The number of young adults who chose tubal ligation and vasectomies as birth control jumped abruptly after the Supreme Court overturned Roe v. Wade in 2022 and has continued to rise, new research shows.
The paper, published Friday in JAMA Health Forum, is the first to focus specifically on the contraception choices of women and men ages 18 to 30 after the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization ended the constitutional right to abortion.
Studying this age group is important because they are “much more likely to have an abortion and … to experience sterilization regret relative to their older counterparts,” said co-author Jacqueline Ellison, an assistant professor at the University of Pittsburgh School of Public Health.
A vasectomy is a routine procedure in men that blocks sperm from reaching semen. Tubal ligation or sterilization involves cutting, tying or removing the fallopian tubes to prevent sperm from reaching the eggs.
It’s difficult to prove the Dobbs decision caused a rise in women and men undergoing permanent birth control. But the new study used a particular statistical approach that, Ellison said, strongly suggested the increase in sterilization procedures flowed from the Supreme Court’s decision and the subsequent actions in 21 states to ban or further restrict access to abortion.
Ellison and her fellow researchers analyzed medical record data from academic medical centers and affiliated clinics nationally from two periods: Jan. 1, 2019, to May 31, 2022, before Dobbs, and from June 1, 2022, to Sept. 30, 2023, after Dobbs.
They found that there were roughly 58 more tubal ligations per 100,000 outpatient visits after Dobbs and 27 more vasectomies per 100,000 visits.
“There was a lot of fear and anxiety … around whether people were going to be able to get an abortion that they needed or wanted and even fears about being able to access contraception down the road,” she said.
Young women may have felt a greater urgency to act than their male partners in the wake of policy changes because pregnancy disproportionately affects them, said Dr. Angela Liang, a clinical assistant professor of obstetrics and gynecology at the University of Michigan who was not involved in the new study. There are medical risks during pregnancy and during delivery, “such as postpartum hemorrhage and the need for a cesarean section,” Liang said, adding that much of the burden after pregnancy also falls on women.
The new study had limitations. For one thing, the data was not broken down by state, which can reveal a more detailed response to policy changes.
In Michigan, for example, the Supreme Court’s decision allowed a 1931 law making all abortions a felony to be enforced. Two and a half months later, a permanent injunction blocked the law, and, two months after that, Michigan voters passed an amendment to the state constitution that established an individual right to reproductive freedom.
Liang and several colleagues analyzed electronic health records at one health care institution in Michigan and found that requests for tubal sterilizations surged in the months after the Dobbs decision and then returned to baseline.
“The decrease back to baseline after 6 months may have been due to the demand being met, a decreased sense of urgency after abortion access was temporarily protected, or crisis fatigue,” they wrote in JAMA last year.
Using medical records to analyze contraception decisions captures the decisions of only patients and not those who have not sought medical care during the time period studied.
In a recent study, Megan Kavanaugh, the principal research scientist at the Guttmacher Institute, and a colleague analyzed survey data of reproductive-age women in four states, finding an increase in condom use but no significant changes in permanent contraception methods. The report from Guttmacher, a research and policy organization that supports abortion rights, was published in a medical journal in February.
This broader population of women “may not necessarily have very strong attitudes about pregnancy prevention,” said Kavanaugh, who was not involved in the new study.
A more complete examination of contraception choices in the United States will be available at the end of the year when the federally sponsored National Survey of Family Growth releases data from January 2022 through December 2023, Kavanaugh said. The pandemic interrupted the survey, and the latest available data is from 2019.
“It is the gold standard for much of the data we track around sexual and reproductive health care and their outcomes,” she said.
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