Brittanei Martinez, 26, has known for a while she doesn’t want to have kids.
“I had always thought that I just wasn't really like the motherly type,” she said. “I was never really around kids growing up, and so I never really saw myself ever being pregnant and having children.”
Getting her tubes tied had long been in the back of her mind, but she wanted to wait until she was certain. She met her now husband in 2015 and got pregnant in 2019. But at the time, she said, she felt her life wasn't stable. And at the end of the day, the two just didn’t feel ready to have a child.
“The cons outweighed the pros for me personally, and for him, so we decided to go through with having an abortion,” she said.
After that experience, the Pflugerville couple felt sure having kids just wasn’t for them.
“We both decided that I think we’re just better off not having kids and just kind of enjoying life as it is,” Brittanei said.
In 2019, abortion was legal in Texas, and Brittanei was able to get one. Fast forward three years, and the procedure is no longer an option in the state for her or millions of other Texans. Shortly after the U.S. Supreme Court overturned Roe v. Wade this summer, Texas’ so-called “trigger law” went into effect, banning all abortions, except in cases where the pregnant person's life is at risk.
When Brittanei heard the news that Roe was overturned, she was scared. She texted her husband.
“We were immediately in communication about, ‘OK, what’s our game plan next?” she said. “‘What are we going to do to protect ourselves, to prevent us from having an unwanted pregnancy?’”
The couple decided it was time to kickstart the process of getting sterilized. Brittanei went on Reddit, where she found a page dedicated to people who are childfree. The page had a list of doctors across the country who perform sterilization procedures on people who don’t have children.
She called one of the doctors listed in Austin and was able to schedule a consultation for the following week. During the telehealth visit, the doctor explained her options. In the end, Brittanei decided to get a bilateral salpingectomy, a procedure that removes both fallopian tubes. People who get this surgery can no longer get pregnant naturally, though in vitro fertilization, or IVF, is still an option.
Her husband, A Martinez, 28, also got a procedure. He saw a urologist in Austin to get a vasectomy just days after the Supreme Court's decision.
“I made the decision for my body just like she did it for hers,” he said. “You know, it takes two. So now neither one of us can do it.”
A surge in requests
The Martinezes are just two of many Central Texans choosing permanent forms of birth control in the wake of the state’s ban on abortion. Local doctor's offices have seen a flurry of requests for salpingectomies and vasectomies since June.
The Supreme Court's ruling came out on a Friday, and when Dr. Amy Chapman came into work at Women’s Health Domain in North Austin the following Monday, her practice had more than 250 new requests for sterilizations.
“Ordinarily, we would have five, six or seven on a weekly basis,” she said.
To meet the demand, Chapman and the other co-owner of the practice offered group information sessions on two weekends where patients could learn about their options and schedule an appointment.
“We were just fitting those surgeries in wherever we could,” Chapman said. “We were doing cases early in the morning before we started clinic, over lunch, in the afternoon after clinic, just trying to get these women taken care of.”
The number of patients coming in for a sterilization procedure has stabilized since then, but Chapman says they’re still seeing about 30% to 40% more requests than before. She said the majority of patients coming in were already on some type of birth control, but they knew those methods could fail — something they more urgently wanted to avoid without abortion as a feasible backup plan.
“We all know that no contraception is 100% effective,” Chapman said. “So they just wanted to take that out of the equation. They just did not want an unplanned pregnancy because there were fewer options for them.”
Women have a few main options for permanent birth control procedures, including a salpingectomy or tubal ligation. The latter is often referred to as “getting your tubes tied” as it involves cutting, tying or blocking the fallopian tubes to prevent pregnancy. Chapman said nowadays salpingectomies are the preferred method because they have an added benefit: Studies have shown the procedure may reduce the risk of ovarian cancer. The procedure, though, can't be reversed.
Chapman says some patients request a tubal ligation because they think they might want to reverse the procedure later in life. While reversals are possible with a tubal ligation, they aren’t guaranteed to work.
“We would definitely counsel that patient that, if reversing sterilization is something that they're thinking about, they probably shouldn't have sterilization in the first place,” Chapman said. “We have other types of long-acting contraception that work very well.”
The same goes for sterilization procedures for male anatomy. A vasectomy involves cutting and sealing the small tubes that carry sperm. While vasectomies can be reversed, doctors, such as Dr. Koushik Shaw of Austin Urology Institute, don’t recommend people view them this way. The success rate of a reversal is not 100%, and in some cases sperm may not return to their original levels. The reversal is also more expensive and more invasive than the original procedure.
“What I tell people is it is reversible, but treat this as permanent,” he said. “Be pretty darn sure that our long-term goal is to not have children and we're done.”
If it’s right for you, though, the procedure is one of the most effective routes to contraception, Shaw said. It’s also less invasive than female sterilization.
Shaw said his practice had to increase availability for appointments by about 50% on a weekly basis after the draft decision reversing Roe was leaked in May. While typically the practice did the operations only on Fridays, it had to open a second day to handle the influx of requests.
“I think people, you know, take birth control a little bit for granted, or it happens in the background and we don't think about it so much,” Shaw said. “And what's happened is all of a sudden — the news, the legislation, the Supreme Court decision — this got put to the forefront of people's minds. … It's made people rethink things.”
Typically, the most common type of patient Shaw’s practice sees are fathers who have two or three children and don’t want anymore. But the recent spike in requests were coming from people who just don't see children as part of their life plan.
That was the case for Cody Tidmore, 33, a single Austinite who says he’s never felt called to be a parent. When Roe was overturned, he decided to get a vasectomy. He saw the procedure as a way to keep potential partners safe. And knowing the burden of birth control has historically fallen on women, he said he wanted to do his part to prevent unwanted pregnancies.
“Once it got overturned, it was just like, well, OK, we’re not really going to just expect women to bear the brunt of the responsibility for this, are we?” he said. “There’s definitely things that I can be doing that don’t mess with my hormones or aren't incredibly painful like an IUD.”
He said the procedure was simple and recovery didn’t take long.
“It's really easy breezy,” he said. “It's really not bad at all.”
Preventing high-risk pregnancy
Even before Roe v. Wade was overturned, triggering a nearly automatic ban in Texas, abortion was out of reach for most Texans. Senate Bill 8, which went into effect in September 2021, made abortions illegal after cardiac activity is detected. That’s usually around about six weeks of pregnancy, which is before most women know they are pregnant. Often described as the “bounty law,” it enables private citizens to sue anyone who performs or “aids or abets” these abortions. It was that initial ban that led Austin resident Jonathan Ortiz to get a vasectomy earlier this year.
He and his wife, Katherine, always knew they wanted to have kids, and today, they have two young girls. But their journey with pregnancy wasn’t easy. Katherine endured a miscarriage the first time they got pregnant. And the second time, in 2018, she had a subchorionic hemorrhage, which led to bleeding episodes.
“You always have these pictures of like your pregnancy is going to be this magical time where you're nesting and just in love and happily awaiting this baby to be born,” Jonathan said. “And it was nothing like that. It was just honestly terror.”
“You always have these pictures of like your pregnancy is going to be this magical time where you're nesting and just in love and happily awaiting this baby to be born. And it was nothing like that. It was just honestly terror.” Jonathan Ortiz
About 21 weeks into the pregnancy, during one of the bleeding episodes, the couple went into the hospital. Katherine had started having contractions, but it was too early for the baby to be born. The doctors tried to slow things down, so the fetus could keep developing. Then things got worse. Katherine developed an infection and spiked a fever. A doctor told them if they didn’t terminate the pregnancy, Katherine would probably die.
“We did make the decision to proceed with essentially what is an abortion and to essentially get my wife the care that she needs,” Jonathan said, “and that would mean terminating the pregnancy and losing the baby.”
But the decision ended up becoming irrelevant. Moments later, the baby came out on its own, stillborn.
“That was really probably the worst I've ever felt in my life,” Jonathan said.
Katherine was later able to give birth to two daughters, after having surgery that removed a septum from her uterus — an abnormality that was believed to have contributed to some of the problems. But still, those pregnancies were considered high-risk and required additional oversight by specialists.
When Texas’ six-week abortion ban went into effect, the couple began talking about Jonathan getting a vasectomy. He mentioned it offhandedly at first — but then they started to seriously consider it. They already had two kids. They also knew pregnancy can get more difficult with age and that Katherine already had risk factors that made pregnancy more dangerous for her. At the end of the day, they never wanted to be in a situation again in which it came down to the life of the mother or the unborn child — because now it wasn’t clear to them if they’d even be given that choice.
While SB 8 carves out an exception for abortions for a medical emergency, the language is vague and left up to doctors to determine. The same is true for Texas’ trigger law. Jonathan said he’d heard too many horror stories of doctors waiting to perform abortions until the mothers were really sick, to avoid overstepping the law. He was worried about what would happen if the situation they were in in 2018 happened again.
“We probably would have needed to wait for a stronger signal that my wife was deteriorating before they took action,” he said. “That language is vague and not very helpful because I think what it's causing medical teams and legal teams at hospitals to do is to wait too long.”
Jonathan got a vasectomy in March. Months later, bans on abortion became even more restrictive. Looking back, he says he feels he made the right decision.
“To be in a much safer place physically so that we don't have to worry about a potential pregnancy leading us to potentially dangerous complications down the road,” he said, “and just being in a position where we can enjoy life without having something like that weighing on us is really tremendous.”
Barriers to access
While many people like Jonathan and the Martinezes were able to afford and access sterilization procedures, that’s not the case for everyone.
The cost of a sterilization procedure depends on a person’s insurance plan. Shaw said most insurance plans will cover a vasectomy to varying degrees, and it's fairly affordable.
Salpingectomies are more expensive, as they require an operating room and general anesthesia, and can cost patients hundreds of dollars or thousands of dollars.
“Depending on deductibles and such, it can be very uncostly or very costly,” Chapman said.
Brittanei Martinez said the procedure was “super cheap” with her insurance, but for Austin resident Arlene Cornejo, 34, that wasn't the case. She’s worked in the reproductive health field for the last 16 years and currently does community outreach for the city. When she woke up to the news that Roe was overturned, her mind went to the worst-case scenarios. Cornejo DJs at night, which means she’s often leaving bars at 2 a.m.
"I’ve had women who bring their fathers with them in case I need their father to sign [off on sterilization]. I’ve had patients who bring their husbands or significant others in case I need their husbands to sign. It’s ridiculous" Dr. Amy Chapman, an OB-GYN at Women’s Health Domain in North Austin
“My mind immediately went to kind of the grimmest idea of, gosh, if I am raped leaving a club one night or walking to my car … I would have to carry the rapist’s child,” she said. Texas’ abortion bans do not make an exception for rape. “I would have to have this everyday reminder of the most horrific moments of my life and have no control over the changing of my own body.”
She decided to look into getting her tubes removed. On Reddit, she came across a post recommending Women’s Health Domain, so she called, and the office, flooded with similar requests, invited her to one of its Saturday information sessions. She went and was able to schedule an appointment for two weeks later.
She thought her insurance would cover the cost, but she later learned she’d still be responsible for paying nearly $3,000, which she couldn’t afford.
“I unfortunately had to cancel the appointment,” she said. “I was really, really upset about that.”
Cost isn’t the only barrier to accessing female sterilization procedures. Finding a doctor who will perform the procedure on young women or women without any children can be a challenge. Chapman, of Women’s Health Domain, said she’s heard story after story from patients who have been refused by doctors because they’re told they’re too young or they’re not married or that their future husband may want a child and they might change their minds.
“I’ve had women who bring their fathers with them in case I need their father to sign,” she said. “I’ve had patients who bring their husbands or significant others in case I need their husbands to sign. It’s ridiculous.”
At her practice, Chapman said she sees women of all backgrounds. The only requirement is that they be at least 21 years old.
“It doesn’t matter if they’ve had a child before or not,” she said. “If they tell us that they can understand our counseling and they know this is permanent and this is the decision that they want, then we’re willing to do that for them.”
Birth control’s precarious status
Back in Pflugerville, Brittanei says she feels fortunate she and her husband were able to get their procedures done. Now, they can continue their lives without the fear of an accidental pregnancy. That means more time to focus on their jobs, each other and their two dogs, Maverick and Oliver. They feel they can always adopt or foster if they change their minds about kids. Or just get more dogs.
“Definitely some more dogs,” Brittanei said, “some more vacations, and just generally genuinely trying to enjoy life for what it is and what we have now, because we don't know what the future is going to be like, especially in the political environment.”
Having her tubes removed also means she doesn’t have to rely on other types of birth control anymore, which she fears might come under fire next. Some legal experts have expressed concern that the Supreme Court decision could open the door to limiting access to contraceptives.
The fear of having birth control "taken away just enhanced my want to be sterilized,” Brittanei said.
She, like many women, had also struggled to find a contraceptive that worked for her. Her IUD was painful, and hormones affected her moods. But, she doesn’t have to worry about that anymore.
“It seems like I'm a little bit happier and am willing to do a little bit more things, so I think that's definitely a plus,” she said. “I definitely feel a lot better than I did before I got the procedure done.”
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