Objective: Female sterilization is a common form of contraception in the United States. On June 24, 2022, the United States Supreme Court eliminated the federal standard protecting a woman's right to abortion via Dobbs v. Jackson Women's Health Organization. Since that time, there have been anecdotal increases in sterilization requests across the country, although there are no publications demonstrating this change. This study hypothesized that there would be increased female sterilization rates at a Texas military hospital post-Dobbs decision due to state restrictions as compared with a Washington military hospital.
Methods: This study retrospectively reviewed female sterilization rates from March 2022 to April 2023. The average rate of sterilization procedures performed pre-Dobbs decision was compared to the average rate following the Dobbs decision in a Texas and Washington military facility due to different state restrictions. The rates of sterilization were also stratified among demographic groups at the Texas military facility.
Results: Female sterilizations encompassed 24/230 (10.4%) of the gynecologic surgeries performed pre-Dobbs compared to 110/629 (17.5%) cases performed post-Dobbs (P = .01) in Texas. However, sterilization rates in Washington state remained the same, with 15/80 (18.7%) benign gynecologic surgeries pre-Dobbs and 28/185 (15.1%) post-Dobbs (P = .59). The average age of sterilization pre-Dobbs was 35 years compared to 33 years post-Dobbs (P = .04). Post-Dobbs group was less likely to use a barrier method prior to sterilization (P = 0.01).
Conclusion: The reproductive health of military medical beneficiaries at one military hospital was significantly impacted by the Dobbs v. Jackson Women's Health Organization decision. Rates of female sterilization increased significantly. In addition, patients choosing permanent sterilization were younger and were less likely to use alternative, reversible contraceptive methods prior to surgery. This study demonstrates a significant change in contraceptive choices toward methods that incur greater surgical risks and potential for regret, as well as greater financial costs to the military health system.
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