# Developing and testing a decision support tool for women making tubal sterilization decisions.

> **NIH NIH R01** · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · 2020 · $703,241

## Abstract

Project Summary/ Abstract
Female surgical sterilization is the second most commonly used contraceptive method in the US and is
disproportionately used by low-income women and women of color. Whether the higher use of sterilization in
these populations reflects inappropriate overutilization is unclear. On one hand, low-income and racial
minority women frequently misunderstand the permanent nature of sterilization, are often unaware of
reversible contraceptive alternatives, and commonly experience regret after the procedure– suggesting
suboptimal decision making. On the other hand, there is evidence of substantial unmet demand for
sterilization among low-income women, due to unique access barriers posed by Medicaid sterilization
regulations, putting them at high risk for unintended pregnancy and the adverse health and social
consequences associated with unintended pregnancy.
Medicaid sterilization policy currently requires that all women requesting a federally-funded procedure
complete a standardized consent form at least 30 days prior to sterilization. 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, there is growing consensus that the policy is incapable of
ensuring informed consent, and that the mandatory 30-waiting period impedes access to desired sterilization
for many low-income women. The lack of a process that can ensure both informed consent and timely access
for sterilization procedures hampers progress toward reproductive health equity for low-income women.
The proposed project seeks to build and test a novel, web-based decision support tool to optimize low-income
women's ability to make informed and value-concordant decisions about surgical sterilization. A decision
support tool may be particularly useful in the context of sterilization decisions because this is a preference-
sensitive decision with permanent implications and because there is a high level of misunderstanding about
sterilization and limited awareness of alternative options among women who have undergone the surgery,
indicating critical gaps in the quality of pre-sterilization counseling. Furthermore, patient-provider interactions
may be complicated by a broader social and historical context in which poor and minority women's
reproductive choices have not always been valued. Thus, the specific aims of this proposal are to qualitatively
determine low-income women's decision support needs and preferences as well as providers' perspectives on
the role of decision support around surgical sterilization (Aim 1); build a patient-directed, web-based decision
aid to support women's sterilization decision making (Aim 2); and conduct a 3-site, randomized controlled trial
to test the effect of the decision aid plus usual care compared to usual care alone on decision quality among 350
racially-diverse, low-income women requesting post-partum sterilizatio...

## Key facts

- **NIH application ID:** 9920197
- **Project number:** 5R01MD011678-04
- **Recipient organization:** UNIVERSITY OF PITTSBURGH AT PITTSBURGH
- **Principal Investigator:** SONYA B. BORRERO
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $703,241
- **Award type:** 5
- **Project period:** 2017-08-14 → 2022-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9920197

## Citation

> US National Institutes of Health, RePORTER application 9920197, Developing and testing a decision support tool for women making tubal sterilization decisions. (5R01MD011678-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9920197. Licensed CC0.

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