HELENA, Mont. — A handful of people recently gathered in the shade of a large pine tree for a going-away party of sorts. Their friend, Dani Marietti, was going to have her fallopian tubes removed, a decision she made after a leaked draft of the U.S. Supreme Court's decision to overturn the constitutional right to abortion was published in May.
The small group kicked off the "sterilization shower" for the 25-year-old by laying out chalk-written signs that said "See Ya Later Ovulater" and "I got 99 problems but tubes ain't one." And they munched on cookies that had abortion-rights slogans, such as "My Body, My Choice," written on them in frosting.
"Cheers to Dani and her choice to get sterilized," Kristina McGee-Kompel said.
Marietti is a full-time graduate student in Helena working toward becoming a therapist. She doesn't want kids to get in the way of her career, she said. She had considered permanent sterilization before, but the possibility that the Supreme Court would overturn Roe v. Wade pushed her to seek out an OB-GYN who would help her with a permanent method of contraception.
"‘I want to do this as soon as possible,'" she recalled telling the doctor.
"I always knew I didn't want children, and of course when you say that as a younger person, everyone is like, ‘Oh, you'll change your mind,' or, ‘Just wait until you find the one,'" she said. "I always kind of ignored that."
Abortion is still legal in Montana, but whether it will remain so is unclear. State Attorney General Austin Knudsen, a Republican, has asked the Montana Supreme Court to overturn its 1999 decision that said the state constitution's right to privacy includes the right to end a pregnancy.
The uncertainty around abortion access in Montana and other states where abortion is now or could become illegal, plus the fear of future legal fights over long-term contraception, has seemingly spurred a rise in the number of people seeking surgical sterilization, according to reports from doctors. That includes Marietti, who is having a salpingectomy, a procedure in which the fallopian tubes are removed instead of tied, as in tubal ligation, which can be reversible.
How many people sought permanent sterilization after the fall of Roe won't become clear until next year, said Megan Kavanaugh, a researcher for the Guttmacher Institute, which gathers data related to reproductive health care across the U.S. and supports abortion rights.
But anecdotal reports indicate that more people have been undergoing permanent birth control procedures since the Supreme Court's June 24 decision in Dobbs v. Jackson Women's Health Organization, which struck down Roe. Dr. Kavita Arora, who chairs the American College of Obstetricians and Gynecologists' ethics committee, said providers across the country are beginning to see an influx of patients into their operating rooms.
The North Carolina OB-GYN recounted what one of her patients said just before a recent surgery. "She wanted to have autonomous control over her body, and this was her way of ensuring she was the person who got to make the decisions," Arora said.
In Montana, Dr. Marilee Simons, an OB-GYN at Bozeman Health Deaconess Hospital, said more adults in their 20s and 30s without children have come to the hospital for sterilization consultations. Many are women who already practice birth control, she said. "They are still worried about an unintended pregnancy and what that might mean in the future," she said.
Most are asking to have their tubes removed to permanently prevent pregnancy. A smaller number of people are asking for hysterectomies, which surgically remove part or all of the uterus. To meet demand, Bozeman Deaconess has dedicated at least one provider to work with these patients multiple days a week.
Planned Parenthood of Montana President and CEO Martha Fuller said clinics statewide have seen an "unprecedented" increase in patients asking to be sterilized, including requests for vasectomies.
But some people seeking sterilization procedures across the U.S. are being turned away. Arora said some patients who don't have children and are in their childbearing years are reporting difficulties finding providers willing to sterilize them.
Those providers' reluctance may stem from studies and data that suggest the risk of regret for patients who are sterilized at age 30 or younger is high. Other studies had mixed results and found that some women feel less regret over time, Arora said.
Arora said she makes sure her patients understand the implications of any sterilization procedure, especially irreversible options. She also asks whether patients are being pressured into asking for the procedure. "I honestly believe my job is not to be a gatekeeper, but to empower and uplift those goals and wishes, especially after good, shared decision-making and informed consent," she said.
Some patients who have been denied sterilizations have turned to therapists like Barbara DeBree, who has a private practice in Helena and writes letters to providers attesting that the patients have thought through their decisions. Other mental health care providers say they're also fielding requests for letters of support, DeBree said.
"This is not a quick decision for them," she said, referring to the patients asking for letters.
Providers' ethical worries about future regrets aren't the only barriers that patients seeking sterilization procedures may face. Cost and insurance coverage can also be issues.
Helena resident Alex Wright, 23, doesn't plan to have children and wants to be sterilized. She plans to schedule a consultation to see whether her provider will perform the procedure. She said that if her regular provider won't do it, she will seek out someone from online lists of providers willing to perform the procedure on younger people.
"That's only helpful if I can get the financial assistance to get it taken care of through those people," she said, referring to her insurance coverage.
Wright said her insurance company estimates she'll pay about $4,000 out-of-pocket if she goes with an in-network provider. Using an out-of-network doctor could cost substantially more.
Although some people are seeking permanent procedures in reaction to the Dobbs decision, others are doing so because they believe the Supreme Court will continue upending reproductive health norms. Kavanaugh, the researcher at Guttmacher, said Justice Clarence Thomas opened that door by suggesting in his concurring opinion in Dobbs that other precedents should be revisited, including the 1965 Griswold v. Connecticut decision that says banning contraceptives violates a married couple's right to privacy.
"I think we are anticipating that there's going to be some attacks on contraception," Kavanaugh said.
That's what worries Shandel Buckalew, of Billings, Montana, who wants a full hysterectomy. The 31-year-old said her doctor thinks she has endometriosis, a painful condition in which tissue that normally grows inside the uterus grows on other parts of the reproductive organs. Buckalew hasn't undergone the full range of testing that can be required for a diagnosis because she doesn't have health insurance and can't afford it.
"Even though I have an IUD, the amount of cramps and the pain I go through — oh, I get so sick," she said.
She hopes a hysterectomy would alleviate that pain, in addition to providing permanent birth control because she doesn't want kids. But her lack of health insurance makes the procedure unaffordable.
She's trying to get health insurance before her intrauterine device expires in two years because she fears the reproductive health care landscape could shift dramatically. She described feeling terrified and angry.
"It feels like my life doesn't matter," she said.
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