According to researchers at Princeton’s Woodrow Wilson School, tubal ligation policies under Medicaid create many issues for women with low income. Tubal ligation or having your “tubes tied” is commonly used as a means of permanent sterilization to prevent unintended pregnancies. Under a Medicaid law passed in 1978, a woman must currently wait thirty days after signing a consent to have the procedure done.
This prerequisite is unreasonable for many women who wish to have tubal ligation performed after giving birth. It also creates a two-tiered system of access because women with private medical insurance are not required to do the same. Additionally, with the upcoming expansion of Medicaid under the Affordable Care Act, even more women could be hindered by these restraints.
According to James Trussell an author of the paper, while the principles behind the policy remain relevant, the system as a whole is in dire need of modification. He feels the thirty day mandatory waiting period is excessive and should be shortened or eliminated. Additionally, the current consent form should be redesigned to be more user friendly and easier to understand. The form could also be replaced by another tool entirely to ensure the informed consent process is more effective.
Within their review, Trussell and his colleagues state that females of low income are not able to exercise the same freedom of reproductive anatomy as their wealthier counterparts because of a two-tiered system of access. This is due to the fact that a lot of women with Medicaid coverage do not have private insurance to cover the costs of the procedure, because soon after delivering a baby, her Medicaid eligibility ends.
The sterilization process utilized by Medicaid was first developed in 1976 by the Department of Health, Education and Welfare (now known as the Department of Health and Human Services). It was designed to protect against nonconsensual sterilizations for males and females. The initial waiting period was 72 hours and it was increased to 30 days in 1978, and hasn’t been modified or updated since that time.
One recent study assessed the form and stated it is overly complicated and written higher than the literacy levels of most adult American’s. When testing the readability of the form, the researchers found that more than 1/3 of women answered incorrectly when asked questions about the consequences of sterilization after they had read the form. The team then administered a lower-literacy version of the form to the same women and the findings showed that they had a better understanding of the 30-day waiting period and the non-permanent contraception options available to them.
However, even if the form were modified and improved, researchers are still concerned with the waiting period effects and its costs to society.
Reducing the barriers associated with the current Medicaid policies could be one way to make a dent in the high rates of unintended pregnancy and the high costs associated with it. Revising and modifying the sterilization policy will honor the reproductive rights of women and create a more fair and equitable access to surgical sterilization for women of all income levels.
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