Medicaid Policies Block Low-Income Women from Tubal Ligation

Pregnancy and Tubal LigationTubal ligation, the most popular method of female sterilization, is highly protective against unwanted pregnancies. However, current Medicaid policies create roadblocks for low-income women who wish to undergo the procedure, argues a review written by researchers from the Woodrow Wilson School at Princeton University and other institutions in the United States as published in the New England Journal of Medicine.

Tube tying, a popular name for tubal ligation, is a surgical procedure that involves blocking, tying, or cutting the fallopian tubes. Tubal ligation is a permanent method of birth control for women, effectively preventing any future pregnancies.

However, due to the federal policy regarding Medicaid-funded sterilizations, low-income women and women from minority racial and ethnic groups face hurdles in obtaining the procedure.

Under a current Medicaid rule first enacted in 1978, women must wait 30 days after signing a written consent form to obtain a tubal ligation. The requirement is unnecessarily prohibitive for women who want to undergo the procedure immediately after giving birth. Women with private insurance are not subject to the 30-day wait-period rule.

Argues James Trussell, an author of the paper and the Charles and Marie Robertson Professor of Public and International Affairs at the Woodrow Wilson School of Public and International Affairs, faculty associate at the School’s Office of Population Research and professor of economics:

“Although the principles behind the Medicaid policy remain relevant, it is in dire need of modification. The 30-day mandatory waiting period is excessive and should be shortened or eliminated. In addition, the current consent form should be redesigned so it is easier to read and more user-friendly. Or, it should be replaced by another tool that can effectively ensure informed decision-making processes.”

Further complicating the problem is that many low-income women lose Medicaid benefits shortly after giving birth. Because of the 30-day waiting period for tubal ligation, many low-income women cannot receive the procedure.

The current Medicaid requirement was developed to protect against nonconsensual sterilizations for men and women.

States Trussell:

“While we certainly don’t want to return to the days when low-income women were coerced into agreeing to sterilization, we feel that the current rule – while well-meaning – goes too far in the other direction. These barriers put women at a greater risk for unintended pregnancy. And this is a substantial issue in the United States with direct public costs of billions of dollars.”

Another study reported that 47 percent of women who requested but did not receive tubal ligation immediately after giving birth became pregnant within a year. Failure to give tubal ligations to women who want the produce results in around 10,000 abortions and 19,000 unintended births at a public cost of $215 million each year.

Concludes Trussell:

“Reducing barriers associated with these Medicaid policies may be one approach to making a dent in this stubbornly high rate of unintended pregnancy and the high costs associated with it. Not only that, but revisiting and amending sterilization policy will honor women’s reproductive autonomy and create more equitable access to sterilization for women of all income levels.”


Low-income Women Face Roadblocks Created by Medicaid’s ‘Tube-tying’ Polices:
Medicaid Policy on Sterilization — Anachronistic or Still Relevant?:

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