# Multi-level factors affecting postpartum sterilization

> **NIH NIH R01** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2022 · $214,257

## Abstract

ABSTRACT
Pregnant or postpartum people experiencing incarceration (PPEI) represent a critical U3 population that is
understudied due to barriers within carceral institutions, underrepresented due to the exclusion of
institutionalized individuals from research, and underreported because they comprise a minority within
incarcerated people. PPEI have higher than average representation of NIH-designated health disparities, and
disparities in the fulfillment of desired postpartum sterilization are particularly complex for PPEI because of the
unique multilevel barriers that influence health outcomes. Tragically, many PPEI have been sterilized without
consent. Thus, policies and laws are in place to limit access of PPEI to sterilization given the challenges
involved in obtaining true informed consent, potential of coercion, and risk of regret after incarceration.
However, others with well-formulated, long-standing desires to obtain postpartum sterilization have
encountered barriers over several domains, including harsh built environments, punitive sociocultural
environments, and health care systems. Therefore, nuanced consideration is required to balance these
protections with the unintended consequence of disparities. Investigation of factors that influence postpartum
sterilization desire and fulfillment in PPEI represents a critical knowledge gap. In this Administrative
Supplement, we seek to extend efforts from our parent R01 (1R01HD098127H) to meet an overall objective
of better understanding the goals, experiences, and health outcomes of PPEI desiring postpartum sterilization
and their delivering medical team. This objective is directly related to Strategic Goal 1.3 of the ORWH and
directly responsive to the NOSI’s specific areas of research interest in terms of assessing structural
determinants of health, utilizing preventive health care and exploring the intersectional stigma impacting this
U3 population through a multidimensional research framework. Leveraging our extensive expertise in bioethics
and observational analysis and long-term collaboration with the North Carolina state prison system, we have
the infrastructure to rapidly meet our objective. Consistently, our Aims are to 1) Longitudinally assess the
contraceptive goals of PPEI by retrospectively abstracting medical record data from pregnant women who
were incarcerated from 2016-2021 (n=850) to understand postpartum sterilization decision-making and
compare with the general population via a similar dataset created through the parent grant. 2) Identify the
attitudes, beliefs, and practices of PPEI and their obstetricians regarding postpartum sterilization by
performing and analyzing semi-structured interviews of PPEI requesting postpartum sterilization and their
delivering obstetrician (n=15 dyads); 3) Develop clinical guidance for ethical postpartum sterilization for
PPEI by performing robust ethical analysis from a patient-centered and health-equity lens. Our results will
provide a cri...

## Key facts

- **NIH application ID:** 10557980
- **Project number:** 3R01HD098127-04S1
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Kavita Shah Arora
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $214,257
- **Award type:** 3
- **Project period:** 2020-05-05 → 2024-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10557980

## Citation

> US National Institutes of Health, RePORTER application 10557980, Multi-level factors affecting postpartum sterilization (3R01HD098127-04S1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10557980. Licensed CC0.

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