Sustained Rise in Vasectomy Rates After Dobbs v. Jackson: A Nationwide Analysis Using Epic Cosmos

To determine the changes in vasectomy rates pre- and post-Dobbs v. Jackson in counties throughout the United States based on political leanings.

This cross-sectional study identified a cohort of men aged 18-70 years old, with an encounter in the 1,041-day time period surrounding the supreme court Dobbs v. Jackson decision. The period was split into the pre- (2/27/2017-12/31/2019) and post-Dobbs (6/24/2022-4/30/2025) era. The main outcome measure was vasectomy rate per county, as measured by number of vasectomies per total men in county.

There were 38.9 million men in the pre-Dobbs era and 55.4 million men in the post-Dobbs era included in this study. There was a significantly higher frequency of men aged <40 (55% vs 25%) and unmarried (18% vs 12%) (both P <.001) undergoing vasectomy in the post-Dobbs era. In counties that mostly voted Democratic in the 2024 presidential election, the percentage of eligible men who underwent vasectomy increased by 22% (range 10%-45%) in the post-Dobbs era. In Republican leaning counties, percentage of eligible men increased by 7% (range 6%-19%) (P = .04).

In a nationally representative dataset, vasectomy rates significantly increased following the Dobbs decision, with a significantly higher rate of men undergoing vasectomy in democratic-leaning counties. To our knowledge, this is the first study to document reproductive decision-making changes that persist for over 3 years, with clear stratification by political affiliation.