All of these reasons for denying sterilization are in direct contradiction of ACOG’s ethical guidance. Yet doctors face no repercussions for refusing to perform procedures; the US does not track data on how many sterilization requests are denied. “So there’s no accountability—there’s no capacity to enforce a consequence,” Hintz says.
Access to the procedure isn’t equitable across society. Echoes of sterilization’s checkered past—in which marginalized groups of women were forced to undergo the procedure, including women of color, women who were poor, and those living with disabilities or mental illnesses—still linger today. Black, Latina, and Indigenous women in the US are up to twice as likely as white women to be approved for sterilization, while women with public or no health insurance are about 40 percent more likely to have the procedure than privately insured women.
“The bottom line is that the way that this is legislated around—and the way that these very subjective sorts of assessments are able to be made—is just a means of perpetuating this very white, wealthy, able-bodied, and cisgender idea of who ought to have children,” says Hintz.
One corner of the internet in which those seeking the procedure can find advice and tips is the r/childfree community on Reddit. The subreddit has folders with extensive information on how to request the procedure, a collated list of doctors who will perform it, and a sterilization binder that members can take to their doctor with a template consent form and a form to list their reasons for wanting the procedure.
Alongside rising requests for permanent forms of birth control, the overturning of Roe has already triggered an uptick in the number of people seeking longer-lasting but nonpermanent birth control, such as intrauterine devices (IUDs). But the idea itself that birth control—permanent or otherwise—could replace access to abortion is inherently flawed, says Krystale Littlejohn, an assistant professor of sociology at the University of Oregon whose work explores race, gender, and reproduction. Despite the fact that the majority of people who can get pregnant use some form of birth control, one in four women will have an abortion in their lifetime. This is why the “just get your tubes tied” or “just get an IUD” rhetoric that has emerged in the wake of Dobbs isn’t helpful, she says.
For one, choosing these forms of birth control is not a trivial medical decision: Heavier, more painful periods and a potentially painful implantation procedure—often with no pain relief—are among the possible consequences of getting an IUD. Tubal ligations require an invasive surgical procedure and, as with any surgical procedure, can lead to complications.
In fact, the advice to use birth control can be seen as just another form of policing people’s bodies, Littlejohn says. “When it comes to people suggesting that their friends or their loved ones get on long-acting birth control, I think that people believe that they’re helping other people, but what they’re really doing is encroaching on their human right to bodily autonomy,” she says. Roe’s fall won’t just mean that people with uteruses are forced to give birth, she says; it’s also about compelling them to use longer-acting or permanent forms of birth control.
A person living in a restrictive part of the US may now feel compelled to seek out longer-term contraception or get their tubes tied—which is tantamount to compulsory birth control. “That’s not the solution right now,” she says. “I think it’s really important that we don’t try and fight reproductive injustice with reproductive coercion.”