A woman's right to sterilisation

Nothing is black and white. I know several women who did change their minds in their thirties. I am one of them. We all change throughout the life cycle.

I’m sure there are women who “just know” they will never want kids, and will never change their minds, but it’s hard for the doctors to distinguish such women from those who may change their minds later on—just as it’s hard to distinguish “true trans people” from those swept up in a trend.

I both agree and disagree with you.
I disagree that doctors should sterilise young women, I think they’re right to be cautious in case she later changes her mind.
So they need to be doubly cautious with children then!
The answer is to be more cautious are hormones and puberty blockers, not less cautious with women

Most women I know who absolutely never wanted children in their twenties went on to have planned pregnancies in their thirties. It seems that there are a lot of women who change their minds.

A female family member who identifies as male has had a hysterectomy in her 20's recently. I'm bewildered by the double standard.

I believe that when you ask for an abortion you do have counselling to help you be sure it is the right decision, not something someone else has forced you into etc.

I know a man who wanted a vasectomy after his 2 kids were born and because he was still quite young he really had to argue against questions about what if he split up, what if a child died etc. And that is when a vasectomy is more easily reversed. So in this case I don’t think it is sexist, just more based on evidence that the younger someone is the more likely they are to change their minds about having children.

And it is not the most effective form of contraception anyway for a woman. The mirena coil is. 3 consecutive coils could see you through your fertile years and would be less intrusive than sterilisation.
Is it just that you want the finality psychologically? What made you go for sterilisation?

I just also want to add that I do feel there are some judgemental aspects around female fertility, for example the hoohaa around getting the MAP- no need for it. But in the case of sterilisation I do see why it’s difficult to come by.
I have been sterilised myself but am older and have 3 kids, have had 3 mirenas and still had to answer questions about not trying other things or getting dh to have a vasectomy (he wouldn’t).

I accept that there are women who may regret their decision to be sterilised but I don't see why it should the the doctor's responsibility to ensure that doesn't happen.

But in a recent thread about a detransitioner confronting her doctor, people were aghast that the doctor didn't see the major regret and trauma it had caused as her responsibility. I really don't see how you can have it both ways. There are very obvious parallels.

I am sure we all know people who were adamant they were not going to have children, and changed their minds. I know several, and it saddens me to think of the disappointment, even trauma, they may have endured had they chosen early in adulthood to take away that opportunity. I also would not want to be the doctor potentially sued in that circumstance...

I agree with babdoc
The reason why is mostly because sterilisation can be very difficult to impossible to reverse and many women do in reality change their minds. It is an extreme option when we have reliable cheap contraception and legal safe abortion access.

Abortions are not really comparable to sterilisation because you can get pregnant again at no cost with no new medical procedure and no high risk of infertility, if you later decide you do want to have a baby.

Vasectomy can usually be performed under local anaesthetic and is cheaper and safer than female sterilisation.
The reason doctors resist sterilising young women is that we have all encountered patients who have later changed their minds. It is very difficult to try and reverse a tubal ligation.
Many women in their twenties are adamant they never want kids, only to become broody as their biological clock starts running down.
I include myself in that group. I had an abusive childhood and was certain I would never want to have children myself. I had a career as a hospital doctor, was a radical feminist, and had never felt remotely maternal. But as I passed thirty, I began to wonder vaguely if I would regret not having kids. The feeling grew slowly, until I eventually realised I very definitely DID want them. I had two in my mid thirties, and am grateful I wasn’t offered a sterilisation when younger.
Some PPs may have remained fixed in their choices, but many women do not - and we doctors do not have a crystal ball to predict who will regret it later.

Do young men find it difficult to get vasectomies I wonder?

Yes, they do.

The NHS pays for contraception. Sterilisation is contraception.

This is the RCOG guidance on consent.
www.rcog.org.uk/globalassets/documents/guidelines/consent-advice/consent-advice-3-2016.pdf

It cannot be described as major abdominal surgery IMO - it’s a quick laparoscopic procedure done under GA but as an outpatient.
I think the NHS are being short sighted in not paying for it - if a woman is sure of her own mind that she doesn’t want any more children then paying for contraception for the next 15-20 years is surely going to cost money too or the cost of maternity care and all the health costs of bringing another child/person into the world.

It was the best decision I ever made - I was sure that I never wanted to be pregnant again and according to my gynae the failure rate is similar to other contraceptives in the first 2 years and after that its virtually 0%.

I was only 32 but had no trouble getting it done (this was over a decade ago). The doctors explained the risks and that reversal wasn’t really an option but no one tried to dissuade me

I was offered sterilisation when pregnant with my 4th. The consultant offering it to me thought I was having my 3rd. I was planning a csection, so I guess it makes sense to get it done during the same op (although I didn’t).

This is an interesting NHS link showing referral criteria in one area.
www.fundingrequests.cscsu.nhs.uk/wp-content/uploads/2014/10/Female-Sterilisation-Referral-Criteria-April-2011.pdf

I got pregnant with a coil in, the pregnancy that led to the termination the NHS paid for.

The nhs should not be paying for this. Come on !

I disagree with that in principle. The NHS pay for other forms of contraception. And funding sterilisations is going to be cheaper than funding maternity care.

Although having said that, I was told recently by my GP surgery that there’s funding issues around female sterilisations. They’d rather give out a contraceptive implant or coil. And they suggested that DH gets a vasectomy instead, so presumably there’s no funding issues there. Incidentally, there wasn’t any mention of medical risks or reasons against female sterilisations during the appointment. Just talk of potential funding problems 🤷‍♀️

Bear in mind that standard tubal ligation is not gold standard contraception. If pregnancy would be truly disastrous (eg it would be medically dangerous and abortion would be difficult to access) then standard female sterilisation may not be a sufficiently safe option. Vasectomy is far more reliable if you’re planning to stick with the same man.

Many of us know women who’ve changed their minds about wanting children between the age of 18 and 40, even if they were apparently completely certain about never wanting them, so I understand why gynaecologists who spend their lives dealing with infertility might be reluctant to risk actively causing that level of distress in a patient. However - nobody ever asks a woman in her twenties who’s TTC, or indeed pregnant “are you sure? You’re quite young and it’s a big irreversible decision. What if you change your mind?”

purpledasies like it being a permanent change to your body that is difficult to reverse that is regretted by a not insignificant number of people who undergo it. Both need safeguards around the gatekeeping of the procedure and the younger the person, the more cautious we should be. That's all.

I don't think people are very well informed about sterilisation though.. often people want to be sterilised because they're definitely sure they don't want any more pregnancies, but it's not actually the best contraception-vasectomy is more effective, and so is Mirena coil. So if you definitely don't want to become pregnant again, there are better options. It's also major abdominal surgery, which can have significant complications/side effects and risks are much higher than for male vasectomy.. increased risk of ectopic pregnancy etc. There are lots of reasons that doctors are reluctant.

Not wanting children or not the same as wanting gender reassignment.

What rabbit hole have I fallen into here?

Like what?

Like making you infertile.

A woman wanting to control her own fertility is nothing like gender reassignment.

There are some parallels with gender reassignment surgery

Like what?