A new study published Wednesday found an increase in the use of tubal sterilization, in which women have their fallopian tubes tied or removed to permanently prevent pregnancy, in the six months after the June 2022 Supreme Court decision that overturned Roe v. Wade. The increase was most pronounced in states that effectively banned abortion, where sterilizations rose 39 percent by December 2022.
The study suggests that the Dobbs decision affected not just abortion access, but “decisions women are making about contraception as well,” said Xiao Xu, an associate professor of reproductive sciences at Columbia University and the study’s lead author.
The paper, published in the Journal of the American Medical Association, looked at insurance claims data for 4.8 million women ages 18 to 49 from January 2021 to December 2022. The researchers broke the data down by three types of states: those that protect abortion access, those that limit it and those that ban it. The study was not able to capture the full picture of contraceptive decision-making, because it examined just six months of data after the Dobbs decision and only included women with commercial insurance.
In states that effectively banned abortion, the sterilization rate climbed to 5 in 10,000 women by December 2022 from an average of 3.6 per 10,000 women per month in the 18 months before Dobbs. The researchers also found that sterilizations rose in states that protected or limited abortion, but those increases were not statistically significant. Outside experts said they may nonetheless point to how women across the country were reacting to the decision.
Dr. Kavita Shah Arora, an obstetrician-gynecologist and a professor at the University of North Carolina at Chapel Hill, said that the study’s findings reflected what she saw in her own clinic in the months after the Dobbs decision.
“Patients would often say things like, ‘I was on the fence, and this pushed me over the edge,’ or, ‘I feel like the safety net was taken away,’” she said. She added that she noticed another uptick in consultations a year after the Dobbs decision, when North Carolina banned abortions after 12 weeks of pregnancy.
Tubal sterilization prevents an egg from traveling down the fallopian tube, and stops sperm from reaching an egg. Research suggests that between one and three out of every 100 women who have had tubal sterilization will still get pregnant after the procedure.
Even before the Dobbs decision, sterilization was the most common form of contraception, according to the Centers for Disease Control and Prevention, particularly among women in their 40s. About 40 percent of women in that age group used it as a contraception method between 2017 and 2019.
Some research had suggested permanent sterilization was becoming less common as long-acting reversible contraceptives, such as intrauterine devices and hormonal implants, grew more popular. But the new study and other recent research suggests that abortion restrictions enacted nationwide may drive more people toward permanent contraception such as tubal ligations and vasectomies.
Jacqueline Ellison, an assistant professor at the University of Pittsburgh’s School of Public Health who has studied contraceptive use after the Dobbs decision, said the findings of these studies posed important questions about how the general population was responding to the decision.
“To me it suggests that people are experiencing fear and anxiety around the ruling, either for their ability to get an abortion or even to access contraception in the future,” she said. One poll conducted by the nonprofit KFF found that one in five women between the ages of 18 and 49 who live in states that have banned abortion either personally experienced difficulty accessing an abortion, or knew someone who did.
Experts noted that the new study had limitations. The researchers looked at only the first six months after the Dobbs decision, and did not look at changes in use of other forms of contraception, such as birth control pills, or intrauterine devices.
Dr. Arora also noted that the study failed to account for seasonal variation. Most insured people schedule elective surgeries for the latter half of the year, after they have met their deductibles, she said. Dr. Xu explained that the researchers compared the monthly rate of sterilizations after the ruling to the average monthly rate for the 18 months before the decision. She added that she and her colleagues plan to examine more recent insurance claims in further research.
The study also did not examine whether sterilization increased among recipients of Medicaid, the federal and state health insurance program for low-income Americans, or the more than 7 million women of reproductive age in the United States who were uninsured in 2022.
Privately insured women “probably are not the population that is going to experience the worst consequences of Dobbs,” Dr. Ellison said, adding that she and other researchers were planning to study sterilization rates using Medicaid data.
She noted that before the Dobbs ruling, those covered by Medicaid were more likely than those covered with private insurance to have abortions. They were also more likely to face barriers in getting their preferred forms of contraception.
