Surge in Americans getting sterilizations given states’ abortion laws

For nearly two years, in the wake of the Supreme Court overturning Roe v. Wade, Alexander W. Pastuszak and his wife grappled with growing anxiety about the implications of an unplanned pregnancy.

As the parents of two children, with no desire to have a third, the Utah couple worried they might not be able to get access to an abortion if the unexpected occurred.

“We weren’t thinking necessarily about a tomorrow timeline, but it was more about like, OK, well, what happens a year from now?” said Pastuszak, 46. “What happens two years from now if these services continue to get diminished?”

So in May, he underwent a vasectomy. Despite their state allowing abortion up to 18 weeks of gestation or later under certain circumstances, he worried that a national ban could be implemented.

“Are we going to fly to another country to have an abortion? I mean, that just seems ridiculous and unsafe,” said Pastuszak, a urologist at the University of Utah School of Medicine.

His decision reflects a growing trend across the country, with health experts predicting that more people will choose sterilization because of fears over restricted access to reproductive health care during a second Trump administration.

Research shows a significant increase in vasectomies and tubal ligations in the months just before and after the Supreme Court ruled in Dobbs v. Jackson Women's Health Organization, the 2022 decision that ended a constitutional right to abortion after nearly half a century.

A study in the journal Health Affairs this month found that from May to August 2022, vasectomies surged by 95% and tubal sterilizations by 70% among adults ages 19 to 26. Researchers used medical records to analyze procedure codes and found that states likely to ban abortions after Dobbs experienced a greater increase in permanent contraception procedures compared with states unlikely to implement bans.

The data tracked with that of a JAMA Health Forum research letter published this past spring, which noted a rise in permanent contraception procedures among adults ages 18 to 30 years following the ruling.

"We know that young people, including young adults, are sensitive to major changes like the Dobbs decision, so it's not totally surprising to me that we would see some type of shift," said Julia Strasser, author of the latest study and an assistant research professor in the Department of Health Policy and Management at George Washington University. "I do think the magnitude of the change was somewhat surprising."

Vasectomies involve cutting and sealing the vas deferens, the tube that carries sperm from the testes to the urethra, to prevent sperm from mixing with semen during ejaculation. While considered a permanent method of contraception, vasectomies sometimes can be reversed through surgery.

Tubal sterilizations are irreversible procedures that either block the fallopian tubes, in the case of ligation, or remove them completely, an operation known as a salpingectomy.

Women’s health clinics are also reporting increases in people interested in sterilization.

Planned Parenthood saw a dramatic jump in interest in tubal ligations, with visits to its main website skyrocketing the day before the 2024 presidential election. In-person queries are soaring at some of the organization's regional health centers, even in parts of the country where abortion remains legal and widely available.

Planned Parenthood of Northern New England has 15 locations that log over 54,000 patient visits yearly. After Donald Trump’s reelection in November, it saw a 368% increase in consultations for vasectomies, chief executive Nicole Clegg said.

“It’s absolutely a phenomenon because urologists in our area had a six-month wait list,” Clegg said. The clinic responded by expanding vasectomy services and hiring a second doctor just for that procedure.

With nearly 20 states now banning or significantly limiting abortion, many Americans are also worried about future access to birth control. Health experts predict the number of people looking for a permanent solution will continue to grow if restrictions expand further.

Marc Goldstein, a board-certified urologic surgeon specializing in male infertility at New York’s Weill Cornell Medicine, said he has seen a big jump in the number of men and couples without children who are opting for sterilization.

“In 43 years of doing this, I’ve seen maybe three or four couples who never had children or men who never had children,” he said. “But now we’re seeing a huge increase in the number of couples who think the world is too awful a place to bring children into.”

In Ventura County, Calif., 30-year-old Maelen Sallee had her fallopian tubes removed in December. That move, she said, reflected her own health issues, a decision not to have children and concerns over the country’s political stability once Trump returns to the White House.

"When Roe v. Wade was overturned, it catapulted this kind of realization and awareness around my health," she said.

Sallee takes medications for epilepsy that could severely compromise a pregnancy and would require full-time monitoring if she got pregnant. She chose sterilization as the best way to prioritize her health and safety, especially given the challenges her condition would pose during a pregnancy.

Yet she was worried about finding a physician willing to perform the procedure. Some people have recounted facing questions and resistance from doctors, particularly if they are young and do not have children.

Karen Tang, a gynecologist from Bryn Mawr, said she has seen a swell of patients wanting to undergo sterilization procedures since 2022 — many of them citing concerns for their reproductive rights if they were to become pregnant.

“Every birth control can fail and you can, even if you’re using reliable birth control, have an unintended pregnancy,” Tang said.

Jonathan Harrison, 33, is a bartender who lives in Palm Beach, Fla. He chose to have a vasectomy last year because “there are not a lot of options for guys, and the options for women are harmful to their health.”

For him, the end of Roe v. Wade "definitely was a wake-up call and influenced me to get my vasectomy sooner rather than later."

Some states impose waiting periods before the procedures. New York, for one, requires an individual to be 21 and to wait 30 days between signing the consent forms and undergoing sterilization. Some states allow health-care providers to refuse to provide such services, according to the Guttmacher Institute, a nonprofit research center that supports abortion rights.

To combat her state’s hurdles, OB/GYN Franziska Haydanek began curating a list of physicians across the country willing to perform sterilization procedures, regardless of a patient’s personal medical history or reasons for pursuing permanent contraception.

Haydanek, who practices in Rochester, N.Y., said she recognized a growing need to support people seeking more control over their reproductive health. “I didn’t really realize how difficult it was for patients to find doctors willing to perform permanent sterilization procedures,” she said.

Many patients face significant barriers beyond restrictive policies, including providers’ judgments because of age, gender, or life circumstances. In Haydanek’s view, “They are adults, and they should be counseled appropriately on what the risks, the benefits and the alternatives are.”