For women who know deep down that they never want children, that hell no response to the thought of motherhood endures long after the echoes of a temper tantrum in the candy aisle at Target subside. But women who want to be sterilized often face obstacles that aren't present for other medical procedures — obnoxious, patronizing speeches from doctors, flat out refusal from health care providers, requests for spousal permission or proof that the woman seeking to dam up her Fallopian tubes would be an unfit mother. And, despite the fact that this is 2012, there's no end in sight.


It's arguably more financially and socially responsible to go childless (or child-free, if you want to use phraseology that upsets self-righteous parents) in a world populated by seven billion hungry mouths, but many women who decided that being a mother is not for them often meet unexpected resistance from doctors. And the younger the woman making the choice, the less likely doctors are to trust that choice.

Slate's J. Bryan Lowder takes a peek between the ears of several doctors who deal with patients who wish to be sterilized. What could a doctor possibly know about a woman's future mental state or her confidence in her decision that she herself doesn't? Many seem concerned that young women who say they want to permanently zone their uteruses for recreation rather than fetal residency don't really mean it; they're just being silly young women who are making a permanent decision about a temporary aversion to parenthood. And they're not entirely off base about women changing their minds; Lowder points out that a Collaborative Review of Sterilization (CREST) study found that 20.3% of women who received tubal ligations prior to age 30 report that they later regret the decision. For women who were over 30 when they tied the knots, about 13% felt remorseful. Despite this, only 1.1% of women who receive tubal ligations attempt to have the procedure reversed.


On one hand, a doctor should make sure that a patient is informed of what a medical procedure entails, possible risks, and other pertinent information before performing a serious, difficult-to-reverse surgery — when not performed as part of a cesarean section or vaginal childbirth, getting ones tubes tied can be a major undertaking. And there are semi-permanent and long term alternatives to tubal ligation on the market that provide just about the same certainty that tube-tying provides without the permanence — IUD's, for example, or Implanon. Essure, a coil that's inserted into the fallopian tubes, can keep a woman unpregnant, is permanent like tubal ligation, and is less invasive. But on the other hand: This is a legal medical procedure. These women are adults. If a patient is informed of what a procedure entails before receiving care, whether or not a patient regrets a procedure in a decade is not the doctor's responsibility. If "regret" was a valid reason for a lawsuit, tattoo artists would have to carry unbelievably expensive "sorry you thought a circle of dolphins surrounding a yin yang symbol would be a cool thing to get permanently put on your lower back" insurance.

According to women who have tried, with varying success, to convince a doctor to perform a tubal ligation on them, doctors often go well beyond being medically responsible in their pre-surgical warnings, acting less like professionals and more like soapboxing pontiffs intent on convincing women that they don't really know that they don't want kids yet, that they should just wait around fecundly, their ladyparts ticking like a fertile time bomb. One 26-year-old woman in the Slate story reported that she had to visit several gynecologists before she found one who would agree to do what she asked. Medicaid requires women who say they want to be sterilized must wait 30 days before having the procedure done (and you thought abortion waiting periods were bad). A 23-year-old woman told her doctors that she never wanted children and that if she wasn't sterilized, she'd abort every pregnancy she ever had, which is much more dangerous than just closing up shop entirely. No dice. Doctors know better than women what women will want in the future, apparently.

It's not just busybody gynecologists who think they know more about how women's brains work than the women themselves. Thanks to a disturbing pattern of secular hospital acquisitions by Catholic-run health providers, many American cities are in danger of losing access to facilities that will perform any procedure that runs contrary to Catholic doctrine — this includes lifesaving abortions, distribution of emergency contraception, and tubal ligation. In Waterbury, Connecticut, for example, a 10% Church ownership stake in a newly merged hospital has led to a compromise with the Church. "Compromise," in this case, means that if newly proposed care guidelines are approved by the state's government, the 110,000 person city may soon lack a hospital that gives women access to tubal ligation, no matter what their age or reason for wanting the procedure.

In the midst of all this noise, an important question remains: why is it anyone's business what women do with their bodies in the first place?


[Slate]