Many US Women Choose Permanent Contraception After Dobbs Abortion Ruling

The political implications of the Dobbs decision were apparent within months as Americans angry at the arrogant abridgement of their rights - which polls had made clear for years - voted overwhelmingly to defeat Republican candidates for office up and down the ballot. 

The broader socio-economic implications are now coming into better focus and reveal the life-changing decisions Americans feel forced to make in the wake of extremist right wing policies. These decisions may affect birth rates, employment, immigration and global economic competitiveness. JL 

The Economist reports:

On june 24th 2022 America’s Supreme Court ruled, in Dobbs v Jackson Women’s Health Organisation, to let states set their own laws on abortion. Since then 14 have banned abortion completely. The journal of the american medical assoc study found a sharp jump in permanent contraceptive procedures among both men and women in the months after the Dobbs decision. Some feared a broader crackdown on contraception. That would suggest permanent contraception, rather than a temporary method, is becoming more prevalent among young people. The decisions that Dobbs is forcing on young Americans may affect their lives in ways that were not widely anticipated.

On june 24th 2022 America’s Supreme Court ruled, in Dobbs v Jackson Women’s Health Organisation, to let states set their own laws on abortion. Since then 14 have banned abortion completely, with exceptions for extreme circumstances. The consequences of overturning Roe v Wade are becoming clearer. A stark one is the sharp rise in permanent contraceptive procedures among both men, through vasectomies, and women, through tubal ligations.

In a paper published on April 12th in jama Health Forum, a medical journal, researchers from the University of Pittsburgh and Boston University analysed data on permanent contraceptive procedures among 18- to 30-year-olds (see chart). They looked at 22m instances of patients attending at least one appointment, for either evaluation or treatment, in each month between January 2019 and September 2023. These were mostly at academic medical centres, so government-funded public clinics providing free family-planning services to poor people may not have been adequately represented. The results are nonetheless striking.

 

The jama study found a sharp jump in permanent contraceptive procedures among both men and women in the months after the Dobbs decision. Before Dobbs, there were around 250 tubal ligations for every 100,000 women with health-care appointments per month. But immediately afterwards that number jumped by 58. In the following months, the growth rate accelerated from its baseline of 2.8 additional procedures per month in the three and a half years leading up to Dobbs to more than five.

Men underwent fewer contraceptive procedures to begin with. Just before the Dobbs ruling, the study finds, there were around 50 vasectomies per 100,000 male outpatients per month. This rate had been steadily increasing by about one procedure per month. In the month right after Dobbs, however, it jumped by 27, before reverting to its previous growth rate.

What to make of these numbers? Those who had already been planning to undergo the procedure may have expedited their decisions. Some may have also feared a broader crackdown on other forms of contraception. Groups advocating the right to abortion have warned that bans from the moment of conception could be interpreted to include the morning-after pill and intrauterine devices.

That would suggest that permanent contraception, rather than a temporary method, is becoming more prevalent among young people. But that carries greater risks of so-called sterilisation regret. A global review of studies in 2005 found that women who had tubal ligations at 30 or younger were eight times more likely to undergo a reversal or an evaluation for in vitro fertilisation than those who had the procedure later in life. A more recent paper, in 2022, focusing on America, found that 13% of surveyed women who had their tubes tied at 30 or younger regretted their decision, compared with 7% of women who were over 30 at the time of the procedure. The decisions that Dobbs is forcing on young Americans may affect their lives in ways that were not widely anticipated.