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How to Prevent Unwanted Pregnancies and Save Money at the Same Time

New research suggests that lowering the hurdles to publicly-funded female sterilization could do both of those things.
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There are several ways to enjoy sex while greatly decreasing your chances of getting pregnant. Condoms, for example. The pill. NuvaRing. Apparently the pullout method has become popular lately, too, though many may find its success rate less than ideal. While not quite here yet, innovative male birth control techniques, such as gels, ultrasounds, and injections to the nether regions, are also on their way. Or, if you want complete assurance, there's always abstinence—but that's often a difficult road for even the most noble in appearance.

And then there's sterilization. Data from the Centers for Disease Control and Prevention (CDC) suggests that female sterilization is the second-most frequently used contraception method in the U.S. (just behind the pill), and it’s first-most for women aged 30 to 44. During 2006 to 2008, for instance, 10.3 million had the operation.

Yet despite all of these ways to prevent fetuses from forming in wombs, a 2011 study found that 49 percent of all American pregnancies in 2006 were unintended. That's roughly 3.2 million unplanned, unwanted, or mistimed conceptions out of nearly 6.7 million. For those who care about such things, this number is way too high.

"While we're trying to prevent unwanted pregnancy, we're also in full support of a woman's reproductive autonomy."

ACCORDING TO RESEARCH PUBLISHED earlier this month in the journal Contraception, some meager revisions to Medicaid's sterilization policy could potentially reduce the number of unintended pregnancies by over 29,000 per year. Not only that, but these proposed modifications would also save taxpayers $215 million in annual public-health costs.

"The whole policy is impeding access to the procedure and creating a two-tiered system, since women with private insurance don't have to adhere to any of these regulations," said the study's lead author, Sonya Borrero, assistant professor of medicine at the University of Pittsburgh. "Our goal is to help support women's reproductive decisions, but we also know that money is of interest to policymakers, so we wanted to capture that piece as well."

As stated in the study, it's estimated that approximately 250,000 women request Medicaid-funded postpartum sterilizations each year, yet only around half of these requests get fulfilled. By revamping some of the logistical hurdles—specifically, the mandatory 30-day waiting period and need to bring a hard copy of the initial consent form to the procedure—Borrero and her colleagues believe that many more women would undergo the permanent operation. Plus, abortions and miscarriages aside, the cost of a Medicaid-covered birth averages $12,774, while each state-funded sterilization amounts to $416.

As the study points out, policymakers originally implemented these logistical hurdles with the best of intentions. In the 1970s, when the current Medicaid regulations on sterilization were first established, reports were surfacing of non-consensual sterilization among minority and low-income women. Patriarchal coercion was strong. Also, the eugenics movement was still somewhat fresh in the public's mind, since figures from Winston Churchill to Adolf Hitler had endorsed it at some point or another. In 1976, the now-defunct Department of Health, Education, and Welfare prohibited the sterilization of women under 21, along with the institutionalized and mentally challenged. In addition, the agency introduced a 72-hour waiting period between consent and operation (which was later extended to 30 days in 1978) and also required that the patient present the consent form at the time of sterilization. These barriers, then, were meant to protect the vulnerable, not hinder their freedom of choice.

Even so, bad things still happen. Just this past July, the Los Angeles Timesreported that doctors in California prisons had performed tubal ligations, a form of sterilization that involves tying the fallopian tubes, on around 150 female inmates without proper authorization. Some of the women said they felt pressured or misled to have the operation—one was allegedly under sedation when it occurred—and now officials are investigating.­­

DESPITE THE OCCASIONAL GRAVE offense, Borerro asserts that public attitudes toward women and minorities have progressed since the 1970s and that the original well-intended policies on sterilization are now doing more harm than good.

"I think there's a critical distinction in our argument that's important to understand," said Borrero. "The women who entered our model requested sterilization, and we are working to help them achieve their own reproductive goals, not set their reproductive goals for them. While we're trying to prevent unwanted pregnancy, we're also in full support of a woman's reproductive autonomy."

The study says that 47 percent of women who request yet do not receive publicly-funded sterilization tend to become pregnant within a year, which is twice the rate of women who don't seek the procedure.

"Women who want a sterilization, for whatever reason, appear to be at really high risk," said Borrero. "These women just seem to know—perhaps because they've had unintended pregnancies in the past, and are hoping to prevent another in the future."

While rates of unintended pregnancy are high for everyone, they're disproportionately high for minority and low-income women. It's a problem with "no simple answer or solution," said Borrero. According to the CDC, education also plays a huge role in determining a woman's contraception of choice. For those aged 22 to 44 who've undergone sterilization, 55 percent haven't graduated from high school, whereas only 16 percent have a four-year college degree.

Ultimately, what Borrero and her fellow researchers want for now is discussion. If the present Medicaid policy is both failing to prevent unintended pregnancies among informed women and costing the nation needless amounts of tax dollars, that's a situation that warrants a conversation.

As Borrero puts it: "The whole thing needs to be revisited."