Sophia Ferst (left) and her wife, Madison Bethke, outside Helena, Montana. Next Roe v. Wade was overturned, Ferst decided to get sterilized. She is one of those people under the age of 30 who are now looking for permanent contraception.
Shaylee Ragar
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Shaylee Ragar
Sophia Ferst remembers her reaction when she learned the Supreme Court had reversed itself Roe v. Wade: He must be sterilized.
Within a week, he asked the provider about the procedure.
Ferst, 28, said she knew she didn’t want children. They are also worried about becoming pregnant as a result of sexual assault – and then not being able to access abortion services.
“It’s not a crazy concept anymore,” he said.
“I think children are really fun. I even see children in therapy practice,” he said. “However, I understand that children are a big commitment.”
In Montana, where Ferst lives, lawmakers have passed several bills to limit access to abortion, which have been tied up in court. Forty-one states have bans or restrictions on abortion, according to the Guttmacher Institute, and anti-abortion groups have advocated for restricting access to contraception in recent years.
The uptick in sterilization is not just a blip
Next Roe ousted in June 2022, doctors say a wave of young people like Ferst are starting to demand permanent birth control like tubal ligation, where the fallopian tubes are removed, or vasectomy.
New research published this spring in the JAMA Health Forum shows just how big the youth wave is in the country.
University of Pittsburgh researcher Jackie Ellison and her colleagues used TriNetX, a national medical records database, to look at how many 18- to 30-year-olds were sterilized before and after the decision.
They found a clear increase in male and female sterilization. Tubal ligations doubled from June 2022 to September 2023, and vasectomies tripled during the same period, Ellison said.
Even with these increases, women are still sterilized more often than men. Vasectomy has leveled off at a new higher level, while tubal ligations still seem to increase.
Tubal ligation among young people has been slowly increasing over the years, but the decision is worth it Dobbs v. Jackson Women’s Health Organization has a discernible impact.
“We saw a substantial increase in tubal ligation and vasectomy procedures in response Dobbs“, said Ellison.
Other interests of the childless
The data is not broken down by country.
But in states like Montana, where the future of abortion rights is uncertain, OB-GYNs and urologists say they recognize the phenomenon.
Kalispell, Montana-based OB-GYN Gina Nelson says she’s seen women of all ages, with and without children, seeking sterilization because of the Supreme Court ruling. Dobbs decision.
He said the biggest change was among young, childless patients seeking sterilization. He says there have been big changes since he started training 30 years ago.
Nelson says he’s more prepared to talk about the process now than in the 1990s, when he first had a 21-year-old patient ask for sterilization.
“I want to respect their rights, but I also want them to consider some future scenarios,” Nelson said. “So I actually made him write an essay for me, and then he brought it, jumped through all the hoops, and I tied the tube.”
Nelson said he doesn’t make patients do it today, but still believes it’s his responsibility to help patients consider what they’re asking for.
They schedule time with patients to talk about the risks and benefits of all birth control options. She said she believes it helps patients make an informed decision about whether to move forward with permanent birth control.
Gina Nelson, an obstetrician-gynecologist in Kalispell, Montana, sees more patients under the age of 30 who are infertile asking about sterilization because Dobbs decision.
Aaron Bolton
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Aaron Bolton
The American College of Obstetricians and Gynecologists supports Nelson’s practice.
Louise King, an assistant professor of obstetrics at Harvard Medical School, helps lead ACOG’s ethics committee.
Providers came around to the idea of listening to patients, King said, rather than deciding whether to get permanent contraception based on their age, or whether they’ve had children.
King said some young patients who ask about sterilization have never had the procedure. She recalls one recent patient who decided against a tubal ligation after King talked to her about an IUD.
“She was afraid of pain” from the IUD insertion, he said. But after he reassured the patient that she would be under anesthesia and unable to feel pain, he proceeded to use the intrauterine device, a reversible method of birth control.
Older doctors can still be reluctant
Helena-based ob-gyn Alexis O’Leary sees a divide between younger and older providers when it comes to female sterilization. O’Leary completed his residency six years ago. They say older providers are more reluctant to sterilize younger patients.
“I’ll often see patients who are rejected by others because, ‘Ah, 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,'” he said.
That’s what Ferst experienced when he first tried to get a tubal ligation.
She consulted her doctor after having the IUD for about a year. Ferst remembers her male OB-GYN asking her to bring her partner at the time, the boy, and his parents, to talk about whether she can get sterilized.
“I was shocked,” he said.
So Ferst stuck with the IUD. But the uncertainty of abortion rights in Montana prompted her to ask again.
She has found a younger ob-gyn who has agreed to sterilize her this year.
This article was produced in partnership with NPR MTPR and KFF Health News.
