More Women Opted for Sterilization After Roe Fell

WASHINGTON — More women underwent sterilization procedures in the 12 months after the Supreme Court’s decision in Dobbs v. Jackson Women’s Health overturned the federal right to abortion than in the year before, with particular increases among young and nulliparous women, a single-institution retrospective cohort study showed.

There were 4.0 sterilizations per 1,000 women in the year following Dobbs — significantly more than the 3.2 per 1,000 women in the year prior (P<0.001). This trend remained significant at 22 months pre- and post-Dobbs (5.3 vs 5.5 per 1,000 women, P<0.001), reported Julia Mendiola, MD, of the Allegheny Health Network Women's Institute in Pittsburgh, at the American College of Obstetricians and Gynecologists (ACOG) annual meeting.

In the post-Dobbs year, the women who underwent sterilizations were younger (35.1 vs 33.4, P=0.0002) and were more often less than 23 years old (0.06% vs 3.7%, P=0.008). Other research of larger databases has found similar trends.

Tubal sterilization, which involves tying off, cutting, burning, blocking, or completely removing the fallopian tubes, can be done at the time of a cesarean delivery or immediately after a vaginal delivery during the same hospitalization. It also can be performed as an interval procedure not related to postpartum timing.

The Dobbs decision happened during Mendiola’s ob/gyn orientation week, which she said greatly shaped her residency experience. Abortion is fairly protected in Pennsylvania, where the analysis took place, though Mendiola said the changing reproductive care landscape still negatively impacts patients in the state.

Nearly a third of sterilizations in the post-Dobbs year (32.5%) were among women who had never given birth before, more than doubling from 15.2% in the year before (P<0.001). Mendiola said the spike in this group surprised researchers.

There were no significant differences in pre- and post-Dobbs vasectomy rates among men, showing that “the war on reproductive healthcare is falling to women,” Mendiola told MedPage Today.

“Not only are women bearing the brunt, but at a younger age and earlier in their like reproductive timeline,” she added.

This retrospective cohort study looked at data from all Allegheny Health Network-affiliated hospitals, a large health system in Pennsylvania. Researchers looked at 6 months, 12 months, and 22 months pre- and post-Dobbs to compare sterilization rates for both female and male patients.

Included patients were between ages 18 and 50 and had a sterilization performed at an Allegheny Health Network facility between August 2020 and May 2024. These patients were identified with CPT codes for bilateral salpingectomy/tubal ligation and vasectomy.

The primary outcome was the incidence of sterilization procedures 12 months pre- and post-Dobbs. Analysis of younger and nulliparous women were secondary outcomes.

There was a slight increase in female sterilizations in the 6 months post-Dobbs compared to the 6 months before, but this was not significant (2.7 vs 2.5 per 1,000 women, P=0.22).

This study was limited by the single-institution design. Additionally, data analyzed does not include more personal data on why patients chose sterilization over other less permanent forms of contraception, which Mendiola said would make interesting fodder for other research.