In the past, both state governments and hospitals often required spousal consent for voluntary sterilization. However, in the 1970s a number of women challenged these requirements in court and generally prevailed. According to the book "Fit to Be Tied" by Rebecca M. Kluchin, courts found in favor of the women in most of these cases. In the case of Ponter vs. Ponter, the New Jersey Superior Court ruled that women had the constitutional right to seek a tubal ligation without spousal consent. Federal courts have ruled state spousal consent laws unconstitutional, but the United States Supreme Court has never ruled on this issue, so it cannot be considered completely resolved.

Federal government policy according to the Office of Population Affairs is that female sterilization procedures do not require the consent of the spouse. Any family planning program funded by the federal government is required to adhere to state laws on consent except for laws requiring spousal consent for sterilization, as these are held to be unconstitutional. The Affordable Care Act requires insurers to cover tubal ligation, but does not require doctors to perform the procedure against their own judgment.

Despite federal court rulings against spousal consent laws, some hospitals still have policies against performing the procedure without the signed consent of both spouses. Publicly owned hospitals are not legally allowed to maintain such a policy, but private hospitals are. Despite the illegality of spousal consent policies at public hospitals, doctors may still refuse to perform the procedure, especially if the woman requesting it is young or has not yet had children.

Although most states no longer have spousal consent laws on the books and any remaining laws may be unconstitutional, sterilization is still difficult to access in a number of states because of other regulations. Some states require waiting periods before a tubal ligation may be performed. Others protect doctors and hospitals from being forced to perform the procedure against their judgment. A doctor or hospital determined to obtain spousal consent before performing a tubal ligation might be protected under these laws, but courts have repeatedly found that tubal ligation does not require spousal consent.