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.”