More Women Are Choosing to Get Sterilized After State Abortion Bans, Study Finds

The loss of Roe v. Wade has led some women to use a more permanent means of birth control, research this week suggests. Scientists have found that rates of surgical tubal ligation noticeably increased across the country soon after the Supreme Court’s ruling on Dobbs v. Jackson Women’s Health in June 2022. This increase eventually leveled off in states where abortion laws remain protected, but continued to rise in states where abortion laws became harsher, the researchers further found.

Scientists at Yale and Columbia University conducted this research, as part of an ongoing effort by many researchers to measure the fallout of the Dobbs decision on women’s health. The decision stripped away the constitutional right to an abortion, with abortion now explicitly regulated on a state-by-state basis. Conservative lawmakers in many states have since passed or enforced increasingly stricter abortion restrictions, with effective total abortion bans in states like Alabama and Missouri. A study earlier this June, for instance, found that prescriptions of oral birth control and emergency contraception fell in states that passed the most restrictive abortion laws following Dobbs.

Tubal ligation is a surgical procedure that sterilizes a patient by closing, removing, or cutting the fallopian tubes, which transport eggs from the ovaries to the uterus for potential fertilization (for that reason, it’s commonly referred to as getting one’s “tubes tied”). Its use in the U.S. has steadily declined since the 1970s, thanks in part to more widely accessible and temporary means of contraception. But the authors of this latest study, published Wednesday in JAMA, wondered if this trend would shift in the wake of the Supreme Court’s decision to overturn Roe.

“As abortion became more difficult to access, we hypothesized that women might turn to contraception to prevent pregnancy. So we examined whether the use of tubal sterilization, a permanent method of contraception, changed after the Dobbs ruling and how these changes varied by restrictiveness of state abortion laws,” lead scientist Xiao Xu, a health outcomes researcher at Columbia University’s Vagelos College of Physicians and Surgeons, told Gizmodo in an email. To do so, Xiao and her team analyzed private insurance claims data in the months before and after Dobbs.

The researchers looked at data from nearly five million women across 36 states and Washington D.C. The states were divided into three groups, depending on how abortion was treated within their borders. Prior to Dobbs, the rate of tubal ligation was stable across all three groups but higher in states with abortion bans relative to states with limited abortion rights and was lowest in states where abortion was protected.

In the month immediately following the Dobbs decision, rates of tubal ligation significantly rose across all three state groups, though these patterns still held steady (states with the worst abortion laws still saw a higher total rate of tubal ligation, for instance). Throughout the rest of 2022, the rate of tubal ligation continued to noticeably rise in abortion ban states, by about 3% each month, but leveled off in states where abortion was protected; in states where abortion was limited but still available, there was a potential increase in tubal ligations, but not enough to be statistically significant.

The procedure usually results in permanent sterilization, though not always. Surprisingly, somewhere between 3% to 5% of women who had their tubes tied still got pregnant, according to research from earlier this year. There is also the chance that some women who felt the need to get this procedure as a result of Dobbs could have later wished that they hadn’t, Xiao says. And even if most people are generally fine with their decision, it’s still valuable to keep track of how these restrictive abortion policies are affecting women’s health in ways big and small, and often not for the best.

“It is important to study tubal sterilization because it is an irreversible method of contraception. There is a potential risk that some patients may later regret getting the procedure. Additionally, while tubal sterilization is a very safe procedure, it is a surgery and has potential risks for surgical complications,” she said.

Xiao and her team do plan to continue studying this topic in the future. As more data comes in, they’d like to see whether this increase in sterilization was temporary or not.