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Pronatalism and the Denial of Sterilization - A Summary

For my final project, I focused on the “pronatalist marginalization” (Gotlib 2016) of women in society and the issue of doctors refusing women sterilization because of it. This is a topic that bothers me for many reasons. I know multiple women who have tried to be sterilized, and they were denied because they were too young, or might change their minds. I, myself, do not ever want biological children. Any child I have has a high chance of being born with a heart defect, like myself, and the pregnancy would be high risk for me because of my heart deformity. I would like to be sterilized, however the chances of a doctor agreeing to do it are extremely low.

The experiences that the women I know are mirrored in the articles I chose. Richie states, “I have yet to come across a story of a woman without children who was granted sterilization on a first request” (Richie 2013). I researched why these women are denied, and if there is any basis in those reasons. I found many commonalities between these cases. Unmarried women are told to “go away and come back when you are married” (Denbow 2014). Women are constantly warned to “consider possible future regrets” and are even “refused treatment in anticipation of such regrets” (Mertes 2016). They are told that they “might change my mind”, and that they are “too young” (Mikkola 2016). Some doctors will cite medical reasons and tell the woman that they will not perform a “mutilation of her body” (Mertes 2016) because of the “risk of death and a risk of about 1 in 300 of requiring an emergency laparotomy to repair damage done to internal organs” (Benn and Lupton 2005). In the end, the top three reasons for denial had to do with Age, Regret, and Medical. But, when examined, none of the reasons for women being denied held up.

I looked at pronatalism and its dangerous effects on women, and why alternative, long term, birth control does not work. I expanded upon the role of the husband and partner when women seek sterilization. I also did a little research into the costs of denying women sterilization when they ask for it after an abortion. I included videos explaining how sterilization procedures work, and provided plenty of examples of what women go through when being denied. Finally, I discussed a plausible theory, called Testimonial Injustice, that may explain why these women are treated this way when seeking sterilization.

Benn, P. & Martin Lupton. 2005. “Ethics in practice: Sterilization of young, competent, and childless adults.” BMJ: British Medical Journal, 330(7503), 1323-1325.

Denbow, J. 2014. “Sterilization as cyborg performance: Reproductive freedom and the regulation of sterilization.” Frontiers: A Journal of Women Studies, 35(1), 107-131.

Gotlib, Anna. 2016. ““But You Would Be the Best Mother”: Unwomen, Counterstories, and the Motherhood Mandate.” Journal of Bioethical Inquiry 13(2):327–47.

Mertes, Heidi. 2016. “The role of anticipated decision regret and the patients best interest in sterilization and medically assisted reproduction.” Journal of Medical Ethics 43(5):314–18.

Mikkola, M. 2017. “Sex in medicine: What stands in the way of credibility?” Topoi, 36(3), 479-488.

Richie, Cristina. 2013. “Voluntary Sterilization for Childfree Women.” Hastings Center Report 43(6):36–44.

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I have yet to come across a story of a woman without children who was granted sterilization on a first request.

Christina Richie, “Voluntary Sterilization for Childfree Women” (2013)

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“I don’t want a baby. Ever.” As I google different ways of tubal ligation and the double standards involved with female sterilization.

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[tobecomechildfree]

I am a ciswoman in a heterosexual relationship nearing my 40s, who has never entertained the prospects of becoming a mother... From my earliest age onwards, living a future life that is childfree was a clear and obvious choice for me. In fact, to say that I have chosen this way of life is slightly misleading: I never knowingly made such a choice since I never questioned my desire to remain childfree or entertained the possibility to the contrary. Despite my lifelong conviction to remain childfree, I have consistently failed to secure a legally available voluntary sterilization. First, I was too young and might change my mind. Then I was too invested in an academic career (and might change my mind were my professional situation less precarious). There have been times when physicians have point-blank refused to discuss the matter with me. And I have been told that it would be unethical for any doctor to perform the sterilization as it is a difficult to reverse and unnecessary medical procedure. Whether I have been covered by national health services or a private insurance policy has made no difference to the justifications offered.

Mari Mikkola, “Sex in Medicine: What Stands in the Way of Credibility?” (2015)

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I find it really obnoxious that I am not legally able to get a tubal ligation because I am single and under the age of 40. Even if I was married, I would then have to get my husband’s consent to get a tubal ligation.

Welcome to the Commonwealth of Virginia.

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So very ironically after what happened to me this week, I had to go to doctors appointment (I was not willing to reschedule) concerning my anatomy, my fallopian tubes, and having a child.

Anyways, after the bad experience at the beginning of this week, this appointment was a good experience for me.

I have known for over 13 years that I did not want children. I had been talking to doctors about tubal ligation since I was 18 (yes I know even before it was legal), and many of them would laugh (even when I was 20), or say at 25 they’d consider it. Finally a year ago I had a doctor that said if I went through six months of therapy (to make sure i can make sound decisions) then they’d be okay. Long story short, I changed therapist and that doctor left.

They said another doctor would want the same thing, well I’m glad I scheduled the appointment anyways. I went in there and after seeing how long I wanted this, and listening to my reasons my new doctor agreed to the procedure.

I signed the paperwork and I can’t do the procedure until 30 days after signing the paperwork, but still. They’re asking if I want it done January-March.

They offered my the one that burns my tubes, or completely take out my entire tubes which I am leaning more towards.

Does anyone have experience in general with this procedure? I have been very concerned if because of my chronic pain it’d cause me pain for the rest of my life (this procedure)

I was so excited though, finally being taken seriously and listened to

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Reasons for Denial: Age

When to comes to sterilization, “the most commonly given reason for a denial” (Richie 2013) is age. The chances of being sterilized while under 30 are extremely low because doctors think you are too young. Sofie Rozendahl, for example, was specifically denied by her doctor “based on her young age” (Mertes 2016) even though she was 27 at the time. Women are told that they are “too young” and that she should “come back later when she is in her thirties or forties” (Richie 2013).

A person is considered an adult in most countries at the age of 18, and you must be 21 to be sterilized. However, women who are legally old enough to choose this procedure, are being denied due to their age. The main reason for this is that “[they] might change [their] mind” (Mikkola 2015). However, we must realize that this is an “assumption” we are making about their future, rather than paying attention to “their present beliefs and desires” (McQueen 2016).

This issue with age ties into regret, and Benn & Lupton phrase the conundrum best. “Treating people as rational adults means letting them do things they may bitterly regret” (Benn & Lupton 2005). Richie points out that “gender-reassignment surgery is available to minors” (Richie 2013) but we do not allow adults to make the choice to be sterilized. If an adult can choose to “[drink] a bottle of whiskey every day, it might be reasonable to ask what is so special about sterilization” (Benn & Lupton 2005).

It is believed that “those who [are] young” are “most likely to regret their sterilization” (Benn & Lupton 2002). It is true that women, who already have children, who are sterilized between the ages of 18 and 30 regret the decision more. Approximately 20.3% of these women regret their decision (McQueen 2016). For women over the age of 30, with children, who were sterilized, that number drops to 5.9% (McQueen 2016). This would seem to indicate that age matters when deciding to be sterilized. However, that 20.3% drops significantly for women who do not have children, who were sterilized between the ages of 18 and 30. Only 6.3% of these women without children regretted their decision (McQueen 2016). Additionally, women without children over 30 only had 5.4% of the participants report regret (McQueen 2016).

Looking at those statistics, we can conclude that age only matters when you have children. There is very little difference in the rate of regret when examining age for childfree women. What is interesting, however, is that childfree women are denied even more than women who already have children, despite the fact that they are less likely to regret it.

Benn, P. & Martin Lupton. 2005. “Ethics in practice: Sterilization of young, competent, and childless adults.” BMJ: British Medical Journal, 330(7503), 1323-1325.

Mcqueen, Paddy. 2016. “Autonomy, age and sterilisation requests.” Journal of Medical Ethics43(5):310–13.

Mertes, Heidi. 2016. “The role of anticipated decision regret and the patients best interest in sterilization and medically assisted reproduction.” Journal of Medical Ethics 43(5):314–18.

Mikkola, M. 2015. “Sex in medicine: What stands in the way of credibility?” Topoi, 36(3), 479-488.

Richie, Cristina. 2013. “Voluntary Sterilization for Childfree Women.” Hastings Center Report43(6):36–44.

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Nothing missing, nothing at all‼💯

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Upon requesting a sterilization, a young woman with no children reported that a physician told her to “go away and come back when you are married.” When seeking a sterilization in her midtwenties, a friend of mine who had no children was turned away by medical professionals who did not take her request seriously. In her own words: “After being rebuff ed by my family doctor, I contacted the local Planned Parenthood and was unequivocally told that no local doctor, whether associated with Planned Parenthood or not, would perform the operation on a twenty- three- year- old woman who would likely change her mind.” After moving to California and after “three ‘are you sure?’ screening interviews,” she was finally sterilized.

Jennifer Denbow, “Sterilization as Cyborg Performance: Reproductive Freedom and the Regulation of Sterilization” (2014)

[tobecomechildfree]

legend has it if you say “i dont want children” three times in a mirror an old person will appear and tell you how you secretly do

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Reasons for Denial: Regret

When examining the role of regret in denying sterilizations, we must ask two questions: “Do people who choose to be sterilized later regret their decision?” and “Ought we to consider the possibility of regret as a reason to refuse a sterilization request?” (McQueen 2016). By examining both of these questions, we can have a clearer understanding of what role regret really should play in these decisions.

Regarding the first question, approximately 20.3% of women with children, who were sterilized between the ages of 18 and 30, regret their decision. For women with children, who were sterilized over the age of 30, that number drops to 5.9%. However, for women who do not have children, who were sterilized between the ages of 18 and 30, only 6.3% regretted their decision. Additionally, women without children, who were sterilized over 30, only had 5.4% of the participants report regret (McQueen 2016). Clearly, the answer is blurry. However, it is clear that in all cases “most women who opt for sterilization are happy with their decision” (Mertes 2016).

Even if this was not the case, however, we can still answer the second question. A woman might regret her decision, but “this does not justify the hampering of females’ autonomy” (Mikkola 2015). Doctors need to realize that “it is unjustified, not to say condescending, to assume that the operation is likely to be regretted” (Benn & Lupton 2005). As Richie points out, “regret is the competent woman’s burden, not the doctor’s” (Richie 2013).

In addition, even if a woman regrets her decision, who is to say that it was a wrong decision? According to studies, 84.2% of women tend to experience “no long-term effects on life satisfaction in response to child birth” (Mertes 2016). In fact, only 4.3% experience “dramatic and sustained improvements in response to parenthood”, while 7.2% experience “a sustained decline” (Mertes 2016). This means, that your life will probably not get any better or worse if you have children, and if you do experience a difference, it is more likely that you will be worse off and less happy with your life.

So, the majority of women who are sterilized never regret their decision. Plus, there is no reason to regret their decision, given that it likely “served their interests and maximized their well-being” (Mertes 2016). We can easily conclude, then, that possible future regret should not be included when considering sterilization.

Benn, P. & Martin Lupton. 2005. “Ethics in practice: Sterilization of young, competent, and childless adults.” BMJ: British Medical Journal, 330(7503), 1323-1325.

Mcqueen, Paddy. 2016. “Autonomy, age and sterilisation requests.” Journal of Medical Ethics43(5):310–13.

Mertes, Heidi. 2016. “The role of anticipated decision regret and the patients best interest in sterilization and medically assisted reproduction.” Journal of Medical Ethics 43(5):314–18.

Mikkola, M. 2015. “Sex in medicine: What stands in the way of credibility?” Topoi, 36(3), 479-488.

Richie, Cristina. 2013. “Voluntary Sterilization for Childfree Women.” Hastings Center Report43(6):36–44.

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A 26 year old woman presented to a general gynaecology clinic requesting sterilisation. She worked as the manager of a large legal practice in central London. She had never been pregnant. She was in a relationship that had lasted five years and was using condoms for contraception. At the age of 17 she had discovered that she had a serious congenital heart defect. Neither she nor her partner had any desire to have children, and they had spoken about this at some length. The reasons she gave for requesting sterilisation were that she did not have faith in other forms of contraception; had no desire to have children; did not wish to change her lifestyle or threaten her financial status (she saw children as a financial burden); felt that children would prohibit many important life choices, including the opportunity to travel; thought the world was already burdened with enough people; and had serious anxieties about the risk of medical complications during a pregnancy as her cardiologist had told her that pregnancy would be risky. The gynaecologist suggested alternative and reversible methods of contraception, including the intrauterine progestogen system. He also asked whether her partner would consider vasectomy. He explained the risks of laparoscopic sterilisation, which include a small risk of death and a risk of about 1 in 300 of requiring an emergency laparotomy to repair damage done to internal organs. The patient declined the intrauterine system and refused to ask her partner to have a vasectomy as he was only 25. She explained that, should she die prematurely, he might meet a new partner who wanted to have children. The doctor reassured her that many of the cardiac risks in pregnancy could be ameliorated by judicious medical care in a centre of excellence. He did not feel qualified to challenge the personal choices that she was making but felt uncomfortable with the permanence of her choice. He explained that the people who were most likely to regret their sterilisation were those who decided to be sterilised on medical grounds, those who were young, and those who had a change of relationship. She acknowledged that these were reasonable points but did not feel they were sufficiently powerful to alter her decision. The gynaecologist still did not feel that he would be acting in her best interests by sterilising her and decided to seek a second opinion about whether the operation was appropriate.

Piers Benn and Martin Lupton, “Sterilization of young, competent, and childless adults” (2005)

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How fucked up is it that I at 19 cant get a tubal ligation but a doctor would gladly help me to get pregnant? Like apparently 19 is “too young” to make a choice about your own body.

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Reasons for Denial: Medical

Doctors are supposed to focus on our health and our medical needs. It is interesting to note, then, that the reason for denying sterilization that was brought up the least had to do with medical reasons. One doctors told his patients that he viewed sterilization as “a mutilation of her body in which he wanted no part, unless there are serious health risks” (Mertes, 2016). Another explained that there was “a small risk of death” and told his patients that 1 in 300 women require emergency surgery to “repair damage done to internal organs” (Benn & Lupton 2005).

This would seem like reasonable issue that doctors could have. However, when examined more closely, “the American College of Obstetricians and Gynecologists’ Bulletin ‘Benefits and Risks of Sterilization’ states that both female and male sterilization are ‘‘safe and effective methods of permanent contraception’’” (Mikkola 2015). This is means that, if your doctors know what they are doing, the procedure is safe to do.

Another reason that doctors give is the difficulty of reversal. Doctors state that “reversing sterilization is difficult and usually quite costly” (Mikkola 2015). Additionally, it is pointed out that reversal procedures are not always successful. However, “a successful tubal ligation reversal is sometimes possible” (Mertes 2016). Additionally, even when it is not possible, in vitro fertilization is always an option.

In the end, even medical objections, as few as they are, have no standing. These reasons can all be argued against.  Yet doctors still cling to the belief that the procedure is dangerous and irreversible. There is evidence to disprove that, but they will not recognize that fact. They maintain their belief that they are right, even when they are not.

Benn, P., & Martin Lupton. 2005. “Ethics in practice: Sterilization of young, competent, and childless adults.” BMJ: British Medical Journal, 330(7503), 1323-1325.

Mertes, Heidi. 2016. “The role of anticipated decision regret and the patients best interest in sterilization and medically assisted reproduction.” Journal of Medical Ethics 43(5):314–18.

Mikkola, M. 2015. “Sex in medicine: What stands in the way of credibility?” Topoi, 36(3), 479-488.