More young Americans are permanently opting out of reproduction since the U.S. Supreme Court overturned the constitutional right to abortion.
That’s according to a new study from the University of Pittsburgh and Boston University that found an immediate jump in tubal ligations and vasectomies among patients between ages 18 and 30 in June 2022, the month after a draft of the Dobbs v. Jackson Women's Health Organization ruling was leaked. The decision was released by the high court in July 2022, overturning a 49-year precedent.
Prior to Dobbs the rates of U.S. residents, between 18 and 30, seeking permanent birth control was already on a gradual rise: Each month saw roughly three more tubal ligations per 100,000 patients, and one additional vasectomy every month per 100,000 patients.
But in June 2022 the number of patients who opted for these procedures jumped by a monthly average of 58 more tubal ligations and 27 more vasectomies per 100,000 patients.
These elevated rates seem to be the new normal, based on the study’s analysis which looked at monthly data from January 2019 through September 2023. In fact, the post-Dobbs rate of tubal ligations has continued to climb by about five additional procedures every month compared to the month prior.
Lead author Jackie Ellison, as assistant professor at Pitt specializing in gender equity and reproductive health, said while the study doesn’t reveal the individual reasons more young people are opting for sterilization, it’s clear this change in reproductive health care is policy driven.
“People are making a decision that's going to affect them for the rest of their reproductive lives in response to this ruling,” said Ellison.
Previous research shows that at least for women, a patient is more likely to later regret a tubal ligation if she was younger or child-free when she had the procedure. But Dr. Kavita Shah Arora, an OBGYN and past chair of the ethics committee of the American College of Obstetricians and Gynecologists, says it is ethically inappropriate to deny younger people permanent birth control based on that data — though Arora does discuss this increased risk of regret with her patients.
“It is worrisome to me that we now have a health policy that in some ways is coercing people into a permanent surgery and a method of contraception that they may not have otherwise desired,” said Arora.
As a tenured associate professor at The University of North Carolina at Chapel Hill, Arora sees patients through UNC’s hospital system. She said not only are more patients seeking tubal ligations, but some specifically cite Dobbs and a desire for more control over their reproductive health now that abortion is harder to access.
Because people from marginalized groups face greater barriers to abortion care, Arora said she worries that disproportionately, Black and brown, disabled or impoverished patients might now feel compelled to choose permanent birth control.
“It is a sort of coercion, compounding coercion, and disparities, compounding disparities,” she said. “But in that sense, also, I am more committed to ensuring that their autonomous health goals get prioritization.”
Arora’s concern is valid, said Pitt’s Jackie Ellison, who is now working on a study that looks at whether patients of certain races or ethnicities are more likely to choose permanent birth control.
Constitutional law professor Michele Goodwin of Georgetown University said the Pitt study raises the question of, ”What qualifies as a choice?” She points to another famous Supreme Court ruling: Loving v. Virginia. The case was brought by a white husband and wife of African American descent who moved from Virginia to Washington, D.C. due to a state law that criminalized interracial marriage.
The Lovings didn’t want to leave Virginia and their extended family, but felt they had no choice. In that same sense, Goodwin says the fact that more people are deciding to undergo sterilization procedures must be viewed within the new legal framework created by Dobbs.
“There’s this enormous fear that’s become a sort of blanket over so many who are of reproductive age,” said Goodwin — these fears include not being able to terminate a pregnancy after being raped, deadly perinatal health complications, and the overall loss of choice.
