Click to Enlarge: Monthly female permanent contraception rates per 100,000, January 2018–February 2023. COVID-19, coronavirus disease, 2019. Source: O&G Open
BETHESDA, MD — Rates of female permanent contraception procedures increased significantly across the Military Health System (MHS) after the Dobbs v. Jackson Women’s Health Organization decision—a June 2022 Supreme Court ruling that overturned the constitutional right to abortion established by Roe v. Wade and allowed individual states to set their own abortion laws.
This finding, published in O and G Open, comes from a new analysis of more than 5 years of medical records that found the sharpest rise among younger, unmarried and active-duty servicemembers and among those living in states with the most restrictive abortion policies.1
Researchers conducted a repeated monthly cross-sectional study using the MHS Data Repository to compare procedure rates before and after Dobbs. Using diagnosis and procedure codes, the team identified incident encounters among female beneficiaries aged 21–49 years from January 2018 through February 2023.1
Monthly encounter rates averaged 64 per 100,000 women but peaked at 78 per 100,000 in August 2022—just two months after Dobbs. Overall, rates increased 6.9% following the ruling, with the greatest increases among women aged 21–24 years, nonmarried individuals and those with junior enlisted rank. Procedure rates were also nearly 30% higher in states with restrictive abortion laws compared with states that maintained protective policies, the study found.
Before the ruling, monthly rates had steadily declined through early 2020 and dropped further at the start of the COVID-19 pandemic, mirroring national trends attributed to delayed childbearing and increased use of long-acting reversible contraceptives. However, researchers found “a surge in rates coinciding with the Dobbs decision and rates returning to pre-Dobbs levels several months after the decision.” They added that the ruling “may have created a sense of urgency to ensure that effective contraception was in place.”
The researchers from the Walter Reed National Military Medical Center, the Henry M. Jackson Foundation and the Uniformed Services University, all in Bethesda, MD, noted that the effects of Dobbs on other types of contraception within the MHS have not yet been fully evaluated, but studies in civilian hospital systems have shown increases in both long-acting reversible contraception and emergency contraceptive pill use after the ruling.
Findings also showed that younger beneficiaries were more likely to undergo permanent contraception procedures than previously reported in national data, a shift that could have long-term implications. “Younger age at the time of permanent contraception has been associated with higher rates of contraceptive regret,” the authors wrote. They added that this trend “may affect future contraceptive regret” within the MHS population.
Rates increased the most among active-duty servicewomen, especially those who were unmarried. The authors suggested that this pattern “may relate to both marital and military-specific factors, such as fear of delayed professional advancement resulting from unintended pregnancy and military treatment facility prioritization of active-duty service to ensure military readiness.” Although parity data were not available, they noted that “military career repercussions of unintended pregnancy may influence active-duty servicewomen to undergo permanent contraception procedures regardless of parity.”
Increases were observed across all military ranks after Dobbs, but the largest rise occurred among junior enlisted servicemembers—a group that might be influenced by education and income level. Before the decision, crude rates were highest among non-Hispanic Black active-duty servicewomen, consistent with national data showing higher rates among Black women compared with white women. After adjusting for other factors, however, the highest rates were seen among non-Hispanic white active-duty servicewomen, both before and after Dobbs, with the differences becoming more pronounced after the ruling.
After Dobbs, rates significantly increased among all racial groups except non-Hispanic Black servicewomen. “When we consider racial differences in receiving permanent contraception, it is important to recognize the historical context of involuntary procedures rooted in disenfranchisement and racial discrimination, as well as the continued practice of differential counseling based on race and other demographic factors,” the authors wrote. They added that, even within a system with universal insurance coverage, “racial disparities in reproductive health outcomes such as rates of cesarean delivery and severe maternal morbidity have been reported.”
Geographic differences were also evident. Before Dobbs, procedure rates were already higher in moderate and restrictive states compared with protective states. After the ruling, rates increased further in those areas, with restrictive states showing the highest median monthly procedure rates both before and after Dobbs. These findings “suggest that more stringent abortion restrictions result in higher female permanent contraception utilization,” the authors concluded.
The study acknowledged several limitations, including the use of billing codes that may not capture all relevant procedures and the absence of clinical details such as parity. The researchers also noted that the timing of Dobbs overlapped with the health system’s recovery from the COVID-19 pandemic, which could have influenced access to care. Still, they emphasized that “the spike in procedure rates immediately after Dobbs suggests direct effects from Dobbs.”
The authors said their analysis “provides a unique lens on the effects of Dobbs on female permanent contraception procedure encounter rates in a population with reliable income, housing and healthcare insurance coverage and highlights the effects of national abortion policy on contraceptive utilization.” They called for efforts to “prioritize contraceptive access for military beneficiaries after Dobbs, particularly those in restricted states,” and to “ensure access to all contraceptive methods to avoid facilitating future contraceptive regret.”
- Lehto A, Cherikh L, Susi A, Shvartsman K, Peterson L, Nylund CM, Brown J. Female Permanent Contraception in the Military Health System After the Dobbs v. Jackson Women’s Health Organization Decision. O G Open. 2025 May 1;2(3):e079. doi: 10.1097/og9.0000000000000079. PMID: 41000091; PMCID: PMC12421968.
