Sterilization by Choice

17 May

I would like to turn your attention to an excellent recent article in the Toronto Star about women who choose to have tubal ligations. It is a great piece and I urge you to read the whole thing, but here’s the part that sums it up for me:

“To [Sarah] Lawrance, tubal ligations are a matter of control and autonomy. And while people have their own opinions, that choice should belong to the woman alone.

‘You need to let people make their own decisions about how to lead their lives,’ she says. ‘Even if you think they’re wrong.'”

I love that this issue is getting some attention. It is one thing to be childfree by choice, which is a movement that is building momentum, and it is another to want to physically, permanently prevent pregnancy. In my experience, many people who are perfectly supportive of the former tend to recoil at the thought of the latter, especially if, as the article mentions, the woman in question is under 30 or hasn’t had children, or both.

I am 27. I recently had an IUD inserted. If I thought there was any chance of a doctor performing a tubal ligation on me, I would have had that done instead, but honestly I didn’t even try. I know at my age, with no children, there wouldn’t be a chance. I was recently talking to a coworker who has had four children (one stillborn), and who is now trying to have a tubal ligation. Her doctor reluctantly provided her with the referral, but not before grilling her at length about how she would react to every possible situation that might make her want more children, such as one of her children dying (“Been there, done that” she says bitterly), or the breakup of her relationship (I’m not sure how that would make someone want more children, but okay). It was only because of her previous deliveries and the fact that she had the consent of her long-term partner that the doctor allowed her to go ahead.

Personally, I’m not in the “childfree by choice” camp entirely; I think there’s a possibility that I may some day want children. However, I know with absolute certainty that any potential children of mine (or anyone else’s) are not being pushed out of my body, no thank you. I have a ridiculously low pain threshold and I am just NOT INTERESTED in being pregnant, nor have I ever been. And as uninterested as I am in being pregnant, I am doubly uninterested in going through labour. I have the greatest respect and admiration for the people who do, but that ain’t for me. I’m too chicken, and I’m ok with that.

This is something I have thought about a lot. I would imagine that most women who want tubal ligations have thought about it a lot as well. I wish that doctors could use the same philosophy in this situation as we want them to in abortion: trust women. Trust that women are making the right decisions for themselves about their own bodies. Trust that if we make a mistake, we are ready to deal with the consequences.

No one asks women who become pregnant by choice whether they are sure they want to have babies. No one is going around at baby showers talking about vaginal tearing (not the fun baby showers, anyway). Another coworker said to me recently “I could handle the pain, but the tearing freaks me out. And it won’t be the same. I could deliver a watermelon out of my mouth, but my face is never going back to how it was.” And no doctors are asking her to give that incisive commentary to women thinking about having children.

When we think on a grander scale of what unwanted/unplanned pregnancies can mean – abortion, obviously, but also overpopulation and poverty, crime and abuse – maybe we should be jumping at the chance to help those who don’t want to give birth, to prevent it permanently. If we have it in our power to grant peace of mind, why shouldn’t we?

Currently in Canada there are no guidelines around who can have a tubal ligation and when. Like abortion in this country, it is the doctors who regulate their own limits and parameters. When it comes to abortion, this usually takes the form of setting gestational limits, which works quite well: there is a clear boundary and only the women who fall outside of it will not be seen (and will almost always be provided with at least a referral instead). But with tubal ligation, doctors seem to be delving into the murky world of deciding on a case-by-case basis who gets one and who doesn’t. In this case I believe solid guidelines from the Society of Obstetricians and Gynaecologists of Canada would at least give doctors a foundation from which to craft their own parameters.

I have pretty much taken it for granted that I will never be allowed to have a tubal ligation. Should I become pregnant, I will probably terminate the pregnancy. For that reason, you would think the anti-abortion people might want to get on board the movement to make sterilization more accessible for those who want it. But of course their whole movement comes from the same place as the medical community’s reluctance in this area: the societal idea that women were meant to have children. That wanting to produce offspring is the norm, effectively Othering people (and especially women) who just…don’t.

I’m lucky. I was able to get an IUD and it is working for me, for now. Many people are not so fortunate, and it would be great to see the contraceptive options expand and become available and accessible for everyone.


23 Responses to “Sterilization by Choice”

  1. Courtney May 17, 2011 at 1:14 pm #

    I hate the double standard. There is hardly ever any question about if a woman is ready to have kids but if she doesn’t want kids, they question if she is READY to make that decision.
    I’m 20 and when I was in elementary school I was wishing for the day when I could turn 18 and just get sterilized. Reality hit and most docs will not sterilize you if you’re under 30 and don’t have kids. I won’t ever change my mind about wanting kids. I just thank my lucky stars I’m a lesbian but I feel sorry for heterosexual women who are being denied sterilization simply because doctors won’t get their head out their bottoms.

  2. khan May 17, 2011 at 1:40 pm #

    They stopped the BC pills when I was 30; couldn’t get a tubal because I was childfree; had an abortion at 41.

  3. Ae3nn May 17, 2011 at 2:22 pm #

    I’m glad to see this issue addressed. Sterilization is one component of reproductive freedom, and it’s being regularly denied to women (and men). Abortion is quite important, but it’s not the only place where we need to stand up to those who would tell women what to do with their bodies.

  4. bathory May 17, 2011 at 3:05 pm #

    I had my tubes tied in Toronto at 25, with no children and no health history to suggest that I wouldn’t be a “good parent” or have a viable pregnancy. With a good doctor referral it can be less stressful than you think but the relationship with your GP is pretty vital in being able to get that referral to a surgeon. I also wanted endometrial ablation but i was nervous that if I pushed it I would lose the tubal so I didn’t.

    Best thing I ever did.

  5. Amy Hartin May 17, 2011 at 3:14 pm #

    It is actually possible to get a tubal ligation under 30, though it certainly can be difficult. I know in Austin, there are at least 3 doctors who will perform them starting at 25, even if you have no children. The trick is finding doctors who are willing – I just wanted to put that out there. Ask local women’s clinics for any referrals they may have for doctors who will do tubals at a younger age! Though I know it’s not cheap and many women don’t have insurance to cover it, so like you I am a big fan of IUDs.

  6. potsherds May 17, 2011 at 3:15 pm #

    I’ve got an appointment on June 7th to talk to an Ob/Gyn I’ve never met before about getting sterilized. I’m 27 with no kids, and plan to type out my talking points with this woman. I’m damn well going to assure her that with the direction the U.S. is taking, I’ll be getting an illegal abortion at some point in the future if I’m unlucky, if I’m not given the right to choose *now*, and get sterilized. I will never, ever, ever be pregnant longer than it takes to secure someone willing to help me in ending it. Period. …And I’m still, with how indelicately I plan to put it, fairly sure I’m not going to be allowed to make a free choice over my reproductive capabilities.

  7. Alicia May 17, 2011 at 3:15 pm #

    I am so glad to see this article (and in such a timely manner!) I was just trying to explain to someone the other day why I wanted to be sterilized: I don’t know if I never want children, but I know beyond a doubt that I never want to get pregnant. I’ve met with very little open hostility towards my decision recently, but plenty of confusion.

  8. Elinor May 17, 2011 at 3:40 pm #

    or the breakup of her relationship (I’m not sure how that would make someone want more children, but okay).

    Some people, when they remarry or start a new relationship, want to have kids with the new partner. They want to raise kids from babyhood with their new partner, or it’s a romantic thing — they feel that having children makes the relationship “real”, or it’s a “fresh start”, or they can “do it right this time”.

    So yeah, sometimes the end of a relationship indirectly causes people to want more children. Not a reason to deny people sterilizations, but it does happen.

  9. Dee May 17, 2011 at 4:06 pm #

    I’m in NY, a pretty liberal state, in its most liberal city, and I was denied sterilization because I’m in my 20s and childless. For me, it’s not an issue I’m ambivalent about. I know, beyond a shadow of a doubt, that I do not want children. By the time most doctors are “comfortable” with sterilization, you probably don’t need it anymore!

  10. Jules May 17, 2011 at 4:13 pm #

    I was shocked when my doctor told me that not every OBGYN would give an IUD to a woman in her 20s. When I left the appointment she told me a list of the doctors in her practice that would do it. I’m not ready to consider tubal litigation, but 5 years pregnancy free (and reversible) should be a viable option.

  11. D W May 17, 2011 at 4:17 pm #

    I used to have a bookmark (lost in a computer reinstall years ago) to the study of a summary about women’s age at sterilization and regret. The summary mostly annoyed me because it was focused on finding differences based on age, which was true for a subset: women who had at least one child before sterilization. A single sentence rather easily overlooked in the middle of the summary noted that women who did not have any children before sterilization had the lowest rates of regret in the study and that it didn’t vary significantly by age.

  12. Not Guilty May 17, 2011 at 5:27 pm #

    I was booked to get my tubal then decided that the failure rate was higher than I was comfortable with so I cancelled it and got an IUD. I went to my GP and the subsequent OB/GYN with my “story”. I was forceful and ready for a fight. Luckily neither gave me one other than risks, etc. But since I know you personally Peggy, I’m not sure I could see you fighting that fight comfortably, whereas it was just another one for me.

    Somedays I *wish* I’d been given trouble by one or the other so I could fight them all the way to the College to make them change the guidelines/rules. Maybe I should just keep seeking doctors until I’m denied then give them all I’ve got…

  13. AC May 17, 2011 at 6:41 pm #

    I am 37, tried for years to get a tubal done and no one would do it.

  14. placenta sandwich May 17, 2011 at 7:18 pm #

    I feel obligated to point out that NOT all anti-abortion people also oppose sterilization, but that their “support” for sterilization is maybe not as welcome as you’d expect: take John Labruzzo, a Congressional representative from Louisiana, who a few years ago proposed a bill to pay poor women $1000 to undergo tubal ligation. Until recently, the woman who started “Children Requiring A Caring Community” (CRACK, get it?) was promising $200 of her personal funds to drug-addicted women for the same purpose. [Now it is a 501c3 offering $300, and IUDs or implants also qualify. Still shady.] When someone is poor or addicted, offering hundreds of dollars for anything may be tantamount to coercion.

    In the US, we also have the dark and shockingly-recent history of forced sterilization of various people deemed by the state or by doctors to be unfit to reproduce (the mentally ill, wards of the state, the chronically poor, petty criminals, people with developmental disabilities, Native Americans, African Americans, teenagers who became pregnant at an early age…). Such violations weren’t totally ended until the 1970s! So now Medicaid in particular has rules making it extremely *difficult* to consent to and proceed with sterilization, so that a signature can’t be wrongly obtained during labor or something like that.

    Not saying that’s working out so well. It does piss me off how difficult it can be to limit our fertility when we want to. But at least down here, there’s some historical context as well as ongoing reasons that I don’t really *want* to see certain people be gung-ho about sterilization!

  15. placenta sandwich May 17, 2011 at 7:19 pm #

    (You may be unsurprised to know that Rep. Labruzzo also wished for [though never formally proposed] financial incentives for “educated” people to have MORE children. So I guess your claim holds true for him too, if you narrow the focus to his “acceptable” kind of childbearers.)

  16. Peggy May 17, 2011 at 7:31 pm #

    Unfortunately in Canada we also have a history of forced sterilization, particularly of First Nations people. I feel that it is a parallel issue to abortion – the key is choice. And for some people, being allowed to have that choice either way, without coercion, is much more difficult because of the various oppressions that they face. Something I didn’t touch on in this piece is how what sterilization means to me is so very different than what it means to, for example, an Indigenous person or a poor or marginalized person, or a mentally ill person. I recognize that I have a great deal of privilege to be able to talk about sterilization as a choice without having to consider the historical baggage around it.

  17. Rose May 18, 2011 at 10:27 am #

    Oh, I love this post. It is EXACTLY how I have been feeling for a long, long time. And you know what? People call me selfish and stupid because I do not want to give birth, because I like my body the way it is. Superficial, even. Why is it so superficial, when no one comments on women getting boob jobs and face lifts? Why I am the superficial one, just because of the lack of desire to reproduce?

    I completely agree. I wouldn’t be against children per se, but they are not coming out of my body.

    Thankfully I am Dutch and Dutch regulations on tube-cutting and abortion things are quite liberal. For now I’ll just get one of those implants to prevent me from getting pregnant, as I am not a fan of operational risks.

    Fabulous blog, and good for writing on themes that need to be written about. The desire NOT to want to have children is one of the biggest taboos in the most liberal countries.

  18. Serena May 18, 2011 at 3:02 pm #

    Peggy, thanks for bringing this up – I’m enjoying the comments on this post.

    Aside from the forced sterilization issue that you and placenta sandwich mention, there is also some similarities to the sterilization debate and women or transguys with PCOS who want to have hysterectomies to stop getting painful cysts on their ovaries. I know several people with PCOS who have repeatedly asked for a hysterectomy who have been denied. The doctors always say, “you might want to become pregnant later on in life,” even though all of these people have said no.

    Personally, I would love to give my ovaries and uterus to some woman who would like to use them. I never plan to get pregnant or have a baby. I am annoyed by my period every month. I’d love to get rid of all that and let someone who does want a baby but can’t get preggars have my junk.

    Just my 2 cents.

  19. juliewashere88 May 28, 2011 at 12:34 am #

    I’ve been trying to get sterilized for quite some time now. At first, I had trouble just getting a referral to the OB/GYN clinic. It was by PA referral only, and I didn’t get to pick my PA. She refused to send me. Not for sterilization, not even for an IUD (she told me that IUDs CAUSE STDs.)
    I eventually did get a new PA who referred me. The OB said that some of his Catholic colleagues had given him heat after sterilizing someone older than me some time back, so he hesitated to sterilize me then. He offered me a deal, try an IUD for 6 months, and if I didn’t like it I could come back to him for sterilization. I wanted Paraguard as one of the reasons I was off the pill was that I didn’t like the hormones, but he insisted on Mirena.
    6 months later, I HATE it, so I came back. Jokes on me, he’s leaving the hospital (retiring, I think.) So now I’ve been referred to a new OB who I see next month, who I’m sure will refuse as well. 😦
    I wonder if casually mentioning that any unintentional pregnancies will result in a very intentional abortion would help my case…

  20. juliewashere88 June 6, 2011 at 7:55 pm #

    Getting sterilized next month. Yay! 😀

  21. Danielle August 29, 2011 at 12:12 pm #

    I am 24 and have two kids ages 5 and 7 and have had one abortion. I absolutely do not want anymore children and have had my mind made up for 7 years, the second pregnancy and child was an accident that my s/o at the time convinced me not to abort.
    I went to an OB/GYN two months before I turned 24 for a consultation for a tubal ligation. She suggested that I get the Essure procedure instead of a tubal. I looked into it and that is definitely what I want to do. But she said she won’t do it until I turn 25 and not a day sooner! I don’t understand why she’s making me wait one more year. AS IF, I’m going to get pregnant sometime this next year and actually keep it! I told her if I accidentally got pregnant I would absolutely get an abortion and she kind of looked at me like I was crazy. She was big and pregnant and also a fertility doctor, so I’m sure she was all baby crazy as well as her other patients LOL.
    I just want to get off birth control. I’ve been on the pill for 5 years and I think it’s starting to really mess with my body. I went to my regular doctor for some symptoms I’ve been having and she even told me that being on hormonal birth control can cause nutritional deficiencies because it somehow blocks your body’s ability to absorb certain vitamins and minerals.
    I guess I’m just going to have to wait another 9 months to get the Essure procedure and then another 3 months until it is effective.

  22. Ally July 23, 2013 at 4:08 am #

    I grew up with a nightmare for a mother and I knew as a teenager I never wanted children so when I was 18 I begged and plead with every doctor I went to to let me get sterilized they refused me so I was seeing two different doctors one for the depo shot and another for the pill when I got engaged he didn’t want kids either so we were very cautious sadly even despite our efforts I got pregnant when he found out he took off and to this day I have heard nothing from him so I was stuck figuring it out on my own. I went from an independent life to living at home I sought to get an abortion but I couldn’t afford it. I thought I had found an adoptive family and they backed out due to a divorce when I was 8 months pregnant. Once he was born I wanted nothing more than to leave him however my parents wouldn’t allow me to abandon him so now at 25 my life is ruined my body will never be the same and sadly everyday when I see him all I see is the biggest mistake in my life. I hate being a mother it is everything I never wanted I lost a good job because of getting pregnant they said it was because they didn’t want to be responsible if something happened and sadly I have been working a job now for less pay. I gave up my beautiful sports car because I couldn’t afford the payments. I no longer enjoy time with friends because they don’t have kids. I take care of the finacial responsiblity for him I pay for everything I come home from work to him every evening but I feel nothing for him I just wished they would have allowed me to get sterilized at 18 because it wasn’t fair to me or to him that he had to be born the doctors should be held responsible for not allowing women to make their own choices on having children because in the end the doctors don’t raise the umwanted child we do or they end up in state homes costing tax payers


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