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​NIH Grant to Pitt Researchers Funds Study of Barriers to Female Sterilization Among Low-income and Minority Women

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PITTSBURGH, Aug. 31, 2017 – The University of Pittsburgh has received a $3.5 million grant from the National Institutes of Health (NIH) to improve the ability of low-income and minority women to make informed decisions about permanent surgical procedures to prevent pregnancy.
Female sterilization, commonly called tubal ligation, is a surgical procedure that blocks a woman’s fallopian tubes, preventing all future pregnancies. It is the second-most commonly used contraceptive method in the United States and is disproportionally used by low-income and minority women, according to data from the National Center for Health Statistics. The NIH grant will help researchers develop and test a web-based decision support tool to help women better understand female sterilization and choose birth control options that align with their preferences, values and reproductive goals.
The web-based tool will be accessible through computers, tablets and mobile devices and will use patient-friendly language and visuals to describe the sterilization procedure, its risks and alternative long-term birth control methods. Quizzes will ensure comprehension and guidance on how to communicate their preferences and/or decisions to health care providers. Researchers will conduct a multi-site, randomized controlled trial to test the efficacy of the decision aid compared to usual care among 350 racially diverse, low-income women who requested postpartum sterilization with respect to their knowledge, decisional conflict and satisfaction with the decision.
Low-income women face unique challenges regarding obtaining sterilization procedures. Medicaid policy currently requires that women who request federally funded sterilization complete a standardized consent form and mandatory waiting period of 30 days prior to the surgery. This policy was originally instituted in the 1970s to protect vulnerable women from coercive sterilization practices by attempting to ensure informed and voluntary consent. However, past research suggests the consent form regulations present significant obstacles. 
“While the policy was well-intended, it has created logistical barriers that impede a woman’s reproductive autonomy,” explained principal investigator Sonya Borrero, M.D., M.S., associate professor of medicine and clinical and translational science, Pitt School of Medicine, and director of the Pitt Center for Women's Health Research and Innovation (CWHRI). “These are issues that contribute to reproductive health inequities among low-income and racial/ethnic minority women who are disproportionately reliant on Medicaid. The Medicaid consent form is not written in a way that ensures comprehension by its intended audience, leading to misunderstandings about the procedure, and the 30-day waiting period prevents many women from obtaining the sterilization, putting them at a high risk for future undesired pregnancies.”