Understanding and Improving Federal Sterilization Policy
Background
Sterilization is the most common form of contraception in the United States. Women who use sterilization are disproportionately people of color, Medicaid recipients, those with low incomes and limited education, and people living with disabilities.
The U.S. government established the federal sterilization consent policy in the 1970s to address a history of coercive sterilization, rooted in harmful ideologies of eugenics and stratified reproduction. The current policy has remained largely unchanged for over forty years.
While this policy is designed to protect against sterilization abuses, it also imposes burdensome consent requirements that create barriers to desired care. These obstacles primarily impact people whose sterilizations are federally funded. Many experts have called for these policies to be reformed.
Why is this work important now?
Evidence suggests that federal sterilization policy creates a two-tiered system in which Medicaid recipients face additional barriers seeking sterilization compared to people with private insurance.
We must work to ensure equitable access to desired sterilization care as part of the broader effort to secure the right to contraception for all and advance sexual and reproductive health equity (SRHE).
This work helps inform current consent policies to better protect autonomy and enable fair and equitable access to sterilization.
Approach
Since 2023, CECA has led a collaborative process with expert stakeholders to understand the impact of current sterilization consent policy and identify a set of recommended actions to update this policy. This effort has included the following activities:
Conducted an Environmental Scan that synthesizes key evidence related to U.S. federal and state sterilization consent policies and relevant outcomes.
Convened expert workgroup meetings, including conversations with disability justice, reproductive health, and reproductive justice leaders, and Lived Experience Panels (LEPs) with community members.
Developed a Recommendations Report that calls for specific changes to the current sterilization consent policy and processes, aligned with the principles of SRHE.
Recommendations and Call for Change
Three key themes informed CECA’s development of the recommendations:
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 are needed to address current and potential future harm.
The recommendations should be implemented alongside a thorough re-examination of the federal sterilization consent form, process, and monitoring approach. Implementation of these changes will require 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, these efforts can help 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.
Resources
Federal Sterilization Consent: A Summary of the Current Context and Recommendations for Change
The recommendations included in the report 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.
Understanding the Impact of Current Sterilization Consent Policy: Environmental Scan Report
This scan presents an overview of sterilization consent policies at federal and state levels, synthesizes evidence on the documented impact of these policies, summarizes available resources to support sterilization care delivery, and highlights areas for future research.