Female permanent contraception (PC, formerly sterilization) is the most common contraceptive method in the US and is often requested during the postpartum period. However, many patients—especially those with public insurance or other markers of marginalization—do not receive desired postpartum PC. In West Virginia (WV), recent policy changes, including heightened abortion restrictions, federal Medicaid rule modifications, and threats to Title X and Medicaid funding, may be worsening barriers to PC for postpartum patients reliant on the contraceptive care safety net. This study aims to determine whether changes in state and federal policy exacerbate disparities in PC counseling and fulfillment in WV. Using a mixed-methods design, we will pursue two specific aims: (1) assess longitudinal changes in the provision of postpartum PC from 2016 to 2024 at five hospitals in the West Virginia University Medicine Health system, stratified by insurance type, delivery route, age, marital status, and race/ethnicity; and (2) explore how postpartum patients and obstetric clinicians perceive and respond to evolving health policy stressors related to PC decision-making, counseling, and provision. This project centers the experiences of those affected by systemic barriers to contraceptive access, providing critical insights into how policy environments shape reproductive autonomy. Findings will inform equitable clinical and policy strategies to ensure postpartum patients can access timely, desired permanent contraception regardless of their insurance or geographic location. This work directly aligns with the Society of Family Planning’s mission to advance reproductive health and justice through research that informs practice and policy.