The results of recent studies and reports revealed a spike in people seeking permanent contraception procedures in the United States. This trend may be the result of the Supreme Court’s 2022 decision to overturn Roe v. Wade, which said there was no constitutional right to abortion care.1-4
Access to permanent contraception for women remains challenging, but some clinicians report increased demand since the court’s Dobbs v. Women’s Health Organization decision.
“There definitely are anecdotal reports of OB/GYNs saying they’re seeing increased demand for permanent contraception,” says Kavita Shah Arora, MD, MBE, MS, division director of the division of general obstetrics, gynecology, and midwifery and an associate professor with tenure at The University of North Carolina at Chapel Hill. “I worry that patients are being pushed into that decision because they don’t have the full ability to make reproductive decisions as they should. Their state laws are removing an option in reproductive care and are therefore coercing people into options they would otherwise not have desired.”
Increased rates of permanent contraception in the United States are worrisome from the perspective of reproductive health providers. “Absolutely, I do worry about it,” Arora says. “Patients would say, ‘I wasn’t thinking about this before, but there is no wiggle room or room for error in my state, therefore I want my tubes tied because I can’t have an unintended pregnancy.’”
When people make a permanent decision based on state laws, it may trouble providers, but the patient’s choice should come first. (For more information, see story in this issue on counseling patients about permanent contraception.) “My worry about future regret cannot overtake the patient’s right to make decisions about her own healthcare,” Arora says.
Posts on social media, such as Reddit, suggest the Dobbs decision was a catalyst for some women to seek permanent contraception. “So after Dobbs, I decided to take the plunge and finally get sterilized. I’ve known since I was 12 that I never wanted to have children but was a bit scared to actually go and do it,” one user wrote.5
In another Reddit post, a user wrote, “Just had my surgery yesterday morning! I started the quest in September, just a few months after Roe v. Wade got overturned.”6
Dobbs also may affect men seeking vasectomy procedures. Researchers found an increase in these procedures in the past year.2
The United States is only one of a handful of nations with rising vasectomy rates. In most places across the world, fewer men are seeking vasectomies than in previous decades.7
Reproductive health providers likely see patients who are worried about access to their contraceptive choice, and some may be attracted to a permanent method, says Jeffrey T. Jensen, MD, MPH, the Leon Speroff endowed professor and vice chair of obstetrics and gynecology at the Oregon Health & Science University (OHSU) School of Medicine. Jensen also is the director of the Women’s Health Research Unit.
“These are relevant concerns,” Jensen says. “It would be sad to me to think women are accepting a permanent method prematurely due to political concerns.”
It is important for clinicians to engage patients in counseling about permanent methods so they can make the best decision for themselves. “Ultimately, women are smart enough to make their decisions,” Jensen says.
Comments on Reddit about permanent contraception decisions show that women — at least in the short term — may not regret their decision. One woman in her mid-20s who underwent bilateral salpingectomy wrote: “Now that I’ve had the procedure, all of that anxiety has evaporated. I feel an overwhelming sense of relief that I no longer have to worry about whether or not I’ll have access to an IUD replacement (or any sort of reproductive care, really) in the future.”5
Permanent contraception access is a problem for Medicaid patients and people who live in areas where the nearest hospitals are Catholic-run organizations, research shows.8-10 Even women who live in progressive states, such as Oregon, can encounter roadblocks to obtaining permanent contraception after giving birth because of an increasing number of hospital beds in Catholic or religiously affiliated hospitals, says Maria Rodriguez, MD, MPH, a professor of obstetrics and gynecology in the department of obstetrics and gynecology at OHSU.
“Oregon has a high penetrance of Catholic hospitals across the state,” Rodriguez explains. “Through mergers and acquisitions of hospitals, Catholic health systems are larger and have more influence.”
For women who live in communities that only have one hospital, they do not have a choice about where to go when they give birth or need a reproductive health procedure. (For more information, see the story in this issue on barriers to permanent contraception.)
“What we found was if you give birth in an area where there’s only a Catholic hospital, you’re half as likely to receive a requested postpartum tubal ligation,” Rodriguez notes.
Rodriguez and colleagues found many women who did not receive their desired postpartum tubal ligation never returned to a reproductive healthcare clinic to obtain the procedure.
Other research revealed women of color experience disparities in obtaining permanent contraception. This is partly due to the required Medicaid sterilization consent form and the 30-day waiting period. Other factors include operating room availability and religious hospitals.9,10
“We found Medicaid insurance was a barrier [to] permanent contraception at every time point, including prior to hospital discharge, six weeks post-delivery, and one year postpartum,” Arora says. “By one-year postpartum, about 60% of patients with Medicaid who wanted permanent contraception got it, and 75% of people with private insurance got it.”9
It is not just women who are worried about anti-abortion laws. Vasectomy rates increased by 20% in the seven months after the overturn of Roe, according to recent research.2
“We looked at nationwide data and saw an increase in vasectomy. Specifically, we’ve seen vasectomies have gone up among men who previously had not conceived a child,” says Ranjith Ramasamy, MD, study co-author and an associate professor of urology at the University of Miami Miller School of Medicine. “Now, 10% of the men having a vasectomy are single and have not had a child. Before that, it was 2%. I think it is because of the Dobbs decision.”
The recent spike in vasectomies in the United States goes against the worldwide trend of decreased interest in vasectomy. Globally, vasectomy rates are 61% lower now than two decades ago — even as the world’s population more than doubled, researchers found.7
“Of this decline, two-thirds of that decline in worldwide vasectomy use is from China and India because they’re the most populous countries,” says Roy Jacobstein, MD, MPH, lead study author and a consultant with IntraHealth International of Chapel Hill, NC. “Only [a few] countries in the world had a vasectomy increase in prevalence over the last 10 years. That’s shocking.”
In almost every low- and middle-income country, only one in 1,000 women rely on vasectomy. Prevalence is higher in countries with high gender equality, Jacobstein notes. The United States joins South Korea, Australia, Bhutan, and New Zealand in the top five nations in vasectomy prevalence. They are among the only 20 countries in the world with a vasectomy prevalence above 1%. Jacobstein and colleagues found tubectomy prevalence is highest in Mexico, Columbia, Costa Rica, Brazil, China, Taiwan, and the United States.7
The global decline could indicate more people are relying on female contraceptive methods and women-initiated permanent contraception procedures. “Contraception use has gone up in most countries, and desired family size is smaller,” Jacobstein says.
Another trend appears to be a higher increase in vasectomy rates among men in states with stricter abortion laws. After Roe was reversed, men of all ages and men in the South and the Midwest are more likely to undergo vasectomy.2 Some physicians and offices are seeing an even bigger increase in vasectomy numbers.
“[After] the Roe v. Wade decision was leaked and then the actual announcement happened, the number of vasectomies we’ve done in the office have gone up by at least 100%,” Ramasamy says.
In more recent months, there has remained an increase of about 50%, Ramasamy adds. “In the beginning, we thought it was an initial increase and it would die down,” he says. “But the abortion laws became stricter, and we’re seeing increased demand based on that.”
While the increase in vasectomy incidence is not as high in mid-2023 as it was in mid-2022, it has remained high. “We don’t have enough people trained to meet the growing demand,” Ramasamy adds.
REFERENCES
- Bolton A, Juhlin E. More people are opting to get sterilized — and some are being turned away. NPR Shots. July 29, 2022.
- Zhang TR, Able C, Ramasamy R, Kohn TP. United States vasectomy incidence rises after the reversal of Roe v. Wade in a national clinical and claims database. Fertil Steril 2023;120:196-197.
- Ghomeshi A, Diaz P, Henry V, et al. The interest in permanent contraception peaked following the leaked Supreme Court majority opinion of Roe v. Wade: A cross-sectional Google trends analysis. Cureus 2022;14:e30582.
- Venkataramanan M. Post-Roe, more Americans want their tubes tied. It isn’t easy. The Washington Post. Aug. 15, 2022.
- (26F) I got my bisalp today! r/childfree, Reddit. October 2022. https://www.reddit.com/r/child...
- My bilateral salpingectomy experience! r/sterilization, Reddit. June 23, 2023. https://www.reddit.com/r/steri...
- Jacobstein R, Radloff S, Khan F, et al. Down but not out: Vasectomy is faring poorly almost everywhere — we can do better to make it a true method option. Glob Health Sci Pract 2023;11:e2200369.
- Rodriguez M, Daly A, Meath T, et al. Catholic sole community hospitals are associated with decreased receipt of postpartum permanent contraception among Medicaid recipients. Contraception 2023;122:109959.
- Ford A, Ascha M, Wilkinson B, et al. Nonfulfillment of desired postpartum permanent contraception and resultant maternal and pregnancy health outcomes. AJOG Glob Rep 2022;3:100151.
- Bullington BW, Arora KS. Fulfillment of desired postpartum permanent contraception: A health disparities issue. Reprod Sci 2022;29:2620-2624.
The results of recent studies and reports revealed a spike in people seeking permanent contraception procedures in the United States. This trend may be the result of the Supreme Court’s 2022 decision to overturn Roe v. Wade, which said there was no constitutional right to abortion care.
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