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A new study finds more people under 30 are getting permanent sterilization procedures. SDI Productions/Getty Images
  • New research shows an abrupt increase in permanent sterilizations among young adults following the Dobbs ruling, which ended a person’s constitutional right to an abortion.
  • The data show twice as many females underwent tubal ligations as males who underwent vasectomies.
  • Experts say fear and anxiety about unplanned pregnancies in states with abortion bans and restrictions could be driving the increase in permanent contraceptive measures.

Earlier this week, the Arizona Supreme Court reinstated a Civil War-era law from 1864, making it a felony to provide an abortion or help a person obtain one.

This near-total abortion ban, which states that life begins at conception, is the latest strike against reproductive rights by conservative lawmakers since Roe v. Wade was overturned in 2022.

As the U.S. Supreme Court weighs whether to ban the abortion pill mifepristone, access to safe and legal abortion is narrowing in many states.

Now, new research highlights the extremes some young adults have gone to in order to protect their bodily autonomy in this post-Roe era.

The national study, published today in a JAMA Health Forum research letter, is the first to evaluate the effects of the historic Dobbs v. Jackson ruling on permanent sterilization measures among young adults.

Looking at data from 113 million people across the United States, policy researchers from the University of Pittsburgh School of Public Health and Boston University found an abrupt nationwide increase in tubal sterilizations and vasectomies among adults ages 18–30.

The findings show gender disparities among the number of women undergoing tubal ligations — also known as getting your tubes tied — compared to men. Overall, rates of tubal sterilizations were twice as high as vasectomies.

The researchers found after the Dobbs decision there was an immediate increase of 58 sterilization procedures for women or about 5.31 procedures a month per 100,000 people. This is nearly double the previous rate of 2.84 procedures per month for women. For men there was an overall increase of 27 procedures but not a significant increase in monthly procedures.

The initial uptick in vasectomies has tapered off, but the data show a continued increase in tubal ligations, which can be up to six times more expensive than vasectomies, more invasive, and difficult to reverse.

“The major difference in patterns of these two procedures likely reflects the fact that young women are overwhelmingly responsible for preventing pregnancy and disproportionately experience the health, social, and economic consequences of abortion bans,” said lead study author Jacqueline Ellison, PhD, MPH, assistant professor in the Department of Health Policy and Management at the Pitt School of Public Health, in a news release.

Researchers say the 18–30 age cohort is more likely to have abortions and experience sterilization regret compared to their older counterparts.

It was, therefore, important to understand the impacts of the Dobbs ruling on permanent contraception choices in this population, Ellison told Healthline.

“Abortion bans introduce a structural barrier to exercising control over pregnancy and childbearing that will indirectly impact contraceptive decision-making and demand for permanent sterilization,” Ellison said.

In a statement shared with Healthline, Megan Kavanaugh, principal research scientist at the Guttmacher Institute, said this new evidence demonstrates how young people are changing their contraceptive strategies in the wake of the Dobbs decision.

“It’s important that people have access to their preferred methods of contraception and that these preferences aren’t constrained by a climate of reduced support for people’s overall reproductive freedom,” Kavanaugh said.

“We do have evidence at the population level in select states that people are experiencing increased barriers to accessing their preferred contraceptive methods since Dobbs, so we need to continue to monitor how these access barriers might be impacting people’s ability to actually obtain their preferred methods,” Kavanaugh added.

Sarah W. Prager, MD, a professor in the Department of Obstetrics and Gynecology at the University of Washington School of Medicine, said that for people living in states with restricted or banned abortion access, unplanned or unintended pregnancy can be a daunting scenario.

“If options for avoiding pregnancy and/or avoiding carrying pregnancies to term are severely limited, as has happened in 21 states since Dobbs, many patients will choose permanent ways to avoid this risk, rather than relying on less effective or less permanent methods,” Prager told Healthline.

“If abortion is not an option after a contraception failure, fewer people are likely interested in contraceptive options with higher failure rates,” she said.

Ellison said the abrupt increase in permanent sterilization procedures likely reflects fear or anxiety among young people with restricted abortion access following the Dobbs decision.

“What is concerning to me is that young people may be feeling pressure to use a contraceptive method that they otherwise would not prefer, which has implications for reproductive autonomy,” Ellison said.

For this reason, adequate counseling prior to undergoing permanent sterilization can help young people avoid making fear-based decisions, Prager noted.

“Choosing permanent contraception at a young age reflects lack of confidence in avoiding carrying an unintended pregnancy to term, and policy changes like Dobbs restrict options for all pregnancy-capable people, likely increasing a sense of urgency around eliminating possibilities of unwanted pregnancies,” Prager said.

Abortion bans impact all individuals of reproductive age but disproportionately affect people who can become pregnant and are faced with the effects of unplanned pregnancy.

“People socialized as women are overwhelmingly responsible for preventing pregnancy relative to cisgender men,” Ellison said.

“Women and people who can get pregnant also disproportionately experience the health, social, and economic effects of unwanted pregnancy. Because of this and the fact that parenting responsibilities fall predominately on women, cisgender men may not feel the same sense of urgency to undergo permanent contraception,” Ellison added.

Prager noted that gender disparities have always been an issue for people who can become pregnant, even long before Dobbs.

“The burden of possible pregnancy consequences has always been higher for pregnancy-capable persons, and this is even more heightened in a time when options for not continuing pregnancy are significantly less available,” Prager said.

New research shows a sharp and abrupt increase in permanent sterilization procedures following the landmark Dobbs decision that ended a person’s constitutional right to an abortion.

The data show tubal sterilization procedures among females were nearly double that of vasectomies among males.

Experts say fear and anxiety may be driving the increase in permanent sterilizations since other forms of contraception, which may be difficult to access, are not 100% guaranteed to prevent pregnancy.

“Permanent sterilization is very safe but still incurs surgical risks that IUDs, implants, and other contraceptive methods do not have,” Prager said.

“Policy changes like Dobbs are forcing people to make choices that put them at risk for surgery complications and limit future options for choosing pregnancy later in life.”