Sophia Ferst remembers one of her first thoughts after Roe was overturned: she needed to get sterilized.
The Helena resident asked her provider within a week about getting the procedure done.
Ferst, 28, said she’s always known she doesn’t want kids.
“I think kids are really fun. I even see kids in my therapy practice, but however, I understand that children are a big commitment,” she said.
She wants to be free to travel and to focus on her career.
Montana lawmakers have passed several bills to restrict abortion access, which have been tied up in court. Anti-abortion groups have also advocated for restricting contraception access in recent years.
That concerns Ferst. She’s in a same-sex marriage, but she worries about possibly getting pregnant if she were to be sexually assaulted.
After Roe was overturned in June 2022, doctors said a wave of young people like Ferst started showing up in their offices asking for permanent birth control - like tubal ligations, where the fallopian tubes are removed, or vasectomies, where tubes that carry sperm are cut or sealed.
University of Pittsburgh researcher Jackie Ellison wanted to know the size of that increase and whether it was a momentary reaction to the Supreme Court’s Dobbs decision, which eliminated the constitutional right to an abortion.
She used a national database to look at how many 18 to 30-year-olds got sterilized before and after the ruling.
“We saw a pretty substantial increase in both tubal ligation and vasectomy procedures in response to Dobbs,” said Ellison.
Tubal ligations among young people had been slowly rising for years. But her research, which was published in the Journal of the American Medical Association, found that the number of tubal ligations doubled between June 2022 and Sept. 2023.
Although vasectomies quadrupled during that same time, men are getting sterilized half as often as women. The number of vasectomies also leveled off while tubal ligations may still be increasing.
The data wasn’t state-specific. So, it’s hard to definitively say whether these increases were greater in states like Montana where conservative lawmakers want to restrict abortion access, said Ellison.
In Montana, OBGYNs and urologists say they are noticing the trend.
“People talk about sterilization more, and they get them more,” said Kalispell-based OBGYN Dr. Gina Nelson.
Aaron Bolton
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MTPR
Nelson said she’s seeing women of all ages, with and without children, seeking sterilization because of the Supreme Court’s Dobbs decision that overturned Roe.
However, she said more young, child-free patients are showing up in her office. She said that’s a big shift from when she started practicing 30 years ago.
She feels better equipped to talk them through the process now compared to the first young patient she sterilized in the early ‘90s.
“I had a fresh 21-year-old insist that she wanted her tubes tied. I wanted to respect her rights, but I also wanted her to consider a number of future scenarios," Nelson said. "I actually made her write an essay for me, and then she brought it in, jumped through all the hoops, and I tied her tubes."
Nelson said she doesn’t make patients jump through hoops like that today. She’s shifted to having conversations about the risk and benefits of all the options. That ranges from long-acting IUDs to pill birth control. That helps her patients make an informed decision about whether they want to move forward with permanent birth control.
That’s something the American College of Obstetricians and Gynecologists, or ACOG, supports.
Providers were coming around to the idea of listening to their patients, not deciding for them whether they can get permanent contraception based on age or whether they have kids, said Dr. Louise King, who leads ACOG’s ethics committee.
King said not every young patient that asks about sterilization is going through with the procedure. She said one recent patient decided against a tubal ligation after King talked about an IUD.
“They were scared of the pain in the office. I was like, ‘We’ll do it under anesthesia.’ They were like, ‘Oh, great.’ So, making sure people have all the options,” she said.
But there still seems to be a divide between younger and older providers when it comes to female sterilization, said Helena-based OBGYN Alexis O’Leary, who’s been practicing for six years.
“I will routinely see patients that have been denied by other people because of, ‘Ah, you might want to have kids in the future, you don’t have enough kids, are you sure you want to do this? It’s not reversible,’” she said.
Sophia Ferst was one of those patients.
She asked her doctor for a tubal ligation in her early twenties after having an IUD for about a year. Ferst recalls her male provider asking her to bring in her partner at the time, who was a male, and her parents to talk about whether she could get sterilized.
“I was shocked by that,” she said.
Ferst refused and stuck with her IUD until now. The overturning of Roe v. Wade convinced her she needed to ask again.
She’s since found a younger OBGYN who has agreed to sterilize her later this year.
