen Habermas will be examined, in the light of bioethics. The focus of the questions will be on the analysis of the ways in which Brazil and France have welcomed the process of voluntary sterilization, and what have been the most important consequences of this legalization.
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Abstract
The objective of this study was to assess the prevalence of domestic violence in ever-married women in India and analyze the relationship between domestic violence and use of female sterilization as contraception. We analyzed data from the National Family Health Survey 2005-2006 (NFHS3). The Domestic Violence Module of the survey included abuse experiences and reproductive health outcomes of ever-married women aged 15 to 49 years (n = 69,704). The main outcome of interest was female sterilization and domestic violence experience was the main independent variable. Covariates in our multivariate regression models were guided by the socioecological model for domestic abuse. We estimated a reference linear probability model for the dichotomous outcome. We also employed an instrumental variables procedure to strengthen causal inference under such potential sources of bias as measurement error in reporting domestic violence and omitted variables. The reference model showed an increase of 2.1 percentage points (p < .001) in the probability of female sterilization associated with exposure to domestic violence. After correcting the estimate for the measurement error and omitted variable bias, we found that domestic violence was associated with an increase in female sterilization by 6.4 percentage points (p < .001), which is 18% higher than the rate of sterilization among non-victims. In conclusion, our findings imply that domestic violence may lead abuse victims to opt for female sterilization as contraception. Domestic violence is a significant obstacle to efficient contraceptive use. Programs directed toward violence prevention should work conjointly with family planning programs in India.
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Affiliation(s)
| | - Jeff Luck
- Oregon State University, Corvallis, USA
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Buturovic Z. Voluntary sterilisation of young childless women: not so fast. J Med Ethics 2022; 48:46-49. [PMID: 32184219 DOI: 10.1136/medethics-2019-105933] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 06/10/2023]
Abstract
An increasing number of bioethicists are raising concerns that young childless women requesting sterilisation as means of birth control are facing unfair obstacles. It is argued that these obstacles are inconsistent, paternalistic, that they reflect pronatalist bias and that men seem to face fewer obstacles. It is commonly recommended that physicians should change their approach to this type of patient. In contrast, I argue that physicians' reluctance to eagerly follow an unusual request is understandable and that whatever obstacles result from this reluctance serve as a useful filter for women who are not seriously committed to their expressed requests for sterilisation. As women already disproportionally bear the birth control burden, less resistance that men might be getting in terms of voluntary sterilisation works to women's advantage, providing a much needed balance. Societal attitudes towards women and motherhood should not be confused with individual physicians' reasonable reluctance to jump at a serious elective procedure at fairly mild expression of interest.
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Henkel A, Beshar I, Goldthwaite LM. Postpartum permanent contraception: updates on policy and access. Curr Opin Obstet Gynecol 2021; 33:445-452. [PMID: 34534995 DOI: 10.1097/gco.0000000000000750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To describe barriers to provision of postpartum permanent contraception at patient, hospital, and insurance levels. RECENT FINDINGS Permanent contraception remains the most commonly used form of contraception in the United States with the majority of procedures performed during birth-hospitalization. Many people live in regions with a high Catholic hospital market share where individual contraceptive plans may be refused based on religious doctrine. Obesity should not preclude an individual from receiving a postpartum tubal ligation as recent studies find that operative time is clinically similar with no increased risk of complications in obese compared with nonobese people. The largest barrier to provision of permanent contraception remains the federally mandated consent for sterilization for those with Medicaid insurance. State variation in enforcement of the Medicaid policy additionally contributes to unequal access and physician reimbursement. Although significant barriers exist in policy that will take time to improve, hospital-based interventions, such as listing postpartum tubal ligation as an 'urgent' procedure or scheduling interval laparoscopic salpingectomy prior to birth-hospitalization discharge can make a significant impact in actualization of desired permanent contraception for patients. SUMMARY Unfulfilled requests for permanent contraception result in higher rates of unintended pregnancies, loss of self-efficacy, and higher costs. Hospital and federal policy should protect vulnerable populations while not preventing provision of desired contraception.
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Affiliation(s)
- Andrea Henkel
- Division of Family Planning Services & Research, Department of Obstetrics & Gynecology, Stanford University, Stanford, California, USA
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Abstract
Although sterilization is the most common and effective form of birth control available, childfree individuals often report difficulty actually obtaining the procedure. The ideological and material constraints that impede access have been well documented, including physicians' pronatalist perceptions that childless women will regret sterilization when they mature or meet the right partner. However, researchers have demonstrated that childfree women experience low levels of regret after sterilization, indicating that physicians' reluctance is empirically unfounded. In order to mitigate physicians' hesitancy, childfree individuals organize and communicate online in order to share health-related information, seek support, and engage in identity work to more effectively procure the procedure. The current study contributes to critical health, interpersonal, and family communication conversations by employing performative face theory to study online interactions on the childfree subreddit, the largest and most active online forum dedicated to child freedom. Through critical-qualitative analysis of a cross-section of subreddit posts about sterilization, this study demonstrates how subreddit discourse draws upon ideological and metaphorical associations to articulate the fixed childfree subjectivity, which rejects negative significations of regret in favor of positive notions of repair and permanence. Users further engage in subversive meta-facework, or facework presented online about facework users engaged in offline, which maintains shared face and denaturalizes taken-for-granted linkages between gender, identity, and parenthood. Implications for health activism across individual, relational, communal, and cultural levels are discussed.
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Affiliation(s)
- Julia Moore
- Department of Communication, University of Utah
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Porceddu L, Bhatia N. Lee (a Pseudonym) v Dhupar [2020] NSWDC 717 : Failed Sterilization: Should a Healthy Child be Considered a "Compensable Injury"? J Bioeth Inq 2021; 18:199-204. [PMID: 33914230 DOI: 10.1007/s11673-021-10105-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/12/2021] [Indexed: 06/12/2023]
Affiliation(s)
| | - Neera Bhatia
- Deakin University, School of Law, Melbourne, Australia.
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35
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Bouma-Johnston H, Ponsaran R, Arora KS. Variation by state in Medicaid sterilization policies for physician reimbursement. Contraception 2021; 103:255-260. [PMID: 33383029 PMCID: PMC7925370 DOI: 10.1016/j.contraception.2020.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate state-level variation in Medicaid sterilization reimbursement policies for physicians in terms of policy details, flexibility, and review process. STUDY DESIGN We reviewed state Medicaid websites and interviewed state employees to better understand reimbursement policies and implementation. We attempted to obtain policy details and instructions for physicians from all 50 state Medicaid office websites. We invited employees in all 50 state Medicaid director's offices to participate in semi-structured qualitative interviews. RESULTS We were able to collect data from 48 states' websites for analysis, conducted 15 telephone interviews, and received 4 written responses from state Medicaid employees. State policies varied greatly in terms of degree of instruction available online to clinicians, number of content-related and logistical changes made compared to the federal policy, type of procedures included, corrections permitted, flexibility in terms of surgeon and procedure changes, review process, reasons for and ramifications of denial, and date of last policy revision. CONCLUSION There is need for increased transparency and instruction by state Medicaid offices as well as revision of the Medicaid policy to account for the contemporary clinical practice of female permanent contraception. Clinicians should communicate with state Medicaid employees in order to clarify important policy details and obtain greater understanding of their state's review process and ramifications to ensure their clinical practice is both correct and reimbursable. IMPLICATIONS Greater consistency between states in terms of Medicaid policy and implementation is crucial to ensuring physicians are fairly reimbursed for their work, and female permanent contraception remains an accessible contraceptive method for women.
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Affiliation(s)
| | - Roselle Ponsaran
- Department of Bioethics, Case Western Reserve University, Cleveland, OH, United States
| | - Kavita Shah Arora
- Department of Bioethics, Case Western Reserve University, Cleveland, OH, United States; Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, United States.
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São Pedro V, Pires R, Santos F, Tovim Rodrigues C, Santos Silva I, Almeida MC, Águas F. [Opportunistic Salpingectomy for Permanent Contraception: A Cross Sectional Study in Portugal]. ACTA MEDICA PORT 2021; 34:258-265. [PMID: 34214417 DOI: 10.20344/amp.14033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/01/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Opportunistic bilateral salpingectomy has been proposed as an ovarian cancer risk-reducing strategy namely as a means of tubal sterilization. We aimed to assess what were the procedures for interval and peripartum sterilization carried out nationwide, related motivational aspects and influential demographic or professional factors. MATERIAL AND METHODS Cross-sectional study based on an original survey sent to Obstetrics and Gynecology specialists and residents from across the country in 2019. RESULTS Two hundred and twenty-five answers were obtained from 42 institutions (37 from the public sector). Laparoscopic tubal electrocoagulation (61%) was the most common procedure for interval sterilization followed by salpingectomy (28%). Major reasons pointed out for not performing salpingectomy were increased operative time (48.5%) and procedure not considered (45.5%). In some hospitals, the choice of salpingectomy depended on specific criteria namely surgical team decision. During cesarean-section, sterilization was most frequently performed using the modified Pomeroy technique (54%), followed by salpingectomy (32.5%), with a statistically significant prevalence in the north of the country. Sixty-nine percent of Portuguese Obstetrics and Gynecology residents and specialists consider that salpingectomy should be the procedure offered to women asking for definitive contraception. DISCUSSION Although data are limited, salpingectomy at the time of cesarean delivery appears feasible and safe and this context might represent the best opportunity for intervention. CONCLUSION Opportunistic salpingectomy is not the most common sterilization procedure performed in Portugal, but it was considered the best choice to offer. Its benefits and risks should be discussed with women.
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Affiliation(s)
- Verónica São Pedro
- Serviço de Ginecologia e Obstetrícia B. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Rafaela Pires
- Serviço de Ginecologia e Obstetrícia B. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Fernanda Santos
- Serviço de Ginecologia e Obstetrícia B. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Carla Tovim Rodrigues
- Serviço de Ginecologia e Obstetrícia B. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Isabel Santos Silva
- Serviço de Ginecologia e Obstetrícia B. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Maria Céu Almeida
- Serviço de Ginecologia e Obstetrícia B. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Fernanda Águas
- Serviço de Ginecologia e Obstetrícia B. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
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Alspaugh A, Im EO, D Reibel M, Barroso J. The Reproductive Health Priorities, Concerns, and Needs of Women in Midlife: A Feminist Poststructuralist Qualitative Analysis. Qual Health Res 2021; 31:643-653. [PMID: 33213259 DOI: 10.1177/1049732320970491] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Reproductive health research rarely involves the inclusion of women over 40, creating a large knowledge gap regarding women in midlife. Women continue to have reproductive health needs, concerns, and priorities up to the point of menopause that should be examined to improve reproductive health outcomes and provide individualized care. In-depth, individual, semi-structured interviews were conducted with 20 women between the ages of 40 and 55 who had not reached menopause and did not have a permanent method of sterilization. Using the feminist poststructuralist tenets, three major themes were identified: (a) knowledge acquisition during the perimenopause, (b) subjectivity regarding family planning, and (c) the agency of aging. Participants spoke to a need for reproductive health that listens to their lived experience, addresses menopause clinically and positively, and encourages autonomously driven health priorities. Further research on effective nonhormonal contraception, education on perimenopausal symptoms, and healthy aging is necessary.
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Affiliation(s)
- Amy Alspaugh
- University of California San Francisco, San Francisco, California, USA
| | - Eun-Ok Im
- Emory University, Atlanta, Georgia, USA
| | - Melody D Reibel
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Julie Barroso
- Medical University of South Carolina, Charleston, South Carolina, USA
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Iemelianenko VV, Gornostay AV, Yevdokimova OV. DEPRIVATION OF REPRODUCTIVE RIGHT OF SEX OFFENDERS: SOCIAL OPINION AND LEGISLATIVE REGULATION. Wiad Lek 2021; 74:2928-2933. [PMID: 35029558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The aim: The purpose of this article is to illustrate the social demand for the need to discriminate against perpetrators of sexual crimes by depriving them of reproductive rights. PATIENTS AND METHODS Materials and methods: The authors of the research used the legislation of various world countries, scientific papers, caselaw, the provisions of international legal acts, in particular, the Convention for the Protection of Human Rights and Fundamental Freedoms. The authors of the research used a complex set of general and special methods of cognition such as dialectical, comparative, analytical, generalization method, statistical and sociological method (questionnaire method). RESULTS Results: The survey conducted by the authors highlights the attitude of physicians and law enforcement officials (100 people) to the sterilization of criminals as a measure necessary to prevent the commission of sexual crimes both by such persons and by others who are prone to committing such crimes but will refrain from their commission due to the fear of sterilization. The questionnaire shows the gap between awareness and recognition of natural human rights such as the right to reproduce and the desire to deprive a certain deviant category of people of this right for their safety. CONCLUSION Conclusion: Based on the conducted analysis, the authors have formulated that there is currently a great social demand for radical measures to prevent the commission of sexual crimes by sterilizing those who committed such crimes. At the same time, the legislation of some countries also embodies such a desire of society in the relevant norms and provides the use of sterilization of criminals for special and general prevention of crimes against sexual freedom and inviolability. The research also demonstrates the erroneousness of this approach and proves the inadmissibility and medical inexpediency of depriving perpetrators of sexual crimes of their reproductive rights.
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Fridmanskyy RM, Fridmanska VI, Dir IY, Kopcha VV. THE HUMAN RIGHT TO STERILIZATION: MEDICAL AND LEGAL ASPECT. Wiad Lek 2021; 74:2674-2677. [PMID: 34923479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The aim: To consider the general principles of the human right to sterilization in terms of medicine and law. PATIENTS AND METHODS Materials and methods: Formal-logical methods of analysis and synthesis allowed to reveal the content of the concepts that make up the subject of research, to classify them, as well as to formulate intermediate and general conclusions. The systematic method allowed to study the role and significance of right to sterilization among other human rights and freedoms. Using the historical method, the doctrinal basis of the study was analyzed, and the main stages of the formation of category "right to sterilization" with human participation were identified. CONCLUSION Conclusions: The issue of surgical sterilization should not be considered during contractions, as happened in this particular case, but before or after childbirth, because a woman in childbirth can not adequately perceive information and make such important decisions. If this decision is made after delivery, the doctor must make sure that the patient is psychologically healthy. In addition, the consent for surgical sterilization of the spouses must be signed together. Although this procedure follows from the human right to dispose of one's own body, however, in the presence of marriage, referring to Part 2 of Art. 54 of the IC of Ukraine, which states that all important issues of the family should be resolved by the spouses together, on the basis of equality. If such a decision is made by the wife alone, she must be considered to have committed the wrongful conduct.
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Affiliation(s)
| | | | - Ihor Yu Dir
- UZHHOROD NATIONAL UNIVERSITY, UZHHOROD, UKRAINE
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Srivastava A, Chhibber G, Bhatnagar N, Nash-Mercado A, Samal J, Trivedi B, Srivastava V, Rawlins B, Yadav V, Sood B, Biesma R, Kim YM, Stekelenburg J. Effectiveness of a quality improvement intervention to increase adherence to key practices during female sterilization services in Chhattisgarh and Odisha states of India. PLoS One 2020; 15:e0244088. [PMID: 33362284 PMCID: PMC7757870 DOI: 10.1371/journal.pone.0244088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/03/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In response to longstanding concerns around the quality of female sterilization services provided at public health facilities in India, the Government of India issued standards and quality assurance guidelines for female sterilization services in 2014. However, implementation remains a challenge. The Maternal and Child Survival Program rolled out a package of competency-based trainings, periodic mentoring, and easy-to-use job aids in parts of five states to increase service providers' adherence to key practices identified in the guidelines. METHODS The study employed a before-and-after quasi-experimental design with a matched comparison arm to examine the effect of the intervention on provider practices in two states: Odisha and Chhattisgarh. Direct observations of female sterilization services were conducted in selected public health facilities, using a checklist of 30 key practices, at two points in time. Changes in adherence to key practices from baseline to endline were compared at 12 intervention and 12 comparison facilities using a difference in difference analysis. RESULTS Several key practices were well-established prior to the intervention, with adherence levels over 90% at baseline, including hemoglobin and urine testing, use of sterile surgical gloves and instruments, and recommended surgical technique. However, adherence to many other practices was extremely low at baseline. The program significantly increased adherence to nine practices, including those related to ascertaining client's medical eligibility, client-provider interaction, the consent process, and post-operative care. The greatest improvement was observed in the provision of written instructions for clients prior to discharge. At endline, however, adherence remained below 50% for 14 practices. CONCLUSION Low adherence to key practices at baseline confirmed the need for quality improvement interventions in female sterilization services. While the intervention improved adherence to certain practices around admission and post-operative care, inadequate human resources and infrastructure, among other factors, may have blunted the impact of the intervention.
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Affiliation(s)
- Ashish Srivastava
- Jhpiego India, New Delhi, India
- Department of Health Sciences/Global Health, University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | | | | | | | | | | | | | | | | | | | - Regien Biesma
- Department of Health Sciences/Global Health, University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | - Young-Mi Kim
- Jhpiego, Baltimore, Maryland, United States of America
| | - Jelle Stekelenburg
- Department of Health Sciences/Global Health, University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
- Department of Obstetrics and Gynecology, Leeuwarden Medical Center, Leeuwarden, The Netherlands
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Joseph. K. J. V, Mozumdar A, Lhungdim H, Acharya R. Quality of care in sterilization services at the public health facilities in India: A multilevel analysis. PLoS One 2020; 15:e0241499. [PMID: 33137153 PMCID: PMC7605679 DOI: 10.1371/journal.pone.0241499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/16/2020] [Indexed: 11/18/2022] Open
Abstract
Female sterilization is the most popular contraceptive method among Indian couples, and the public sector is the major source of sterilization services in the country. However, concerns remain on the quality of services provided, deaths, failures, and complications following sterilization. In this paper, we study the complexities around the quality of care in female sterilization services at public health facilities and identify strategies for improving the measurement of such quality. A better understanding of these issues could inform pragmatic strategies for enhancing quality. This study uses data from the National Family Health Survey (NFHS) 2015–16 and District Level Household and Facility Survey (DLHS) 2012–13. The study is limited to only districts whose data are available in both DLHS 2012–13 and NFHS 2015–16. The methods of analysis include bivariate statistics, Pearson’s chi-square test, and two-level mixed-effects logistic regression. We found that the quality of care (QoC) in sterilization service at the public health facilities in India is associated with facility readiness and the socio-economic characteristics of the clients. There is a significant association between household wealth and the QoC received. Our study provides empirical shreds of evidence on the role of structural attributes in delivering quality sterilization services. The spatial analyses revealed the geographies in the country where the QoC and facility readiness are low. Quality should be an overriding priority to establish the credibility of any health care delivery system. It is essential to provide safeguards against adverse events to develop the client’s confidence in the services, which is the key to success for any voluntary family planning program like in India.
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Affiliation(s)
- Vinod Joseph. K. J.
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Arupendra Mozumdar
- Reproductive Health Division, Population Council, New Delhi, India
- * E-mail:
| | - Hemkhothang Lhungdim
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Rajib Acharya
- Reproductive Health Division, Population Council, New Delhi, India
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Bouma-Johnston H, Ponsaran R, Arora KS. Perceptions and practice of state Medicaid officials regarding informed consent for female sterilization. Contraception 2020; 102:368-375. [PMID: 32739505 PMCID: PMC7606490 DOI: 10.1016/j.contraception.2020.07.092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 07/19/2020] [Accepted: 07/22/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To explore the attitudes, beliefs, and interpretations of individual state Medicaid office employees regarding their state's postpartum sterilization policy and its impact on patient care. STUDY DESIGN We invited employees in all 50 state Medicaid director's offices who self- or peer-identified as best informed about the sterilization policy to participate in semi-structured qualitative interviews. Using a pilot-tested interview guide, we transcribed, coded, and analyzed each interview. We attempted to obtain supplemental data, including relevant policy details and instructions for physicians in the state, from all 50 state Medicaid office websites. RESULTS We collected data from 15 telephone interviews, four written responses, and 48 states' websites for analysis. Participants had varying responses regarding the impact of the Medicaid-mandated sterilization consent form in terms of informed consent as well as the utility and ramifications of the waiting period. State policies varied in terms of the age of consent, complexity of the form, availability of translations, use of unclear terminology, and the consent-obtaining process. CONCLUSION State Medicaid employees have differences in opinions regarding the intent of the Medicaid-mandated sterilization consent form and policies. Better understanding of the variation in individual state policies that may contribute to inequitable access to sterilization is necessary. IMPLICATIONS Provision of consistent guidelines and widespread coordination of the Medicaid sterilization policies in identified areas impacting informed consent may reduce existing obstacles and provide more equitable access to contraceptive care.
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Affiliation(s)
| | - Roselle Ponsaran
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, United States; Department of Bioethics, Case Western Reserve University, Cleveland, OH, United States
| | - Kavita Shah Arora
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, United States; Department of Bioethics, Case Western Reserve University, Cleveland, OH, United States.
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Arora KS, Ascha M, Wilkinson B, Verbus E, Montague M, Morris J, Einstadter D. Association between neighborhood disadvantage and fulfillment of desired postpartum sterilization. BMC Public Health 2020; 20:1440. [PMID: 32962666 PMCID: PMC7509918 DOI: 10.1186/s12889-020-09540-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 09/14/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Adequacy of prenatal care is associated with fulfillment of postpartum sterilization requests, though it is unclear whether this relationship is indicative of broader social and structural determinants of health or reflects the mandatory Medicaid waiting period required before sterilization can occur. We evaluated the relationship between neighborhood disadvantage (operationalized by the Area Deprivation Index; ADI) and the likelihood of undergoing postpartum sterilization. METHODS Secondary analysis of a single-center retrospective cohort study examining 8654 postpartum patients from 2012 to 2014, of whom 1332 (15.4%) desired postpartum sterilization (as abstracted from the medical record at time of delivery hospitalization discharge) and for whom ADI could be calculated via geocoding their home address. We determined the association between ADI and sterilization completion, postpartum visit attendance, and subsequent pregnancy within 365 days of delivery via logistic regression and time to sterilization via Cox proportional hazards regression. RESULTS Of the 1332 patients included in the analysis, patients living in more disadvantaged neighborhoods were more likely to be younger, more parous, delivered vaginally, Black, unmarried, not college educated, and insured via Medicaid. Compared to patients living in less disadvantaged areas, patients living in more disadvantaged areas were less likely to obtain sterilization (44.8% vs. 53.5%, OR 0.84, 95% CI 0.75-0.93), experienced greater delays in the time to sterilization (HR 1.23, 95% CI 1.06-1.44), were less likely to attend postpartum care (58.9% vs 68.9%, OR 0.86, CI 0.79-0.93), and were more likely to have a subsequent pregnancy within a year of delivery (15.1% vs 10.4%, OR 1.56, 95% CI 1.10-1.94). In insurance-stratified analysis, for patients with Medicaid, but not private insurance, as neighborhood disadvantage increased, the rate of postpartum sterilization decreased. The rate of subsequent pregnancy was positively associated with neighborhood disadvantage for both Medicaid as well as privately insured patients. CONCLUSION Living in an area with increased neighborhood disadvantage is associated with worse outcomes in terms of desired postpartum sterilization, especially for patients with Medicaid insurance. While revising the Medicaid sterilization policy is important, addressing social determinants of health may also play a powerful role in reducing inequities in fulfillment of postpartum sterilization.
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Affiliation(s)
- Kavita Shah Arora
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | - Mustafa Ascha
- Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, USA
| | - Barbara Wilkinson
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Emily Verbus
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Mary Montague
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Jane Morris
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Douglas Einstadter
- Center for Health Care Research and Policy and the Departments of Medicine, and Population and Quantitative Health Sciences, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Abstract
AbstractObjectiveTo point out the proportion of intellectually disabled women (IDW) who are sterilised, and the medical and social factors associated with an increased probability to be sterilised.Study designA population-based study among 97% of IDW aged 18–46, attending government-accredited institutions in the region of Brussels-Capital and the province of Walloon Brabant (Belgium).ResultsAmong the IDW included in this study, 22.2% are sterilised, which is superior to the 7% in the general Belgian population. Factors associated with an increased probability to be sterilised are: living in an institution, having a higher intellectual quotient (IQ), being enrolled in an institution where sexual intercourse is authorised and attending an institution where contraception is required. The last three factors are significant only among women living in institutions and the last two, only in women with severe disability. Among IDW using contraception, no factor was associated with a greater probability to be sterilised.ConclusionThe prevalence of sterilisation among IDW is three times higher than that in the Belgian population and it is mainly correlated with factors related to the institution where these women live, especially the severely disabled.
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Affiliation(s)
- L Servais
- Department of Electrophysiology (Professor Cheron), Université de Mons Hainaut, Avenue du champ de Mars, 7000 Mons, Belgium.
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Taylor J. Medical Practitioners Who Deny Young Women Sterilisation Surgery "Because They Will Regret It Later": Patient-centred Practice or Discrimination? J Law Med 2020; 27:663-678. [PMID: 32406628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Women in Australia routinely access medical services which, by design or consequence, sterilise them. There is evidence which suggests that some medical practitioners are not offering procedures to young women where the surgery will make them infertile. These decisions are often defended on the basis that women who lose their fertility will go on to regret the medical procedure in the future. This article will consider the legal and ethical implications of this practice. It will first critically analyse the ethics of this decision according to the Beauchamp and Childress principles of justice, applying them through the lens of a patient-centred practice framework. It will then examine whether such practice may constitute discrimination under the Federal and Victorian discrimination frameworks, focusing on whether such decisions constitute age discrimination, gender discrimination, or discrimination on the basis of parental status. This article will draw the conclusion that such decisions are generally unethical and may constitute discrimination under Australian laws.
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Affiliation(s)
- Joshua Taylor
- Conciliator, Victorian Equal Opportunity and Human Rights Commission Victoria
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Stevenson AA, Bauman BL, Zapata LB, Ahluwalia IB, Tepper NK. Intimate Partner Violence around the Time of Pregnancy and Postpartum Contraceptive Use. Womens Health Issues 2020; 30:98-105. [PMID: 31911042 PMCID: PMC10983028 DOI: 10.1016/j.whi.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 11/14/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES We sought to examine postpartum contraceptive use among women who reported physical intimate partner violence (IPV) during or within 12 months before pregnancy compared with women who did not report physical IPV and to identify factors associated with nonuse of contraception among women who reported physical IPV. METHODS Data were obtained from women with a recent live birth from 2012 to 2015 who participated in the Pregnancy Risk Assessment and Monitoring System. We described characteristics of women and postpartum contraceptive use by method effectiveness (most effective [female sterilization, male sterilization, intrauterine device, implant], moderately effective [injectable, pill, patch, ring], less effective [condoms, natural family planning, withdrawal, other]) or no method, stratified by reported physical IPV. Multivariable logistic regression was used to examine characteristics associated with nonuse of contraception among women who reported physical IPV. RESULTS The proportion of women using most or moderately effective contraception was similar for women reporting and not reporting physical IPV. Less effective contraceptive use was lower among women who reported physical IPV (13.9%) than those who did not report physical IPV (25.1%) (p < .001). Nonuse was higher among women who reported physical IPV (33%) than those who did not report physical IPV (21%) (p < .001). Having no health insurance at the time of survey and experiencing traumatic stress within 12 months before delivery were associated with nonuse of contraception among women who reported physical IPV. CONCLUSIONS The higher proportion of contraception nonuse among women who reported physical IPV indicates a potential unmet need for contraception among this vulnerable population. Recommended screening for IPV and counseling about the full range of contraceptive methods should begin during pregnancy and continue through the postpartum period.
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Affiliation(s)
| | - Brenda L Bauman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lauren B Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Indu B Ahluwalia
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Naomi K Tepper
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
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Haider S, Stoffel C, Rankin K, Uesugi K, Handler A, Caskey R. A Novel Approach to Postpartum Contraception Provision Combined with Infant Care: A Randomized, Controlled Trial. Womens Health Issues 2020; 30:83-92. [PMID: 31964564 PMCID: PMC8696743 DOI: 10.1016/j.whi.2019.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 11/05/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Unintended pregnancy among women with short interpregnancy intervals remains common. Women's attendance at the 4- to 6-week postpartum visit, when contraception provision often occurs, is low, whereas their attendance at well-baby visits is high. We aimed to evaluate if offering co-located contraceptive services to mothers at well-baby visits increases use of long-acting reversible contraception (LARC) at 5 months postpartum compared with usual care in a randomized, controlled trial. METHODS Women with infants aged 4.5 months or younger who were not using a LARC method and had not undergone sterilization were eligible. Generalized linear models were used to estimate risk ratios. Likability and satisfaction of the contraception visit were assessed. RESULTS Between January 2015 and January 2017, 446 women were randomized. LARC use at 5 months was 19.1% and 20.9% for the intervention and control groups, respectively, and was not significantly different after controlling for weeks postpartum (risk ratio, 0.85; 95% confidence interval, 0.59-1.23). Uptake of the co-located visit was low (17.7%), but the concept was liked; insufficient time to stay for the visit was the biggest barrier to uptake. Women who accepted the visit were more likely to use a LARC method at 5 months compared with women in the control group (risk ratio, 1.97; 95% confidence interval, 1.26-3.07). CONCLUSIONS Women perceived co-located care favorably and LARC use was higher among those who completed a visit; however, uptake was low for reasons including inability to stay after the infant visit. Intervention effects were possibly diluted. Future research should test a version of this intervention designed to overcome barriers that participants reported.
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Affiliation(s)
- Sadia Haider
- The University of Illinois at Chicago, Chicago, Illinois.
| | | | - Kristin Rankin
- The University of Illinois at Chicago, Chicago, Illinois
| | - Keriann Uesugi
- The University of Illinois at Chicago, Chicago, Illinois
| | - Arden Handler
- The University of Illinois at Chicago, Chicago, Illinois
| | - Rachel Caskey
- The University of Illinois at Chicago, Chicago, Illinois
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Iemelianenko V, Alesia G, Nataliya M. COERCED STERILIZATION AS A REPRODUCTIVE RIGHTS VIOLATION. Wiad Lek 2020; 73:2902-2908. [PMID: 33611301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The aim: To outline and systematize the issues related to violations and restrictions on the realization of the right to reproduction. To develop propositions and recommendations on improving the prevention and combating various manifestations of coerced sterilization. PATIENTS AND METHODS Materials and methods: Theoretical basis for studying this issue includes scientific publications, research of the legislative systems of different countries, the conclusions of international non-governmental organizations. The authors of the paper have also taken into account international regulations, including UN Conventions and Directives, decisions of the European Court of Human Rights (ECHR), as well as analytical data provided by international organizations. Determinants in the study of this problem are the analysis, synthesis and generalization of the experience and legislative base of foreign countries, which are closely related to formal and comparative methods. Systematic, structural, dialectical and statistical methods have been also used in this paper to substantiate the problem of sterilization. CONCLUSION Conclusions: The most radical decision to refuse from reproduction is surgical sterilization (defertilization). It can be classified as voluntary, forced and coerced. The problems of preventing and combating coerced sterilization are among the most difficult ones. Bribery and mental coercion of persons in order to obtain consent for sterilization are either not regulated by law and do not entail any liability, including criminal, or even are part of the state government policy to regulate the number of citizens in overpopulated countries, HIV-infected people, including prisoners or transgender people.
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Iemelianenko VV, Gornostay AV, Ivantsova AV. Reproductive rights violations: forced sterilization and restriction of voluntary sterilization. Wiad Lek 2019; 72:2536-2540. [PMID: 32124781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Introduction: realization of reproductive rights is a relevant medical, social and legal problem in modern society. It is due to unfavorable demographic situation in almost all European countries, overcrowding problems in Asian countries, religious and moral oppression against persons, who do not wish to realize their right to reproduction. The aim: To define problems related to the protection of the right to reproduction and to develop propositions to improve the prevention and fight against forced sterilization and restrictions on voluntary sterilization. PATIENTS AND METHODS Materials and methods: The research is based on theoretical basis, which includes scientific articles, legislation reviews, reports of non-governmental organizations, as well as empirical basis - 3 judgements of the ECHR, international legal acts and directives, based on the analytical data of the World Health Organization. Systematic, structural, functional and legal comparative methods, as well as systematization, analysis and synthesis, were crucial in the research process. CONCLUSION Conclusions: Nowadays, it is possible to distinguish such types of sterilization in the world as voluntary and forced ones. Forced deprivation of the right to reproduction is a serious criminal offense that still takes place in modern society. Violations in the form of restricting voluntary sterilization have more latent nature and are not sufficiently regulated by legislation. Forced sterilization requires greater effectiveness in combating both at the national, and at the international level. Voluntary sterilization, as a method of contraception, requires clear regulation at the legislative level and the development of uniform principles and standards, both in national and in international law, in order to preclude restrictions in freely disposing reproduction function.
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Espey E, Hofler LG. Evaluating the Long-term Safety of Hysteroscopic Sterilization. JAMA 2018; 319:2670235. [PMID: 29362776 DOI: 10.1001/jama.2017.21268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Eve Espey
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque
| | - Lisa G Hofler
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque
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