Permanent and long-acting reversible contraception volumes at a multihospital system in Ohio before and after Dobbs

Jameson A Mitchell; Meng Yao; Rie Maeda; Justin R Lappen; Ashley R Brant

doi:10.1016/j.contraception.2024.110471

Permanent and long-acting reversible contraception volumes at a multihospital system in Ohio before and after Dobbs

Contraception. 2024 Apr 20:110471. doi: 10.1016/j.contraception.2024.110471. Online ahead of print.

Authors

Jameson A Mitchell¹, Meng Yao², Rie Maeda³, Justin R Lappen⁴, Ashley R Brant⁵

Affiliations

¹ Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States. Electronic address: mitchej7@ccf.org.
² Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States.
³ Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States.
⁴ Division of Maternal-Fetal Medicine, Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH, United States.
⁵ Division of Family Planning, Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH, United States.

PMID: 38648922
DOI: 10.1016/j.contraception.2024.110471

Abstract

Objectives: Immediately following the Dobbs decision, Ohio prohibited abortion after the detection of fetal cardiac activity. We aimed to characterize changes in the uptake of long-acting reversible contraception (LARC) and permanent contraception following the abrupt enactment of restrictive abortion legislation.

Study design: We conducted a retrospective cohort study using electronic medical record data of patients aged 15 to 55 who underwent permanent contraception (tubal ligation, vasectomy) or LARC placement (intrauterine device, contraceptive implant) at a multihospital system in northeast Ohio from January 1, 2022 to Decemeber 31, 2022, 6 months before and after Dobbs. We compared procedure volumes and patient characteristics.

Results: We identified 4247 tubal ligation and LARC procedures pre-Dobbs, including 725 (17.1%) permanent contraception and 3522 (82.9%) LARC. Post-Dobbs, the total number of tubal ligation and LARC procedures increased by 15.8% (4916), and there was a significant increase in the proportion of permanent contraception, (p < 0.001). Vasectomy volume increased by 33.3% post-Dobbs, from 1193 to 1590 procedures. Compared to pre-Dobbs, patients undergoing contraceptive procedures post-Dobbs were younger (tubal ligation and LARC, 30.9 median years [24.5, 36.8] vs 31.5 [25.2, 36.9], p = 0.011; vasectomy, median 36.6 years [32.9, 39.6] vs 37.2 [34.2, 40.4], p < 0.001) and more likely to report single relationship status (57.4% vs 55.9% for tubal ligation and LARC, p = 0.028% and 23.0% vs 18.1% for vasectomy, p = 0.002).

Conclusions: This study demonstrates increased uptake of contraceptive procedures following the Dobbs decision. This rise in permanent contraception suggests a relationship between abortion policy and contraceptive decision-making, especially among younger patients.

Implications: Increased permanent and long-acting reversible contraception procedures following Dobbs reveal shifting contraceptive choices, particularly among younger individuals, indicating a connection between abortion policy and reproductive decisions.

Keywords: Abortion policy; Long-acting reversible contraception; Permanent contraception; Salpingectomy; Vasectomy.