After Dobbs, twice as many women sought tubal ligation than men turned to vasectomies

Immediately after the Supreme Court overturned Roe v. Wade, Google recorded the highest volume of searches for “vasectomy” in the past five years. Last year, published data in the International Journal of Impotence Research identified a significant uptick in vasectomy consultations after the Dobs decisions.

Anecdotally, urologists previously told Salon they’ve seen an increase in interest in vasectomies post-Dobbs, and patients have usually been younger and childless. However, since Dobbs there has yet to be a study displaying a comprehensive view of the permanent contraception landscape in the United States post-Dobbs — until this week. 

Published today in a JAMA Health Forum research letter, policy researchers from the University of Pittsburgh School of Public Health and Boston University show how the 2022 U.S. Supreme Court ruling affected preferences for permanent contraception among males and females between the ages of 18 to 30. It’s the first study to assess how the Dobbs ruling affected both females and male interest in permanent contraception procedures. What the researchers found was that despite all the attention on male vasectomies post-Dobbs, the rise in tubal sterilizations among females was twice as high as the increase among vasectomies in males.

“This increase is likely reflecting the fear or anxiety among young people about restricted access to abortion and potentially restricted access to contraception down the road,” lead author Jacqueline Ellison, an assistant professor in the Department of Health Policy and Management at the Pitt School of Public Health, told Salon. “The findings have implications for understanding how abortion bans affect reproductive autonomy beyond just the ability to access abortion, and that abortion policy is also shaping contraceptive decision making. We really need to understand this.”

Ellison and her colleagues looked at national electronic medical record data to see specifically how the Dobbs ruling might have changed rates in both tubal ligations and vasectomies from April 1, 2021, to May 31, 2022, — pre Dobbs — to June 1, 2022, to September 30, 2023, after Dobbs. Ellison said they found an “abrupt” increase. Prior to Dobbs, the researchers found the permanent contraception rate increased by 2.84 among females and 1.03 procedures among males. After Dobbs, the permanent contraception rate increased to 58.02 among females and 26.99 procedures among males. 

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“The increase in procedures for female patients was double that for male patients,” the researchers said in their study. “These patterns offer insights into the gendered dynamics of permanent contraceptive use and may reflect the disproportionate health, social and economic consequences of compulsory pregnancy on women and people with the capacity to become pregnant.”

Additionally, the researchers found that the increase in tubal ligations was sustained after the initial peak — while the increase in vasectomies waned. The study did have some limitations, specifically the researchers were unable to look at state or health care organizations, as the platform they used didn't provide this data.

"We were therefore unable to assess the potential outcomes of state abortion policy or account for changes in the sample attributable to fluctuations in the organizations contributing data over the study period," the authors write. "Additionally, our findings do not provide insight into the differential experiences of Black, Indigenous, Hispanic, disabled, immigrant and low-income women, who disproportionately encounter interference and coercion in their contraceptive decision-making."

In other words, that means they couldn't tell if vasectomies in Texas rose post-Dobbs, for example.

“The fact that people who can get pregnant are more likely to experience the consequences of abortion bans is probably contributing to the differential effects that we're seeing,” Ellison said, noting that tubal ligation is more expensive than vasectomies. “The cost and complexity of the procedure of a tubal ligation is much higher, yet we're still seeing different uses of tubal sterilization versus vasectomy.”

Ellison said this study emphasizes that the Dobbs decision increased the demand for permanent contraception, which is still “highly gendered.”

“People who get pregnant are overwhelmingly responsible for this tendency relative to cis-men,” she said.