How Missouri doctors are meeting a post-Roe demand for vasectomies

ST. LOUIS — Aaron Willison had been thinking about getting a vasectomy done for over a decade. But after the Supreme Court overturned Roe v. Wade last year, reversing nearly 50 years of abortion rights, he knew he couldn’t wait any longer.

He also wasn’t sure if he could afford the surgical procedure, which nearly half a million people get each year.

“Looking back into it, getting the costs for [a vasectomy], that was not within the realm of possibility for me,” he said, adding that he was told the procedure, one of the cost-effective forms of contraception, would range from $1,000 to $2,000.

Months later, Willison’s partner was scrolling through TikTok when she stumbled upon a video about free vasectomies. Within a few days he was able to schedule an appointment with Planned Parenthood, which was providing free appointments for underinsured and uninsured people ahead of World Vasectomy Day, which falls on the third Friday in November each year,.

Willison is among the many people who sought the birth control method soon after the Dobbs decision, which determined that the Constitution did not protect the right to an abortion. SCOTUS’ reversal sent shockwaves across the country as states either moved swiftly to affirm or eliminate abortion rights. It also meant that people were looking to other forms of contraceptives, like a vasectomy, a minor procedure that cuts and seals the tubes that supply sperm to a person’s semen. Doctors describe it as a “quick snip.”

Researchers from the Urological and Kidney Institute at the Cleveland Clinic Foundation and the Case Western School of Medicine sought to quantify, for the first time, the rising number of vasectomy consultations and procedures that clinics and other health care providers were seeing after the landmark Supreme Court ruling.

For World Vasectomy Day, Planned Parenthood held a 3-day clinic in three Missouri cities where doctors performed a total of 91 procedures. Photo by Gabrielle Hays/PBS NewsHour

There was a 35 percent jump in consultation requests and a more than 22 percent increase in actual vasectomy consultations when comparing those figures before and after the Dobbs decision, according to the study released in February. The researchers also found that the number of “men under 30” and “childless men” seeking vasectomy consultations had increased after the Dobbs decision as well.

Providers in Missouri saw a similar spike in appointments for the procedure, said Dr. Margaret Baum, who serves as the medical director at Planned Parenthood of the St. Louis region in Southwest Missouri and is still working to make vasectomies available to those unable to afford or access them.

Missouri was the first state to pass a near-total abortion ban after the high court’s ruling.

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“Our numbers from July and August of 2022, right after the Dobbs decision, doubled from June of 2022,” Baum said.

Most of the patients who sought the treatment, like Willison, said they had been considering it for years and felt the sudden change in the law meant it was time to act.

Jon Willison, 37 and no relation to Aaron, had also been thinking about getting a vasectomy for a while. He and his wife had agreed that after one child their family was complete.

“All the birth controls [my wife has] ever tried have just either gotten her sick or they give her a super long period when she’s done with it,” he said. “It’s just always been troublesome for her.”

After she stumbled upon a post about free vasectomies he too was able to sign up for a free appointment for Planned Parenthood’s vasectomy clinic, something he said having access to is a “basic human right.”

Though Jon Willison said he didn’t do it as a direct result of the reversal of abortion rights, he said he “absolutely” saw the correlation for people who did.

Dr. Esgar Guarín, who performed Jon’s vasectomy, said it’s important that the topic of contraception doesn’t rest solely on people with uteruses.

“The practice of obstetrics allowed me to see from a front row view, perspective the difficulties female individuals face when it comes to contraception,” Guarín said. “We not only have left pregnancy and childbirth to individuals with uteruses, but also all the responsibility on contraception,” he added.

Barriers to contraception and meeting the need

Before Dr. Esgar Guarín began the vasectomy procedure, he sat with Jon Willison and his wife to discuss what’s involved with the quick surgery and the proper aftercare the father of one would need to follow. Photo by Gabrielle Hays/PBS NewsHour

In early October, Jon sat in Planned Parenthood’s Central West End location in St. Louis, in the same seats abortion patients would wait to be seen before the state made abortion illegal. Today, it’s where health care professionals walk vasectomy patients through the procedure.

Baum said some patients have shared their fear over other rights being curtailed.

“So people will say, ‘Gosh, they took away my partner’s right to terminate a pregnancy in Missouri; are they also going to take away my right to be sterilized or my partner’s right to protection?’”

Providers in the state, including Baum, continue to see an “exponential increase” in interest in vasectomies, and patients are coming from not only across the state but across the country in part because they’ve been denied access. Some patients, Baum said, say their doctor won’t do the procedure.

“I will have somebody tell me, ‘Oh, I was told I was too young for this procedure or I didn’t have children,’ so the doctor wouldn’t do it,” Dr. Baum told the NewsHour.

Although the laws vary in different states, you have to be at least 18 years of age to consent to a vasectomy in the United States.

Guarín operates two clinics in Iowa, as well as a mobile clinic that he drives 750 miles once a month to different corners of the state to reach patients. After the Dobbs decision came down, he saw a 300 percent increase in traffic to his website within the first 48 hours. Within that time frame, 20 people had sought consultation about a vasectomy — half the number of people he usually saw in a month.

Seeing that increase in interest was nice, Guarín said, because it meant more people were “choosing [or] questioning what they could do in reproduction beyond procreation.”

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“But at the same time, it was kind of sad to see that it took restricting the rights of an individual to choose about her body, for the counterparts to say, ‘You know what, there’s something we can do’ when that something has been there for quite some time,” he added.

Guarín, who’s also trained in maternal and child health services, initially thought the number of people seeking a procedure would spike and eventually decrease. Though the numbers did start to drop, the volume never returned to what it was before Dobbs.

Guarín performs about 60 to 70 vasectomies each month. The doctor has performed approximately 5,000 vasectomies total in his career. A vasectomy is nearly 100 percent effective in preventing pregnancies, according to the Cleveland Clinic.

“It’s important for us to increase the number of vasectomies, mainly at the expense of reducing the number of tubal ligations so that we can have a more equitable and balanced playing field when it comes to contraception, particularly permanent decisions,” he said.

Guarín performed Jon Willison’s procedure. The father of one sat down with his wife inside of the mobile clinic and talked through what the appointment would entail, how long it would take, what Jon would feel and how he should take care of himself afterward, including a recommended follow-up appointment after three months.

After years of consideration, it took only 15 minutes to decide to go into the room. With his wife’s hand in his, he got a quick snip.