Post-Roe, Americans seek tubal sterilizations — but barriers persist

Faced with pushback from doctors, patients seeking tubal sterilizations are on the rise — and are spreading the word online

Frances Vermillion has a tubal ligation scheduled for November.  They were photographed at the sculpture garden in downtown Des Moines on Aug.  10.
Frances Vermillion has a tubal ligation scheduled for November. They were photographed at the sculpture garden in downtown Des Moines on Aug. 10. (Kathryn Gamble/Photo by Kathryn Gamble for the Washington Post)
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Frances Vermillion showed up to their consultation for a tubal ligation prepared for the worst. Expecting resistance from their gynecologist, the 24-year-old from Ames, Iowa, carefully assembled a binder containing information about sterilization, including their reasons for wanting to get their tubes tied.

When they arrived at the initial consultation in late July, Vermillion said their doctor “didn’t even look at the binder” and instead pressed them on why they wanted the procedure, suggesting they were too young and might change their mind later.

Vermillion has long known they don’t want children. They have considered getting the procedure for “at least five years,” but three years ago settled for an intrauterine device (IUD) as a temporary contraceptive measure.

But when the Supreme Court announced its decision in Dobbs v. Jackson Women’s Health Organization overturning Roe v. wade in June, the stakes felt higher. That’s when Vermillion finally scheduled the appointment.

Vermillion is one patient among a wave of Americans rushing to get their tubes tied after the dobbs decision. Anxious about abortion access, these patients are mobilizing online to spread the word about getting sterilized while trying to surmount challenges that have long made it difficult to access the procedure, which is meant to be permanent but still allows for planned pregnancies through in vitro fertilization (IVF) or surrogacy.

In the weeks after the Supreme Court’s decision, Google searches for Plan B and contraception increased; men hit to get vasectomies. And though official data is not yet available, anecdotally, OB/GYNs across the country said they have seen tubal ligation requests spike, too.

Dawn Bingham, an OB/GYN in Columbia, SC, said she has seen a surge in child-free patients “calling around finding out who will do this for them, particularly as fast as possible.” Pam Parker, an OB/GYN in the Rio Grande Valley of Texas, also said she has seen an increase in requests for tubal ligations.

“One of my patients who’s pretty young, never had any kids, just wrote me this super heartfelt email the other day about how she is terrified, and that she thinks she should just get her tubes tied,” Parker said.

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Jamie Tomasello, 42, had a tubal ligation on July 25, almost exactly one month after the Supreme Court decision was announced. Tomasello, who is bigender and lives in Ann Arbor, Mich., saw the procedure as both gender-affirming and important for her reproductive autonomy in a post-gnaw world.

“I realized if we had a worst-case scenario, I could be coerced into making a decision under the threat of potential pregnancy via rape,” Tomasello said, adding she received a bilateral salpingectomy to remove her fallopian tubes.

As a person in her 40s with one child, Tomasello told The Post she did not receive much pushback from her physician, who went over other options for Tomasello, including asking her partner to have a vasectomy, a less invasive procedure that involves cutting the vas deferens. When Tomasello reaffirmed her commitment to receiving a tubal ligation, the doctor was willing to perform the procedure, she said, although he had to perform it in a nearby surgery center because the local Catholic hospital would not allow the procedure to be performed electively.

Men rush to get vasectomies after Roe ruling

But Vermillion and other patients in their 20s who did not have children said it was much harder to get approved for a tubal ligation. Some, like Vermillion, said they engaged in back-and-forth discussions with their doctors, and others have been denied the procedure entirely.

The American College of Obstetrics and Gynecology (ACOG) has put together recommendations for the sterilization of women, including emphasizing the permanence of the procedure, discussing with patients other reversible contraceptive options, and, “in appropriate cases,” discussing the sterilization of male partners “as an option with fewer risks and greater efficacy than female sterilization.”

ACOG also believes it is “ethically permissible” to perform sterilizations on young patients who have not had children, encouraging OB/GYNs to avoid paternalism. The organization also reaffirms that forced sterilizations are unethical and should never be performed, a nod to America’s brutal history of forcibly sterilizing people deemed “unfit” to have children.

She survived forced sterilization. Activists fear more could occur post-Roe.

Sarah Salkowski, a 24-year-old who received a tubal sterilization in March, said she faced a host of challenges while meeting with her OB/GYN, whom she said questioned her commitment to getting sterilized and asked her what would happen if she found the “perfect man” who wanted to have children with her.

“[My doctor] expressed that he did not feel extremely comfortable doing the procedure on somebody my age,” said Salkowski, who lives in Royal Oak, Mich. She added that he ultimately agreed to perform a bilateral salpingectomy after she attended two consultations with him and one with her colleague.

Although Salkowski was sterilized before the dobbs decision was announced in June, she said that threats to abortion access were what influenced her decision: Salkowski considered the Texas abortion ban signed into law last year a harbinger that the Supreme Court would take away the fundamental right to an abortion.

What to know about the Texas abortion law

Less than two months after her tubal sterilization, the Supreme Court draft opinion overturning Roe v. wade was leaked. The very next day, Salkowski published an op-ed on Medium about her decision to get sterilized. She also started a Reddit thread to answer questions about the procedure.

OB/GYNs have also taken to the internet to educate others about tubal sterilizations.

Franziska Haydanek, an OB/GYN in Rochester, NY, has been creating TikToks about tubal sterilizations, among other aspects of obstetrics and gynecology, since 2020.

Shortly before the dobbs decision came out, Haydanek started an online list of gynecologists she as “willing to perform describes a tubal ligation on any patient, 18-21+, no matter their marital status or number of children.” The list evolved from a Facebook group of OB/GYNs, she said, but patients can also submit the names of doctors to the list.

When the Supreme Court officially announced its verdict on June 24, Haydanek made a TikTok promoting the list, which at that point included 150 gynecologists. In just over a week, the list had expanded to include more than 1,000 gynecologists willing to perform sterilizations, sourced from doctors and patients alike. As of early August, that number has grown to more than 1,300 physicians, and the original TikTok has 4.7 million views.

Supreme Court overturns Roe v. wade

Haydanek said she was inspired to create the list in part because several of her own patients had told her about the barriers they’d faced in getting sterilized, including being denied the procedure more than once by other physicians.

“I felt so bad that in a time that we were already facing a lot of issues with bodily autonomy and making our own reproductive choices, these patients who knew thoroughly what they wanted weren’t being helped,” she said.

Other OB/GYNs have also used social media to help compile resources about tubal sterilizations. Amy Lasky, an OB/GYN in Stony Brook, NY, posted on a Twitter thread in 2020 offering tubal sterilizations to anyone older than 21, regardless of how many other children they have, and listing other physicians who would do the same. Last month, she promoted the original thread and told The Post that more people have engaged with it after the Supreme Court decision.

“Virtually every person I’ve seen since dobbs has mentioned the decision,” she told The Post, referring to sterilization consultations. She has also seen a “significant increase” in the number of child-free patients younger than 30 seeking sterilizations, she said.

But some patients are still unsure whether they can afford a tubal ligation. Under the Affordable Care Act, tubal sterilizations must be fully covered under private health insurance plans, unlike vasectomies. Patients using Medicaid to cover sterilization must wait at least 30 days to receive the procedure after giving consent — another requirement that some say is a barrier. And tubal sterilizations can cost up to $6,000 without insurance, also unlike vasectomies, which are often a fraction of that cost.

Debunking myths about vasectomies as their popularity increases post-Roe

Stephanie Locey, a 41-year-old from Sevastopol, Calif., is worried about the cost. She said she has a blood disorder that could cause a miscarriage if she were to get pregnant, and her body dela did not respond well to hormonal birth control and an IUD. But her private insurance provider has been unclear as to how much she will have to pay out of pocket, she said, given the elective nature of the procedure.

Last week, Locey, who has previously had a miscarriage because of her blood disorder, met with an OB/GYN for an initial consultation for a tubal ligation — an experience she called “discouraging.”

Locey said her quest for a tubal ligation has been a long one: It began two years ago, when she consulted a hematologist for her blood disorder and brought up the possibility of sterilization to remain child-free and prevent future miscarriages. “He just brushed me off and told me I’d change my mind,” she said. At her consultation, her OB/GYN put her on a year-long waitlist to get the procedure, in part because of the coronavirus pandemic, and encouraged her to “shop around” for other providers in the meantime, Locey said.

But Locey remains committed to getting a tubal ligation, even if it takes another year. “Maybe if more people realize what a process it is, knowing what’s happening with Roe v. wademaybe there can be something done to help make this more accessible,” she said.

Vermillion, of Iowa, has scheduled their tubal connection for November. They are “really excited and happy” about getting the procedure, which they said is gender-affirming and especially important to them as a person with multiple mental health issues. This includes a recent borderline personality disorder diagnosis, which they worry their potential future children could inherit.

“I have had to be hospitalized before for my mental health,” Vermillion said, explaining one of their reasons for seeking a tubal ligation. “Sometimes I can’t even take care of myself. And I just don’t think that I could be the parent that my child would deserve or the parent that I would want to be.”

correction

A previous version of this article misstated that Stephanie Locey’s blood disorder did not allow her to take birth control.

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