October 07, 2011

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

by Kal Cobalt

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?