Sitting in the living room of her Cleveland home, 30-year-old Grace O’Malley reflects on when she ruled out having kids of her own.
O’Malley has Ehlers-Danlos syndrome, a genetic condition that weakens the body’s connective tissue, and can get much worse postpartum. About three years earlier, when she was in her mid-twenties, her condition worsened. O’Malley’s doctors told her that if she did get pregnant, her uterus could rupture and her child would be more likely to be born premature.
O’Malley was on hormonal birth control up until last May. But after the U.S. Supreme Court overturned Roe v. Wade, she knew an abortion ban was likely coming in Ohio and she might not be able to end a pregnancy if her birth control failed. She booked an appointment with her gynecologist.
“I went in that day and I knew right away I wanted a more permanent solution,” said O’Malley. “I was like, ‘I actually want to talk about getting surgery.’ And the nurse was surprised, and she was like, ‘Oh, okay.’”
Increased Uncertainty
Dr. Clodagh Mullen, an obstetrician-gynecologist at MetroHealth Medical Center in Cleveland, said since the Dobbs v. Jackson came down, many of her patients have been increasingly worried about access to reproductive healthcare and seeking more permanent solutions.
“Some patients will say, ‘Oh, could you stash some IUDs for me?’” Mullen said. “They get very nervous that [birth control] is just going to go away overall. Nobody can re-implant your tube once it's been taken out, so I think that they have that comfort of there's no way anybody can take this part away from me.”
Ohio legislators have floated bans on birth control, which, so far, haven’t gone anywhere. Mullen doesn’t anticipate access to contraception will disappear.
“But I get why people have that fear, as I also probably didn't really think that Roe was going to get overturned, if you had asked me this four or five years ago,” she said.
What Mullen is seeing in Cleveland is mirrored across the state and country. The Kaiser Family Foundation surveyed more than 500 gynecologists throughout the U.S. in the spring and more than half reported they had more patients asking for contraception than before the supreme court ruling. The doctors said they were mainly asking for sterilization, IUDs and implants.
Three Ohio health systems that track contraception – MetroHealth Medical Center in Cleveland, University Hospitals in Cleveland, and Ohio State University Wexner Medical Center in Columbus – reported a sharp rise in the number of patients seeking tubal sterilization.
Contraception decisions
Mullen said after Dobbs, some of her patients have expressed a desire for sterilization because they worry their doctor won’t remove an implant or an IUD, even if it has ill health effects.
“A lot of times, doctors can be problem solvers and they just are like, ‘Oh, it's the bleeding or it's the cramping or it's this headache’ and they just want to fix the issue without necessarily taking out the contraception,” she said. “I think a lot of women feel like they can get ignored or passed over during those conversations, which makes them fearful naturally.”
There aren’t many big health risks to the type of sterilization procedure Mullen performs. Doctors mostly worry about regret. Most studies found that when doctors followed up, a small percentage of women wished they hadn’t gone through with the procedure.
The majority are like O’Malley, who had some complications post-surgery, but said she never second-guessed her decision.
“I've never really thought about it, honestly,” said O’Malley. “It's just kind of been, it’s become kind of a fact of my daily life. It’s like, ‘Hi, I'm Grace. I have red hair and I can't have kids.’”
O’Malley’s happy her doctor respected her choice – she believes the political climate helped.
She shares the story of her best friend who sought sterilization in her late 20s, about five years ago. She says her friend had to meet with several doctors before one agreed to do the procedure, and even then, made her wait another year in case she changed her mind.
“My friend did not have that kind of grace,” O’Malley said. “Her doctor probably thought like, ‘You would have other options. If you got pregnant and decided that it's really not what [you] wanted, then you could get an abortion.’ Whereas for me, that might not be the option.”
Men decide, too
Men are also changing their contraception patterns, according to physician reports.
Dr. Sarah Sweigert, a urologist at Ohio State University Wexner Medical Center, said doctors at her office performed double the number vasectomy consults and procedures as they had before the ruling.
She points to a Cleveland Clinic study, which showed the average age of men getting the procedure has dropped from late 30s to mid-30s following the court decision. The study also showed an uptick of men who had never had kids getting the procedure. Sweigert’s seen that trend first-hand in her practice.
“I think as more women speak out about perhaps not wanting to be on various forms of birth control for decades, I think that men are more aware of vasectomies and perhaps are doing their part,” she said.
Vasectomies are generally safer than female sterilization and have a much quicker recovery.
But Mullen isn’t surprised that so many women want the procedure themselves – they are the ones who would have to carry the pregnancy and handle the ensuing health impacts.
O’Malley feels that acutely. She had been in vulnerable situations in the past. She was sexually assaulted in college and went through a period where she was homeless. O’Malley said her choice was an act of self-protection.
“It’s not like I sit around thinking that the worst case scenario is going to happen,” she said. “But I would want to know that I was going to be safe and I wasn't going to end up in a situation where I was pregnant and I would have no path to go.”