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WASHINGTON — In a striking shift following the Supreme Court’s Dobbs decision that ended federal abortion protections, young Americans are increasingly turning to permanent contraception methods like tubal sterilization and vasectomy, particularly in states likely to restrict abortion access.
Researchers examining medical claims data found that after May 2022, when the draft Dobbs opinion leaked, there were notable increases in both tubal sterilizations and vasectomies among people aged 19-26. The effect was especially pronounced in states deemed likely to ban abortion, where tubal sterilization visits rose about 1% and vasectomy visits increased roughly 2% per state per month compared to states unlikely to implement bans.
This quantitative data was complemented by survey responses from hundreds of young adults that revealed deep anxieties about reproductive autonomy in a post-Roe landscape. Some respondents described specific plans to pursue permanent contraception, while others expressed broader concerns about bringing children into an environment of restricted reproductive rights.
Most notably, the study found that the surge in permanent contraception procedures was unique to young adults. When researchers examined the same trends among people aged 27-44, they found no significant increases in either procedure type in states likely to ban abortion versus those unlikely to do so.
“Our study shows that the Dobbs decision has had a profound effect on young adults’ reproductive choices, leading many to opt for permanent contraception in the months following the decision,” said study co-author Julia Strasser, director of the Jacobs Institute of Women’s Health at the GW Milken Institute School of Public Health, in a statement. “While access to all contraceptive methods, including permanent ones, is critical for reproductive autonomy, young people should not feel coerced into making decisions based on fear and uncertainty surrounding their rights.”
Beyond raw numbers, the findings illuminate how a major legal shift can rapidly influence deeply personal healthcare decisions. Young people appear to be responding to the new reproductive health landscape by seeking more definitive forms of contraception, even as they continue facing various barriers to accessing these procedures.
The study’s results suggest this isn’t just a temporary reaction: the elevated rates of permanent contraception procedures persisted throughout 2022. This sustained increase indicates young adults are making long-term calculations about their reproductive futures in response to shifting state policies.
Some survey participants explicitly connected their interest in permanent contraception to concerns about future restrictions, with one noting they worried the Supreme Court might eventually outlaw these procedures too. Others described changing their minds about having children specifically because of the new legal environment.
These findings arrive amid ongoing debates about reproductive healthcare access and highlight how young adults are navigating an uncertain landscape. While permanent contraception represents a definitive choice, the study notes that younger patients often face additional hurdles in accessing these procedures, from insurance limitations to provider reluctance.
“It’s important for contraceptive services to be accessible and offered in a patient-centered way,” Strassler said in a video interview (below). “That include clinicians being able to offer the full range of contraceptive methods to young adults and anyone who needs them.”
What’s now clear is young Americans are increasingly pursuing permanent contraception, whether due to fears about future pregnancy in a restricted environment or simply wanting to ensure they maintain control over their reproductive choices — while simultaneously encountering various barriers to obtaining these services.
Paper Summary
Methodology
The researchers used a two-pronged approach combining quantitative analysis of medical claims with qualitative survey responses. They examined IQVIA medical claims data covering about 191 million patients to track monthly visits for tubal sterilizations and vasectomies throughout 2021-2022. States were classified as “likely” or “unlikely” to ban abortion based on Guttmacher Institute analysis from May 2022. Additionally, they collected survey responses from hundreds of young people aged 14-24 through the MyVoice project, which uses text message-based polling to gather youth perspectives on current events.
Results
The study found statistically significant increases in both tubal sterilization (1% increase) and vasectomy (2% increase) visits among 19-26 year olds in states likely to ban abortion compared to other states after May 2022. These increases weren’t seen in older age groups. Qualitative survey responses revealed themes of fear about bodily autonomy and changing attitudes toward having children in light of abortion restrictions.
Limitations
The researchers note several important limitations. The claims data may be incomplete since it only includes participating providers and clearinghouses. The data only extended through 2022, limiting longer-term analysis. While the survey sample was large and diverse, it wasn’t nationally representative. Additionally, the survey focused on current events and controversial topics, potentially introducing selection bias in who chose to respond.
Discussion & Takeaways
The research suggests the Dobbs decision has meaningfully impacted young adults’ contraceptive choices, particularly in states likely to restrict abortion access. The findings highlight ongoing challenges in reproductive healthcare access, especially for young patients seeking permanent contraception who often face additional barriers. The study also emphasizes the broader implications for reproductive autonomy and family planning decisions in a post-Roe environment.
Funding & Disclosures
The research was supported by a Research Innovation Award from George Washington University’s Milken Institute School of Public Health. The MyVoice project received funding from the Michigan Institute for Clinical and Health Research and the University of Michigan Department of Family Medicine.
Publication Information
Published in Health Affairs, Volume 44, No. 1, January 2025. Authors include Julia Strasser, Ellen Schenk, Sara Luckenbill, Danielle Tsevat, Lauryn King, Qian Luo, and Julie Maslowsky from various institutions including George Washington University, University of North Carolina at Chapel Hill, and University of Michigan.
