More young adults seek tubal sterilizations, vasectomies after Dobbs

Key takeaways:

• National data reflect a rise in sterilization procedures among young adults beginning after the leak of the Dobbs decision.
• Survey respondents expressed concerns about unintended pregnancy after Dobbs.

Tubal sterilizations increased by 70% and vasectomies rose by 95% among young adults during the initial months after the release of the Dobbs decision that overturned Roe v. Wade, according to an analysis of national claims data.

“After the Dobbs decision, we knew there would be enormous ripple effects throughout health care; in addition to affecting abortion, we expected [the decision] would affect contraception access,” Julia Strasser, DrPH, MPH, assistant research professor of health policy and management, director of the Jacobs Institute of Women’s Health and core faculty in the Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University, told Healio. “We had seen early research suggesting people were more likely to be pursuing longer-acting contraceptive methods, like IUDs, but also permanent methods like vasectomy and tubal sterilization after the Dobbs decision and even after the leak of the Dobbs decision. We wanted to see if this was in fact taking place and if there were any differences by state abortion policy.”

Claims data analysis

Researchers conducted difference-in-differences analyses of tubal sterilizations and vasectomies by age and state policy, using national level medical claims data from IQVIA from 2021 and 2022 for adults aged 19 to 26 years, and also analyzed young adults’ perspectives on permanent contraception using open-text survey responses from national MyVoice surveys conducted in July 2022 (immediately after the Dobbs decision; n = 638) and May 2023 (1 year after the Dobbs decision; n = 596).

Researchers classified states as either likely to ban abortion or not likely to ban abortion as of May 2022, based on an analysis by the Guttmacher Institute.

“We used likelihood of abortion bans, rather than actual bans, as we posited that publicly available information regarding the likelihood of abortion restrictions would inform a person’s contraceptive decision-making just as strongly as the actual policy implementation

in the tumultuous months immediately after the Dobbs ruling, when several states’ abortion policies shifted between ban and no ban,” the researchers wrote.

The findings were published in Health Affairs.

Difference-in-differences analyses showed 6.88 more tubal sterilizations per state per month from May to December 2022 in states deemed likely to ban abortion compared with states unlikely to ban abortion (95% CI, 1.06-12.69), and 3.39 more vasectomies per state per month during the same period (95% CI, 0.63-6.14). There were no changes for either form of contraception for adults aged 27 to 44 years, according to researchers. In August 2022, there were 799, or 70%, more tubal sterilizations, and 346, or 95%, more vasectomies compared with May 2022 data for young adults, according to the researchers.

Additionally, researchers observed a rise in both tubal sterilizations and vasectomies during the post-Dobbs decision leak period, with monthly changes in visits in states likely to ban abortion vs. states unlikely to ban abortion relative to data from October 2021.

Changing views post-Dobbs

Survey responses showed respondents feared a loss of bodily autonomy and changes to pregnancy plans after Dobbs. Among respondents who mentioned permanent contraception, some described specific plans or desires to obtain permanent contraception for themselves or their partners; others described general interest in permanent contraception and some described an element of fear about getting pregnant or of safety.

“We already knew before the Dobbs decision that young people seeking permanent contraception were experiencing barriers, particularly from clinicians who were concerned about regret after the procedure,” Strasser told Healio. “I have heard many anecdotal stories of people who know someone in this age group seeking one of these services and they could not find a clinician to provide the service. My hope is that this study is not used to suggest that we create more barriers for young people. We want to make sure people have access to the contraceptive method that they seek and feel is best for themselves and their partners.

“These are claims data; these are the people who were able to be seen,” Strasser told Healio. “There are likely more people who would seek these services, but they have not been able to identify a clinician to perform them. This is not a flip decision for people. Having patient-centered contraceptive care is the goal, recognizing that people understand their own needs and preferences.”

For more information:

Julia Strasser, DrPH, MPH, can be reached at jstrasser@email.gwu.edu; X (Twitter): @juliastrasser.