Sophia Ferst remembers her reaction when she heard the Supreme Court had overturned it Roe v. Wade: He needed sterilization.
Within a week, he asked his provider about having the procedure done.
Ferst, 28, said she always knew she didn’t want children. She also worries about getting pregnant because of sexual abuse and not being able to access abortion services. “That’s not a crazy idea anymore,” he said.
“I think the kids are really happy. I even see children in my treatment, but then, I understand that children are a great sacrifice,” she said.
In Montana, where Ferst lives, lawmakers have passed several anti-abortion bills, which have been held up in court. Forty-one states have bans or restrictions on abortion, according to the Guttmacher Institute, and anti-abortion groups have advocated limiting access to contraception in recent years.
After Roe was overturned in June 2022, doctors say a wave of young people like Ferst started asking for permanent birth control such as tubal ligations, where the fallopian tubes are removed, or vasectomies.
A new study published this spring at the JAMA Health Forum shows just how big that wave of young people is nationally.
University of Pittsburgh researcher Jackie Ellison and her co-authors used TriNetX, a national medical record database, to look at how many 18- to 30-year-olds were sterilized before and after the decision. They found a sharp increase in sterilization in both men and women. Tubal ligations doubled from June 2022 to September 2023, and vasectomies tripled during that time, Ellison said. Even with that increase, women still sterilize more often than men. Vasectomies have fallen to a new high, while tubal ligations still seem to be on the rise.
Tubal ligations among young people have been on the rise for years, but the trend is there Dobbs v. Jackson Women’s Health Organization had a noticeable effect. “We saw a significant increase in both tubal ligation and vasectomy procedures in response Dobbs,” Ellison said.
Data were not declassified. But at least in states, like Montana, where the future of abortion rights is deeply uncertain, OB-GYNs and urologists say they’re seeing this phenomenon.
Kalispell, Montana-based OB-GYN Gina Nelson said she sees women of all ages, with and without children, seeking sterilization because of the Supreme Court. Dobbs decision.
He said the biggest change is among young patients without children who want sterilization. He said that has changed a lot since he started working out 30 years ago.
Nelson said she believes she is better equipped to discuss the procedure with them now than she was in the 1990s, when she first had a 21-year-old patient request sterilization. “I wanted to respect his rights, but I also wanted him to consider a few future scenarios,” she said, “so, I had him write me an essay, and then he submitted it, and jumped through all the hoops.” , and I tied her tubes.”
Nelson said he doesn’t make patients do that today, but he still believes he has a responsibility to help patients think deeply about what they’re asking for. She schedules time with patients to discuss the risks and benefits of all their birth control options. He said he believes that helps his patients make an informed decision about whether to move forward with permanent birth control.
The American College of Obstetricians and Gynecologists endorses Nelson’s practice.
Louise King, an assistant professor of obstetrics at Harvard Medical School, who helps lead the ACOG committee, said providers came to the idea of listening to their patients, not deciding whether to get permanent contraception based on age or whether to have children.
King said some young patients who question sterilization have never had the procedure. He remembers one of his recent patients who decided to fight tubal ligation after the Lord spoke to him about the IUD.
“They were afraid of pain,” he said. But after he assured the patient that she would be sedated and unable to feel pain, she proceeded with the intrauterine device, a reversible method of birth control.
Helena-based OB-GYN Alexis O’Leary sees a divide between young and old providers when it comes to female sterilization. O’Leary completed his residency six years ago. He said older providers are more reluctant to sterilize younger patients.
“I’ll see patients who have been rejected by other people because, ‘Well, you might want to have children in the future.’ ‘You don’t have enough children.’ ‘Are you sure you want to do this? It’s irreversible,’” she said.
That’s what happened to Ferst when he first tried to get a tubal ligation.
She asked her doctor for one after having an IUD for about a year. Ferst remembers her male OB-GYN asking her to bring her partner at the time, who was male, and her parents to talk about whether she could get a sterilization.
“That shocked me,” she said.
So Ferst stuck with her IUD. But the uncertainty over abortion rights in Montana prompted her to ask again.
She found a young OB-GYN who agreed to sterilize her this year.
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