Post-roe world: the effects on contraception and sterilization requests

In 1973, Roe v Wade classified abortion as a fundamental right. When the Dobbs v Jackson Women’s Health Organization (Dobbs) decision was leaked on May 2, 2022, this fundamental right was threatened. On June 24, 2022, the final decision was released to remove the federal protection of abortion. At the time of the Dobbs decision, many states had an immediate decline in abortion clinic numbers[1]. The impact on contraceptive and sterilization requests after the decision of Dobbs is unknown. Additionally, we know there are factors that impact a patient’s regret of sterilization including young age and other social circumstances [2]. The impact of Dobbs on regret of sterilization has yet to be explored. Our goal is to describe patient characteristics and trends related to contraceptives and sterilization at an academic medical center in a conservative state. Deidentified data of patients attending the University of Nebraska Medical Center’s OB/GYN clinic was extracted from our electronic medical record to include all clinic visits that were coded under any contraceptive type or sterilization ICD-10 code. Data was collected from six months prior to the leak of Dobbs on May 2, 2022, to six months after the decision on June 24, 2022. Age was compared using independent sample t-tests, while Chi square or Fisher’s Exact test were used to compare categorical variables between leak and decision time periods. Single interrupted time series analysis (SITSA) was performed to assess for the effect of the leak and decision on sterilization consult rates relative to all contraceptive visits. P-value <0.05 were considered statistically significant. 1463 clinic visits were included for contraceptive and sterilization visits. Overall, there was no significant difference in age, race, marital status, or insurance carrier in patients evaluated pre- versus post-decision. Rates of sterilization requests differed significantly pre vs post decision (11% vs 19%, p<0.0001). There was also a significant difference in marital status of those requesting sterilization after the leak of Dobbs vs before (p=0.01) with more women likely to be single after the leak of Dobbs. There also appears to be a higher representation of White women requesting sterilization after the Dobbs decision compared to before (70% vs 52%). Result from the SITSA, including 1336 of the 1463 visits demonstrated no significant difference in sterilization rate from pre- to post-leak and pre- to post-decision. Post-leak trend in sterilization rate increased significantly by approximately 1.44% each month (p<0.0001). An increasing percentage of patients were seen following the leak of Dobbs and within six months of the decision release with requests or consultations for sterilization. Further evaluation of contraceptive and sterilization request rates at multiple institutions in a variety of political climates will be valuable to determine if this trend is seen on a larger scale.