Health care justice and its implications for current policy of a mandatory waiting period for elective tubal sterilization

Amirhossein Moaddab, Laurence B. Mccullough, Frank A. Chervenak, Karin A. Fox, Kjersti Marie Aagaard, Bahram Salmanian, Susan P. Raine, Alireza A. Shamshirsaz

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Tubal sterilization during the immediate postpartum period is 1 of the most common forms of contraception in the United States. This time of the procedure has the advantage of 1-time hospitalization, which results in ease and convenience for the woman. The US Collaborative Review of Sterilization Study indicates the high efficacy and effectiveness of postpartum tubal sterilization. Oral and written informed consent is the ethical and legal standard for the performance of elective tubal sterilization for permanent contraception for all patients, regardless of source of payment. Current health care policy and practice regarding elective tubal sterilization for Medicaid beneficiaries places a unique requirement on these patients and their obstetricians: a mandatory waiting period. This requirement originates in decades-old legislation, which we briefly describe. We then introduce the concept of health care justice in professional obstetric ethics and explain how it originates in the ethical concepts of medicine as a profession and of being a patient and its deontologic and consequentialist dimensions. We next identify the implications of health care justice for the current policy of a mandatory 30-day waiting period. We conclude that Medicaid policy allocates access to elective tubal sterilization differently, based on source of payment and gender, which violates health care justice in both its deontologic and consequentialist dimensions. Obstetricians should invoke health care justice in women's health care as the basis for advocacy for needed change in law and health policy, to eliminate health care injustice in women's access to elective tubal sterilization.

Original languageEnglish (US)
Pages (from-to)736-739
Number of pages4
JournalAmerican journal of obstetrics and gynecology
Issue number6
StatePublished - Jun 1 2015
Externally publishedYes


  • ethics
  • health care justice
  • health policy
  • medicine as a profession
  • tubal sterilization

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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