Sterilization rates among women rose following Dobbs ruling

Key takeaways:

• Tubal sterilization rose 3% each month in the 6 months following the Dobbs ruling in states that banned abortion.
• The findings warrant attention because tubal sterilization is irreversible, a researcher said.

Tubal sterilization rates in women rose in the U.S. after the Supreme Court’s 2022 decision in Dobbs v. Jackson Women’s Health Organization, results from research letter published in JAMA revealed.

The Dobbs decision overturned precedent set by the Supreme Court’s 1972 ruling in Roe v Wade that established a woman’s constitutional right to an abortion. “The Constitution does not confer a right to abortion,” Justice Samuel Alito wrote in the court’s majority opinion in the Dobbs case. The final opinion would go on to call the Roe decision “egregiously wrong from the start” and based on weak legal reasoning.

“Our study suggests that the Dobbs ruling and subsequent state laws banning or limiting access to abortion may affect a woman’s choice of contraception,” Xiao Xu, PhD, a health outcomes researcher from Columbia University, said in a press release.

According to background information from the American College of Obstetricians and Gynecologists, tubal sterilization — which closes off or removes the fallopian tubes — is a highly effective method of birth control in women, with fewer than one in 100 women getting pregnant within 1 year after the surgery.

However, the rate of tubal sterilization had decreased from its peak in the mid-1970s as effective reversible contraceptive methods became available, according to the release.

In the analysis, the researchers determined the impact of the Dobbs ruling on sterilization procedures by assessing 2021 to 2022 claims data of 4,795,545 women aged 18 to 49 years across 36 states and Washington, D.C.

Researchers categorized state abortion policies as banned, limited or protected based on their abortion laws. Banned states included those with a total or near-total ban on abortion, protected states included those with state laws that explicitly recognized abortion rights and limited states included states where abortion rights were not explicitly recognized by state laws and abortion was legal up to a certain gestational age.

The researchers found that the use of tubal sterilization remained stable in all three groups from January 2021 to June 2022.

In the first month after the Dobbs ruling, however, sterilization use increased in:

• banned states (RR = 1.19; 95% CI, 1.09-1.31);
• limited states (RR = 1.17; 95% CI, 1.06-1.29); and
• protected states (RR = 1.17; 95% CI, 1.04-1.31).

Sterilization use increased by 3% each month in banned states from July to December 2022 (RR = 1.03; 95% CI, 1.004-1.05).

Xu and colleagues noted a similar but nonsignificant pattern in limited states, whereas no further increases occurred in protected states.

The researchers acknowledged two important study limitations. They pointed out the short follow-up period that was analyzed “[precluded] more rigorous assessment of trends.”

There was also potential confounding by other policy changes during the study period.

“The findings also warrant attention because tubal sterilization is an irreversible method of contraception” Xu said in the release.

References:

• Sterilization for women and men. Available at: https://www.acog.org/womens-health/faqs/sterilization-for-women-and-men. Accessed Sept. 11, 2024.
• Sterilization rates among women rose after Supreme Court abortion ruling. Available at: https://www.cuimc.columbia.edu/news/sterilization-rates-among-women-rose-after-supreme-court-abortion-ruling. Published Sept. 11, 2024. Accessed Sept. 11, 2024.
• Supreme Court of the United States. Syllabus. Dobbs, State Health Officer of the Mississippi Department of Health, et al v. Jackson Women’s Health Organization et al. https://www.supremecourt.gov/opinions/21pdf/19-1392_6j37.pdf. Accessed Sept. 11, 2024.
• Xu X, et al. JAMA. 2024;doi:10.1001/jama.2024.16862.