Tuesday, May 26, 2009

Why, No—I'm Not an Idiot, But Thanks for Assuming

When I was much younger, I didn't know that childless (by choice) women existed. I believed that every good girl had to get married and have children when she grew up. But even in the patriarchy-induced stupor, my girlish fantasies involved loopholes. I didn't daydream of mini-groggette's, but about convents or adoption.

I didn't want biological children then, and I don't want children at all now. Hey, I like kids; I just have no desire to have children of my own. And, well, being an atheist kind of knocked that whole nunnery thing right out of the picture. I don't want children, but—surprise, surprise—I do like sex with men (sorry, Catholic Republican parents!), so I decided to opt for a birth control that was a bit more permanent and didn't come with the negative reactions I've experienced with other temporary options. I thought about it, did the research, thought about it some more, did even more research, then decided on a permanent, nonreversible option that worked best for me and my concerns.

Unfortunately my OB didn't care about any of that. She didn't care how long I had thought about it or how much research I had done. She didn't even care about the serious reactions I was having to my current birth control method. She didn't care about any of that because she never heard it. All she heard was 25 and childless and her only response was along the lines of, "No, you might regret it. Lots of other women have."

After lots of tears and screaming into the phone (oh, I was classy, let me tell you), I decided to do some research on that one little thing that I kept being told: "Lots of women have regretted it." Something about it just didn't sit right, starting with never being told how many women "lots" is, and also not being told, despite asking numerous times, what this magical age was when I'd finally be able to determine my own reproductive future. I decided to find out for myself.

1. The most recent (2002) study I found said that only 7% off all women who were voluntarily sterilized experienced regret up to 5 years after their sterilization, comparable to the rate of women regretting their husband's vasectomy.* And the greatest risk factor for regret (according to the abstract) was when the women reported conflict with their partners at the time of sterilization. Even so, the reversal rate (not just regret) for women topped out at 2.2%.

2. In a Journal of Reproductive Medicine study that broke down the results among age groups, women under 27 years had only a 2% higher rate of regret than older women. And, the part that made me particularly happy, "single women were more certain than mothers of their decision to be sterilized."

3. A CDC study also found the same 2% difference between older and younger women, with the former having a regret rate of 2.4% and the latter having a regret rate of 4.3%.

4. The longest-running study I found (14 years versus 5 years) had the highest regret rates—20.3% for women under 30.

This last one is most likely the number (1 in 5! 1 in 5!!!! BOOGABOOGA!) that doctors will cite to young women like me, but even just looking at the abstract, 20% is not the end of the story:

For women aged 30 or younger at sterilization, the cumulative probability of regret decreased as time since the birth of the youngest child increased … and was lowest among women who had no previous births (6.3%).
Women who don't want children tend to continue to not want children. Who knew?

And what is this dreaded regret anyway? First off, regret does not necessarily mean desire for a reversal. I regret not applying to MIT for college. I wouldn't have gone there regardless, but it would be kind of neat to see if I would have been accepted. Regret can simply mean you didn't think out all the details as well you would have liked. And yes, young age is a stronger indicator of possible regret, but so is a change in marital status, having experienced marital problems at the time of the procedure, and being sterilized immediately after giving birth. And what is the best way to ensure satisfaction instead of regret? Presterilization counseling. Something I was never offered.

Yes, regret after a permanent procedure like sterilization is a horrible outcome, but looking at the numbers, and knowing how to counteract a lot of potential regret, it is ridiculous that an entire subset of the population is outright denied this procedure. Are there any other common procedures that are denied to huge swaths of people simply because of possible regret afterwards?

Liss made the point: "Millions of women have elective—and irreversible—cosmetic surgery procedures done every year, some of them high-risk, just to adhere more closely to the contemporary beauty standard, and yet doctors don't routinely discourage the practice by ominously quoting rates of regret or reconstructive surgery to 'fix' or make further adjustments to surgically-altered areas. Isn't it funny (where funny equals totally fucking infuriating) that women who want to alter their bodies to conform to patriarchal expectations aren't disabused of their desires, but women who want to alter their bodies in a way perceived (often rightly) as a rejection of those expectations are discouraged at every turn?"

Isn't it just?

This is a huge issue. Doctors (once again) are trying to protect women from themselves, when the evidence clearly shows that we do not. need. protecting. It took me 3 pages of doctors** and half a day of phone calls before I was finally able to find a doctor even willing to see me. What happens when a woman doesn't have the time that I did to make those phone calls? If she lives in a place that doesn't have 3 pages of doctors who do a certain procedure? If she gets discouraged by the constant nos and inability for anyone to listen? If she doesn't have insurance (or good enough insurance) to be able to cover the procedure when she finally does find a doctor, or if any doctor she finds will even be on her insurance plan?

This is just one more aspect of women being "less than" and it's fucking sickening. If you don't want children, you're outta luck. If you do want children, but society doesn't find you "acceptable," you could have your children forcibly taken away from you or you could be sterilized against your will or under false pretenses. You're outta luck. If you want children and you're fortunate enough that society does find you "acceptable," society will still do fuck-all for you the second you need any kind of help in caring for your children. You're outta luck. Even if you do the "right" thing by society, and give up unwanted children as opposed to aborting, you're still outta luck.

We need to fight for all of our reproductive rights, and for the rights of women who can't fight, because the people in charge sure won't do us any favors.

UPDATE: I don't know how I missed this article in all the rampant google research I did on sterilization. It describes just perfectly the frustration young women like myself go through when we are denied sterilization and the paternalism of doctors who refuse to provide us with treatment. There are 2 quotes I'd like to highlight, but definitely go check it out for yourself.

Why do we arbitrarily choose thirty? Because of the thirty years of practice in my life. Because of the number of years of experience that we, as physicians, have come to see that twenty-five, twenty-six, twenty-seven year old women have, historically, more often than not, told you they regretted their decision to get their tubes tied.

That was Dr. Daniel Wiener, assistant professor of obstetrics and gynecology at McGill University in Montreal, who obviously did not do the whopping half a day of research that I did.

I think there's definitely this idea where a woman's function is to have babies cause your body is made to do it. My body is made to do a lot of things. It's made to run. That doesn't mean I go running every day. Nor should I have to.

And that was Lauren Green (name changed), giving the best. quote. eva.


* In all my mad googling, the only regret rates I could find for vasectomies studied the wives and not the men themselves.

** Until I called up that last doctor, only one person even bothered to ask why I wanted permanent sterilization. At one point she asked me what I would do if 10 years from now I changed my mind. Evidently "adoption" is not a legitimate answer.



  1. Oh my god I think I love you. Thanks for the well presented thoughts and research on female sterilization. I feel like so much less of a freak after finding out there are others with the same feelings as me.

  2. I. Love. This.

    Perfect article to sum up the same frustrations I've been feeling. I'm 25, married for four great years to a great husband, have a good degree and an even better career, great credit, etc. Yet, through all this, I am considered incapable of making my own decisions about my own body. I can get as many tattoos as I want and regret them all (I'd like to see the statistics on THAT), yet I can't make my own choice to prevent accidental pregnancy. One person that I talked to even told me this: "I don't believe in sterilization for a woman, just like I don't believe in abortion."

    Hmm. Okay, so I can't get sterilized by choice because...why again? I'm pretty sure I would have shut her up if I were honest and told her that I'd like to be sterile so that I wouldn't HAVE to have an abortion.

    Perhaps if you find doctors that are willing to do the procedure and who are nonjudgemental about it, you could post a list- the rest of us could use knowing where to find them!

  3. Meika,
    Sorry I just saw your comment so you might not ever see this response, but if you're in Houston I could give you the name of the doctor I finally found. Unfortunately I don't think there's a list anywhere of doctors willing to sterilize younger women. You're best bet is to just get a list of all the doctors in your area who perform the procedure you're interested in, and keep on calling until you find one willing to see you. Ask up front on the phone if they are willing to sterilize younger women so you can save yourself the time and money of setting up an appointment only to be turned down.

    It's frustrating and it takes time and effort on your part but sadly that's probably the easiest option unless you already know someone in your area who's already done this.

    Goodluck and thank you TigerTrails and Meika for the comments!

  4. Here in the UK they can't tell you no if you are over 18, they just make you sign a release form.I want a tubal ligation so badly but my husband doesn't want me to risk surgery. However, its key whole now and you are out that day. So, the dentist is worse. I will have it done @ 40 which is in 10 or so years. However, in UK/EU the male pill/patch will be out in 3 years, so.. We will see, he wants to take it. AMazing husband.

  5. I've had a tubal, via laparoscopic (keyhole) surgery. Trust me, it's NOT comparable to going to the dentist. I'm not saying you shouldn't do it, just don't delude yourself that it's without risk or that you'll be out on the dance floor the next day.

    I, too, found it hard to convince doctors that I didn't want, had never wanted, and would never want children. After nearly two decades of being on birth control (and having bad reactions to it), I got a copper IUD. Loved that! No hormones...no surgery...it really *is* easier than a dentist visit. I highly suggest that option for anyone who does not want to incur the risk or cost of surgery, or who can't find a doc willing to sterilize you.

    Finally, in my 40's, I had an ovarian cyst that needed surgical attention...while they were in there, I had them tie my tubes.