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The future of medication abortion in the US is uncertain. These women say they’re glad they got sterilized

By Elizabeth Cohen and Carma Hassan, CNN

(CNN) — In January, as a 28th birthday present to herself, Mariah Marsh got herself sterilized.

Five months later, she says she’s very glad she did.

On Wednesday, a panel of federal judges in New Orleans will consider whether a drug used in medication abortions should be taken off the market. More than half of all abortions in the US use the drug, called mifepristone, in combination with another pill called misoprostol.

Marsh has known since she was a teenager that she doesn’t want children. A few years ago, a diagnosis of myasthenia gravis, a neuromuscular disease that can make pregnancy risky, further solidified her decision.

She wasn’t in a rush to get sterilized until June, when the US Supreme Court overturned Roe v. Wade, ending the federal right to an abortion.

“It scared me. I knew that the only way I could really protect myself is to go ahead and get the surgery,” she said. “It’s a surgery I knew I would always have. My timeline was pushed up by fear.”

Now she says she’s particularly glad she got her fallopian tubes removed, considering that mifepristone might not be available for abortions in the future anywhere in the United States.

“It makes me happy that I made the decisions that I made because it validates my thought process, which was [that] they’re just going to come for any access to care,” said Marsh, an admissions officer at Indiana University.
Although there are no national statistics on whether more women have opted for sterilization because of legal cases limiting abortion rights, some doctors say they’ve recently seen an increase in requests for such procedures.

“Being concerned about access to abortion care has definitely driven up the request for sterilizations,” said Dr. Leah Tatum, a spokesperson for the American College of Obstetricians and Gynecologists who practices in Austin, Texas. “I see about three times the consults for sterilization as I used to.”

Tubal ligation is a permanent surgical sterilization procedure that aims to prevent pregnancy by either cutting, removing or sealing off the fallopian tubes so an egg and sperm can’t meet for fertilization.
The surgery is typically done at a hospital or at an outpatient surgical center, and women can go home the same day, according to the US Centers for Disease Control and Prevention. The procedure is immediately effective at preventing pregnancy, and recovery is quick; most women can get back to their regular activities after a few days, the CDC says.
Most insurance plans are required to cover sterilization procedures, according to the US Department of Health and Human Services. People without health insurance may be able to enroll in Medicaid or use state programs to offset the cost of the procedure, according to Planned Parenthood.
Dani Marietti, a licensed clinical social worker candidate in Montana, had her fallopian tubes removed about a month after the Supreme Court decision overturning Roe last summer.

Abortion remains legal in Montana through about the first half of pregnancy, but the 25-year-old said she’s glad she opted for sterilization, since state legislators could ban abortion in the future.
And she said she was especially glad she was sterilized after US District Judge Matthew Kacsmaryk ruled on April 6 that the US Food and Drug Administration’s approval of mifepristone more than 20 years ago should be suspended.
“I feel even more confident in my decision,” she said.

Kacsmaryk’s ruling was put on hold by the Supreme Court on April 21, and it will remain on hold until the case goes back to the high court, regardless of how the 5th US Circuit Court of Appeals in New Orleans rules on the merits of the case.

The 5th Circuit is considered one of the most conservative in the country. Circuit Judge James Ho, one of the three judges who will hear the case Wednesday, is a Trump appointee who has called abortion a “moral tragedy.”

Tatum, the doctor in Texas, said her patients worry that after last year’s decision overturning Roe and the ongoing battle over mifepristone, the next step might be that state legislators will try to limit access to birth control.

“What if their reproductive rights are restricted even further?” she said. “Patients want their autonomy respected, and so they are trying to take back control over their reproductive health.”
CNN’s Amanda Musa and Kyla Russell contributed to this report.

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