On the day the US Supreme Court overturned Roe v. Wade, the Urology Institute in Austin fielded 400 calls, double its usual volume.
Not every call was a patient inquiry about a vasectomy, but many were. The office has added additional appointment slots to meet increased requests for consultations for the sometimes reversible contraceptive procedure, said urologist Dr. Kushik Shaw.
Reproductive health professionals 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 a response that limits the procedure in most cases.
“People are rethinking their contraception, life planning, family planning and speeding up their decision-making process,” he said.
The apparent rush for long-term contraceptive options began after Texas’ near-total abortion ban went into effect in September, with interest rising after a draft Supreme Court ruling on the constitutionality of abortion expired 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 ligation — or “tubal tying” — spiked in the days after the ruling.
Patients are of all ages, genders and incomes, although the decision is likely to affect low-income people the most. These include people who are already parents and people who never 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.
Quick change of plans
Dr. John Topil, president of the Texas Association of Obstetricians and Gynecologists, said his private practice in Austin has seen a 50 percent increase in requests for long-term contraceptives since the Supreme Court ruling, particularly for tubal ligations.
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, of Austin, scheduled a consultation with Topil immediately after the Supreme Court decision, saying her “sense of security” if she became pregnant was now gone.
Related: Texas clinics can temporarily resume abortions, state court rules
In the past she was on the pill and had an IUD but had negative side effects. She decided she would try the Nexplanon arm implant, which releases hormones that prevent pregnancy.
“It’s really unfortunate that we have to either choose, ‘I’m going to risk getting pregnant despite my best efforts not to,’ or ‘I’m putting these hormones in my body that are affecting me negatively and giving me side effects,'” she said.
Hormonal birth control methods, such as the daily pill, hormonal IUDs, and Nexplanon, can lead to numerous side effects such as weight gain, nausea, and mood changes.
Trust Her, a Dallas-based initiative that partners with eight area community health clinics to financially support patients seeking same-day birth control services, has seen a “steady increase” in patients seeking contraceptives since the Senate bill’s passage 8.
The organization’s director, Kate McCollum, reported a 54% increase in the number of patients covered by them in the first quarter of 2022 compared to the same quarter of the previous year.
“These would be women who are uninsured and not enrolled in any payer program like Medicaid or Healthy Texas Women who probably wouldn’t be able to afford their method out of pocket,” she said.
She also reported an increase in the number of teenagers visiting birth control clinics and an increase in the number of women choosing “highly effective methods such as IUDs, which often have the most barriers to access.” The Navy can have high out-of-pocket costs and may require someone to take time off work to recover from the short procedure.
One of Trust Her’s partner clinics, the Women’s Health Center of Dallas, has seen a 10-15 percent increase in women seeking long-term birth control methods “in all forms” since September, said nonprofit clinic founder Dr. Sherry Tennyson.
“These are our low-income, low-income women, of all ages and races,” she said.
Dr. Shanna Combs, a pediatrician and adolescent gynecologist in Fort Worth, has seen not only an increase in the number of young women seeking long-term reliable birth control, but also a significant jump in the number of parents asking about female birth control for their children. you are Both groups cited legal developments in Texas abortion law and a recent Supreme Court decision.
“In September, I saw a lot of parents saying, ‘Well in light of the latest news or the latest changes in the law, I want to make sure she’s protected because if she gets pregnant, there’s nothing she can do.’
Other patients are more concerned that the Supreme Court ruling could pave the way for a ban on contraceptives in the future. In a concurring opinion, Justice Clarence Thomas said the court should review other past decisions, including one codifying the right to access contraception.
Related: Abortion rights supporters, opponents clash in downtown Dallas rally
Dallas podcast producer Kelly Kolf, 25, learned of the monumental ruling an hour before her previously scheduled gynecologist appointment. She hadn’t planned to talk to the birth control doctor, but her plans quickly changed, she said. Kolff has been on birth control pills since 2019.
She told her doctor she wanted to get the IUD, a long-term birth control option that can last three to 10 years. Kolff had previously been 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, that I had 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’s long-term enough that I know I’ll be protected if Texas starts banning contraceptives.”
Kolff is due to undergo an IUD next week.
People are also rushing to stock up on emergency contraception. CVS announced Tuesday that it is limiting the sale of “morning after pills,” such as the well-known brand name Plan-B, after a spike in consumer inventories. Emergency contraceptives can be bought without a prescription.
Male contraception after Roe
Dr. Shaw of the Austin Institute of Urology routinely performs vasectomy on men who do not want to have children. During the procedure, which he performs in his clinic using local anesthesia, Shaw enters the scrotum through a small incision and severs the vas deferens, or the tube that carries sperm from the testicles to the penis.
Recovery takes about a week, and after about 90 days, the procedure is more than 99 percent effective, Shaw said.
His patients typically range in age from 25 to 55, although he has recently seen a significant spike in patients under 30.
Interior of a patient examination room at the Austin Institute of Urology, Tuesday, June 28, 2022, in Austin, Texas. (Rodolfo Gonzalez/Special Contributor) (©2022 Rodolfo Gonzalez / GonzoFotoz.com / Special Contributor)
“The population under 30, [they’re] saying, “We don’t want kids, it’s not in our life plan,” he said.
Vasectomies can be reversed through another outpatient surgery, which has up to a 95% success rate, depending on how much time has passed since the original procedure and what type of reversal is required. Shaw said she advises patients to consider a vasectomy as permanent because there’s always a chance the reversal won’t work.
While the Affordable Care Act requires insurance companies to cover female 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 get vasectomy because they don’t want their partner to have to take birth control pills or the IUD. Other patients cited concerns about failed condoms. That’s a notable shift in thinking, Shaw said, because the responsibility for contraception has historically fallen on women.
“We’re changing that male factor a bit because women are responsible for all the family care planning. What’s happening is men are starting to talk about it more,” he said. “We’re spreading the word that it’s not a big deal. Easy to do, no long term effects, affordable. If the time is right, I think it’s a safer alternative.
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