Study Examines Dobbs Decision Effects on Permanent Contraception Rates
December 1, 2025 7 minutes read
By Melinda Young
A close look at data from hundreds of thousands of permanent contraception procedures from Jan. 1, 2019, through March 31, 2023, found an increase in permanent contraception procedure rates for both females and males after the U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization.1 Females living in areas with higher educational attainment, lower poverty rates, and located further from abortion care had the greatest increase in rates of permanent contraception, the study found.1
“In our study, we saw this increase in permanent contraception procedures after Dobbs, and three-fourths of it lasted, and then kind of went back down,” says Alice Abernathy, MD, MSHP, an assistant professor in the department of obstetrics and gynecology at the Perelman School of Medicine, University of Pennsylvania in Philadelphia.
Other studies that looked at permanent contraception rates nationally have found increases post-Dobbs that spiked initially and then fell — but remained elevated after the initial spike. They also found that the increases were greatest among young adults.2-4
A nationwide analysis of permanent contraception trends before and after Dobbs found consistent vasectomy increases across states in the past few years and increased tubal permanent contraception in states with laws restricting or banning abortions. Both trends are most pronounced for people younger than 30 years of age.4
The Pennsylvania study shows how permanent contraception rates changed a couple of times, depending on what happened in the months following the Dobbs decision. “All the research I undertake is motivated from patient stories and what we observed clinically, and right around Dobbs, I had a huge amount of patients who asked about permanent contraception,” Abernathy says. “It seems like there were more people who were interested, and they were coming from all different walks of life.”
Some of the women wanted a tubal procedure after delivery of a child; others wanted sterilization because they did not want to have children ever or anymore, Abernathy recalls. “These were young women and more people who [wanted] this as their primary method of contraception,” she adds.
As a researcher, Abernathy was interested in the experience of Pennsylvania residents’ permanent contraception rates because the state is fairly unique in the current politically divisive era. For one difference, Pennsylvania did not pass new restrictive abortion laws as did more than a dozen other states across the nation, and it did not have old abortion ban laws on the books that were enacted when Roe v. Wade was overturned. The state also did not follow the trend of its Northeastern neighbors and states on the West Coast and enact laws that made abortion easier to obtain.
So, abortion remained legal in Pennsylvania in the post-Dobbs era, but abortion care remained subject to intense scrutiny and debate.1 “Pennsylvania is one of the only true states where it is very purple,” Abernathy says. “As it relates to abortion policy, it’s highly contested and regulated in this state.”
Taking data from a claims database of all ambulatory and surgical facilities in the state, researchers saw sterilization procedures in males and females, as well as location and other data, she says. “We looked at the data to see if there was a change from an expected trend at any point in our study period, and the answer was, yes, it changed after the Dobbs decision,” she explains. “Then, we separated sterilization procedures by sex and asked if there was a change in volume of procedures for men and women and looked at other key characteristics — ZIP code measures, educational attainment, poverty, and distance to an abortion-providing clinic.”
Distance from an abortion center was an important factor because it could be that people who lived further away from an abortion clinic might perceive the threat of losing access to abortion more significantly than people who were closer to abortion-providing clinics, Abernathy explains. “There was a large and significant jump in the number of women who pursued abortion procedures after Dobbs, and a smaller and sustained increase in men getting vasectomies,” she says. “But this data may not be the best measure of vasectomy rates because the procedure can be done in a doctor’s office, so we may have underestimated the effect.”
Investigators also found differences related to ZIP codes, poverty level, educational attainment, and proximity to an abortion-providing clinic.1 “We did a number of other tests to make sure what we were measuring was truly the result of the Dobbs decision; it is state-level data, and we don’t know why they got this procedure,” Abernathy notes. “But there were no other changes at the same time that would possibly explain their behavior, and this has also been observed nationally.”
The study’s findings suggest that the Dobbs decision was incredibly impactful for people who grew up with access to abortion under Roe v. Wade, and this was true regardless of whether they lived in states with abortion restrictions, she adds. “It wasn’t impacted by state, economics, race, and other factors,” Abernathy says. “I think the main conclusion is that even in a state where legality of abortion did not change, this idea that it could change and the ability to interrupt a pregnancy that was not wanted and posed a health risk to a person or that was complicated in some way, the possibility of not being able to get an abortion caused people to seek out permanent contraception.”
Even the threat of abortion becoming illegal in Pennsylvania was enough to produce a behavioral change among Pennsylvanians, she adds. “That speaks to how salient the Dobbs decision is and how impactful it is,” Abernathy says. “Even being concerned that it might not be accessible was enough to drive changes.”
Some of the new study’s findings are challenging to understand. For instance, the finding that there were increased permanent contraception rates among women living in higher-income and higher-educational attainment ZIP codes does not have an easy answer. “We don’t know why that is,” Abernathy says. “But that would typically speak to maybe this procedure being more accessible in some way.”
For example, there are more barriers to permanent contraception for people who enrolled in Medicaid coverage because of the 30-day waiting period, she explains. “We may have captured some differences by insurance, so it’s hard to say if permanent contraception wasn’t seen as a priority,” or was not accessible, Abernathy adds. “We need more individual-level data to make more accurate conclusions about the effect of income, insurance, and education.” Also, in Pennsylvania, vasectomies are not covered by Medicaid — only female tubal contraception is covered, she says.
The increase in permanent contraception rates was short-lived in Pennsylvania, where abortion remained legal and accessible. The study found that permanent contraception rates rose sharply for female tubal sterilization procedures at the time of the Dobbs decision and then began to dip through the first quarter of 2023.1 “It’s hard to draw [long-term] conclusions around that because we only did the first quarter of 2023,” she says. “We didn’t apply any statistical test and didn’t look at comparisons after the spike in relationship to the pre-Dobbs trend.”
Other reasons women might seek permanent contraception also are not known from the study’s data. “I don’t have detailed conversations in a clinical setting about the reasons why people want a sterilization,” Abernathy says. “If that’s their desired contraceptive method, and they’re well-informed about the options for them, we should support their decision,” she explains.
From a clinical perspective, the patient-provider counseling on permanent contraception should include all available information and rely on shared decision-making. Patients should choose the contraceptive method that works best for them, and it is the clinicians’ responsibility to provide whatever method they choose with the least amount of barriers to obtaining it, she adds.
“All we can really say or hypothesize is that these adults we see are driven by the immediate result of Dobbs,” Abernathy says. “In Pennsylvania, there was talk about things changing, and then they didn’t. So, maybe that’s why in Pennsylvania the increase was short-lived and a nonsignificant change in the long run.”
Changes in permanent contraception rates in the United States appear to be affected by large-scale societal changes. More research could shed light on whether these changes are resulting in long-term changes in women’s contraceptive decisions.
“When looking at these changes in contraceptive behavior, there’s always room for qualitative studies that expand on the ways people are accessing tools to maintain reproductive autonomy,” Abernathy says. “But changes in permanent contraception use — specifically in people who may have better access to care — may result in people who have more challenges than those burdened by access inequities,” she explains. “These inequities may become more pronounced if there are more geographical accessibility and structural barriers to care.”
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Abernathy AM, Schreiber CA, Kim S, Chatterjee P. Changes in permanent contraception rates in Pennsylvania associated with the Dobbs v. Jackson Women’s Health Organization decision. O G Open. 2025;2(5):e114.
2. Ellison JE, Brown-Podgorski BL, Morgan JR. Changes in permanent contraception procedures among young adults following the Dobbs decision. JAMA Health Forum. 2025;5(4):e240424.
3. Krewson C. Permanent contraception use increased in US young adults following Dobbs. Contemporary OB/GYN. Jan. 6, 2025. https://www.contemporaryobgyn.net/view/permanent-contraception-use-increased-in-us-young-adults-following-dobbs#
4. Wahlstedt J, Wahlstedt E, Ramsay J, et al. A nationwide analysis of the trends in permanent contraception utilization before and after Dobbs ruling. Fertil Steril. 2025;124(2):372-374.
A close look at data from hundreds of thousands of permanent contraception procedures from Jan. 1, 2019, through March 31, 2023, found an increase in permanent contraception procedure rates for both females and males after the U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization.
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