Understanding and Improving Federal Sterilization Policies
Learn about CECA’s recommendations to reform federal sterilization consent policies
The recommendations included in the report, Federal Sterilization Consent: A Summary of the Current Context and Recommendations for Change, are based on a review of existing research, stakeholder input, and consideration of the complex issues surrounding sterilization consent. Our aim is to inform policymakers, healthcare providers, advocates, researchers, and other stakeholders about the current context and the need for reform, and to institute changes that will better protect autonomy and increase access to care.
Background
Sterilization is the most common contraceptive method among women in the United States. It is disproportionately used by people with marginalized identities, including those with low incomes, public or no insurance, lower education levels, disabilities, and people of color.
Current sterilization consent policies, enacted in the 1970s, posed barriers to access while not eliminating coercion. These policies stem from a history of sterilization abuses, rooted in the harmful ideology of stratified reproduction. Additionally, advocates have expressed concerns about unfair treatment differences between those with public and private insurance.
Approach and Call for Change
CECA’s recommendations were developed with input from a diverse group of stakeholders, in keeping with principles of sexual and reproductive health equity (SRHE). CECA reviewed existing evidence, conducted expert workgroup meetings and conversations with disability justice and reproductive health and justice stakeholders, and convened Lived Experience Panels (LEPs) with community members. Three key themes informed the development processes:
Proposed changes to the federal sterilization consent form and process must balance ensuring access to desired sterilization while also preventing coercion.
Creating conditions that enable informed consent necessitates multi-level interventions.
Robust accountability mechanisms need to be implemented to address current and potential future harm.
Implementation of the recommendations should come with a thorough re-examination of the federal sterilization consent form, process, and monitoring approach. Implementation will necessitate close cooperation and collaboration among federal agencies, state and local policymakers, healthcare providers, advocates, researchers, community organizations, and the public at large. In the long term, such efforts can help to advance better policies, improve individual and community experiences, and improve public trust in the healthcare system.
Recommended Changes
Lower the minimum age of consent to 18 to reduce access barriers for young people.
Enable consent when seeking to obtain or obtaining an abortion to support patient-centered care and challenge abortion stigma.
Extend consent form validity to one year to align with processes for other healthcare procedures and reduce logistical challenges in accessing sterilization.
Shorten the mandatory waiting period to alleviate challenges disproportionately faced by people seeking federally funded sterilization.
Reassess and streamline data collection to gather valuable information without imposing undue burdens on individuals.
Offer guidance on supported decision making (SDM) to acknowledge the autonomy of individuals with intellectual and developmental disabilities.