A few years ago, Dr. Leah Tatum, an obstetrician-gynecologist in Austin, noticed a shift among her patients.
Texas had passed a law in 2021, commonly known as the Heartbeat Act, banning abortion after about six weeks. Soon after, more young, child-free women were coming to her clinic for sterilization surgeries.
Dr. Tatum noticed a similar uptick a year later, when the Supreme Court overturned Roe v. Wade, which established the constitutional right to abortion. And again earlier this year, after the second inauguration of President Trump.
Her patients expressed concerns about their continued access to other forms of contraception in the current political landscape.
“There was a sense of desperation,” she said. “Women feel like they are backed into a corner.”
Female sterilization, medically called tubal ligation or salpingectomy, entails removing, severing or blocking the fallopian tubes. It is a permanent and highly effective form of contraception. For decades, the typical sterilization patient was an older woman who had already had children, according to the Centers for Disease Control and Prevention.
But emerging data mirrors what Dr. Tatum was seeing at her clinic: After Roe was overturned in 2022, more younger, child-free women opted for the consequential procedure, effectively eliminating their chances of unintended pregnancies. One study, published last April, which looked at medical records from across the country, found that from June 2022 to September 2023, 21,180 18- to 30-year-olds had tubal ligations, up from 11,480 in that age group in the four years before the decision.
And, while more recent data isn’t available, patients and clinicians from seven states, some of which had abortion bans and others of which did not, as well as representatives from Planned Parenthood, told The New York Times that interest in the procedure among that demographic had remained high over the last three years, including after the 2024 election.
Some women told The Times that sterilization was a way to control their bodies and health at a time when their reproductive rights are in jeopardy and abortion is banned or restricted in 19 states.
Others said that economic fears, like the loss of their job or income, drove them to choose sterilization over other forms of birth control. Still others said that the procedure was simply the contraceptive option that suited them best.
Dominique Bird knew from as young as 8 years old that she did not want to grow up to be a mother. She started taking the pill at 16 and never wavered.
But something urgent shifted in her, she said, as she watched Mr. Trump’s inauguration in January: It was in that moment that Ms. Bird, 31, who lives in Austin, decided to have her fallopian tubes removed.
Given the administration’s stances on contraception and abortion, she said, pregnancy “just wasn’t something that I wanted to take the chance on.”
She had her surgery in April.
Reluctance About Motherhood
For some women, the political environment has made their choices about motherhood feel more urgent.
Trinitty Zacharias, 29, who lives in West Peoria, Ill., raised her younger sister, who is disabled, starting from the age of 7. Their mother struggled with drug use, she said, and though she has two older brothers, it fell on her to be the babysitter.
“I took on that caretaker role before I was even old enough to decide if I wanted coffee or not,” she said. The experience cemented for her that she didn’t want to be responsible for another child in her life. “There is this lingering bitterness that I was forced into that role.”
Ms. Zacharias is currently training to be a court reporter and eventually plans to move south to a different state for her job. But she said she worried that state-level laws on reproductive health might restrict her choices. She had sterilization surgery last September.
B, a 30-year-old government worker in Utah who asked to use only her first initial to protect her privacy and job, said that watching the Trump administration’s culling of federal workers prompted her to choose sterilization. She worried that she would be fired, too, which raised concerns about her health insurance and her ability to afford birth control.
B was raised in the Latter Day Saints community. She realized at 22 that the life plan set out for her — to grow up, marry and have children — wasn’t what she wanted. Around that time, her partner won custody of his 14-year-old daughter from a previous relationship. B found the situation awkward; he wasn’t a very involved father, and she often became the default caregiver, which created tension.
“I started feeling kind of trapped,” she said. “And I realized how much I don’t want to parent.”
Then, this year, when she heard of co-workers being fired, she realized she could easily be next.
She was sterilized in April and didn’t tell anyone in her family because of their more conservative views.
‘Are You Regretting Your Hip Replacement?’
Despite rising interest in the procedure, getting it can be challenging.
Patients have reported being met with resistance from doctors who have doubted their resolve to be child-free. They also said they had to jump through hoops to get their insurance providers to cover a surgery that typically costs thousands of dollars.
Ashley Hedley, 36, who lives in Fort Worth, first asked her physician about sterilization when she was 30. She said she had been sexually assaulted when she was younger and had searched for ways to protect against pregnancy. She tried hormonal birth control and a copper intrauterine device, but the side effects of both were affecting her quality of life.
Ms. Hedley, who is an environmental consultant, said the doctor “laughed in my face” when she asked to be sterilized and fixated on the fact that she was single at the time. The doctor then denied her request.
“I kind of swore off doctors for a while after that whole experience.”
She paused and then laughed, adding, “I mean, if you don’t laugh, you cry.”
For much of the country’s history, forced sterilization was used by the government to prevent some women of color and disabled people from reproducing. The practice, rooted in eugenics, continued for most of the 20th century, too, said Dr. Kavita Arora, a professor of obstetrics and gynecology at University of North Carolina at Chapel Hill. In 1973, after a lawsuit exposed that the government had sterilized more than 100,000 women over decades, federally funded involuntary sterilization was largely outlawed.
But today, as more child-free people opt for the procedure, they face a different kind of bias from physicians, Dr. Arora said. Many doctors, she added, refuse to approve sterilization for child-free women, citing the possibility that patients might change their minds if they meet the right partner, or otherwise regret the decision later in life.
But studies that have examined whether women regret their decision have had mixed results or have found that only small groups experience regret, Dr. Arora noted. And a patient’s decision-making about female sterilization is more scrutinized than it is for other routine procedures, or for male sterilization, she added.
“Folks aren’t asking ‘are you regretting your hip replacement?’” she said. But, when it comes to female permanent contraception, “we’re essentially saying you’re not allowed to regret this one decision.”
“It is also paternalism to say ‘I know better than you,’” she added.
Last February, Dr. Arora, who also noticed a growing interest for the procedure among young, child-free women at her clinic in recent years, worked with a committee of experts at the American College of Obstetrics and Gynecology, which sets industry practice standards, to update its guidelines for permanent contraception. Medical professionals should “avoid paternalism,” the committee stated, and age and whether or not a patient has a child should be de-emphasized.
Those seeking sterilizations have turned to online communities to offer support and guidance. A Reddit community called r/childfree has over a million followers, a majority of whom are based in the United States, where both men and women cheer on one another for choosing sterilization. The community also collects the names of doctors or clinics in each state who are “child-free friendly” — those who patients say are accepting of sterilization.
After Texas introduced the Heartbeat Act, Ms. Hedley returned to the idea of sterilization. “I could see the writing on the wall,” she said.
“By the time I realized I did not want kids, that choice was being taken away from me,” she said.
She discussed the procedure with her husband. Two years ago, she found a doctor who removed her tubes, no questions asked.
Alisha Haridasani Gupta is a Times reporter covering women’s health and health inequities.
The post With Rights and Resources Uncertain, They’re Seeking Sterilization appeared first on New York Times.
