Permanent Birth Control—Vasectomies and Tubal Ligations—Up following Supreme Court Abortion Ruling
Researchers find Dobbs decision ending right to abortion spiked use of permanent contraception
After the Supreme Court’s Dobbs ruling, many public health experts expected women to take their healthcare into “their own hands, if need be, to maintain autonomy over their own bodies,” says BU researcher Jake Morgan. Photo by China News Service via Getty Images
Permanent Birth Control Up following Supreme Court Abortion Ruling
Researchers find Dobbs decision ending right to abortion spiked use of permanent contraception—vasectomies and tubal ligations
When the Supreme Court overturned the national right to abortion in June 2022, some friends and family of Jacqueline Ellison (SPH’20) underwent or considered “permanent contraception”—vasectomies and tubal ligations. Suspecting similar effects nationally, Ellison, a health sciences researcher, pulled together a team to study voluntary sterilization rates pre- and post-Dobbs v. Jackson Women’s Health Organization.
Among those she turned to was an expert from her alma mater who specializes in using data to answer public health questions: Jake Morgan (SPH’17), a Boston University School of Public Health research assistant professor of health law, policy, and management. Together, the team found that among 18- to 30-year-old men, post-Dobbs vasectomies leapt by about 27 additional procedures per 100,000 outpatient visits. The increase in tubal ligations among women of the same age roughly doubled the spike among men: about 58 per 100,000.
The study, published in April in JAMA Health Forum, used anonymized data involving 113 million patients nationwide at academic medical centers and clinics, including Boston Medical Center, BU’s primary teaching hospital. To get a before-and-after look, the researchers reviewed the period from June 2019—three years before the Dobbs decision—to September 2023, covering a year and a few months following the ruling.
”Permanent contraception procedures were on the rise even before Dobbs,” says Ellison, who earned a PhD in health services research at BU and is now an assistant professor at the University of Pittsburgh. She speculates that rise was owed in part to millennials’ and Gen Z’s precarious finances, compared with previous generations’ finances.
For those who are hoping abortion bans will reverse declining birth rates, Morgan says the study offers a cautionary yellow light. He spoke with The Brink about the research and its implications as states debate abortion bans.
Q&A
with Jake Morgan
The Brink: Did the magnitude of the greater spike in procedures among women surprise you?
Jake Morgan: I don’t think that I was surprised, because we know that women tend to bear the burden of reproductive planning a lot more than men. Even pre-Dobbs, the rate of tubal ligation was a lot higher than vasectomy. The change in the rate at which sterilization was increasing post-Dobbs [being] greater for women corresponds to what we have always known about how the world works, and who is disproportionately taking on the burden of making those choices. Is there a benefit in educating men more or creating better access to vasectomies? Both procedures are safe and effective, but a vasectomy is quicker, cheaper, less invasive. From a healthcare perspective, that might be an interesting thing to study in the future.
The Brink: Any idea about the socioeconomic traits of the typical person who received these sterilization procedures?
Jake Morgan: There’s a mix of effects going on. There are systematic barriers built into healthcare that make it difficult for low-income people, people of color, to access healthcare. That could be getting the bus fare to get there, finding child care, getting time off from work. So, it can both be true that poor women are sort of nudged to this option, but also that it’s harder for them to get into the healthcare system to begin with.
Everyone should have options to any sort of procedure that they and their doctor decide is right for them. But what we’ve seen with Dobbs is that people are being shunted into this option that may not have been their first choice, but they’re trying to do what they can to preserve autonomy over their own reproduction—i.e., with permanent contraception. So, while we think that everyone should be able to choose sterilization, the concerning point with this increase is that clearly this was not the first choice of folks.
The Brink: Are a heavy proportion of people who opt for permanent contraception from marginalized or disadvantaged groups?
Jake Morgan: There’s a long history of sterilization being forced on minority communities, either through pressure from doctors or sometimes the courts.
For example, you’re a poor woman with lots of kids, maybe you go to get healthcare, and your doctor is like, “You really should consider this procedure.” There is research about that.
The Brink: What are the implications of your findings, as states debate their individual abortion policies?
Jake Morgan: A legislature or policymaker needs to carefully consider expected benefits [and] the implications for patients. In the case of abortion, if you are pro-life, you are happy that fewer abortions are taking place. But if one of the reasons you’re against abortion is because you believe that we need to procreate, this should be concerning, because people are getting sterilized.
People have been debating population collapse or population explosion for hundreds of years. Just because you ban abortion does not mean that the demand for services related to not having a child is going to go away. Sterilization is definitely not the most common choice: you can cross state lines [to get abortions where they’re legal]; people are getting mail-order medications. The people that you’re targeting with these policies are still going to work to maintain their autonomy to the extent that they can.
My academic career is focused on empowering people to make choices for their own healthcare and their own bodies. I hope that policymakers, when they pass laws that shrink autonomy, are really sure why they want to do that and what they think is going to happen. People who study this, I think, knew that there would be repercussions. Whether that is underground—back-alley abortions—or crossing state lines or sterilization, women will take this into their own hands, if need be, to maintain autonomy over their own bodies.
This interview was edited for clarity and brevity.
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