Permanent Contraception Procedures Surge Among Young Adults After Dobbs.

Permanent Contraception Procedures Surge Among Young Adults After Dobbs Decision
Tubal ligation and vasectomies increased sharply after the Supreme Court overturned Roe v. Wade in 2022—with tubal ligation soaring twice as fast, according to a new study.
After the US Supreme Court overturned Roe v. Wade and ended the constitutional right to abortion, permanent contraception procedures soared among young adults, according to a new study by Boston University School of Public Health and the University of Pittsburgh School of Public Health.
Following the Dobbs v. Jackson Women’s Health Organization decision in June 2022, tubal ligations—commonly known as getting tubes tied—and vasectomies spiked abruptly among 18 to 30-year-olds, the age group that is more likely to have an abortion, as well as experience sterilization regret.
Published in JAMA Health Forum, the study is the first to assess the impact of the Dobbs decision specifically on young adults’ contraception choices. While the findings do not definitively confirm that the ruling caused an increase in permanent birth control procedures, the data emphasize the life-altering consequences of removing federal protections to abortion. Since the decision, 21 states have either partially or fully banned abortion procedures, and other legislation, such as “personhood” laws, continue to severely limit reproductive rights.
“Our study underscores that health policy often has far-reaching consequences that may not be anticipated by those who pass these laws,” says study senior author Jake Morgan (SPH’17), research assistant professor of health law, policy & management and a graduate of SPH’s doctoral program in health services and policy research. “Limiting or banning a substance, product, or service does not automatically remove demand for it. Instead, the demand is driven underground or individuals seek ways to circumvent the policy. Policymakers need to understand these responses, and carefully weigh the desired benefits of the policy against the consequences, particularly when the policy seeks to limit individual autonomy.”
For the study, Morgan and researchers analyzed nationwide clinical data among 113 million patients from academic medical centers and clinics to compare permanent contraception rates from January 2019–May 2022, before the Dobbs decision, to sterilization rates from June 2022–September 2023, after the ruling. Tubal ligation blocks the fallopian tubes, while vasectomies block sperm from entering semen, to prevent pregnancy.
“Within mixed-gender couples, promoting access to male sterilization is one way to begin equalizing the responsibility of reproductive planning.”
Notably, tubal ligation increased twice as much as vasectomies, reflecting the reality that women shoulder more of the responsibility for reproductive planning, Morgan says. The team observed an increase of about 58 additional tubal ligations per 100,000 outpatient visits and 27 additional vasectomies per 100,000 outpatient visits, in the weeks and months after the ruling. Tubal sterilization rates continued to increase faster than vasectomy rates in 2023.
“While both procedures are extremely safe and effective, male sterilization procedures are less invasive and expensive,” he says. “Within mixed-gender couples, promoting access to male sterilization is one way to begin equalizing the responsibility of reproductive planning.”
The researchers hope that their study underscores the policy and political implications of the Dobbs ruling and spurs additional research to better understand how the landmark decision and related policies disproportionately affect Black, Indigenous, Hispanic, disabled, immigrant, and low-income people, who often face additional challenges when making reproductive planning choices, Morgan says.
“Dobbs demonstrated to people that the Supreme Court was willing to overturn prior precedent based on the current ideological makeup of its members,” he says. “Our results demonstrate that there is little optimism for a nationwide protection of abortion rights, and instead individuals are using permanent sterilization solutions to guarantee autonomy over their own bodies.”
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