Penn researchers find rise in sterilizations following removal of federal abortion protections

A new study led by Penn researchers found that rates of permanent contraception have increased in Pennsylvania since the removal of federal protections for abortion access.

Published this month in “O&G Open,” the study analyzed more than 450,000 permanent contraception procedures in Pennsylvania from January 2019 to March 2023. Researchers also found a statistically significant increase in sterilization rates following the Dobbs v. Jackson Women’s Health Organization decision that reversed Roe v. Wade, particularly among more-educated, higher-income women as well as those who live further from abortion care. 

“I see patients throughout all different phases of their lives,” corresponding author and obstetrics and gynecology assistant professor Alice Abernathy said in an interview with The Daily Pennsylvanian. “Shortly after the Dobbs decision dropped, I had a number of patients come in to request permanent tubal contraception procedures. We wondered if it was just a fluke, or if people were really changing some of their decisions as a result.”

The work, supported by the Leonard Davis Institute of Health Economics at Penn, explores what its authors describe as “the unseen fallout” of abortion-policy shifts: a change in reproductive behavior that goes beyond simple access to abortion itself.

“I think it’s really important to conduct research that’s directly responsive to the type of care that we provide, the practice environment that we work in, and ultimately the patients to whom we’re accountable for taking the best care of,” Abernathy added. “There are a lot of people who are struggling with similar questions.”

Using insurance claims data, the research team applied interrupted time-series analyses to track changes in tubal ligation and vasectomy cases among individuals aged 15 to 44 during the period of the study, comparing trends before and after the removal of federal protections for abortion access.

“While the study design chosen is good, the only limitation is that it can’t really assess whether another factor at the time affected it,” biostatistics and epidemiology professor Nandita Mitra told the DP. “But in this case, it’s hard to imagine what else would be true.”

The study also found that increases in permanent contraception were not evenly distributed across populations. Women in areas with higher educational attainment, lower poverty rates, and greater distance from abortion-care facilities experienced the largest proportional rise in procedures.

“There’s a long and shameful history of forced sterilization in the United States, which has led to a mandated 30-day waiting period for people with Medicaid insurance, which can serve as a barrier,” Abernathy said. “Those with higher incomes may simply find it easier to act on their desire for permanent contraception.”

Past campus discourse has reflected similar concerns about reproductive autonomy. In 2023, student organizations and advocacy groups at Penn expanded efforts to promote reproductive justice following the Dobbs decision, hosting educational events and resource drives to raise awareness about access to contraception and abortion care.

“We need to destigmatize these conversations around miscarriage, around abortion, and empower people to feel comfortable speaking with their communities, with their physicians, with their lawmakers, to make sure they can access the care that they want and should be supported in,” Abernathy added.

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