A month before the Supreme Court officially overturned Roe v. Wade, millions of women knew the landmark decision establishing the right to an abortion was at risk. Tillie Hall, a 29-year-old from Kansas, was one of them.
The grim foreshadowing came in the form of a leaked draft opinion authored by Justice Samuel Alito, which detailed how the hard-right majority of the nation’s highest court was intent on demolishing the 1973 ruling that identified a right to privacy in the Constitution.
“I was in shock after I saw the draft opinion,” Hall told The Daily Beast on Wednesday. “People still said it wouldn’t go through and not to worry, but it’s very important to me to be in charge of my reproductive health, and I knew I wanted to be childfree.”
Just hours after the May leak, Hall said, she set up a consultation to get a bilateral salpingectomy—where her doctor will remove both fallopian tubes—before, she feared, it might be too late.
“The thought of a forced pregnancy is a nightmare to me, so getting a sterilization scheduled was imperative,” Hall added.
On Friday, many Americans’ worst fears were realized by way of Dobbs v. Jackson Women’s Health Organization, imperiling access to abortion for roughly 40 million women and girls in nearly two-dozen states. Now Hall is just one of scores of women who have begun the process of seeking permanent sterilization as reproductive rights face new danger, according to interviews with providers and patients in several states this week.
“It felt impossible, even though I had known it was most likely coming. I felt sick to my stomach, weak, and shaky,” Hall said about the moment the ruling came down. “Waking up Saturday with less freedom than I had the day before was very heavy and reinforced my determination to do everything I can to advocate for women’s rights.”
Unlike in the 13 states that immediately moved to impose severe restrictions or even ban abortion altogether via “trigger laws,” reproductive freedom is still up in the air in Kansas. In August, the state will hold a referendum on a constitutional amendment that could eliminate abortion productions previously established by the state’s Supreme Court.
As the first statewide anti-abortion measure to go before voters after Dobbs, the amendment may pave the way for the Republican-controlled state legislature to pass further regulations and possibly a total abortion ban.
Hall noted that even though she did find a “supportive” doctor in Kansas, she ended up moving to North Carolina, where she set up another consultation at a women’s clinic. On Wednesday, Hall had an appointment for her sterilization procedure “and the doctor emphasized it was my choice and supported me.”
While sterilization is not expected to be impacted by most abortion bans, North Carolina represents a relative oasis of abortion rights in the South.
“I was extremely grateful that he didn’t make me defend my decision or jump through hoops like I’ve heard others seeking sterilization have had to do,” she said, noting that in three weeks she will have surgery for a bilateral salpingectomy.
“I am so relieved to get it done and out of the way, in case our access to birth-control methods are further removed,” she added.
Women in other states already facing extreme abortion restrictions since Friday are also seeking sterilization as the right to choose dwindles, local doctors said.
One of those states is Texas, which already had a six week cut-off for abortion even before Dobbs. Next, a more total abortion ban will go into effect in about a month, identifying life as beginning at fertilization—with vague exceptions for life-saving abortions or those that might result in “substantial impairment of major bodily function.”
Dr. Nancy Binford, an OB-GYN in Austin, Texas, told The Daily Beast that since Friday, she had received three requests from women in their 20s asking for tubal ligations, in which a physician cuts, ties, or blocks the fallopian tubes to permanently prevent pregnancy. (This is generally referring to as getting your “tubes tied.”) She said that to put that number into perspective, over the last 20 years she has been in practice, she normally receives about one request a year for the sterilization procedure from a person in that age group.
“These are women who never wanted to have children and because of the state of the world, they want to get their tubes tied,” Binford, who is also a member of Texas Association of Obstetricians and Gynecologists, explained. “It’s chilling to think that what the SCOTUS ruling is doing is pushing women toward sterilization.”
Binford insisted that she will not be performing a tubal ligation for a 20-year-old “requesting it out of fear right now,” because they may regret it later. That said, she is “putting in IUDs left and right.”
“The world is burning right now, and looks like The Handmaid’s Tale,” she added. “And I think even seeing these requests for tubal ligations from women so young proves how scared they are about their freedom.”
Dr. Tyler Handcock, another OB-GYN in Austin, told The Daily Beast on Tuesday that the Women’s Health Domain, his clinic, had received over 130 new patient requests in the last 96 hours from women seeking permanent sterilization.
The requests represent a stark increase, he noted, since the normal number of consultations for tubal ligations at the facility was about one or two a week. On the Women's Health Domain website, the clinic even issued a warning that inquiries for appointments including sterilization procedures and services had increased by nearly 1,000 percent since Friday.
In Kentucky, another state with a “trigger law” that went into effect Friday morning and bans abortion except as a life-saving measure, at least one provider was also seeing an increase in tubal ligation requests. A Louisville OB-GYN who requested anonymity for fear of retaliation told The Daily Beast her office had received over 50 such requests for consultations since Friday. She, too, cautioned that women should be seeking the permanent procedure because of a desire never to procreate—and not as a reaction to Dobbs.
Even before the country saw abortion rights upended, healthcare providers like Dr. Franziska Hasselhof had been informing women of all their healthcare rights—including, as Hasselhof has been discussing on her TikTok over the last month, tubal ligation.
In a series of videos to the 148,000 followers, the Ohio OB-GYN has been answering questions about how to get the procedure, and which physicians in every state are providing the service. Inundated by requests from women seeking recommendations for doctors willing to perform tubal libations, Hasselhof told The Daily Beast, she decided to “make a google document where all the information could live in one place.”
Since she made the document, Hasselhof said, she has included 650 gynecologists who have been recommended to her as reliable healthcare providers for tubal ligation.
“It’s been incredible to see the amount of women who have interest in getting their tubes tied,” Hasselhof said. “My goal is just to continue keeping it updated and have it be a resource for people who may be more willing to help these women. I am just trying to eliminate some hurdles for women to provide resources.
Hasselhof, who said she had seen an influx of requests at her own practice over the last month, cautioned that she had not necessarily seen an uptick in tubal requests since the Friday ruling. But she also noted that she was booking weeks in advance, so she was not sure yet if patients might soon turn up who were inspired by the end of Roe.
The doctor stressed that the abortion ban and a woman’s desire for a tubal ligation should be “two separate discussions”—and that women should not rush to get the permanent procedure just because they might lose their right to choose in any given state.
“Both are very important components of healthcare. Full sterilization is not supposed to negate the need for abortion,” Hasselhof stressed. “Of course, I am devastated by the decision that has been made in the Supreme Court last week, but patients shouldn’t be seeking to get their tubes tied as a reaction to not getting [or being able to get] an abortion.”
For some women, Friday’s ruling served as a final nudge for a long-held goal.
Emily Back, who has known for years she did not want to be a mother, said the decision to finally take the plunge and learn the logistics behind tubal ligation came after Dobbs. This even though she lives in a decidedly pro-choice state in New York.
The 29-year-old told The Daily Beast that she first asked about the process of sterilization at her annual gynecological appointment last fall—but was quickly shot down by her doctor who insisted the procedure was for women between the ages of 30 and 35. “When I answered that I would make the appointment next year, my doctor told me that I was too young again. She asked me, ‘What if I regret it?’ Honestly, I would probably regret having kids more than not having time,” she said.
Back added that hours after Dobbs, she had reached out to her insurance company to see if sterilization was covered under her plan. Now, she said, she was set to gift herself a different type of 30th birthday present: a consultation to get permanently sterilized in August.
“Happy birthday to me!” Back said on Tuesday, “I will have to wait after my consultation to get the procedure…. But the Roe decision definitely helped me make the final step to get the ball rolling.”