Women in Canada and the United States face extraordinary difficulties in seeking the birth control method of sterilization. When going to medical professionals to ask about the procedure, they often hear something like, “You’ll regret it” or “Get your husband to do it.”

The most common reason medical professionals provide for denying women’s voluntary sterilization is potential future regret.

There are many studies on the possibility of women regretting sterilization. The most commonly cited study from the U.S. finds that the rate of women’s post-sterilization regret is 20.3 per cent of those 30 or younger and 5.9 per cent of those over 30.

In contrast men who seek sterilization through vasectomy do not appear to be denied the procedure or subjected to the same concerns about regret. The absolute lack of data on how men feel about their sterilization, framed as regret or otherwise, shows a stark contrast.

Likewise, when women decide to seek fertility treatment they are not subject to the same level of scrutiny and do not usually have difficulty securing it.

The position of a woman opting for sterilization is thus unique. The decision to have children, to not have children or to render oneself unable to have children, has potentially life-changing consequences. However, it is only in the case of women seeking sterilization that regret is seen as a strong reason for denying reproductive choice.

Womanhood means motherhood

My research finds that women face difficulty in seeking voluntary sterilization because childless women challenge what is viewed as normal.

Currently, the reproductive norm is that women should want to give birth to children and have a duty to do so.

Challenging this idea carries social penalties. Stereotypes of childless women have been consistently negative since the late 1970s.

Women who are childless are viewed as less happy and as having a less rewarding life. They are also seen as socially undesirable, selfish and immature.

Women face discrimination about their decision to be childless at a greater rate than men due to beliefs that motherhood is biological to women (e.g. the maternal instinct), whereas fatherhood is learned for men. Such a belief is not substantiated but still widely held.

This finding is in line with studies on abortion regret, where women are often taken to be at high risk of regretting their decision to undergo an abortion due to similar reproductive norms.

Expectations that womanhood means motherhood promotes the belief that women should regret the decision to be childless. This is especially the case with voluntary sterilization, as opposed to other birth control methods, given the relative permanency of the procedure.

Ignoring women’s desires

The view that womanhood means motherhood is an inaccurate and harmful definition that excludes trans women.

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It also leads to gendered assumptions that impact our medical system, as doctors make decisions based on sexist reproductive norms, rather than a woman’s desires and what is best for her.

For women seeking sterilization, this means they may not have an option for birth control or they may have to use a method that is unsuitable or undesirable to them.

It should be noted, however, that some women are more likely to receive access to sterilization or be involuntarily sterilized due to colonialism, racism, classism, heteronormativity, cisnormativity and other forms of discrimination.

This makes it even more important to investigate and account for who is granted and who is denied sterilization, and why.

The freedom to regret

The risk of regret pervades many of our large decisions, like those of undergoing a medical procedure or having children.

Since we do not have perfect knowledge of the future, the possibility always lingers that an individual may regret their decision. Still, we move on with our lives to the best of our abilities and we are generally free to make decisions that we might regret.

This freedom does not exist for women seeking voluntary sterilization. These women are viewed as extremely vulnerable to regret, when men seeking sterilization and women seeking fertility treatment are not.

Recognizing this phenomenon allows us to confront our biases against women who choose to be voluntarily childless and to ensure their access to the birth control method most suited to their needs.