Recent Trends in Tubal Ligation Incidence Among Active-Duty Servicewomen

Background: Dobbs v. Jackson Women's Health Organization (Dobbs) has had far-reaching effects on reproductive health care in the United States. Studies have shown increased demand for permanent contraception following Dobbs. In the Military Health System (MHS), vasectomy incidence increased significantly post-Dobbs. No research has yet evaluated the impact of Dobbs on permanent contraception for women (tubal ligation/sterilization) in the MHS. Methods: We queried health care data from the MHS Data Repository to identify active-duty servicewomen (ADSW) ages 18-45 between fiscal years 2020 and 2023. Study analyses included descriptive statistics, monthly incidence rates of tubal ligation/sterilization per 1,000 ADSW overall and at the state level to compare trends in Texas and Virginia, and t-test and chi-square tests to assess demographic differences before and after Dobbs. Results: Of the 339,052 ADSW included in the study, less than 2% received tubal ligations/sterilizations during the study period. The majority of these were aged 30-34 years, non-Hispanic White, married, senior enlisted, and in the Air Force. There was an abrupt increase in tubal ligations/sterilizations among ADSW within 2 months after Dobbs, and the rate remained above pre-Dobbs levels for 4 months. No differences were observed in the rate of tubal ligation/sterilizations in Texas and Virginia. Conclusions: The trend in tubal ligations/sterilizations among ADSW mirrors the general population. The abrupt increase indicates an association between Dobbs and changes to contraceptive decision-making. It is important to consider these changes to understand the short- and long-term effects of Dobbs on reproductive health care in the MHS and the nation.