Sophia Ferst remembers her reaction to learning that the Supreme Court had overturned Roe v. Wade:She needed to be sterilized.
After a week, she asked her provider if she could have the procedure done.
Ferst, 28, said she’s always known she doesn’t want to have children. She also worries about getting pregnant as a result of sexual assault and then not being able to access abortion services. “That’s not a crazy concept anymore,” she said.
“I think kids are a lot of fun. I even see kids in my therapy office, but I understand that kids are a big commitment,” she said.
In Montana, where Ferst lives, lawmakers have passed several bills to restrict abortion access, which have been blocked in court. Forty-one states have abortion bans or restrictions, according to the Guttmacher Institute, and anti-abortion groups have advocated for restricting access to contraceptives in recent years.
After Roe was repealed in June 2022, doctors said a wave of young people like Ferst began asking for permanent birth control methods like tubal ligations, in which the fallopian tubes are removed, or vasectomies.
New research published this spring in JAMA Health Forum shows just how big that wave of young people is nationwide.
University of Pittsburgh researcher Jackie Ellison and her co-authors used TriNetX, a national database of medical records, to analyze how many young people between the ages of 18 and 30 were getting sterilized before and after the ruling. They found a marked increase in both male and female sterilization. Tubal ligations doubled between June 2022 and September 2023, and vasectomies increased more than threefold over that same period, Ellison said. Even with that increase, women are still getting sterilized far more frequently than men. Vasectomies have plateaued at the new, higher rate, while tubal ligations appear to continue to rise.
Tubal ligations among young people had been slowly increasing for years, but the sentence in Dobbs v. Jackson Women’s Health Organization had a perceptible impact. “We saw a fairly substantial increase in both tubal ligation and vasectomy procedures in response to dobbs“Ellison said.
The data was not broken down by state. But at least in states like Montana, where the future of abortion rights is deeply uncertain, obstetricians, gynecologists and urologists say they are noticing the phenomenon.
Gina Nelson, an obstetrician and gynecologist in Kalispell, Montana, said she is seeing women of all ages, with and without children, seeking sterilization because of the Supreme Court decision. dobbs decision.
He said the biggest change is among younger patients who do not have children and are seeking sterilization. He said it is a big change since he started practicing 30 years ago.
Nelson said she believes she is better equipped to explain the process now than she was in the 1990s, when a 21-year-old patient first asked her for sterilization. “I wanted to respect her rights, but I also wanted her to consider a number of future scenarios,” she said, “so I asked her to write an essay for me and then she brought it in, jumped through all the hoops and got her tubes tied.”
Nelson said she doesn’t force patients to do that these days, but she still believes she’s responsible for helping patients deeply consider what they’re asking for. She schedules time with patients to discuss the risks and benefits of all their birth control options. She said she believes that helps her patients make an informed decision about whether to move forward with permanent birth control.
The American College of Obstetricians and Gynecologists supports Nelson’s practice.
Louise King, an assistant professor of obstetrics at Harvard Medical School who helps chair ACOG’s ethics committee, said providers are embracing the idea of listening to their patients, not deciding for them whether they can get permanent contraception based on their age or have children.
King said some young patients who ask about sterilization never undergo the procedure. He reminded one of her recent patients that she decided not to have a tubal ligation after King told her about the IUD.
“They were afraid of the pain,” he said. But after she assured the patient that she would be under anesthesia and that she would not be able to feel pain, she went ahead with the intrauterine device, a reversible method of contraception.
Alexis O’Leary, a Helena-based OB-GYN, sees a divide between younger and older providers when it comes to female sterilization. O’Leary finished his residency six years ago. She said older providers are more reluctant to sterilize younger patients.
“I routinely see patients who have been turned away by other people because they say, ‘Oh, maybe you want to have children in the future.’ ‘You don’t have enough children.’ ‘Are you sure you want to do this? It’s not reversible,’” she said.
That’s what happened to Ferst when he first tried to get a tubal ligation.
She asked her doctor for one after having an IUD for about a year. Ferst remembers that her OB-GYN asked him to bring her partner at the time, who was a man, and her parents to talk about whether they could sterilize her.
“I was shocked by that,” she said.
Ferst continued to use her IUD, but uncertainty about abortion rights in Montana convinced her to seek it again.
She found a younger OB-GYN who agreed to spay her this year.