DALLAS – On the day the U.S. Supreme Court overturned Roe v. Wade, the Austin Urology Institute fielded 400 calls, double its usual volume.
Not every call was a patient inquiry about a vasectomy, but many were. The office added extra appointment slots to accommodate the increased requests for consultations for the sometimes-reversible contraceptive procedure, said urologist Dr. Koushik Shaw.
Reproductive health specialists across the state are seeing increased interest in long-term and permanent contraceptive options, including vasectomies, tubal ligations and intrauterine devices, known as IUDs, in response that limits the procedure in most cases.
“People are revisiting their contraception, life planning, family planning, and they’re fast forwarding the decision process,” he said.
The apparent rush for long-term contraceptive options began as Texas’ near-complete abortion ban took effect in September, with interest climbing since the Supreme Court’s draft decision on abortion’s constiutionality was leaked in May. The overturning of Roe v. Wade last Friday appears to have only accelerated the demand for birth control.
Google searches in Texas related to vasectomies and tubal ligations – or “getting your tubes tied” – jumped in the days following the decision.
Patients span all ages, genders and income brackets, although the ruling will likely impact low-income people most. They include people who are already parents and people who don’t ever plan to have children. The common denominator is their desperation for more reliable birth control options, even if they come with potentially negative side effects.
A swift change in plans
Dr. John Thoppil, president of the Texas Association of Obstetricians and Gynecologists, said his private practice in Austin has had a 50% increase in requests for long-term contraceptives since the Supreme Court decision, especially tubal ligation.
The sterilization procedure, which can be reversed in some cases, is performed under anesthesia by a surgeon who blocks or cuts the fallopian tubes to prevent pregnancy.
Jessica Moore, 36, from Austin, scheduled a consultation with Thoppil immediately after the Supreme Court ruling, saying her “sense of security” if she were to become pregnant was now gone.
In the past, she had been on the pill and had an IUD, but suffered negative side effects. She decided she’ll try the arm implant Nexplanon, which releases hormones that prevent pregnancy.
“It’s really unfortunate we have to either choose, ‘I’ll risk getting pregnant, despite my best efforts not to,’ or ‘I’m putting these hormones in my body that negatively affect me and give me side effects,’” she said.
Hormonal birth control methods such as the daily pill, hormonal IUDs, and Nexplanon can result in numerous side effects such as weight gain, nausea and mood changes.
Trust Her, a Dallas-based initiative that partners with eight community health clinics in the area to financially assist patients seeking same day birth control services, has seen a “steady increase” in patients seeking contraceptives since the passage of Senate Bill 8.
Organization director Kate McCollum reported a 54% increase in the number of patients they covered in the first quarter of 2022 compared to the same quarter a year prior.
“These would be women who are uninsured and not enrolled in any kind of payer program like Medicaid or Healthy Texas Women, who likely couldn’t afford their method out of pocket,” she said.
She also reported an increase in the number of teens visiting clinics for birth control and an increase in the number of women choosing “highly effective methods like IUDs that often have the most barriers to access.” IUDs can have high out-of-pocket costs and can require someone to take time off work to recover from the short procedure.
One of Trust Her’s partner clinics, Women’s Health Care Center in Dallas, saw a 10-15% increase in women seeking long-term birth control methods “in all forms,” since September, said the non-profit clinic’s founder Dr. Sherry Tenison.
“It’s our low income women, low insured women, with all ages and all races,” she said.
Dr. Shanna Combs, a pediatric and adolescent gynecologist based out of Fort Worth, saw not only an uptick in young women seeking long term reliable birth control, but also a significant spike in the number of parents inquiring after female birth control for their children. Both groups cite the legal developments of Texas’ abortion law and the recent Supreme Court decision.
“In September, I saw a lot of parents saying, ‘Well in light of recent news or recent law changes, I want to make sure that she’s protected because if she got pregnant, there’s nothing she could do.”
Other patients are more concerned that the Supreme Court decision could open the way for a ban on contraceptives in the future. In a concurring opinion, Justice Clarence Thomas said the court should reconsider other past rulings, including one codifying the right to contraception access.
Dallas podcast producer Kelly Kolff, 25, learned of the monumental court decision one hour before her previously-scheduled gynecologist appointment. She wasn’t planning on talking to the doctor about birth control, but her plans quickly changed, she said. Kolff had been on the birth control pill since 2019.
She told her doctor she wanted to get an IUD, a long-term birth control option that can last anywhere from three to 10 years. Kolff had been previously hesitant to get the device because of pain during and after the procedure.
“But there was no hesitation in my mind that day. I felt, and still feel, like I have no choice but to get an IUD for my own survival,” she said. “I don’t know what’s going to happen next, and I wanted something that was long term enough to know I’d be protected if Texas starts banning contraceptives.”
Kolff is scheduled to have the IUD procedure next week.
People are also rushing to stock-up on emergency contraceptives. CVS announced Tuesday it is limiting the sale of ‘morning after pills,’ such as the well known brand name Plan-B, after a surge in consumer stocking. Emergency contraceptives can be purchased over the counter without a prescription.
Male contraception post-Roe
Austin Urology Institute’s Dr. Shaw regularly performs vasectomies for men who don’t want to have children. During the procedure, which he performs at his clinic using local anesthetic, Shaw goes into the scrotum through a tiny incision and severs the vas deferens, or the tube that carries sperm from the testes to the penis.
Recovery takes about a week and, after around 90 days, the procedure is more than 99% effective, Shaw said.
His patients typically range from age 25 to 55, although he’s recently noticed a sizable jump in patients under 30.
“The sub-30 population, [they’re] saying, ‘We don’t want kids, it’s not in our life plan,’” he said.
Vasectomies can be reversed through another outpatient operation that has an up-to-95% success rate, depending on how much time has passed since the original procedure and what type of reversal is required. Shaw said he advises patients to consider a vasectomy as permanent because there’s always a chance a reversal won’t work.
While the Affordable Care Act requires insurance companies to cover women’s contraceptives, it does not require all companies to cover vasectomies. The procedure can cost up to $1,000 out-of-pocket, Shaw said.
Many of Shaw’s patients said they’re getting a vasectomy because they don’t want their partner to have to take birth control pills or get an IUD. Other patients cited worries about condoms failing. It’s a noticeable shift in thinking, Shaw said, as the responsibility of contraception has historically fallen on women.
“We’re changing a little bit of that machismo factor in that women are responsible for all of the family care planning. What’s happening is that men are starting to speak about it more,” he said. “We’re getting the word out that this is not a big deal. It’s easy to do, no long-term repercussions, it’s affordable. If the timing is right, I think it’s a safer alternative.”
