In addition to the recent talk about sterilization and regret, an article in this month’s edition of Vogue takes a very good angle on the topic of sterilization… The title of the article is: “Q: Just how hard can it be to avoid getting pregnant? A: Much harder than you’d think.” When it comes to sterilization, to that answer many childfree would say, “Indeed!” The verbiage in the subtitle is what really gets it right:
“Pamela Paul considers a brewing under-the-radar issue: The Right Not to Have Children.” This is at the heart of the issue of doctors refusing to perform sterilization procedures of men and women of any adult age.
Take the example of 27 year old Erin Iwamoto-Galusha described in the article. She wanted a “low maintenance, long-term” birth control solution and she asked her gynecologist for a tubal ligation – the most common form of female sterilization. She explained her “deep rooted desire not to have children” and that her husband felt the same way. This gyno refused to do the procedure.
For 5 years Erin looked for a doc that would perform the procedure. Docs said things like, “You’re too young to make a decision like that,” and “That is what I thought at your age.” One asked her to write and essay about why she did not want children.
That reminded me of my own situation. In my late 20s, I went to my gyno and asked for information on a tubal. Just wanting the information my gyno asked me to write and essay why I thought I did not want to have children, then he would discuss the procedure and whether he would do it. What did I do? Found another gyno! Ultimately, however, my husband got a vasectomy instead (easier!).
Think of the flipside – As Paul points out in her article, unfortunately it is difficult to imagine a doc putting up “roadblocks to a third round of IVF.” If it is about not having children-it’s oooh no you don’t. If it is about making babies it’s another thing.
Why do docs create roadblocks to sterilization? Here’s three reasons –
-Religious beliefs or moral preferences. OK I can go with this, barely. In this case, what is appropriate is to refer the woman to a doc who does not have this issue.
-Liability concerns – getting sued if she changes her mind in the future. This can so easily be avoided with full documented disclosure at the time of the procedure, not to mention the fact that the percentage of women who change their minds is very low (and we need to know more about those who do – are they more likely to already be mothers? Childless? Childfree who change their mind? On this last one I would bet money the answer is no).
-Pronatalist beliefs (like but surely not limited to – all women will want a kid one day, or something must be wrong with you if you don’t want a child) that make docs conclude they know the women better than they know themselves.
The outcome of the roadblocks? Vanessa Cullins of Planned Parenthood Federation of America sums it up by saying that denying “access to tubal ligation is another form of reproductive injustice.”
Erin is the wiser of any doc who refuses the procedure – simply put, she says, “Grown men and women should have control over their own health and bodies.”
In the larger picture, violating women’s rights to have no children is part of the continued prejudicial context – driven by pronatalism – that prevents full reproductive freedom in our society.
What do you think it will take for the answer in the title of Paul’s article to be “A: Not as hard as it used to be?“
I honestly believe that the state of the economy will come into play. If fewer women are going to the doctor for well-woman check-ups and other procedures due to lack of insurance coverage (or ability to pay), those who *do* come forward with the means to pay for a tubal will be tantalizing for the doctor who has to keep his or her practice going. Same for vasectomies. A little cynical, but there you have it.
Hi Lisa Marie! Mmmm…so you think we might see more docs doing tubals without the baulking? Interesting. Let’s watch and see… Will also be interesting to see if vasectomies go up too and the economy is a reason…
I had the exact same scenario but my gp happily referred me for the procedure it was once I got to the hospital that they refused – and I was 33 & had previously had an abortion. I found it revolting that this woman felt I was unable to make a decision about my life – reproductive injustice indeed! My husband also ended up getting a vasectomy (way easier) – check out our story on parazero.com
I have been trying to get a tubal for 7 years with no luck. I had 3 back surgeries when I was 24 and 25 years old, with my orthopedic surgeon as well as other surgeons stating flat-out that I should never become pregnant or risk undoing the surgeries. I was absolutely fine with that. Not only did I never want children, I also didn’t want to mess up my already-messed-up back. And thus started the search for someone to do a tubal for me. I’ve seen at least 10 gynecologists and none will do it for me because of fear that I will change my mind. I would sign any document agreeing not to sue, and yet no one will do it for me. It’s just another form of reproductive injustice.
Boy, is your situation a Case in Point – Big Time. If you are willing to state, and totally understand if not, but what state are you in? Maybe other visitors/commenters here know of docs in your state who will do the procedure. One of the childfree resource sites used to have a childfree friendly doc list – anyone know what happened to it? Also, you might check out the adiana and essure options. They are non-surgical and it may be easier to find docs willing to do this. I did a post on the pros and cons of each awhile back – http://laviechildfree.com/2011/04/essure-adiana/ – and have contact to the doc I quote in the article who does adiana. I bet he could refer to a doc in your state who will do it. ~L
I couldn’t agree with Lisa Maria more, except I have a different, more cynical take. There is almost no financial incentive for a doc to do a tubal on a child free woman. (She might never come back, even for annual exams.) on the other hand, if a doc can do years of the exams needed to get birth control prescriptions, then have a patient go through a few pregnancies, that means more money in their pocket. If a man gets a vasectomy, his urologist only gains. I’m sure to offend the medical profession here, but we’d be naive to pretend money doesn’t come into play. I would have happily had a tubal, but it was so easy for my husband to get a vasectomy.
Ah yes, sterilization is not good for long term regular business! Husband getting vasec is sure easier indeed…!
There’s also just something politically charged about being a doctor who sterilizes someone, even if you have the patient’s full consent. Western medicine has a very sordid history when it comes to sterilization. The twentieth century is full of examples of doctors sterilizing people without their consent, and I think there is still that specter looming over the procedure. Even if the patient demands it, there’s still a bit of a taboo about being “the doctor who sterilizes women.” Maybe right now this is just the historical pendulum swinging to the opposite extreme.
Consider also from the doctor’s point of view how it might look to outside observers if there was the slightest whisper of a suggestion of a pattern of any kind of discrimination. Imagine if, strictly by coincidence, a doctor performed more tubal ligations on black women than on white women, or on a disproportionate number of Jewish women. Now to the public you are a racist social engineer playing God with people’s lives. You’re the next Josef Mengele. You must have talked them into signing off on the procedure, you sick bastard.
American culture tends to treat doctors as godlike beings who can pressure someone into doing just about anything, so even if you signed off on a procedure, the legal system could still hold the doc responsible.
This is no excuse for denying someone the right to make a fertility decision, of course. I just think that part of it for some doctors is just fear of opening an ugly can of worms.
Regarding the pronatalist beliefs you mentioned, I think one root of that kind of “thinking” can be found in Suzanne LaFollette’s book titled “CONCERNING WOMEN.” I came across a terrific excerpt from this book in a collection of feminist writings called THE FEMINIST PAPERS, edited by Alice S. Rossi, which I found in my local public library. This book also included “The Second Sex,” by Simone de Beauvoir, whom I know is one of your favorites. 🙂
Of course you may already know about LaFollette, but it was a real revelation to me, since I just found it three weeks ago. Although LaFollette’s book was published in 1926, I think some of what she said still applies today.
Hi Susan, I have heard of Concerning Women but have not had my nose into it for long time — thanks for the inspiration! ~L
Hi Laura, you’re very welcome. It’s always a real treat for me when I discover feminist works I haven’t read before. To me, this one had a gold mine of information. 🙂
I would love info if anyone knows of docs that are more likely to be open to sterilization in any state. Someone really should set up some sort of website for this.
I’m currently in the search for a partial hysterectomy or Endometrial ablation. I’m in a same sex relationship, so a tubal ligation is pointless. I have excessive menstrual pain and fibroids and finding a willing doc since I’m only 32 is beyond difficult.
I’ve not only been turned down, but the times I’ve had a yearly and mentioned that I do not want children before the exam begun, I’ve had doctors be less gentle, to the point of overly hurtful physically during the exam.
My little sister had her first kid when she was 17. She had 3 more immediately after. They agreed to tie her tubes after the 4th child, but she had to argue with them about it. She can’t support the kids she has, I’ve had to been their guardian at times. I despise the fact that its more acceptable for a 17 yr old high school dropout with a drug problem to have multiple children, but being in my 30’s, financially stable, and in a long term relationship, I’m not allowed to make my own choices.
PS: sorry for the little rant!
Nina, Thanks for writing. No apology necessary! Boy could not agree with you more that it is insane how our society allows people to have children, and lots of them, when they are not in a position to raise them, and leave you – an adult – to Not be able make your own reproductive choices when it means nixing the possibility of having biological children. It is pronatalism in action. My latest book, The Baby Matrix. really gets into the issues you describe and the pronatalist assumptions that drive them…and it needs to stop!