A nationwide analysis of the trends in permanent contraception utilization before and after the Dobbs ruling

and after the Dobbs ruling OBJECTIVEThe United States Supreme Court ruling of Dobbs v. Jackson shifted abortion regulation from the federal level to states, leading to new restrictions (1).This change heightened attention on permanent contraception (2, 3).Our research investigates nationwide trends in permanent contraception utilization before and after the ruling. STUDY DESIGNWe conducted a retrospective review of individuals aged R18 years who pursued vasectomy or tubal permanent contraception before and after the Dobbs ruling using the Epic Cosmos database under IRB 00166615.Although this database has limitations, including changes in participating organizations, we addressed this by using rates rather than absolute counts, with a denominator reflecting patients aged R18 years undergoing these procedures for subgroup analyses and patients aged >18 years eligible for these procedures for state-specific analyses.We compared utilization from July 2021 to December 2021 (pre-Dobbs) to the period July 2022 to December 2022 (post-Dobbs).Procedure counts were obtained for demographic subgroups.States were categorized by legal landscape per the Center for Reproductive Rights, and state-specific counts described utilization by legal climate.Rates were estimated using incidence rate ratios (IRRs), and stratified models were run for each demographic factor and legal status.