Sterilization: A Personal Journey
I made the decision to have my tubes tied last year. I was twenty-four years old, unmarried, and childfree. For me, the decision was easy, but I knew acting on it could be difficult. I was sure my doctor would question me, and refuse to take me seriously. After all, no one else did Friends, relatives, and even nosy strangers smirk at the decision to be sterilized with, “You’ll change your mind!” and other clichéd responses.
However, this response from members of the medical community infringes on our very human rights, undermining our ability to be taken seriously, and even to make autonomous decisions as adults and women. Breast implants? OK! Tubal Ligation? Not so fast, missy! Doctors can exert power over our decisions against our wishes, and some choose to exercise that power to the detriment of childfree women everywhere. When that happens, childfree women and their families lose.
“My doctor wouldn’t have the conversation with me about getting my tubes tied, even though I am really not happy with the hormonal birth control options,” said Kacey, a 31-year-old childfree woman from the Washington D.C. area. “I was pretty angry and upset when I left the office, but I don’t know what other options I have.”
I was one of the lucky ones. I live in a liberal community and had insurance coverage under my fiancé Adam’s “domestic partner” plan. This was essential: a $7,653 operation does not pay for itself.
A month and a half from looking up a nearby women’s health clinic in the phone book, I was in surgery. But in between, I had to meet the doctor. Before my first appointment, I did my research, so that when I met the doctor, I could disarm any quips about how, at my age, I couldn’t possibly know what I was getting myself into.
I was prepared to answer every “You’ll regret it” with “I’d rather regret not having kids than having them.” I was ready to shoot down each “But you’re so young and healthy” with “All the more reason to do it now.” I anticipated blocking “You’re too young to know what you want” with “I guess I should stop voting until I am.”
The only question asked, however, was, “You’re sure?” Yes, I said. I firmly stated both my fiancé and I were childfree, and we were not satisfied with the birth control methods we were using. Having this procedure was preferable to a vasectomy, and would “complete our family.” Adam was extremely squeamish about the idea of a vasectomy, while I did not mind surgery, and it was a giant leap in me owning my own fertility.
I felt victorious, and yet oddly disappointed, when I left the office with the appointment date for my surgery without a fight. Why was I so sure I needed to be on the defense? Why was I on fire over having to defend my status?
A quick Google of the words “young tubal ligation” reveals why: at the top are articles about spaying your malamutes, breast cancer risks, and the process of getting your tubal done post-partum. Of course, at the top is an ad for “Tubal Ligation Reversal.” The assumption by many, including advertisers, is that if you’ve been sterilized, you regret it. They don’t want to hear or know that the vast majority of women who have been sterilized are happy with their choice. Statistically, however, few young women regret sterilization. I had been a contributing member to a collaborative childfree blog and heard numerous stories from women younger than 30 who had run into a wall of resistance when trying to get their tubes tied. Many said it was impossible. Others said surgeons would only perform the procedure on women that young if they already had a minimum number of children.
Tubal ligations are not a rare procedure: 26 percent of U.S. women aged 15-44 have had the procedure. Between 1965 and 1988 (the most recent year of available data), the prevalence of all forms of surgical sterilization rose dramatically among this group, from 16 to 42 percent. In 1965, 16% of women had been sterilized, while in 1988, that number climbed to 42%.
For the young, however, tubal ligation presents a higher risk of eventual failure, simply because a woman has more childbearing years ahead of her in which the body may reconnect the tubes, and, if the ligation was for non-sterilization health reasons, the procedure carries a slightly increased risk of later requiring a hysterectomy.
The laparoscopic tubal ligation, like any invasive procedure, carries risks, mostly with infection. Are there other risks? (No, unless you’re thinking of allergic reactions to anesthetic or something, which is not a risk specific to this procedure, and therefore doesn’t seem worth specifically mentioning, as it has little to do with the procedure.)
An almost-unnoticeable scar inside my navel is the only telltale sign of the half-hour procedure. During that half hour, each fallopian tube was cauterized in three places with a small burning clamp. A tiny camera guided the surgeon.
Adam, my fiance, and I celebrated my operation like most couples would celebrate the birth of a child: we sent out announcements and took time off work. He bought me flowers and we took lots of pictures, reveling in our new family status. I took a week off but recovered almost fully in about half that time.
Still, I hear from an unbelievable number of women, some as young as 15, and some in their mid-40s, recall with dismay and frustration that their roadblock to sterilization is an emphatic “no” from every doctor they contact. Some have traveled hundreds of miles to find a doctor who will say yes; others resign themselves to an IUD until they are older or even postmenopausal. Some doctors will not perform a tubal ligation on a woman regardless of her age if she is unmarried and/or childfree, and others will not due to their religious beliefs. This makes it essential for women to research the doctors in their area to find one that will help them without prejudice.
The issue of sterilization is at a crossroads of lifestyle, human rights, economics, health, and feminism. It is hard enough to find common acceptance of the decision to permanently and prematurely end a woman’s ability to bear children. Add age and marital status to the mix and it can become a topic of fierce contention. When women lose access to sterilization, they lose their human rights.
Copyright June Hatfield. Published 1 March 2007 in Editorials.
Reader comments
Commenting is closed for this article.
Why not just lie to the doctor and say you have 5 kids. How would he ever know?
permalink — 1 March 2007, 07:04
Uh, any gynecologist can tell if you’ve given birth or not. That’s why.
permalink — 1 March 2007, 09:42
Great article. LOL at the comment about breast implants being no problem, and not even questioned, but voluntary sterilization raising so many eyebrows and inspiring so many bingos.
permalink — 1 March 2007, 13:57
I just had my tubes tied, and I am 22, unmarried, with no children. I was fortunate in so many ways, but mainly in finding a clinic and a doctor who were willing to let me have autonomy over my reproductive decisions. (They also had a discount for those paying out of pocket, like myself, which made a big difference.)
It’s terrible that it’s so rare for someone my age to be taken seriously when they say they want to control their own body.
permalink — 1 March 2007, 20:29
I wish doctors would take us seriously in this regard. To me it seems so demeaning to question someone else’s choice in this matter. We decided to go the vasectomy route rather than tubal ligation due to the cost and quickness of the procedure. I was 25 at the time and my husband was 30. He had to call around quite a while before he could find a doctor to do it. Even then we had to sign documents stating we were sure etc. before he would perform the operation. So sad!
permalink — 2 March 2007, 17:56
I am 35 and thought about sterilization. I experienced some resistance when I went to get my Mirena inserted. She tried to tell me that because I had never given birth, the IUD might not make it through the cervix. I thought if that little tube can’t make it through, not much else should either.
I have thought about getting my tubes tied as well, but I am quite enjoying the period-free-ness that the Mirena is giving me as well.
permalink — 4 March 2007, 20:41
I decided when I was in my 20’s that I didn’t want children. I didn’t even try to find a doctor who would perform a sterilization because that was over 20 years ago. I often heard stories about young women wanting tubal ligations and being refused. I am now in my 40’s. I had a sterilization process called Essure performed. My husband was leery about going in for a vasectomy but at the same time he didn’t want me to go through the risks of surgery, even one as low-risk as a tubal ligation. Though he really tried to follow through with a vasectomy, he just could never do it.
I found out about the Essure procedure after I visited a female doctor whose up and coming Number One procedure was ablation to end menstruation. She advertised that women could make a choice about their bodies and that as a female doctor, she understood a woman’s right to making her own choices regarding her body. The doctor boldly declared in her TV commercial that we could “Stop the flow!” It sounded good to me so I called her office to inquire about the procedure. I knew I didn’t want to have children and figured why be bothered with periods?
When I went in for the ablation consult, the doctor told me that in the US, ablation is not recognized as a viable birth control procedure, so she had to inform me that I would have to continue on birth control. She saw I wasn’t happy with that so she recommended the Essure procedure. Essure is essentially a “non-surgical” procedure where small metal coils are placed in each tube vaginally (no cutting/incisions). Scar tissue forms around the coils and block the tube openings. It takes about three months for the tubes to become completely blocked with scar tissue. I didn’t think this was a big deal because that’s about the same amount of time it takes for a man to “shoot blanks” after a vasectomy.
I had both the Essure sterilization procedure and the ablation done at the same time. Both procedures were completed in about a half hour. I was home less than one hour after the procedures. There was virtually no pain or discomfort. I was feeling like myself the next day. I missed no days of work.
I love my child-free, period-free life. I have such a wonderful feeling of freedom. I wish I could have had this done 20 years ago. But better late than never!
permalink — 17 March 2007, 01:18