Trends in Female Permanent Contraception in a Northeastern Health System Before and after the Supreme Court Dobbs Decision.

INTRODUCTION:The 2022 U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization eliminated federal abortion protections, delegating abortion law to individual states and complicating access to reproductive health care. This study examines trends in female permanent contraception before and after Dobbs within a large academic health system in a state with abortion-protective legislation following the ruling. METHODS:We conducted a retrospective analysis of permanent contraception procedures from July 2021 to June 2022 (pre-Dobbs) and July 2022 to June 2023 (post-Dobbs) in a Northeastern U.S. health system. Linear regression modeling assessed changes in procedure volume overall and by demographic factors for each 12-month period, including a test of difference between periods. RESULTS:We included 1,115 procedures. Procedure volume did not demonstrate significant slopes in either period, nor differed between periods. However, among publicly insured patients, permanent contraception declined pre-Dobbs (β = -0.90, p = 0.04), increased post-Dobbs (β = 1.19, p = 0.03), and differed between periods (p < 0.01). Permanent contraception in Hispanic patients increased post-Dobbs (β = 1.01, p < 0.02) with a significant difference between periods (p < 0.02). Patients identifying as "other" race demonstrated similar patterns as Hispanic patients. For the overall cohort, no significant changes were observed between periods by age, postpartum status, or hospital site. CONCLUSION:Post-Dobbs, permanent contraception remained stable in our health system overall. The increase in permanent contraception among publicly insured and Hispanic patients suggests that factors beyond state-level abortion protections shape decisions regarding permanent contraception. Further research is required to better characterize the effects of reproductive policy changes on patient decision-making and long-term access to reproductive health care.