Los Angeles Times

Fall of Roe leads more women to seek sterilizat­ion

- By Melissa Gomez

On the morning of May 3, Abby C. burst into tears when she learned that a leaked draft opinion signaled that the U.S. Supreme Court would likely overturn Roe vs. Wade.

Before getting out of bed, the 23-year-old booked a consultati­on to begin the process of getting sterilized. Abby, who did not want her last name published for privacy reasons, said her previous gynecologi­st had dismissed her requests, citing her age. But with the leaked opinion throwing the future of reproducti­ve rights into jeopardy, Abby stood firm in her decision.

“I ended up telling her, ‘This is the option I want,’ ” Abby said. “This is the only answer for me.”

It wasn’t until after she woke up from the procedure — a bilateral salpingect­omy, in which her fallopian tubes were removed — that she felt relief.

Following the decision in Dobbs vs. Jackson Women’s Health Organizati­on, which overturned the once constituti­onally protected right to an abortion, young women and others across the country have increasing­ly requested sterilizat­ion, according to obstetrici­an gynecologi­sts who have seen upticks in Arizona, North Carolina, Texas and Florida.

Dr. Diana N. Contreras, chief healthcare officer of Planned Parenthood, said that after the Supreme Court’s decision, the organizati­on saw a huge spike in traffic to its webpages explaining how an individual

can get a vasectomy or be sterilized.

In interviews, women who are planning to remain child-free said they pushed up their timelines to get sterilized. Others said the Supreme Court decision made them consider sterilizat­ion more seriously, out of concern that reproducti­ve rights would be continuall­y stripped.

In San Antonio, Dr. Michelle Muldrow said the number of women coming into Innovative Women’s OBGYN and requesting sterilizat­ion is unlike anything she has seen.

“I’ve had more consultati­ons for sterilizat­ions in volume per patient load than I’ve ever had in my career,” Muldrow said Wednesday.

While she used to see a couple of patients for sterilizat­ion every now and then, she now conducts consultati­ons daily.

“Never before have I seen so many women in such a panic or state of anxiety about their bodies and their reproducti­ve rights,” Muldrow said. “They feel like this is their only option.”

Dr. Kavita Shah Arora, an OB-GYN in North Carolina and ethics committee chair for the American College of Obstetrici­ans and Gynecologi­sts, said she has noticed “a dramatic increase” in the number of women requesting sterilizat­ion both within her own practice and in conversati­ons with colleagues across the country.

One of her recent patients, who already has children, was previously unsure about permanent contracept­ion, she said.

“The Dobbs decision pushed her over the edge to scheduling the surgery, as she wanted to retain bodily autonomy and have independen­ce over her decisionma­king,” Shah Arora said.

Many women said opting for sterilizat­ion was their way of retaining control at a time when they fear lawmakers will continue to chip away at reproducti­ve rights, including contracept­ives and sterilizat­ion.

But the procedure is not always easy to secure. It has a long, complex history in the United States.

Historical­ly, women, often from marginaliz­ed groups, have been forcibly sterilized without their knowledge. Because of that, the American College of Obstetrici­ans and Gynecologi­sts recommends an ethical approach with patients, while also taking precaution­s against “coercive or otherwise unjust uses.”

Sometimes young women, especially those in their 20s who are unmarried and without children, face pushback from healthcare providers who strongly discourage the procedure out of fear that the patients might change their minds in the future.

A 1999 study found that patients under 30 reported a higher rate of regret after the surgery.

OB-GYNs say their job is to make patients feel respected while ensuring that they make informed choices and understand the risks and benefits, Muldrow said.

“If someone’s been thinking about it long enough and decided upon it, we have to respect that,” said Muldrow, who can be found on a list circulatin­g online of healthcare providers who are willing to perform tubal ligations on young patients, no matter their marital status. She said she has had patients in their early 20s cry with relief when she approved their requests.

It used to be that the more common sterilizat­ion method was tubal ligation, a procedure in which the fallopian tubes are blocked,

burned, cut or tied. While doctors still perform that procedure, the current standard calls for a bilateral salpingect­omy, in which the fallopian tubes are removed, OB-GYNs said.

Dr. Melodie Zamora, an OB-GYN in San Antonio, said the dynamic of the conversati­ons has shifted in recent weeks among her patients. Texas has long had restrictio­ns on abortion, but the ban is forcing patients “to think about the extreme.”

“Now that the option [of abortion] has been completely taken away, women feel more responsibi­lity or a sense that they have to do something that is going to be in the ‘100% successful’ category to never have to be in a situation where they say, ‘Where do I go now?’ ” Zamora said.

Brandi Shepard, a 26year-old living in Ohio, said she felt she had little choice but to get sterilized after the Dobbs decision. When she was 21, she said, her doctor dismissed her request for sterilizat­ion and told her they could revisit the topic when she was older.

Five years later, Shepard’s feelings have not changed.

On the day the U.S. Supreme Court overturned Roe vs. Wade — something she thought would never happen — she asked her health insurance provider if it covered sterilizat­ions. It did, and she scheduled a consultati­on the same day.

She has been approved for a bilateral salpingect­omy. While children were never in her plans, Shepard felt frustrated over having to scramble to get the procedure earlier than she had anticipate­d.

“Because of Roe being overturned, it is causing me to undergo a major surgery and take on the complicati­ons and risks that come with it just so that I don’t have to worry about carrying an unwanted pregnancy,” she said.

In Ohio, legislator­s approved a “heartbeat” law, which bans abortions after six weeks. Already, state lawmakers are drafting a bill that could effectivel­y ban nearly all abortions and some methods of birth control.

Access to abortion meant Shepard could pursue a child-free life, she said. But lawmakers appear determined to take away her choices.

“I’m pissed. It’s insane that this is what I had to do to maintain bodily autonomy,” she said.

Hannah Morgan, 35, of Missouri said getting sterilized wasn’t an option she seriously considered until the Dobbs decision. She has been on birth control for 20 years, trying just about everything: intrauteri­ne devices, hormonal pills. But none offered a permanent solution. With Missouri among one of the first states to ban abortions, it felt like “now or never,” she said.

“Abortion’s not an option that most people want to consider, but it’s always there as a last resort,” Morgan said. Now, she said, “I can’t rely on anything anymore. I just need something permanent so I don’t have to add this to my list of worries anymore.

“It’s scary what’s happening,” added Morgan, who lives in the Kansas City metro area. “All the rights that have been fought for ... and it’s like, ‘Nope, you can’t have that anymore.’ ”

In Orlando, Fla., Dr. Matthew Wollenschl­aeger went from consulting one or two patients a week about sterilizat­ion to about a dozen after the Dobbs decision leaked, he said.

His typical patients used to be women from all over Florida. Now the practice has grown to include Georgia residents, Canadians and transgende­r men seeking hysterecto­mies. Wollenschl­aeger said he had to request hospital privileges at a second location to accommodat­e his patients.

Florida legislator­s have banned abortions after 15 weeks of pregnancy, but many patients have expressed fear that state lawmakers will move quickly to implement a total ban, Wollenschl­aeger said.

“People feel like they’re racing against time. That’s the prevailing sentiment,” he said.

Ciara Walter, 33, said her decision to get sterilized came after the Dobbs decision was leaked. The Pittsburgh resident said she knew she did not want to have children but felt unsure of what path Pennsylvan­ia lawmakers would pursue when it came to reproducti­ve rights.

“I almost feel like they’ll start with this, and what’s next?” Walter said. She rushed to schedule a bilateral salpingect­omy and had her surgery June 29.

Catherine K., a 27-yearold in Minnesota, said that although abortions remain accessible in the state, she fears that the influx of antitransg­ender bills and signals that the Supreme Court may overturn gay marriage and restrict access to contracept­ion are signs of difficult times ahead.

Catherine, who did not want her last name published due to privacy concerns, said she booked a consultati­on appointmen­t to begin the sterilizat­ion process.

“I thought, well, now is as good a time as ever,” Catherine said. “I am very afraid of the way things will continue to go, because I feel that this is only the beginning.”

 ?? Gina Ferazzi Los Angeles Times ?? DR. ALAN BAIRD, right, of Alamo Women’s Reproducti­ve Services in San Antonio, and Executive Director Andrea Gallegos, center right, inform patients June 24 that the clinic can no longer provide abortion services.
Gina Ferazzi Los Angeles Times DR. ALAN BAIRD, right, of Alamo Women’s Reproducti­ve Services in San Antonio, and Executive Director Andrea Gallegos, center right, inform patients June 24 that the clinic can no longer provide abortion services.

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