By Melinda Young
EXECUTIVE SUMMARY
Requests for permanent contraception among women have increased since June 2022. OB/GYNs report in a new study that their patients often bring up threats to their reproductive health autonomy as a reason for requesting a permanent contraception procedure.
- One patient told her clinician that she feared getting pregnant and having a problematic pregnancy where she would be forced to carry a fetus that would die outside of the womb.
- Some clinicians said they were remotivated by abortion-restrictive laws to prioritize fulfilling permanent contraception requests.
- The American College of Obstetricians and Gynecologists recommends that OB/GYNs be careful to not discourage patients who request the procedure.
Clinicians have reported an increase in patient requests for female permanent contraception since June 2022 and the U.S. Supreme Court’s decision to overturn abortion rights with the decision in Dobbs v. Jackson Women’s Health Organization.1 Researchers asked OB/GYNs in four states — Ohio, Illinois, Alabama, and California — to discuss their experiences with patients asking for permanent contraception and how the clinical community has met their reproductive needs.1
“We analyzed in-depth interviews with 51 postpartum patients who desired permanent contraception and 55 delivering OB/GYNs across four hospitals,” says Suzanna Larkin, MPH, a research specialist in the department of obstetrics and gynecology at the University of North Carolina School of Medicine in Chapel Hill. Larkin answered questions via email.
Some providers said the more restrictive atmosphere under Dobbs has made some clinicians focus more on how patients who desire a permanent contraception procedure can access it through their insurers. One clinician told researchers, “I think that [Dobbs] probably has made the medical community more in tune to prevention of pregnancy so that … they don’t find themselves in a situation where there’s an undesired pregnancy without access to termination.”1
“We had four major takeaways,” Larkin explains. “Several patients discussed how the Dobbs decision impacted their decision to seek permanent contraception due to limited access to abortion or worries about putting their health at risk with another pregnancy,” she says. “About half of patients reflected on how the decision threatens reproductive health autonomy; this perspective was shared both by patients that live in abortion-restrictive states and in abortion-permissive states,” she adds.
At the time of the research — immediately post-Dobbs — Ohio and Alabama were abortion-restrictive states, while Illinois and California were abortion-permissive states. Ohio voters passed a new constitutional amendment to protect abortion access on Nov. 7, 2023.2
For example, one 32-year-old patient interviewed said the Dobbs decision was a definite factor in her thinking that she would have more limited options if she got pregnant again.1 Another 33-year-old person expressed fear of possibly getting pregnant and having a problematic pregnancy in which she would be forced to carry a fetus that would die outside of the womb. “That’s why, ultimately, for myself and my body, I decided to get my tubes tied and then still have him do the vasectomy.”1
Patients expressed concern for women being put into difficult situations and not having as many options as they did previously. One patient from a permissive state told researchers, “It’s like everybody has their own body and their own thinking, and it just sucks that we put our lives in the government to make our decisions.”1
Clinicians noted that they had seen a significant increase in tubal consultations since Roe v. Wade was overturned.1 “Some clinicians indicated that they were noticing greater requests for permanent contraception in their clinical practice, especially among younger patients,” Larkin says. Several clinicians said the Dobbs decision remotivated them to meet their patients’ reproductive needs and to prioritize fulfilling permanent contraception requests, she says.
A clinician from a state with abortion restrictions said that, since June 2022, “I’ve had a dozen young women who don’t have kids who come in and they want their tubes tied. I’m like, ‘This is what we have. We have these options for you. An IUD can be as effective.’ If they still say, ‘No. No. I just don’t want any chances,’ I’m taking their tubes. If that’s what they want, that’s what they shall have.”1
Clinicians should be aware that evolving reproductive policy restrictions and other political factors may be considerations in their patients’ decisions about contraception, Larkin notes. “Clinicians in our study who mentioned an increase in permanent contraception requests noticed it especially among young patients,” she says. “Prior research suggests that clinicians might be biased against offering permanent contraception to young, nulliparous patients.”1,3
When shared decision-making is valued in contraception counseling as a collaborative process, clinicians will have a conversation about their patients’ preferences and values, Larkin says, referencing a paper that calls shared decision-making the “most ethically sound form of counseling, as it maximizes patient autonomy.”4
When patients bring up political stressors, such as Dobbs, during patient-provider conversations, clinicians should respond with offering the evidence-based information that can allow the patient to make a well-informed decision, and this is regardless of their age or parity, Larkin says. “People are worried about their reproductive autonomy being taken away,” she adds. “I think our study reflects this.”
One OB/GYN mentioned the need for addressing permanent contraception counseling as a component of prenatal care and meeting patients’ demands for an end to their ability to get pregnant. For people enrolled in Medicaid, there is a barrier with the Medicaid Consent to Sterilization policy, which has a mandatory 30-day waiting period from the time a patient signs a standardized consent form to when the patient has the permanent contraception procedure for Medicaid reimbursement.5
Providers have a great interest in meeting patients’ permanent contraception requests because of Dobbs, and they may make it a priority and not allow themselves to become distracted or too busy to meet Medicaid’s timeframe, a clinician notes.1
“Contraceptive counseling should be included in prenatal visits so that the patient’s preferred postpartum contraception plan is documented,” Larkin says. “For patients who use Medicaid insurance and desire postpartum permanent contraception, it is very important that patients are informed of the required consent form and 30-day waiting period mandated by the Medicaid Sterilization Policy so that the waiting period can be completed by delivery.”
Clinicians can help improve access to permanent contraception for patients with Medicaid by following recommendations from the American College of Obstetricians and Gynecologists (ACOG) and also by being careful to not discourage patients who request the procedure.1 ACOG published a committee statement in April 2017 on ethical considerations of permanent contraception.6 The statement notes that permanent contraception is the most used method of contraception among women aged 15-49 years, and it also is a straightforward surgical procedure that OB/GYNs can perform.6
“Ethical counseling and shared decision-making for permanent contraception should adopt a nonjudgmental, patient-centered approach, using up-to-date information about permanent contraception procedures and alternatives,” according to ACOG’s statement.6
ACOG recommends OB/GYNs give patients counseling and information on reversible alternatives and emphasize the permanence of the procedures. They also should discuss vasectomy as an option with fewer risks, and they should engage in longitudinal counseling to minimize patient regret. But this does not suggest paternalism or imposing age or parity thresholds on patients who seek permanent contraception.6
“If individual physicians or institutions will not provide surgery for permanent contraception because of personal religious beliefs or institutional policy, the patient must be informed as early as possible,” ACOG’s paper states.6
Robert A. Hatcher, MD, MPH, founding author of Contraceptive Technology, and Professor Emeritus of Gynecology and Obstetrics, Emory University School of Medicine in Atlanta, says, “The America College of Obstetricians and Gynecologists now recommends that tubal sterilization be accomplished by completely removing the fallopian tubes. When this is done, it leads to 100% protection against pregnancy and to excellent protection against ovarian cancer. Complete removal of both tubes is probably the most important change in the past 100 years in how a woman who wants no more children would best be served.”
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Larkin S, Bullington BW, Berg KA, et al. How the Dobbs decision shapes postpartum permanent contraception decision-making among birthing people and their OB-GYNs. J Womens Health (Larchmt). 2025;34(6):817-822.
2. Smyth JC. Ohio voters just passed abortion protections. When and how they take effect is before the courts. Associated Press. Updated Nov. 24, 2023. https://apnews.com/article/abortion-ohio-constitutional-amendment-republicans-courts-fb1762537585350caeee589d68fe5a0d
3. Kathawa CA, Arora KS. Implicit bias in counseling for permanent contraception: Historical context and recommendations for counseling. Health Equity. 2020;4(1):326-329.
4. Bullington BW, Sata A, Arora KS. Shared decision-making: The way forward for postpartum contraceptive counseling. Open Access J Contracept. 2022;13:121-129.
5. Hartheimer JS, Bullington BW. Berg KA, et al. Postpartum patient perspectives on the US Medicaid waiting period for permanent contraception. Open Access J Contracept. 2025;16:31-41.
6. American College of Obstetricians and Gynecologists. Permanent contraception: Ethical issues and considerations. ACOG committee statement. Number 8. Feb. 2024. https://www.acog.org/clinical/clinical-guidance/committee-statement/articles/2024/02/permanent-contraception-ethical-issues-and-considerations
Requests for permanent contraception among women have increased since June 2022. OB/GYNs report in a new study that their patients often bring up threats to their reproductive health autonomy as a reason for requesting a permanent contraception procedure.
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