Female Permanent Contraception in the Military Health System After the Dobbs v. Jackson Women's Health Organization Decision

OBJECTIVE: To evaluate female permanent contraception procedure rates in the Military Health System before and after the Dobbs v. Jackson Women's Health Organization decision.

METHODS: We performed a repeated monthly cross-sectional study of female permanent contraception encounters using the Military Health System data repository. We used International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis and procedure codes and Current Procedural Terminology codes to identify incident encounters in beneficiaries aged 21-49 years from January 2018 to February 2023. We performed change-point and trend analyses and Poisson regression to evaluate differences by age, marital status, active-duty status, military rank, service branch, and state abortion restriction level (protective, moderate, and restrictive), and we performed a subanalysis of race and ethnicity in active duty.

RESULTS: Monthly encounter rates averaged 64 per 100,000 and peaked at 78 per 100,000 in August 2022, 2 months after Dobbs. Rates increased 6.9% (adjusted rate ratio [RR] 1.07 [95% CI, 1.04-1.10]) after Dobbs with greatest increases in those aged 21-24 years (adjusted RR 1.34 [95% CI, 1.22-1.47]), nonmarried individuals (adjusted RR 1.39 [95% CI, 1.26-1.53]), and individuals with junior enlisted rank (adjusted RR 1.16 [95% CI, 1.08-1.23]). Adjusted median monthly encounter rates were lower in non-Hispanic Black and Hispanic active-duty service members compared with non-Hispanic White active-duty service members after Dobbs (adjusted RR 0.68 [95% CI, 0.58-0.80] and adjusted RR 0.83 [95% CI, 0.70-0.98], respectively). Rates were significantly higher after Dobbs in non-Hispanic White and Hispanic race active-duty service members (adjusted RR 1.41 [95% CI, 1.29-1.55] and adjusted RR 1.22 [95% CI, 1.05-1.42], respectively) but not in non-Hispanic Black active-duty service members. Procedure rates were 29.3% higher in restrictive states after Dobbs compared with protective states (adjusted RR 1.29 [95% CI, 1.20-1.39]). Median encounter rates were highest in restrictive states before and after Dobbs (70/100,000 and 80/100,000, respectively).

CONCLUSION: Female permanent contraception encounter rates spiked in the Military Health System after Dobbs, with the greatest effect in those who were young, nonmarried, and on active duty and those in restrictive states. Differences in encounter rates by race in active duty may suggest inequities in care delivery. Abortion policies are affecting permanent contraception decision making in the Military Health System.