Helena, Mont. — A handful of people recently gathered in the shade of a large pine tree for a farewell party. Their friend, Dani Marietti, was about to have her fallopian tubes removed, a decision she made in May following a leak of a U.S. Supreme Court decision striking down constitutional rights to abortion.
The small group started a “sterilization shower” for the 25-year-old by laying out chalk-written signs that read “Ya later see the ovulator” and “I’ve got 99 problems but the tubes aren’t one.” And they munched on cookies with abortion-rights slogans, such as “My Body, My Choice” written in frosting.
“Cheers to Dani and her love of sterilization,” said Christina McGee-Compel.
Marytie Helena is a full-time graduate student working toward becoming a therapist. She doesn’t want kids to get in the way of her career, she said. He had previously considered permanent sterilization, but was likely to be overturned by the Supreme Court Roe v. Wade Pushes her to find an OB-GYN who will help her with a permanent method of contraception.
“‘I want to do this as soon as possible,'” he recalled telling the doctor.
“I always knew I didn’t want children, and of course when you say that as a young person, everyone is like, ‘Oh, you’ll change your mind’ or, ‘Wait until you find the one,'” she said. . “I’ve always ignored it.”
Abortion is still legal in Montana, but it’s unclear whether it will remain. State Attorney General Austin Knudsen, a Republican, asked the Montana Supreme Court to overturn its 1999 decision that the right to privacy in the state constitution includes the right to terminate a pregnancy.
Uncertainty about access to abortion in Montana and other states where abortion may now or may become illegal, and fear of future legal battles over long-term contraception, have apparently spurred an increase in the number of people seeking surgical sterilization, according to reports from doctors there, including Marietti, who is undergoing a salpinectomy. A procedure in which the fallopian tubes are removed rather than tied, such as tubal ligation, which may be reversible.
How many people sought permanent sterilization after miscarriage? Ro That won’t become clear until next year, said Megan Kavanaugh, a researcher at the Guttmacher Institute, which collects data on reproductive health care across the United States and supports abortion rights.
But anecdotal reports indicate that more people are undergoing permanent birth control since the Supreme Court’s June 24 decision. Dobbs v. Jackson Women’s Health OrganizationWhich hits down Ro. Dr. Kavita Arora, who chairs the American College of Obstetricians and Gynecologists’ ethics committee, said providers across the country are starting to see an influx of patients in their operating rooms.
A North Carolina OB-GYN recounts 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 making sure she was the one to make the decisions,” Arora said.
In Montana, Dr. Marilee Simmons, an OB-GYN at Bozeman Health Deaconess Hospital, says more adults in their 20s and 30s without children come to the hospital for sterilization consultations. She said many women who already practice birth control. “They are still worried about an unintended pregnancy and what it could mean in the future,” she said.
Most are asking to have their tubes removed to permanently prevent pregnancy. A small number of people are asking for a hysterectomy, which is the surgical removal of part or all of the uterus. To meet the 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 requesting sterilization, including requests for vasectomy.
But some people seeking sterilization procedures across the United States are being turned away. Arora says some patients who have no children and are in their childbearing years are reporting difficulty finding providers willing to sterilize them.
The reluctance of these providers may stem from studies and data that suggest a risk of regret for patients sterilized at age 30 or younger. Other studies had mixed results and found that some women felt less regret over time, Arora said.
Arora said she makes sure her patients understand the implications of any sterilization procedure, especially irreversible options. He also asks if patients are pressured to ask for the procedure. “I honestly believe my job is not to be a gatekeeper, but to empower and promote those goals and aspirations, especially after good, shared decision-making and informed consent,” he said.
Some patients who have been denied sterilization have returned to therapists like Barbara DeBry, who has a private practice in Helena and writes letters to providers proving patients have thought through their decisions. Other mental health care providers say they are also fielding requests for letters of support, DeBry said.
“It’s not a quick decision for them,” he said, referring to patients who asked for the letter.
Providers’ ethical concerns about future regret are not the only barriers that may cause patients to seek sterilization procedures. Costs and insurance coverage can also be issues.
Helena resident Alex Wright, 23, does not plan to have children and wants to be sterilized. She plans to schedule a consultation to see if her provider will perform the procedure. She said that if her regular provider won’t do it, she will look for someone from an online list of providers willing to perform the procedure on younger people.
“It’s only helpful if I can get financial support to take care of it through those people,” she said, referring to her insurance coverage.
Wright said her insurance company estimates she would pay about $4,000 out-of-pocket if she went with an in-network provider. Using an out-of-network doctor can cost significantly more.
Some, however, are seeking a permanent process in response Dobbs decision, others are doing so because they believe the Supreme Court will uphold reproductive health rules. Kavanaugh, Guttmacher’s researcher, said Justice Clarence Thomas opened that door by suggesting his concurring opinion. Dobbs Other precedents that should be reconsidered, including 1965 Griswold v. Connecticut Decision that says banning contraception violates a married couple’s right to privacy.
“I think we’re anticipating that there’s going to be some attack on contraception,” Kavanaugh said.
Shandel Buckalew of Billings, Montana, who wants a total hysterectomy, is worried. The 31-year-old said her doctor thought she had endometriosis, a painful condition in which tissue that normally grows inside the uterus grows in other parts of the reproductive organs. Buckalew did not undergo the full range of tests that would be required for a diagnosis because he does not have health insurance and cannot 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 will relieve that pain, along with providing permanent birth control because she doesn’t want children. But her lack of health insurance made the procedure unaffordable.
She is trying to get health insurance before her intrauterine device expires in two years because she fears the reproductive health care landscape could change dramatically. He described feeling terrified and angry.
“It seems like my life doesn’t matter,” he said.
This story is part of a partnership that includes Yellowstone Public Radio, NPR and KHN.
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