CHANGES IN FREQUENCY AND DECISION-MAKING FOR FEMALE PERMANENT CONTRACEPTION FOLLOWING THE DOBBS DECISION

Objectives

We aimed to compare the frequency of female permanent contraceptive procedures before and after the Dobbs v Jackson Women’s Health Organization decision, and to assess impact of political factors on patient decision-making.

Methods

We conducted a retrospective cohort study of patients who underwent interval permanent contraceptive procedures in New York and Pennsylvania, comparing a pre-Dobbs (7/1/2020-6/30/2022) and post-Dobbs cohort (7/1/2022-6/30/2023). The primary outcome was change in procedure volume; secondary outcomes included differences in patient characteristics. We implemented standardized decision-making documentation beginning summer 2022, which allowed assessment of patient considerations in the post-Dobbs cohort. We performed Student t-tests, chi square tests, and descriptive statistics in Stata SE.

Results

There were 429 procedures pre-Dobbs and 310 post-Dobbs, including 194 (26.3%) procedures in New York and 545 (73.7%) in Pennsylvania. Volume grew significantly at both institutions, together increasing from an average 8.9 to 12.9 procedures/month (p=0.009). Patients post-Dobbs were more often under age 30 (31.7% vs. 39.0%, p=0.039) and nulliparous (10.7% vs. 21.0%, p<0.001). Decision-making documentation was recorded for 96 patients and was similar between sites, with 20% of patients considering future access to permanent contraception, 18% considering future access to reversible contraception, and 23% considering future access to abortion. At both sites, 47% of patients said their decision was somewhat or very related to current political events.

Conclusions

In two states without new abortion restrictions, permanent contraception was sought by more patients post-Dobbs, particularly 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 threats to patient autonomy.