More men, women choosing permanent contraception after Dobbs

NEW ORLEANS — Rates of vasectomy and tubal sterilization rose in the months after the Dobbs decision removed a federal right to abortion, according to data presented at the ASRM Scientific Congress & Expo.

The rate of tubal ligation increased significantly in states where abortion became illegal, whereas increased vasectomy rates were similar across states with different levels of abortion access, according to Jessica Schardein, MD, MS, an andrology fellow and visiting instructor at University of Utah Health.

“It is interesting to see the consistent increase in vasectomies post-Dobbs among most states regardless of legal climate,” Schardein told Healio. “Often reproductive health and contraception falls on the onus of the partner with a uterus, so seeing the other partner ‘step up’ and take responsibility to ensure there is no unintended pregnancy highlights how reproductive health matters to all people, even those without a uterus who may be carrying a pregnancy or undergoing an abortion.”

Schardein and colleagues conducted a retrospective review of data included in the Epic Cosmos database of 217 million U.S. patients. They analyzed demographic data from all adults aged at least 18 years who underwent vasectomy or tubal sterilization from July to December 2021 before release of the Dobbs decision and from July to December 2022 after Dobbs. For identifying associations in relation to the legal status of abortion in individual states, the researchers used categories determined by the Center for Reproductive Rights.

The researchers found that among adults younger than 30 years, rates of vasectomy (incidence rate ratio [IRR] = 1.59; 95% CI, 1.48-1.7) and tubal sterilization (IRR = 1.29; 95% CI, 1.24-1.35) increased significantly after Dobbs. Among unmarried adults, the vasectomy rate increased significantly (IRR = 1.13; 95% CI, 1.08-1.18), but the rate of tubal sterilization remained the same.

Both before and after Dobbs, vasectomy rates were significantly higher in states that prohibited or greatly restricted abortion than in states where abortion was legal. All states saw increased vasectomy rates after Dobbs without regard to the legal status of abortion. Those with the greatest increases were Tennessee and Missouri, where abortion became illegal, and Virginia, Vermont, Florida and Nevada, where abortion remained available, according to Schardein.

Tubal sterilization rates both before and after Dobbs were higher in states where abortion became illegal compared with nonrestrictive states (pre-Dobbs: IRR = 1.59; 95% CI, 1.53-1.65; post-Dobbs: IRR = 1.75; 95% CI, 1.69-1.82). Tubal sterilization rates rose significantly after Dobbs only in states where abortion became illegal (IRR = 1.13; 95% CI 1.08-1.18).

States with the greatest increases include those where abortion remained available — Virginia, Massachusetts, Washington and New Jersey — but also Utah, which greatly restricts abortion, according to Schardein.

“This study informs how changes in reproductive health laws can impact decisions regarding permanent contraception,” Schardein told Healio. “Providing appropriate counseling on how to decrease the risk of an unintended pregnancy is important, especially with restrictions on abortions. We should continue to offer permanent contraception to patients who are not interested in future fertility, regardless of their age or marital status, to ensure reproductive autonomy for those patients. Patients may need increased access to these procedures if the increased rates continue over time.”