Why Women Can't Get Sterilized

What happens when a woman decides that she doesn’t want to utilize her reproductive capability? And – just as importantly – why does no one take them seriously?

In an age where an increasing number of women are being told that they don’t need to let their sex stop them from anything, it would seem as though this doesn’t extend to rearing children. Becoming a mother, eventually, seems to be something that is taken for granted by society, and those women who choose not to reproduce and ask their doctors for permanent procedures to stop them from doing so are often made to feel marginalized and their opinion not taken seriously.

Difficulty to get sterilized is something that is a problem worldwide. The article ‘When Women Choose Sterilization’ from the New York Times documented the story Andrell and Aaron Laniewicz, from Virginia, made the decision for Andrell to undergo an endometrial ablation, a process designed to ease menstrual difficulties and would make conceiving extremely difficult. Four doctors denied her request, using the excuse that she had no children or that she was too young. When Aaron called the doctor, however, he was able to get a vasectomy scheduled for the following day. Upon her fifth consultation, Andrell finally received her procedure.

More and more women are joining “childfree” online societies to get support and information about providers who can perform these procedures. In 2007, the American Congress of Obstetricians and Gynecologists wrote that sterilization “may have important effects on individuals other than the patient”. Doctors impose their own decisions on whether a woman is suitable for the surgery, and around 18% of the population have been sterilized.

‘When Women Choose Sterilization’ prompted several letters to the editor, including one from an obstetrician-gynecologist who admitted she has turned down the request of women to get sterilized, writing “…please don’t expect us to knowingly sentence you to a childless life until we know that you really mean it”. Another letter from the chief of Northwell Healthy Fertility wrote that 30% of couples choose female sterilization, as opposed to 17% who choose male sterilization. She also said that couples who change their minds later can use in vitro fertilization if they should choose.

The most common dynamic is married women who have two or more children, and are over 35. The biggest factor in doctor’s reluctance to perform the procedure is patient regret – a 2008 study in the United States saw as much as 26% say they regretted the procedure, with women under 30 twice as likely as women over 30 to have misgivings. Younger women who wish to be sterilized have difficulties finding a doctor who will even listen to their reasons, let alone perform the procedure.

An updated policy statement from The American College of Obstetricians and Gynecologists read “Women who have completed their childbearing are candidates for sterilization”. So, is this completion only applicable to women who have birthed and raised children? Are the wishes of women who do not see children as part of their future declared invalid? The official stance is that regardless of age and if they’ve had children, the choice is that of the woman’s. This is quite a far cry from the ACOG’s old stance - until 1969, they said that sterilization should only be considered as an option if the woman’s age multiplied by the number of children she had was 120 or greater. Obviously, women were expected to fulfill a kind of quota before their rights to their own body were even taken seriously.

However, doctors still are reluctant to perform the procedure, with Dr. Eve Epsey from the University of New Mexico saying “In some ways, it’s very difficult to see a 22-year old make a decision for the 35-year old she will be someday and not have major concerns that she might regret her decision, on the other hand, at what point do you say, ‘Of course the woman is autonomous and can make her own decisions about her reproductive health’?” 18 states have laws that allow medical practitioners to cite their personal morals as a valid reason to refuse to sterilize.

There has been in recent years a move towards long-acting reversible contraception methods, or LARCs, which are recommended as the first choice for sexually active teens by the American Academy. These options provide long-lasting protection against conception, yet for some women, they know their own minds and that they won’t change. Heather Gentry, a 28-year old from Georgia who had never had children, wanted a hormone-free method of birth control and her health care practitioner actually recommended the procedure for her. Gentry doesn’t regret her decision for a minute, and actually finds that she is more tolerant of children than before.

Canadian magazine Chatelaine reported that approximately 20,000 tubal litigations are performed yearly in Canada, a procedure that has been around for 136 years. In a tubal litigation, the Fallopian tubes are cauterized, tied or cut. A non-surgical way to perform this is through hysteroscopic sterilization, where a metal device is inserted into both tubes causing scarring and eventually, blockage. In 2007 in Saskatchewan, a 39-year old who had given birth to her second child and was refused sterilization was compensated by a Catholic hospital. In 2009, a 21-year old Toronto woman who was having her second child and had requested sterilization after the birth was told she was too young for the procedure.

There is, of course, the history behind sterilization. Until 1972, forced sterilizations were legal in the Canadian province of Alberta, and allegations have been made that in Saskatchewan, indigenous women were pressured by hospital staff to undergo the procedure. Philosopher professor Christine Overall at Queen’s University states that procreation is an autonomous right, and that ageism is at work when doctors deny young women the choice to make this decision for themselves. When Alyna Poremba from Ontario told her doctor she wished to be sterilized, she was told she needed psychological counseling. She finally received her procedure, but not before being rejected two more times.

In Europe, women also find it difficult to be taken seriously. In 2015, Holly Brockwell from London, who was 29 at the time, said that “there’s nothing about creating another human that appeals to me”. There is no minimum age for sterilization in the UK but she was finally approved after being dismissed for being too young four separate times. However, arranging the operation, she was told no surgeons were available, and moving into a new area meant that she had to start the whole process again. Holly said “We can choose to get pregnant at 16 but not to decline motherhood at 29. It seems our decisions are only taken seriously when they align with tradition”. Holly finally became sterilized in 2016, and spoke about the abuse she faced online when she went public with her decision, including comments that she shouldn’t have sex if she isn’t going to reproduce, as well as being “broken” and a “waste of life”. In her article ‘Why is society still so afraid of women who don’t want children?’ Holly also touched on the differences between childless and childfree – she calls herself childfree because childless implies that something is missing.

In an interview with Vox, a woman who lived in Sweden was told she could still have the procedure in five or ten years, even though she had been thinking about it for 15 years. When the woman explained that she was concerned that she wouldn’t be able to get an abortion in Ireland, where she worked a great deal, she was laughed at. She was referred to a therapist in order to “convince” her doctor that she was serious about her decision. She eventually got the procedure, and the last words her doctor said to her before she left where “You know, when you regret this, a few years from now, the government will no longer subsidize your in vitro fertilization”.

Right now, women are still fighting for the right not to reproduce. Men who request a vasectomy are granted it almost immediately – the American Urological Association assumes that men who ask for a vasectomy have been considering it for a long enough time that their decision should be taken seriously. In an age where many women are encouraged to attend universities, have careers and put their happiness first, why is the question of their reproductive capacity still taking precedence over their right to decide?


Picture by Hush Naidoo / Unsplash