States with abortion bans saw a rise in tubal sterilizations after Roe was overturned, new study finds

Rates of sterilization procedures soared nationwide after the U.S. Supreme Court overturned Roe v. Wade and its constitutional protection of abortion rights in June 2022. New research now finds that that’s especially true for women living in states with trigger laws that banned abortion after the Dobbs v. Jackson Women’s Health Organization decision. The new study, published Sept. 11 in JAMA, found that the rate of permanent sterilization procedures continued to climb by 3% each month through the end of 2022 in states where abortion is banned.

Here’s what to know about sterilization, and why the research suggests to experts that the court’s decision to overturn Roe is impacting women — especially in states that have banned or restricted abortion — well beyond access to the procedure.

What is female sterilization?

The term refers to one of two surgical procedures — also sometimes collectively called “tubal sterilization” — performed on women, both of which prevent pregnancy permanently. They are:

• Tubal ligation: Sometimes called getting your “tubes tied,” this procedure blocks each fallopian tube so that eggs can no longer move from the ovaries into the uterus or become fertilized by sperm.

• Salpingectomy: The fallopian tubes are removed entirely, which both permanently prevents pregnancy and reduces the risk of ovarian cancer by about 80%, a large review of research published in 2023 found.

Both forms are considered “permanent” sterilization, because they are difficult, if not impossible to reverse. However, they may not be as effective as once thought; more than 8% of women became pregnant within 10 years of undergoing sterilization, one recent study found. And while the procedures are considered very safe, they do require surgery and are performed under either local or general anesthesia, so there is some risk of complications, including bleeding and infections.

Sterilization is also the most popular form of contraception in the U.S. (and has consistently been the top choice since 1982), according to data from the Guttmacher Institute. (It must be said, however, that some groups — including people of color and those with disabilities — have also been subjected to forced sterilization; the practice is still legal to do without the consent of people with intellectual disabilities in 31 states.)

What did the new study find?

Like previous research, the study found a dramatic spike in tubal sterilizations across the U.S. immediately after Roe fell. But this latest paper is distinct because it shows the differing rates in states with and without abortion bans or restrictions. For at least six months following the Dobbs decision, sterilization rates continued to rise by 3% per month in states with abortion bans (following a 8% spike in the month after the decision). Between July and December 2022, rates continued to trend upward in other states too, but less dramatically, the researchers found.

“The main implication of this research is … that policy decisions like Dobbs can have a broader impact and broader implications beyond abortion and affect women’s health care decisions,” study co-author and Columbia University health services researcher, Xiao Xu tells Yahoo Life.

What experts say

The new study didn’t answer whether the Dobbs decision caused more people to get sterilized. But, “what we’re seeing is that people don’t want to get into a situation of needing an abortion and not being able to obtain one,” Gretchen Borchelt, vice president of reproductive rights and health at the National Women’s Law Center (NWLC), tells Yahoo Life. She cites anecdotes from calls to the NWLC’s CoverHer hotline, which helps women get insurance coverage for contraception. Borchelt adds that the upward trend in sterilizations is likely to continue.

While sterilization is a safe, effective option for people who are certain they are done having children, or don’t want to have any in the first place, the unusual surge in sterilization procedures concerns experts. “No one should feel pressured to make decisions about their bodies, not by the law, not by health care providers and not by politicians,” Dr. Jamila Perritt, an ob-gyn and president and CEO of Physicians for Reproductive Health, tells Yahoo Life. “We have long known that abortion bans negatively impact our health as individuals, as families and as communities,” she says.

Borchelt suspects that concerns over abortion access aren’t the only driving force behind the uptick in sterilizations. Federal law, expanded in 2010 by the Affordable Care Act, now requires many insurers to cover 18 forms of “female controlled” contraception, including sterilization, at little or no cost to the patient (there are some exceptions, however). “The ACA has put sterilization on an equal cost-level with other forms of contraception, where it once would have been cost prohibitive” for many people, Borchelt says.

On one hand, more access to more forms of contraception, and more people taking advantage of highly effective forms of birth control are all good things, experts say. But on the other, the trend in sterilization reflects the ripple effect of the loss of federal protections for abortion.

Borchelt says that the Dobbs decision is still “upending our society” and “has opened up a broader conversation” about contraception and access to reproductive health care. “It’s not just panic … but improved contraceptive access or use [doesn’t mean] we don’t need abortion care; we need both,” she says.