Offspring Off Limits: The Real Reasons Doctors Won’t Sterilize Women

So you thought you lived in a liberal society, where doctors understood (supported, even!) a woman’s right to choose NOT to do the whole parent thing. But growing numbers of women and couples who want to keep a modest family size of two are having trouble finding support from their doctors. More and more women are seeking out ways to make their bodies catch up to their decisions, without the troubles of daily pills and hormones. But many doctors flat-out refuse to sterilize women of childbearing age who haven’t yet had children, and the reasons don’t have anything to do with physical health. Should doctors deny us our right to choose not to have kids, forevermore? We talked to a few friends with M.D.s to find out why so many doctors won’t do the deed.

“I personally HATE the idea of sterilization and I try REALLY hard to talk people out of it. Why? Because life is long, and even when people say they’re certain of their decision, I know that the only thing certain in life is uncertainty,” wrote Dr. Lissa Rankin, gynecologist and author of What’s Up Down There: Questions You’d Only Ask Your Gynecologist if She Was Your Best Friend, in an email about the issue. Lissa runs the website Owning Pink, and is all about empowering women to get in touch and take control of their sexuality, so we were surprised to find out that she’s so against it.

“I ask my patients these questions when they request sterilization: 1. What if you husband and three kids were all in a car accident and died. Would you ever want more kids? and 2. What if you partner ditches you tomorrow, and you meet this hot young dude who has never had children but wants nothing more than to have them with you. Will you wish you could?” Lissa says that she’ll only agree to help patients if they answer “no” to both of those questions, and hear out her pitch for intrauterine device (IUD), an effective, reversible form of long-term birth control. “I put them through the ringer first because the risk of regret is about 7% in a study that evaluated women age 18-44. The younger the woman, the higher the risk of regret, in general.”

In a National Institutes of Health press release, Duane Alexander, director of the NIHCD, commented on the same study, which was published in Obstetrics and Gynecology in 2002: “This study is reassuring in that a comparatively small number of the women in the study experienced regret after either they or their husbands underwent a voluntary sterilization procedure,” he said. “However, the finding also underscores the importance of the health care professional in providing thorough counseling for those considering sterilization as a means of family planning.”

But many women under 30, who haven’t had kids, can’t find a doctor who will perform tubal ligation at all. In response to a post about birth control options, one Blisstree reader explained her frustration with the lack of doctor support for her preferences:

I’m very, very, very sure I never want to have children for a multitude of reasons, and have been certain of this for some time. It’s just not something I’ve every considered or felt that I needed to live a fulfilled life. However, my gyno has explicitly told me on several occasions that sterilization is not an option for people under the age of 30, despite my asking after it extensively. The pill/patch/IUD are all temporary fixes for something I’m very sure I never want, so sterilization has always felt like the right choice. Unfortunately, I have to wait it out until someone is willing to give me what I want.

And in this clip from an episode of The Tyra Show features a married couple who was denied tubal ligation or vasectomy by several doctors, despite having come to a firm mutual agreement not to have children:

If this debate seems like fodder for an episode of Grey’s Anatomy or Private Practice, you’re not alone: Many women and couples feel that they’re being disempowered by doctors because of moral evaluations that aren’t really any of their business. While most doctors seem reluctant to perform tubal ligation because of the permanent change in patient options, Dr. Lissa Rankin reminded us that there are also implications for our physical health:

Well, it requires surgery. When I was a resident, we had a healthy young woman who died as a complication from a laproscopic tubal ligation. It’s not to be undertaken lightly. Newer procedures like Essure make it safer than previously, but there’s still risk.

If you’re set on a childfree life, many doctors recommend IUDs over sterilization. Psychologist Ellen Walker, Ph.D, author of Complete Without Kids: A Childfree Handbook, says “It’s absolutely true that doctors don’t like to sterilize young women, and even for vasectomies, doctors are hesitant to allow younger men to get them. I would encourage a young woman who’s pretty positive she doesn’t want to have children to consider getting an IUD. It’s long-term, safe birth control that’s pretty much 100% effective, and some can be in place for 10 years. That’s a lot of years to not have to think about being pregnant. And you never know, you might meet someone who wants to be a stay at home dad, and that way you haven’t closed the door.”

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    • regrets

      I can honestly say that I regret my decision although at the time it seemed to me that I would NEVER want more children. In my 20′s I often said I did not want to be tied down, I was busy and having a great life just as I was…then along came my husband, and that went right out the window, I could not wait to have his children. We lost a baby and after 2 pregnancies, I really did not think I would ever desire to go though that again…so at the ripe old age of 32 I had a tubal. But as my children grew and our love of being parents grew, my thoughts on another child changed. Too late for me. But the advice I always give when someone asks me or if the topic comes up is NEVER say NEVER. As our lives change and we mature we can never say for certain what we may want. A lesson I learned the hard way.

    • Sarah

      IUDs are considered safe and painless. That is a load of BS. I want children, however, I had an IUD not long ago trying to control other issues. It was painful, and that was the entire time it was in not just the few minute insertion which was very painful. It then came out on its own and my medical “professional” tried to prove me wrong when I said it had come out. She said it had just gotten into a more comfortable position. Well, I was right it was not there. Anyone in the medical profession needs to learn to listen to their patients before they try and push their opinion/agenda on them. If they can’t listen and consider the fact that their patients past the age of majority have the right to make their own decisions and in spite of your medical training I know my body better than you ever will need to change professions. I wish their was a way to warn others about poor experiences with doctors and nurses.

    • Tessie Mora

      Thanks for doctors who think like this. They are sensible and do not subscribe to the fad of “not wanting children” anymore. Children are the future. We do not live for ourselves alone but we have an obligation to humanity in general to continue the human species. I love children and seeing my grandson now at 2 years old, I praise God that He was born and bring delight to all people around him. Who knows, some of these children to be born will become saints!

      • Leigha

        Do you want kids to be raised by parents who don’t want them? I’m sure that would go very well for the kids. We have lots of kids like that already; many are abused, many end up in foster care, many are physically just fine (because their parents are responsible, upstanding people who just happen to not want kids) but feel unloved and unwanted. Why you would wish that on any child is beyond me.

        We as a species have an obligation to continue the species, yes. There are 7 billion of us. I think if a few, or a few hundred, or a few hundred thousand of that 7 billion choose not to have kids, we’ll still be perfectly fine. If EVERYONE has kids, we will be less fine, especially if they have more than 1 or 2. The population is growing fast enough as it is.

        Further, it is absolutely ridiculous for you to want to take their decision away from them. You want kids. They do not. How would you feel if they said, “Well, Tessie Mora should be sterilized [before you were a mom, let alone a grandma], because there are too many people.” Wouldn’t you be really upset that you had the decision to have kids taken from you? You trying to make people feel guilty about not wanting kids is kind of like that. Forcing them to have kids when they don’t want to (which you seem to imply, since you call not wanting kids a “fad”) is the direct inverse of sterilizing people against their will (something our government has done in the past, damaging many people’s lives).

        And lastly, as stated in the video, if they do happen to ever change their minds, there are thousands of kids up for adoption who would be more than happy to be given a family. No need to add more. All those thousands of kids in foster care, group homes, and orphanages around the world? That’s what happens when people have kids they don’t want.

    • Carole

      I had a tubal at 23 from a doctor who asked my husband’s opinion. My husband didn’t want kids either. He said that if I didn’t want children, that was my choice.He said he never had to get pregnant The doctor and I had a long talk, and I had a tubal ligation the next month. Never regretted it. I’m 58, and have enjoyed being an aunt to other people’s children, but I’m always happy to give them back.

    • Carole

      BTW – Regrets. There are lots of children who need a loving parent who enjoys being a parent. Fostering, adopting, and mentoring are just a few ways to share you love and wisdom.

    • T

      This article was insulting in many ways. The doctors from this article are taking the stance that their patients are not capable of making decisions for themselves with regards to their reproductive health. If the tables were turned however the doctors would not have the same reservations. If a patient came to them and said that they wanted to have children and wanted to take those steps they would not hesitate to start on that course. Why is the converse so hard to accept.

      I am CF and 26. I have know this since I was 13 and have never had a moment of doubt. Being childfree is not a fad. It is a deliberate life decision. I do not mentor, or babysit or seek out interactions with children because I do not want to. And citing the need for humanity to continue as a justification for reproduction is sadly ironic. The more human beings reproduce the less resources there are and the less likely it will be that the current population is sustainable.

      If someone meets a mate and they are childfree then in order for them to be perfect for each other the mate should also be childfree. Meeting someone who wants to be a “stay at home dad” means that they are not my perfect mate. Also bringing religion into the debate falls on deaf ears for many. Not everyone subscribes to your religion.

      • Briana Rognlin

        Hi T,

        Thanks for commenting. I definitely agree with you on a lot of points, and was surprised to find that these doctors (who, as I noted in the article, I expected to be a little more supportive of patients who seek out sterilization) were so skeptical about tubal ligation.

        But I’m confused about a couple of things – when you say “citing the need for humanity to continue as a justification for reproduction is sadly ironic,” are you referring to a comment from one of the doctors? This isn’t really part of either of their stances, so I’m not sure where that came from. I also wanted to clarify the religion issue – that’s something that I purposely left out of the discussion for this post. I really wanted to focus on the doctor-patient relationship to find out why so many women like yourself have a hard time finding doctors who will give them what they want – sterilization.

        Thanks again for your comment; I think you bring up a lot of issues that are interesting, controversial, and good to address in this discussion!

        -Briana Rognlin (deputy editor)

    • Carole

      T – I couldn’t agree with you more! Better that people who don’t want children don’t have them

    • T

      When I wrote about religion I was talking about the comment as well as various comments I have received personally from individuals. And the comment about continuing humanity was a reply to an earlier comment.

      I guess for me there is a sense of frustration because there are individuals who completely disregard the desire to not have children. The fact that in this article the individuals are the very doctors who should be looking out for a patients well being is doubly frustrating.

    • Kristin

      I’m a twenty-four-year-old childfree woman, and I find the lack of doctors willing to sterilize childfree women troubling and upsetting.

      I understand that people change their minds (though I never will–I have enough reasons to write a book), but I don’t believe it’s up to a doctor to make those decisions for their patients. A reasonable amount of questions is fine, to ensure the person knows what they are getting into, but outright refusal does not seem fair or right, especially if the patient has done their research and considered this decision over multiple years.

      I think it’s the fear of lawsuits primarily that stops doctors from doing sterilizations, as well as a paternalistic attitude that the person in question may change their minds and come crying to them later. However, a clear waiver should be enough to prevent the doctor from receiving future harassment from flip-floppers.

      I feel insulted as an adult woman when people insinuate that I might change my mind. I have a phobia of babies and pregnancy, deep moral reasons to never add to the human population, and there is no situation I have yet thought of where I would want offspring. I should not even have to justify my decisions. If I was choosing to have a child, which is a permanent decision that affects not only myself but also the child in question, no one would be questioning me. It’s hypocritical.

    • Kohoutek

      Who is hell is Ms. Rankin to try to sway anyone? If people “regret it later,” too effing bad. They are adults, and that’s life. If those people are so confused about such an important decision, their “regret,” rather than the initial sterilization, indicates an immaturity that suggests that they should never be parents, as they will likely swing back again and regret having kids. Who do doctors like these think they are?

    • cfrules

      It scares me that sexist women like this are gynecologists. Nearly all their comments boil down to “What if you meet a man who wants kids? If you’re sterile you can’t possibly submit to his wishes!” Even the stay-at-home dad comment is infuriating, because having to sit at home with a kid is hardly the sole reason many women are choosing to be childfree.

    • Nate H

      The number of women who regret it who are under 30 is 20% or more. That’s one out of every 5 women under 30 are going to regret it. Then there’s the syndrome that we don’t understand and may be connected to our body needing to, you know, do it’s NATURAL process of dropping an egg. The older a woman is when she gets the surgery the less likely she is to have that syndrome happen (but keep in mind, we can’t prove the syndrome exists or what it’s about, so doctors can’t say they believe in it, but if they see it happening with tubal ligations, and a 10 year birth control method would remove so much of that risk, then why not err on the side of caution?) A permanent elective surgery that is committing genetic suicide and is not reversible (and if you do want it reversed the try won’t be covered by insurance) is not something to be taken lightly.

      • Ella Warnock

        Childfree women, especially, do not take sterilization “lightly,” as if they wake up one morning after a long night of partying and just decide to have a tubal on a whim. I was sure I didn’t want kids when I was six years old. I’m 48 now and not once in all those many years have I ever wavered one iota. I was married for 9 years before my husband had a vasectomy, 9 years that I should not have had to take hormonal birth control. And not every woman is a good candidate for an IUD. Also, childfree women are much less likely to experience sterilization regret than women who have children.

        Of course, what really weakens your argument is the “genetic suicide” reference, whatever that actually means.

      • Sylvia

        Thank you for saying that.

      • BJ Survivor

        Dawg, Ella. Don’t you know how selfish you are for not wanting to share your special snowflake DNA? For not giving life to a special snowflake baby? What if your mom had decided to never have children? What then, huh? Huh? Gotcha, didn’t I! /snark

      • Ella Warnock

        I hang my head in shame. You’ve convinced me of the error of my ways! Despite the fact that I’m menopausal, I shall strive to produce a few progeny forthwith!

      • BJ Survivor

        “Genetic suicide”!!?? Oh, FFS, there are over 7 billion human beings on this planet, and counting. The world will get along just fine without my DNA contribution. FSM, the narcissism inherent in the pro-natalist/anti-childfree is just nauseating.

    • Tim Jones

      When I was 17, I knew a few couples that had no kid’s and had a great life. I knew then it was a no brainer. I made my decision permanent @ 22. Lucky I found an opened minded doctor! I’m now 53, married to a childfree girl for 20 years and VERY happy.