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Denial of Sterilization as a Form of Birth Control: Discrimination or Due Diligence?

Denial of Sterilization as a Form of Birth Control: Discrimination or Due Diligence?
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Nothing polarizes debate like birth control. Though many high-profile arguments rage on about abortion, the “morning-after” pill, and insurance payments for birth control pills, sterilization is an often overlooked but equally charged form of contraception.

  Emma’s Story

“I never wanted children,” says Emma, a 27-year-old single mother of two. “Everybody always told me that I was very good with children and I did enjoy them, I just never wanted to be in a situation where I couldn’t walk away from them.... I liked babysitting, didn’t want to be a parent.”

Emma’s change of heart about motherhood came during a pregnancy scare while in a solid relationship. “I was convinced that I was pregnant,” Emma says. “I had already had an abortion at 19, and had been perfectly fine with it,” Emma says, “but this time was very different, if only because I felt more attached to my partner.”

During her pregnancy scare, Emma saw a number of pregnant women and found her outlook changing. When Emma found that she was not pregnant, “I felt like I had actually lost something important to me, and called my partner to tell him so. When I got back we had a long conversation about whether or not we wanted to have a child at that point....which was something that he had always wanted. And we made a decision.”

Emma and her partner had another child before their relationship ended. “I am very glad that I made the decision that I did,” Emma says.

  Rayne’s Story

Rayne, a 31-year-old mother of four, requested tubal ligations each time she delivered a child. She was refused at 17, 18, and nearly 20, but was only granted one at age 21. “I absolutely would have had less children if they would have given me the tubal [earlier],” she says. “It would have been six [kids] had I not had a miscarriage when I was pregnant for the twins.”

For Rayne, a tubal ligation was the only method of birth control that made sense: “I don’t remember to take pills and the insurance I had back then made you pay for birth control and then would reimburse you. I couldn’t afford the prescription and my parents wouldn’t pay for it. So condoms were my way. And then my fiancee (at the time) started refusing to use condoms and raping me with the intention of getting me pregnant.”

Though Rayne dealt with three different obstetrics-gynecology doctors, the refusal to perform her tubal ligations was consistent. “My first OBGYN was Indian and had something insane like ten kids,” Rayne says. “He was just convinced if I found someone who treated me better I’d change my mind.”

Another OBGYN “seriously considered the procedure, but then decided not to for ‘personal reasons.’“ Though Rayne explained her situation thoroughly — “I was already on WIC, welfare and HEAP, and my ex had just been convicted of a felony so he was going to jail after I gave birth to my fourth and last child” — the doctor “just kept giving me reasons why it was better not to.” Though Rayne finally convinced this doctor to sign off on the procedure, he refused to perform it himself.

  Is It Discrimination?

These two accounts tell two very different sides of the same coin. As with many of our most contentious social and political issues, there is no obvious one-size-fits-all answer. One could argue that there is a certain moral bias acted out in the refusal of tubal ligations to young women; the refusals often feel rooted in the premise that of course all women will eventually want to bear children. But one could also argue that since tubal ligations are irreversible, the medical community is performing due diligence by ensuring that women making such a permanent decision have every opportunity to consider its weight beforehand.

Then there’s my story — not a whiff of sterilization here, but perhaps relevant nonetheless. I was a pornographer before I became a legal adult and I was leaning on my HIV+ friends for details of their medication regimens to ensure realism in my gay male porn. You bet I was thinking about contraception before I ever got to first base with somebody. When I enrolled in college classes at age fifteen, my mother and I had a baldly pragmatic conversation: It was a good idea to get started with contraception before roaming a campus alone, and a better idea for that contraception to be the pill just in case the worst happened and I was raped.

It’s medically required to receive a pelvic exam before birth control pills are prescribed. So there I was with my mother calling OBGYNs to find out exactly what needed to be done for her fifteen-year-old virgin daughter to be sexually responsible, and there she was receiving answers like “Well, the doctor will have to put his fingers inside her, but if she wants to get on the pill, obviously she’ll be fine with that.” (I wasn’t, actually. I did not in fact consider my vagina open to all comers just because I was considering becoming sexually active. And while I’m dispelling myths here, I might as well note that I did get on the pill at age fifteen, and ran right out to have sex...four years later.)

That one’s pretty easily tagged as discrimination. But the women above don’t report that kind of in-your-face snideness from their providers, no matter which side of the fence they were on; in fact, Rayne noted that her doctors were universally mild in their conversations on the topic and did not cop attitude, although one could argue that the patient insistence that she would change her mind is a far more insidious, condescending expression of discrimination. It may be that with notably outrageous exceptions, there is too much subtlety between a refusal based in discrimination and a refusal based on sound principle for us as a society to come to any sort of consensus anytime soon.

  Your Stories

Have you or your partner considered a tubal ligation or hysterectomy, been refused one, or had one done? What was your experience like? Even if you’ve never considered one, tangled issues of health and discrimination are only unknotted if the culture at large has something to say about it, so regardless of whether you’ve had personal experience: Where do you stand?

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Comments

I am very pro-sterilization, regardless of age and your current status as a parent or not. My now-almost-seven-year-old daughter is the result of an unplanned pregnancy, when I was just 20, and my then-fiance-now-husband was 22. However, unplanned =/= unwanted. She was a shock to be sure, and my husband (then he was "just" my fiance) and I were unprepared, but we quickly got ourselves situated and moved in together and financially stable enough to take on the responsibility of a baby two months before she was born.

We decided to have a second a year after that, and I knew as soon as I was pregnant that I did NOT want any additional children, as two would be more than enough (I joke that you shouldn't have more kids than you have hands, but sometimes I think that's a very good motto to live by!). My husband was on board with me, especially since at that time we were both working full time to make ends meet.

I was fortunate to have a decent OB who was honest when she said *she* didn't think giving me a tubal ligation when I was "only" 22 and had "only" two children was a good idea, but that she respected my views (especially when I pointed out that, at the time, I was ONLY 22 with a toddler and a baby on the way, on state-funded health insurance and WIC and still barely making ends meet) and would present my "case" to the board of whoever decided yes or no. It took several weeks and I had to attend several counseling sessions, during each one trotting out all of the reasons why I wanted to be permanently sterilized, but in the end I had my way. The only concession, which my OB took upon herself to make during the procedure and didn't inform me of until later, was to use the least permanent form of a tubal ligation - placing plastic spring clamps on my fallopian tubes, instead of cutting, tying, burning or just ripping the bastards out.

That was July of 2006. In December of 2008 my husband and I had a pregnancy scare, despite my tubal ligation - my "period" was 45 days later, and I tested positive on three different pregnancy tests. So in March of 2011, after me bringing up again to my husband that I was terrified of the idea of ever becoming pregnant again because I DO not want more kids but would NOT want to have to make the very difficult decision to have an abortion (while I am pro-choice, I don't think I could do it myself), he contacted a urologist and had a vasectomy that same month. Unlike me, he had no hoops to jump through: just an initial consult to go to, insurance paperwork to fill out, and a $160 co-pay to pay on the day of the procedure.

I'm still chafing over the fact that I had to jump through a bazillion hoops and still hope and pray for an approval, and then had a slightly underhanded OB who went the least-permanent route with my tubal ligation; while all my husband had to do was show up with his health insurance card and cash and he was good to go.

10/10/2011
Peggi  

In response to the previous comment, as unfortunate as it is, it is easier for a man to have a vasectomy than it is for a woman to have any form of sterilization, simply because it is reversible for the man. Although it can be reversed through clamping, it is much more invasive than a vasectomy and so it is assumed by some medical bigots that it puts the surgeon at risk to perform this (simple in my opinion) procedure on a woman, therefore, they must make sure that you know what the heck you want. Because, ya know, they know what you want more than you do, of course! But who didn't know that!

I myself have never run into this issue yet, although for years I've wanted to have my tubes tied or have a hysterectomy. I do not want children. I am 23 years old, and do not have kids. I don't have the patience for children. I do not like having to take care of something that requires more attention than my cats (which, for me, are quite enough, thank you!) and although I would never feel crushed should I become pregnant, I would prefer not to.

I would be a candidate for these procedures because I have a family history if pregnancy issues, I am anemic, and if all else fails I can use the ole "I'm bipolar and might kill myself if I become hormonally imbalanced" method (not that I feel I would, but a backup plan is always nice!) Also, I am 5'2 and very tiny, and with severe back problems. One of the few times that comes in handy!

I have hesitated, however, because when I asked my boyfriend if he wanted kids, he was undecided. I am currently on birth control, but I am allowing him to change his mind if he would like. He doesn't particularly want kids either, but he said he doesn't know how he'll feel in the future. So, if he decides he wants them, I'd be more than happy to give them to him. I'd just have to adjust my responsibilities. And I know my maternal instincts would kick in! It isn't that I dislike children. I just don't particularly like them.

10/10/2011

I don't particularly like children either -- just my own, haha.

10/11/2011

A form of sterilization that s also often overlooked is a procedure called uterine ablation or endometrial ablation. Basically, it consists of boiling out the lining of the uterus in such a way that it does not return. Ths does not prevent ovulation, but it does prevent menses and any ferltlized zygotes have nothing to attach to to implant. (there are exceptions and complications like any other medical procedure, but these are the basics.)

This procedure is rarely offers but is used in patients that suffer from dysmenorrhea. Crippling, hospital-trip-inducing cramping and menstrual pain as well as excessive bleeding during menses. Everyone bitches and moans about feeling pain for uterine cramping, but dysmenorrhea os characterized by pain so intense it causes sufferers to pass out and is not effected by over the counter pain medications. One of the reasons the cramping can be so bad is if the menstrual matter clots so the body has to work even harder to force it all out.

Like tubal ligation and hysterectomy, it is permanent and is also something women have to fight for their right to have performed.

In my years as a sufferer of dysmenorrhea, I have come to the understanding that the medical community is undeniably biased against women. I do not ever want children. My family line carriers with it horrible diseases I would not wish to inflict on any person, let alone a child. So why must I suffer constantly and be denied medical treatment that is available? It's because the medical community believes me incapable of having the cognitive functionality to make the "right" decision.

It's discriminatory and it routinely degrades the lives of women who could otherwise be saved years of physical and emotional suffering. It's disgusting.

10/14/2011

we can always freeze our eggs for later =D. but yeah if some one has had one child there should be no excuse not to preform sterilazation, those doctors where selfish and they didn't have to pay for the consequences. I haven't felt safe enough or responsible enough to have children. plus I don't have the patience for 24hrs 7 days a week, even though peopel say I would be an awesome mom. I have enough to deal with on my own, I'm pretty sure being pregnate would be a mental health hazard for me.

04/05/2012

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