So, I'm an Ob/Gyn and my hospital sees a substantial prison population. Cost effectiveness should never enter the discussion when you are counseling a patient about a permanent sterilization procedure, especially when long acting reversible contraception is readily available. We do end up performing a lot of hysterectomies on incarcerated patients though for a multitude of other indications, usually chronic pelvic pain, fibroids, or abnormal uterine bleeding. In my experience this is because when people are incarcerated, they suddenly have access to medical care that they never had in the free world because of lack of insurance/Medicaid qualification. But consent from patients, especially incarcerated patients, is absolutely critical. I have never encountered a patient who wasn't 100% ready to have their surgery because it is easy for them to refuse it at multiple points (most just don't get on the bus to the hospital for their surgery if they change their mind). Furthermore, I don't think we even do tubal ligations on incarcerated patients, or at least I've never seen it here. I can't speak for other hospital systems, but I'm proud of the service we have given to incarcerated women.
That being said, there is definitely a power imbalance between providers and a vulnerable population like those in prison, and it needs to be taken into account. There needs to be public scrutiny to ensure that these patients aren't being coerced or taken advantage of, so I am glad to see this coming to light.
