Have you ever thought about having kids? Yes? No? Maybe later?

Melisa Noonan knew from her early teens that she never wanted to have children, it just wasn’t on the radar, and at 20 brought up tubal ligation with her first GP.

Tubal ligation is surgery to have your fallopian tubes tied or sealed shut. This stops any eggs moving from the ovaries, along the tube to the uterus - meaning you can’t get pregnant.

Melisa wanted to know what was involved in the process but says the response from her doctor wasn’t what she expected.

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“My GP turned to me and said ‘oh wait, hang on - you’re 20 years old, come back when you’re 30 and we'll discuss this further’, and that was that,” Melisa told Hack.

While changing social trends are revealing increasing numbers of millennials opting out of having children, a small group of young Australians are choosing a more permanent option than long term contraception or abstinence - sterilisation in their twenties.

But many, like Melisa, are running into some unforeseen roadblocks; their doctors. The medical profession is reluctant to perform such drastic procedures with long-term forms of contraception being readily available.

Melisa says the reasons doctors knocked her back over the next seven years kept changing.

“Initially it was, ‘you're too young’, ‘you’re not in a permanent relationship’, and then it moved into the ‘I'm not comfortable with that’ - very subjective sorts of reasons.”

“Then we moved further into ‘I’m not going to consider it until you've had an IUD’, so that was sort of the bargaining chip, [and after] I had found someone that I was long term with, ‘oh, you just haven't met the right guy yet’ - that was a quote I got from a doctor.”

“It was a little bit patronising but I do also have to respect why doctors said that because there is actually evidence in the literature that says that your risk of regret is increased if you change your partner. There's also certain cultural elements as well but I would have appreciated doctors actually using that as a reason instead of making it very subjective.”

People who want the procedure say this debate is about choice, arguing that they should have a right to do what they want with their bodies, as the consequences are theirs to bare. But doctors argue that this decision can have severe consequences on their patients later down the track and would go against their Hippocratic Oath to do no harm.

Sterilisation is permanent

Dr Emma Boulton is the clinical director of a sexual and reproductive health centre in Sydney.

She says a lot of doctors prefer to prescribe long-term, reversible birth control. The option to implant an IUD lasting up to three, five or ten years with minimal side effects is a far more attractive prospect for patients who might change their mind about children.

“It’s the concept of permanence that is the problem with sterilisation, and so that’s really the problem with a surgical procedure for sterilisation and the fact that there are alternatives,” she said.

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Having consulted and performed vasectomies in younger men, Dr Boulton warns that doctors are trying to keep the patient's best interests in mind when consulting them about the procedure.

“What we’re wanting to do is not jeopardise that person’s ability to fulfill that person’s reproductive desires later in life. So, if we went around giving young men vasectomies then it might actually disadvantage them later. So we're doing it in their best interests, so if we decline to give them a vasectomy it’s because we don’t think that it’s in their best interests to do so at that time”.

But as Melisa explains, in her situation, hormonal contraceptives didn’t suit.

“[The decision] really came down to wanting something permanent. I never want children and temporary reversible methods are always going to be a bit of a stopgap … [and] being on the pill for 3 years was actually quite stressful to manage. There's also the added element of hormonal contraception, your IUD, your pill - all of those are putting hormones back into your body that I don't really feel comfortable with”.

“I tried Implanon. It did not work for me. I had to stop halfway through and that's a big part of why I didn't want an IUD.”

David and Susan Moore, who run the Child Free Zone website, decided that a vasectomy was a better option for them.

David first tried to get a vasectomy at 26, before he met Susan, but was also turned away. It wasn’t until ten years later, after he was married and in his mid-thirties, that he was finally able to have the procedure done and Susan was able to come off the pill.

“You hear a lot of noise about surgeons complaining about reversing vasectomies and stuff like that,” says David, “but that comes about as potentially a lack of information in the first place. Not because people aren’t sure of their decisions, but they made the decision for the wrong reason."

David has since written a book, Child Free Zone, and runs a website and Facebook page of the same name to discuss remaining childless by choice.

“All the people that we talk to through our website, through our book, all say the same thing: they’re very sure, they have a lot of good reasons, they’ve done a lot of thinking about it, it’s a well-informed decision, let me do what I want with my body.

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“It’s really quite insulting when, particularly people in the medical profession, sort of say, ‘oh well we’re not going to do this because you’re young and you don’t know what you’re thinking and you’ll change your mind’.

“It is very easy to ruin a young life with having kids and having accidents than it is to reverse a minor surgery.

"If you’re old enough to vote, drink and join the military then you should be able to have a vasectomy.”

‘Everyone’s paths are different’

43-year-old Natasha David made a declaration when she was five: she would never get married or have kids. Although she did end up getting married, she never changed her mind about children.

“As I grew older I never really changed that fundamental outlook and then other things came on top of it to influence if further things like; I want to have a career, I want to be financially independent, I want the flexibility of doing things I want to do, and I never really had a strong maternal or breeding instinct … which I know a lot of women have when the hormones and biological drive kick in, that never kicked in for me.”

While Natasha was adamant that society has never influenced her actions, she admits that there are some ingrained connotations about remaining childfree.

“I find it interesting that people aren't even aware that they consider that to be the norm, it’s very ingrained in society, that you are presented with certain life milestones and if you don’t follow that path that you are not considered a fully functioning adult, you’re abnormal or an aberration of what should happen.

“I think everyone’s paths are different in life and I think there is a strong undercurrent of one path for the norm. I wouldn't stay it’s stigma, but I would say the consensus is: if you don’t follow that path we will put you in the too-hard-basket.”

Stigma facing childless adults

Childless adults are often characterised in a negative light, especially if you happen to be an accomplished woman in the public domain. Most would remember Julia Gillard’s parliamentary speech accusing Tony Abbott of misogyny, and the barrage of comments that were directed at her prerogatives instead of her policies.

I mean anyone who chooses to remain deliberately barren… They’ve got no idea what life’s about.” — Senator Bill Heffernan, 2007.

She has chosen not to be a parent… She is very much a one-dimensional person… she just doesn’t understand the way parents think about their children when they reach a particular age.” — Senator George Brandis, 2010.

Anyone who chooses a life without children, as Gillard has, cannot have much love in them.”— Mark Latham, 2011.

And you don’t need to look further than a thesaurus entry for ‘childlessness’ than to be paraded with words like ‘desolate’, ‘unnatural’, or ‘ineffectual’ - which undoubtedly leads to a stigmatisation of women who decide to remain childless.

However, changing social trends are revealing that more and more millennials are opting out of having children, with childless couples increasing from 35 per cent in 1997 to about 38 per cent in the 2011 and 2016 census, as well as an increase of couples who are not expecting to have any children.

‘No regrets’

Seven years and 12 doctors later, at the age of 28, Melisa finally received a referral for a urologist to discuss the merits of the procedure further and had it done.

When Melisa first started this process, there was not a lot of community support for her decision, which is why she remained closed about her decision.

“I chose to go to social media because nobody in my life; friends, family, were really supportive or accepting of not having children, it was seen as quite an unnatural thing.”

“It's definitely different now. With the recent increase in social media groups, online forums, I’m seeing significantly more acceptance, significantly more positivity around the decision.”

Melisa says she joined an online forum 10 years ago where perspectives on not having children were mostly negative.

“It was all doom and gloom about the decision, it was all the negative effects, the stigma, the social isolation, the sometimes even physical isolation, partners abandoning their spouses and family members forcing their children to move out because they have expressed these opinions.”

But she believes that’s changing.

“Now it's becoming a much more positive space and i am actually finding that with some of my extended family - the younger members, there is huge amounts of acceptance and positivity, even though it's not for them, they're able to acknowledge that everyone's different.”

Sterilisation is pretty permanent, but so is having children.