With new laws in 19 U.S. states giving residents little choice but to carry an unwanted or dangerous pregnancy to term, many people consider access to birth control more essential than ever.

In the six months after the Supreme Court revoked the constitutional right to abortion in Dobbs v. Jackson Women’s Health Organization, permanent contraception use surged. Rates of tubal sterilization increased most among U.S. women aged 18 to 49 who lived in states with abortion bans. In those states, from June to December of 2022, procedure rates rose 39 percent, from 3.6 procedures per 10,000 women per month to 5 procedures per 10,000 women per month (a “person-month” is a way researchers can measure change over time in a given population).

This increased reliance on permanent contraception has been made possible by federal mandates requiring that health insurers cover contraceptives without out-of-pocket costs. By law, the federal low-income plan Medicaid, the U.S. military insurer TRICARE, and most employer-based private health insurance plans protect the vast majority of insured women—perhaps as many as 90 percent, according to our calculations—from receiving bills as high as $6,000 for tubal ligation surgery.

Yet, even as more women seek permanent or long-acting reversible contraception to avoid unwanted........

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