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Madison Clark did not celebrate when Donald Trump won the 2024 election. But one thought gave her solace: “At least I don’t have to worry about having a baby.”
In September, Clark, a 24-year-old nursing student from Battle Creek, Michigan, underwent a bilateral salpingectomy, a sterilization procedure that removed her fallopian tubes, ensuring she will never get pregnant. Clark considers the procedure her fail-safe against any further rollbacks of reproductive rights that might occur under the new Trump administration.
Clark had always known she didn’t want to have children. “I just don’t personally see myself on that path,” she said. In 2022, when she learned she was pregnant, she got an abortion. But that same year, the supreme court overturned Roe v Wade with its decision in Dobbs v Jackson Women’s Health Organization, leading Clark to seriously consider permanent contraception. She’s not the only one.
A study published this month in the Health Affairs journal found that among young adults aged 19-26, tubal sterilization visits increased 70% after May 2022 – when the Dobbs decision leaked – in states likely to ban abortion. Tubal ligation, known as getting one’s “tubes tied”, involves cutting or blocking the fallopian tubes with clamps. A salpingectomy for permanent birth control, like Clark received, removes both fallopian tubes altogether.
The study also found that vasectomy procedures, a form of male birth control, increased 95% – but were still not as popular as tubal sterilizations. A previous study, published last spring, found the number of tubal ligations among women ages 18 to 30 shot up after Dobbs, at a rate of increase double that of vasectomies.
“Patients are scared of losing access to all kinds of reproductive care,” said Dr Sarah K Horvath, associate professor of obstetrics and gynecology at Penn State College of Medicine. “There are people who had the idea of permanent contraception hovering somewhere on their to-do list, and now they’re pushing it up to number one.”
On TikTok, sterilization content has swelled. In one video liked more than 73,000 times, a creator posted footage of herself driving to an appointment and waiting on a hospital bed, with the caption: “Getting sterilized because y’all couldn’t act right in the voting booth.” One popular TikTok doctor shared a “how to” video about tubal sterilization a week after Trump’s inauguration. “I go on Thursday to get this procedure done,” a user wrote in the comments. “I was so worried the current administration would prevent this option so we got it scheduled Asap.”
Krysten Stein, an assistant professor at the University of Cincinnati Blue Ash College who studies doctor influencers on TikTok, said that conversations on social media about sterilization reflect gen Z’s current political anxieties.
“We have this rapidly changing landscape around reproductive health, and seeking information about it or posting on social media feels like a way to take back control,” Stein said. “It feels empowering to claim authority and to normalize these life choices.”
In some states – including Michigan, where Clark lives – voters have enshrined abortion protections in state constitutions, and according to a recent Gallup poll, a majority (54%) of Americans consider themselves “pro-choice”. That has not stopped Trump from cozying up to an invigorated anti-abortion movement. His first week in office saw him pardon activists who illegally blockaded the entrances to reproductive health clinics, limit funding for overseas groups that provide or advocate for abortions, and sign an executive order declaring gender begins “at conception”, a tenet of the “fetal personhood” doctrine.
Robert F Kennedy Jr, Trump’s nominee for secretary of health and human services, said at his confirmation hearing on Thursday that he believed that “every abortion is a tragedy.”
Trump indicated that he was also open to regulating contraception last May – though the president later posted on Truth Social that he “WILL NEVER ADVOCATE IMPOSING RESTRICTIONS ON BIRTH CONTROL”. This month, the supreme court, stacked with anti-abortion justices, agreed to hear a case that threatens the Affordable Care Act’s coverage of preventative care such as birth control and pre-exposure prophylaxis for HIV (PrEP).
“The news cycle was a huge, huge reason that I took sterilization seriously and decided to spring into action,” Clark said. “Now, it’s a common conversation between my boyfriend and me: ‘God, at least we don’t have to worry about having to travel to get an abortion, or having to leave the country for one, or even being forced to carry a child, which is the most scary option in all of this.’”
Nineteen states currently restrict abortion access, with bans for nearly all circumstances present in a dozen states. Even though Julia Wolf, 29, lives in Pennsylvania, a state with abortion access, the fall of Roe planted the idea of sterilization in her mind. Like Clark, Wolf always knew she didn’t want children. After she learned that the US has the highest maternal mortality rate among high-income countries, even the thought of becoming pregnant frightened her.
“Whether you agree with a woman’s right to choose or not, it’s naive to think that other things aren’t on the line, like contraceptives or sterilization,” said Wolf, who works in social media.
After the 2024 election results rolled in, Wolf scheduled her bilateral salpingectomy procedure as soon as she could – the first Monday in December. Her gynecologist told her that she performed three other sterilization procedures for women that same week.
“I don’t worry that I am going to regret this,” Wolf said. “I’m 100% confident in this decision, and I’m just really glad I did it, especially because everything’s moving so fast since Trump’s been president.”
This month, the congressman Andy Biggs of Arizona introduced a House resolution aiming to set a new standard for women’s healthcare that “should also address the needs of men, families and communities as they relate to women’s healthcare”. The line scared Wolf.
“I just know for a fact that women will never have any input on men’s health, and so for it to be the other way around is just crazy,” she said.
‘I’d change doctors, get denied again’
Not every person who wants a sterilization will receive one – or else they might find the process to get one needlessly arduous.
Some doctors are hesitant to sterilize women under the age of 30, especially if they are unmarried or do not already have children. Though studies show that most women do not regret getting permanent contraception, those who do tend to be between the ages of 21 and 30 at the time of their procedure. (Sterilization is the most common form of contraception for married couples, with 700,000 performed on women annually, half of which are performed postpartum.)
The United States has an ugly history of forced sterilizations. In the 20th century, they were performed under eugenics programs aimed at controlling “undesirable” populations such as minorities, poor people, unmarried women or the mentally ill. Today, people on Medicaid are legally required to wait 30 days after signing a consent form to be sterilized – in theory, to prevent vulnerable people from being manipulated into undergoing forced sterilization as they were in the past. But activists say this practice is outdated and unfair. For one, there is no such restriction for people on private insurance. Thirty-day waiting periods also recall delaying tactics used in red states to limit abortion access.
The American College of Obstetricians and Gynecologists (ACOG) says doctors should advise patients about “reversible alternatives” such as vasectomy or other forms of birth control, and emphasize the permanence of tubal ligation or salpingectomy. But the ACOG also notes that doctors should “avoid paternalism” and “not [impose] thresholds based on age or parity or both for permanent contraception”.
“Respect for an individual patient’s reproductive autonomy should be the primary concern guiding permanent contraception provision and policy,” the ACOG says.
In her own practice, Horvath, the OB-GYN, doesn’t care so much why a person wants the procedure. She just wants them to be sure they’re making the best decision. “There are 18 different contraceptive methods, and no one is perfect,” Horvath said. “I ask that people think through all of the choices. If they’re just really worried about getting through the next four years, have they thought about an IUD? That might leave the door open for you, if permanent sterilization doesn’t feel like the right thing yet, or if you feel like you’re really just having this reaction out of fear.”
Some young people say they’ve been turned away from the procedure for sexist reasons. Kasey Peterson, a 25-year-old property manager who lives in Oceanside, California, remembers playing with Barbies as a child and hearing her father say: “You’re going to make a really great mother one day.”
“I distinctly remember looking at him and going, ‘Oh, I don’t want kids,’” Peterson said. As soon as she became a legal adult, she asked for a sterilization at every annual check-up. “Every single doctor said, ‘You’re too young,’ or laughed it off. I’d change doctors, get denied again, change doctors, get denied again.”
The doctors’ reasoning for delaying the procedure seemed straight out of the 1950s: her “future husband” might want children; she wasn’t mature enough to make a permanent decision. They said to come back in a couple of years, and then maybe they’d talk.
“The overall tone was that I didn’t know what I wanted as an individual,” Peterson said. “It was irritating. They were basically telling me that if I was pregnant right now, they would want me to keep the pregnancy, that I was emotionally mature enough for that, but I wasn’t emotionally mature enough to decide that I don’t want children.”
Peterson’s partner considered getting a vasectomy, which his doctors were more than happy to perform. “But I decided I would rather do it for myself, for insurance reasons, but also because if I were to get assaulted by someone else, his vasectomy wouldn’t cover that.”
Young people navigating the serpentine process of finding OB-GYNs willing to perform sterilizations come together in forums on Facebook and Reddit, where they vent their frustrations, cheer each other on and share a Google doc of vetted doctors. Peterson eventually found her doctor through that list, and she now serves as an administrator for the Childfree and Sterile/Seeking Sterilization Facebook group.
“When Roe v Wade was overturned, and when Trump got elected, our group got absolutely flooded,” Peterson said. “It’s great that people are finding a community and a resource, but I hate how it happened. People are worried about protecting themselves in the future.”
