Since the U.S. Supreme Court overturned decades of abortion access protections established by Roe v. Wade with the Dobbs v. Jackson Women’s Health decision last month, more women have been scheduling appointments for sterilization.

North Carolina OB-GYN Dr. Kavita Shah Arora, who serves as ethics committee chair for the American College of Obstetricians and Gynecologists, said she has noticed “a dramatic increase” in the number of women requesting sterilization. According to a Los Angeles Times report, she noticed this both at her own practice and “in conversations with colleagues across the country.”

The Los Angeles Times also said obstetrician-gynecologists in Arizona, Texas and Florida have seen increased demand for sterilization procedures and that there has been a spike in traffic to Planned Parenthood web pages about sterilization for both men and women.

“I’ve had more consultations for sterilizations in volume per patient load than I’ve ever had in my career,” Dr. Michelle Muldrow of the Innovative Women’s OB-GYN in San Antonio, Texas, said Wednesday. Muldrow said she conducts consultations about the procedure daily.

“Never before have I seen so many women in such a panic or state of anxiety about their bodies and their reproductive rights,” Muldrow said. “They feel like this is their only option.”

Texas has some of the strictest abortion laws in the country. When the Dobbs decision was announced, a slew of states tightened their laws, according to the Center for Reproductive Rights.

“Now that the option [of abortion] has been completely taken away, women feel more responsibility, or a sense that they have to do something that is going to be in the ‘100% successful’ category,” said Dr. Melodie Zamora, an OB-GYN who is also in San Antonio.

In Orlando, Fla., Dr. Matthew Wollenschlaeger said he went from consulting one or two patients a week about sterilization to about a dozen after the Dobbs decision leaked in May. People have traveled to his clinic from Georgia and Canada, including transgender men seeking hysterectomies.

According to Planned Parenthood, there are two types of female sterilization available in the U.S.: tubal ligation, or cutting of fallopian tubes, and bilateral salpingectomy, complete removal of fallopian tubes. A 2020 study published in the American College of Obstetricians and Gynecologists said that bilateral salpingectomy is now recommended rather than tubal ligation.

After both procedures, sperm will not be able to access eggs and cause pregnancy. People who undergo the procedure will get their period and ovulate, though eggs will be re-absorbed into the body, according to the International Planned Parenthood Foundation.

In rare cases, people who have had female sterilization surgery develop life-threatening ectopic pregnancies. However, “the risk of ectopic pregnancy occurring in women after tubal sterilization is lower than in women who do not use any birth control,” according to the American College of Obstetricians and Gynecologists.

Data from 2017 through 2019 included in the National Survey of Family Growth showed that female sterilization was the top method of contraception in the U.S., with 18.1% of women aged 15 to 49 relying on it for birth control.

“Among women aged 20 and over, female sterilization increased with increasing age,” said the data, published by the U.S. Centers for Disease Control and Prevention. Around 39% of women age 40 to 49 relied on female sterilization as contraception, as well as around 21% of women age 30 to 39.

“With higher education, female sterilization declined and use of the pill increased,” said the CDC.

According to a 2008 study, “female or male sterilization is the most common contraceptive method utilized by couples in the United States, with 36% of fertile women using contraception employing this method.”

Data from 2002 cited by the study showed that more women (27%) relied on female sterilization for contraception than male sterilization, known as a vasectomy (9.2%). Around 700,000 were performed annually at the time the study was published, compared to 500,000 vasectomies. Around half of all female sterilization procedures were performed within 48 hours post-partum. In fact, sterilization was performed following around 10% of all births.

According to the L.A. Times, younger people often face resistance when seeking female sterilization procedures. A 23-year-old woman identified by the outlet as Abby, said a gynecologist had dismissed her requests, because of her age.

“I ended up telling her, this is the option I want,” Abby said. “This is the only answer for me.”

She said she felt relief after receiving a bilateral salpingectomy.

Brandi Shepard is a 26-year-old who is lives in Ohio, another state with strict abortion laws. She tried to book a female sterilization procedure when she was 21 but was denied due to her age. Five years later, she was still sure she wanted it.

She has been approved for a bilateral salpingectomy, but said that she now is frustrated about having to schedule it in a rush.

“I’m pissed. It’s insane that this is what I had to do to maintain bodily autonomy,” she said.

In Minnesota, 27-year-old Catherine K said that although abortions remain accessible there, she fears what might come next from the conservative-leaning Supreme Court. In his concurring opinion on the Dobbs case, Justice Clarence Thomas said he thought the court should look into other rulings on same-sex marriage and contraception.

Catherine said she booked a consultation appointment for a female sterilization procedure.

“Historically, women, often from marginalized groups, have been forcibly sterilized without their knowledge,” so doctors are careful about advising patients on the procedure, said the Los Angeles Times. Planned Parenthood also stresses that patients should not feel pressured by others, such as family, to undergo the operation.

A 1999 study also found that 20.3% of women aged 30 or younger who underwent female sterilization regretted the decision, compared to around 6% of women over 30. While female sterilization is considered permanent birth control, there might be some option for those who have had the procedure to get pregnant.

“If you have a sterilization procedure and you change your mind after the operation, you can have surgery to try to reverse it,” said the American College of Obstetricians and Gynecologists. “You can also try assisted reproductive technology (ART) to attempt pregnancy. These procedures are expensive and may not be covered by insurance. There is also no guarantee that you will be able to get pregnant afterward.”

In North Carolina, Shah Arora’s recent patient who already has children said she was inspired to explore female sterilization after the Dobbs opinion was announced.

“The Dobbs decision pushed her over the edge to scheduling the surgery as she wanted to retain bodily autonomy and have independence over her decision-making,” Shah Arora said.

Hannah Morgan, 35, of Missouri, and Ciara Walter, 33, of Pennsylvania, also said the Supreme Court decision inspired her to look into sterilization.

“Abortion’s not an option that most people want to consider, but it’s always there as a last resort,” Morgan said.