Permanent contraception procedures substantially rose for young women vs. men after Dobbs

Key takeaways:

• After Dobbs, the increase in sterilization procedures per 100,000 person-months for women was more than double that for men.
• Monthly sterilization procedures increased for women but did not change for men.

Numbers of tubal ligation and vasectomy procedures increased after Dobbs for young adults, with a substantial increase observed among women vs. men, according to a research letter published in JAMA Health Forum.

“Early research has documented increased demand for permanent contraception in the months following Dobbs, including tubal sterilization and vasectomy. This change may reflect fears of restricted access to abortion and/or contraception,” Jacqueline E. Ellison, PhD, MPH, assistant professor in the department of health policy and management at the University of Pittsburgh School of Public Health, and colleagues wrote. “However, no research, to our knowledge, has evaluated the differential effect of Dobbs on permanent contraception among men relative to women or among younger adults who are more likely to have an abortion and to experience sterilization regret.”

Ellison and colleagues conducted a cross-sectional study using the TriNetX platform to obtain data on permanent contraception procedures that occurred before (January 2019 to May 2022) and after Dobbs (June 2022 to September 2023). Over 22,063,348 person-months (36.9% men and 63.1% women), researchers calculated rates of tubal ligations and vasectomies per 100,000 person-months among women and men aged 18 to 30 years.

Monthly tubal ligation rates increased by 2.84 per 100,000 person-months (95% CI, 2.19-3.5), and monthly vasectomy rates increased by 1.03 per 100,000 person-months (95% CI, 0.84-1.23) after vs. before Dobbs.

After vs. before Dobbs, increases in procedures among women were 58.02 per 100,000 person-months (95% CI, 10.77-105.27) and 5.31 procedures per month (95% CI, 0.98-9.64). Men had an increase of 26.99 procedures per 100,000 person-months (95% CI, 12.32-41.66) with no significant change in the number of procedures per months after vs. before Dobbs.

According to the researchers, the findings offer insights into the gendered dynamics of permanent contraceptive use and may reflect the disproportionate health, social and economic consequences of pregnancy on women.

Limitations of the study include the inability of researchers to assess potential outcomes of state abortion policies, account for changes attributable to fluctuations in organizations providing data or provide insight into those who disproportionately experience barriers in contraceptive decision-making.

“The abrupt increase in permanent contraception rates may indicate a policy-induced change in contraceptive preferences. Dobbs may have also increased a sense of urgency among individuals who were interested in permanent contraception before the decision,” the researchers wrote. “Changes in contraceptive decision-making must be considered to understand the short- and long-term implications of Dobbs on reproductive autonomy.”