Changes in female permanent contraception at academic medical centers following the Dobbs decision.

OBJECTIVES

To compare the volume of female permanent contraceptive procedures before and after the Supreme Court Dobbs decision, and to assess the impact of political factors on patient decision-making.

STUDY DESIGN

We conducted a multicenter retrospective study of interval permanent female contraceptive procedures at four academic medical centers in New York, Pennsylvania, Florida, and Tennessee, comparing a pre-Dobbs (July 1, 2021-June 30, 2022) and post-Dobbs cohort (July 1, 2022-June 30, 2023). The primary outcome was a change in procedure volume, with secondary outcomes including differences in patient characteristics and decision-making. We performed descriptive statistics, Student t tests, and χ tests in Stata SE.

RESULTS

There were 445 procedures in the year pre-Dobbs and 674 in the year post-Dobbs. Total average monthly procedure volume increased (mean 9.3 to 14.0, p < 0.001), with individual institution increases ranging from 28-129%. Patients post-Dobbs were more often under age 30 (37.0% vs 30.3%, p = 0.024) and nulliparous (21.2% vs 10.2%, p < 0.001). Decision-making documentation was recorded for 96 post-Dobbs patients in New York and Pennsylvania and was similar between sites, with one-fifth of patients considering future access to permanent contraception, reversible contraception, and abortion in their decisions. At both sites, 47% of patients said their decision was somewhat or very related to current political events.

CONCLUSIONS

There was an increase in permanent female contraception in the year post-Dobbs at four academic medical centers with different state abortion policies, particularly in younger and nulliparous patients. Fear of losing access to future reproductive options is integrated into reproductive decision-making, illustrating the wide-reaching impact of political interference in patient autonomy.

IMPLICATIONS

Patients are increasingly seeking permanent contraception following the Dobbs decision, countering pronatalist policies by preventing any possibility of future childbearing. Residing in an abortion-protective state does not prevent the fear that arises from legislative control over reproductive health decisions, which threatens reproductive justice and patient autonomy.