"That’s my decision”patient experiences requesting permanent contraception during incarceration in a U.S. state prison: a qualitative study

Permanent contraception remains the most commonly utilized contraceptive method in the United States but given a historic and contemporary legacy of nonconsensual sterilization of incarcerated persons, its routine use during custody is discouraged. However, of the 58,000 pregnant individuals experiencing incarceration each year, many may request the procedure. Our objective was to explore the perspectives and experiences of pregnant and postpartum people with a history of incarceration who request permanent contraception, an understudied population with multiple barriers to research participation. We recruited and interviewed individuals who experienced pregnancy or postpartum and requested permanent contraception while incarcerated in North Carolina. We applied narrative portraiture analysis, a qualitative analytic tool for small samples, to the interviews to contextualize research findings within broader social narratives and to avoid systematically deconstructing each unique narrative. A codebook was developed based on narrative elements and phenomena of interest. We interviewed four participants, none of whom had their request for permanent contraception fulfilled while in custody. Intersecting phenomena of interest included incarceration as motivation for permanent contraception, internalized stigma entangled with a desire for bodily autonomy, and comparing care treatment during incarceration and in the community. All participants supported having the choice of permanent contraception but shared different perspectives on the potential for coercion during incarceration. Participants vehemently endorsed that people should be able to make autonomous choices regarding their reproductive futures during incarceration while acknowledging the influence incarceration had on decision-making. Our findings provide important insights into how carceral conditions shape reproductive autonomy and decision-making and highlight the need for well-developed ethical guidance for physicians approaching the care of pregnant people experiencing incarceration who request permanent contraception.