How the Dobbs Decision Shapes Postpartum Permanent Contraception Decision-Making Among Birthing People and Their OB-GYNs.

The Supreme Court's Dobbs decision in June 2022, which overturned the federal protection of abortion, has been associated with increases in patient requests for female permanent contraception (i.e., tubal ligation, salpingectomy). Our objective is to understand perspectives of postpartum patients and their delivering obstetrician-gynecologists on the impact of Dobbs on patient decision-making surrounding permanent contraception. From March 2022 to January 2023, we interviewed postpartum women with a documented desire for permanent contraception (n = 81) and their delivering obstetrician-gynecologist (n = 67) at four hospitals in the United States. Participants included in this analysis were interviewed after the Dobbs decision was released in June 2022 and commented on the impact of Dobbs on the patient's decision to request permanent contraception. We used rapid qualitative analysis to create initial key themes and subthemes related to discussions of Dobbs, which were further refined using thematic analysis. Twenty-three patients and 15 clinicians commented on the impact of Dobbs on permanent contraception decision-making. Several clinicians described an increase in permanent contraception demand, especially by young patients. Some patients said the ruling influenced their decision to get permanent contraception. Several patients suggested feelings of threat against reproductive autonomy and asserted that women should be able to make their own reproductive health decisions. Some clinicians reported a renewed dedication of the clinical community to meet reproductive health needs, including permanent contraception fulfillment. Several patients and clinicians indicated that the impact of Dobbs on permanent contraception decision-making was dependent on the level of abortion protection in their state. Clinicians should be aware that abortion restrictions from Dobbs may impact patient decision-making surrounding postpartum permanent contraception. In the presence of abortion restrictions, clinicians should help ensure patients have accurate information about their contraceptive options to support their reproductive autonomy.