HERSHEY, Pa. — In June 2022, the U.S. Supreme Court's decision in Dobbs v. Jackson Women's Health Organization ended the federal constitutional right to abortion and returned authority to individual states to regulate abortion. A new study from researchers at Penn State, Albany Medical Center, University of South Florida and University of Tennessee Medical Center revealed that the change in abortion policies appears to have a trickle-down effect, influencing reproductive health and family planning decisions.
The research team found that the number of women undergoing tubal ligations — a surgical procedure that permanently prevents pregnancy — increased 51% across four academic medical centers in four states in the year after the Supreme Court decision compared to the prior year. A greater proportion of those seeking the procedure were also younger and had never given birth before.
The study, which was published in the journal Contraception , is the first to examine the impact of political factors on patients deciding to seek female permanent contraceptive procedures. Almost half of those seeking the procedure reported that their decision was somewhat or very related to the current political climate, even in states considered to be protective of abortion access.
"The Dobbs decision was an inflection point that made people think about their future plans," said Sarah Horvath , associate professor and vice chair of research in the department of obstetrics and gynecology and co-author on the study. "More than anything, we saw that the Dobbs decision impacted the timing for people seeking tubal ligations more than it influenced the actual decision to have the procedure."
Tubal ligations are a safe and effective method of preventing pregnancy permanently, explained Horvath. After the Dobbs decision, she and her colleagues witnessed an uptick in the number of people pursuing tubal ligations or asking about the procedure, a trend that has been noted in other studies in the field. But there wasn't much information available on the reasons why individuals were seeking this method of contraception.
The researchers collected data from four academic medical centers across states with a range of abortion policies and compared procedure volumes the year before and after the Dobbs decision — from July 2021 to June 2022 and from July 2022 to June 2023, respectively. The centers were located in New York, Pennsylvania, Florida and Tennessee.
In New York and Pennsylvania, the researchers also asked patients to complete a survey during their consultation appointment to learn more about their decision-making process. The survey included questions about how long a patient has known they wanted permanent contraception, any prior attempts to obtain permanent contraception, reasons for choosing this method of contraception over reversible options, reasons for seeking the procedure at this time and if their decision was related to the current political climate.
Across all four centers, the number of procedures increased from 445 in the year prior to Dobbs to 674 in the year after, an increase of 51%. The profile of those seeking permanent contraception shifted, too, with more individuals under the age of 30. The proportion of patients who haven't previously given birth also increased from 10.2% to 21.2%.
"I didn't really have anyone come in who had never thought about permanent contraception before Dobbs and now, all of a sudden, they wanted the procedure. That didn't happen," Horvath said. She explained that most patients she encountered were satisfied with their current reversible contraceptive method but were worried that their options would be more limited in the future or that their insurance wouldn't cover their preferred method anymore. Those concerns prompted them to seek a permanent method to prevent pregnancy.
The data also showed differences across states that didn't align with the degrees of abortion restrictiveness in the state, the researchers explained. New York, a state considered to be protective of abortion access saw the biggest jump in monthly procedures, increasing by 128%. Procedures increased by 70.6% and 32.6% in Tennessee and Florida, respectively — states that are more restrictive when it comes to abortion — whereas procedures increased 28.4% in Pennsylvania.
Among individuals in New York and Pennsylvania, 47% reported that the current political climate was somewhat or very related to their decision to obtain permanent contraception. While most individuals sought the procedure because of its effectiveness and permanence, one in five individuals cited concerns about future access to reproductive health options including abortion in addition to permanent and reversible contraception options.
"There was a lot of fear after Dobbs that people would no longer have control over their reproductive rights," said co-author Alice Cai, who earned her medical degree and completed her residency at Penn State College of Medicine during the time of the study and currently practices in West Chester, Pennsylvania. "We saw that even in states with more protective policies like New York, people still made decisions based off of that fear."
Other authors on the paper include Rachel Flink-Bochacki and Sarah Pogge from Albany Medical Center; Amelia Llerena and Cheryl Godcharles from the University of South Florida; and Megan Young, William Havron IV and Nikki Zite from the University of Tennessee Medical Center.
