Permanent sterilization or contraception as a family planning method

Sterilization or permanent contraception is the most commonly used family planning in the United States. There are two main methods of sterilization: Tubal ligations and vasectomies. Both are safe and almost 100% effective to prevent pregnancy. The requirement of contraceptive coverage of the Act respecting affordable care (ACA) applies to sterilization procedures for women, but not for men. Some states, however, have adopted laws that require male procedures to be covered by state -regulated insurance schemes. However, permanent contraception services are not available in all health care establishments due to policies followed by confessional health providers who have religious objections to procedures. This information sheet explains the types of permanent contraception or permanent sterilization procedures, examines the private insurance and the coverage policy of Medicaid and discuss questions that affect availability in the United States

Types of sterilization

Tubal ligature

The tubal ligature is an ambulatory surgical procedure carried out on people with female reproductive organs in which the fallopian tubes are removed or blocked to prevent eggs from moving towards the uterus and sperm of fertilizing eggs. Data from the KFF 2024 women’s health survey show that a woman in four aged 18 to 64 declares that she had sterilization procedure. Smart shares of women aged 50 and over, women with lower income and women with Medicaid have had a sterilization procedure (Figure 1).

There are two main methods of surgical tubal ligature: mini-laparotomy (or laparoscopic mini-sterilization (laparoscopic sterilization (Table 1). The minilap can be carried out immediately after childbirth, just after childbirth, while the laparoscopic procedure cannot. Tubaire’s ligature procedures come into force immediately and have a failure rate of less than 1% during the first year after surgery. After 10 years, the failure rate can increase by 18 to 37 pregnancies out of 1,000 women depending on the closure of the fallopian tubes. Complications are rare, but they may include bleeding, infections and an extra-uterine pregnancy. Although the procedure can sometimes be reversed, the process is expensive, invasive, generally not covered by insurance and is not guaranteed to work. Sterilization does not protect against sexually transmitted infections (IST).

Vasectomies

Vasectomy is an ambulatory procedure carried out on people with male reproductive organs and is generally done under local anesthesia. In the traditional procedure, a doctor cut, cut and link or cauterize the vas vas. There is also a more recent “non-scale” technique which is less invasive, reducing complications and recovery time (Table 1). Despite a lower frequency of use compared to tubal ligations, vasectomies are safer, cheaper and even more effective. Only one in 10,000 women will fall pregnant using this contraceptive method; However, vasectomies are not effective immediately. It can take two to four months for sperm to be reabsorbed or ejaculated, so another form of contraception must be used to prevent pregnancy. Vasectomies do not protect against the STIs either.

The KFF 2024 women’s health survey revealed that a man in ten (11%) aged 18 to 64 said he had undergone sterilization procedure. The part that has been sterilized is higher in white men, men with higher income and men with private insurance (Figure 1).

Insurance coverage

Sterilization is a very profitable method of contraception. Although it can have high initial costs, it generally does not require long -term follow -up care and can therefore be cheaper in the long term than other methods. Depending on the location, insurance and type of procedure, tubal ligature ligature procedures can vary from $ 0 $ 6,000 to $ 6,000, while vasectomy can cost between $ 0 and $ 1,000.

Private law on insurance and affordable care

The ACA requires that private health insurance plans cover at least one form of the 18 contraceptive methods approved by the FDA for women undivided costs, which means that tubal ligature procedures should be entirely covered by most private health insurance diets. This federal policy does not include vasectomies; However, nine states – California, Illinois, Maryland, New Jersey, New Mexico, New York, Oregon, Vermont and Washington – have rebalanced private health insurance plans to cover vasectomies at no additional cost for the patient (Figure 2). State-regulated services requirements do not apply to self-insured employers’ plans, which covered 63% of workers covered in 2024.

Medicaid

Medicaid, the national health coverage program for low -income persons, is funded and used jointly by federal governments and states. Under Medicaid, it is compulsory for states to cover family planning, including sterilization procedures for women. Vasectomies should not be covered by the federal government by one of the Medicaid roads, but an investigation by the state of KFF revealed that most of the states report that they cover the procedure.

Regulations prohibit federal funds from being used for sterilization procedures on women under the age of 21. They also require patients to sign an informed consent form at least 30 days before the procedure, with a few exceptions. In the event of premature delivery, consent must have been obtained at least 30 days before the due date. However, if premature delivery or emergency abdominal surgery occurs in the 30 -day waiting period, the doctor must certify that consent has been obtained at least 72 hours after the date of the patient’s signed consent form. This provision has been implemented to protect themselves against coercive practices and abuses which were historically directed to low -income women, disabled women, women of color and incarcerated women. However, some defenders suggest that this requirement exercises a burden on publicly insured women looking for sterilization services that women with private insurance are not confronted.

Uninsured

Some states have extended access to family planning services to populations not guaranteed through the family planning extension program of Medicaid which provides Medicaid coverage only for family planning services to women and men who are not eligible for complete social benefits of Medicaid. These programs are available in 32 states in January 2025, and most report that they cover the ligations and tubal vasectomies.

Although most of the public sterilization funds come from Medicaid, a share is provided by the Federal Family Planning Program of Title X and subsidies of maternal and infant health and social services. Changes in federal funding for clinics providing family planning programs can hinder access to sterilization services for those relying on these health coverage programs.

Religious providers

Currently, federal and state laws allow providers of religious objections to refuse patient sterilization services. Church amendments prohibit the federal government to demand that supplier help abortion or sterilization services if it violates the supplier’s religious beliefs. In 2023, 19 states have laws that allow certain health care providers to refuse to provide sterilization services for religious reasons (Figure 3). In the fields with a limited choice of health care providers, refusal policies could limit the availability of sterilization services.

Another challenge for the availability of sterilization services is the growing number of active care hospitals that are affiliated with the Catholic Church. These hospitals generally adhere to the religious restrictions required by the American conference of Catholic bishops, which prohibit the use of sterilization. These directives also prohibit references for contraception, abortion and sterilization services. In 2020, 7 of the 25 largest national health systems are affiliated with Catholics. It is to be feared that the growing domination of Catholic hospitals in certain regions could limit access to tubal ligations and post-delivery sterilization procedures. The absence of a postpartum sterilization option could make a particular challenge for women in communities where the only hospital available to them is part of a Catholic health system (Figure 4). Hospitals affiliated with Catholics receive a share of their income from public sources, such as Medicaid and Medicare, and serve various populations which may not be aware of the limits set for their care, nor follow the religious principles of the hospital.

Impact of Dobbs Decision

The landscape of reproduction health in the United States has changed considerably since the decision of the Supreme Court to overthrow Roe c. Wade In Dobbs c. Jackson Women’s Health Organization In 2022 and contraceptive choices also changed in response to the decision. A KFF survey revealed that in 2023, four out of ten Obgyn (43%) reported an increase in the number of patients who have requested sterilization since Dobbs. A little more than half (51%) of Obgyn in states with abortion prohibitions or restrictions declared the same thing, against 36% of Obgyn in states where abortion is legal. Research suggests that the demography of individuals looking for sterilization may have changed since the Dobbs Decision, although it is important to note that research is limited and that long -term trends continue to be studied. Although sterilization is the most frequent in individuals over 35 years old, a limited number of studies have revealed that the number of sterilization procedures carried out in adults under 35 years old increased afterDobbs. In addition to being younger, similar research has revealed that a higher share of men who have undergone vasectomies or sought after consultations since Dobbs have been childless and single.