Risk of regret and denying women sterilisation

[DisappearingGirl]

BBC article - some interesting parallels ...

Risk of regret used to deny women NHS sterilisation

https://www.bbc.co.uk/news/articles/cp8p1q207mzo

"A woman who was refused a form of permanent birth control by an NHS body over fears she may regret the procedure has won her case with the health ombudsman...

Her request had been refused over concerns regarding potential regret and cost-effectiveness, despite the ICB regularly funding vasectomies for men without applying the same criteria....

Spasova said she had been enquiring about sterilisation for 10 years...

The decision "did not follow the widely recognised principle that clinicians provide advice, but patients ultimately make decisions about their own bodies"," she said....

In issuing its judgement on the case, the ombudsman said: "At the time, the ICB did not routinely fund female sterilisation and cited the risk of regret as a reason for refusing women the procedure." ..."

I got sterilised when I was 27 as a contraceptive choice. Nobody ever tried to fob me off, just checked I knew it had to be treated as permanent. I’ve never regretted it. I’m glad I was taken seriously.

And so what if people regret it?! Tough. If there are mentally normal adult humans who make decisions that they know are irreversible, then that’s their right - and their problem. No other person should stand in their way. The decision and regrets are for the patient. Anything else is sheer paternalism. They can sign a full disclaimer.

And given the CQC and numerous reviews and enquiries have shown that NHS maternity care is largely failing with unprecedentedly high rates of maternal death and baby disability, maybe there’s an argument that taking away the ability to become pregnant is the medically responsible choice!

I have been repeatedly refused sterilisation because I might change my mind. Despite being nearly 40, having 2 kids already and having a medical condition which would make a further pregnancy very dangerous for me.

The relevance was that the Dr mentioned her husband as he assumed she had one. So she corrected him. He then told her she might marry a man in future. Of course, having a wife there was also another womb available should they change their minds.

Yes, I have no doubt this happens. That doesn't mean it's the main reason that crazy shit is allowed for gender medicine. It also doesn't tell us a whole lot about how widespread it is for these kinds of decisions to be made.

Removing body parts should be something that is seen as a last resort, that doesn't mean doctors are getting the balance right, but it's a more appropriate response. We aren't collections of parts, they are even less quick to take out an appendix these days.

They can sign a full disclaimer

There's no such thing as that though. It's happened many times that people have signed a consent for a surgery or procedure, it hasn't gone well and they've complained or sued. People have said they didn't understand, felt pressured to sign, didn't read it, or the doctor didn't explain it properly. Now probably that has been the case in some of these instances, maybe some of them it wasn't. But there's no such thing as a fool proof consent form that a patient can sign and no complaints are possible.

Again, I don't agree with women being denied sterilisation but I can see it from the doctors perspective.

Absolutely! In terms of women’s ability to consent, and to understand their own medical condition, refusing a mature, adult woman’s request to be sterilised ‘because she might change her mind’ is saying that women are just the same as children.

No that's not how it works..the surgery went wrong

Then the doctors are putting their own interests against those of the patient - which is fine but as a profession, they need to stop putting themselves on a pedestal and expecting more respect and adulation than any other service provider!

I was refused sterilisation on the NHS back in the late 90s early 2000s I was in my late 20s early 30s at the time. Im childfree by choice After that i spent 5 years on Depo Provera and have now been on Desogestrel for four and a half years. 5 years or more on Depo carries the risk of a brain tumour and seven years on Desogestrel the same If i take NHS advice and stay on desogestrel until im 55 i will have been on it for seven years.
https://www.mumsnet.com/talk/inthenews/5489394-depo-provera-contraceptive-injection

I agree with this. Men and women aren’t physically the same so it doesn’t follow that equal treatment means equal results. I understand though why people are sensitive about these issues as there were and still are issues around equality of care.

Thing is if we were being denied for medical reasons and/or risks that would be fair and acceptable. But we aren't we are being treated like children who don't know our own minds, we are being rejected because some doctor thinks we may change our minds in later life and regret it. That's not ok or acceptable.
As for vasectomies being reversible thats not exactly accurate, after on average about 2 years men start producing antibodies that attack and kill the sperm so even if they can reattach the tubes they cut (they can only do so in some cases) it doesn't mean that the man will no longer be sterilised.
With tubal ligation a woman can still go onto have more children with IVF at her own expense.
Also the 1 in 200 failure rate for female sterilisation is only correct if you are sterilised at the same time as you have a c section, when sterilised as a separate procedure atleast 12 weeks after giving birth the failure rate is less than 1 in 400. If they remove part of your tubes, fold the remaining ends back over on themselves and then stich or clamp them (again 12+ weeks post birth) the failure rate is less than 1 in a 1000.
What we are seeing is the failure rate for the worst types of sterilising surgery, which btw is the most convenient for the dr, is being used to prevent women from getting the treatment we need or want.
Yes have a conversation about ending sterilisation during a c section and instead have done as a laproscopic procedure at 12+ weeks post birth and use the most effective method which would reduce the failure rate by more than 500%.

Open question, what other medical procedures done only on men would it be acceptable for the drs to only offer the version that has 5× higher failure rate because its more convenient for the dr usually without warning the patient that there's a better option, and offering the more effective treatment?

Oh and before anyone asks i got the stats from my female gynecologist when she explained in great detail (much more than was on the forms and leaflets they give you) all the risks of failure and the types of surgery ie just clamp, cut and clamp, cut remove a chunk fold over and stitch or clamp.

Just don't have sex, or don't have babies. How hard is it?

Something else a man would never get told so another good example of the misogyny we are talking about,

I asked about sterilisation in my early 30s. I was relatively recently out of a long term relationship where my not wanting children was the cause of the relationship breakdown.

Not only was I told I might change my mind but I was asked to consider what would happen if a (hypothetical) new partner wanted children? I was so gobsmacked I didn't have my wits about me to say "Well he'd have to go too, then".

And this was from a female nurse.

If women want to have sex - for what ever reason - she's allowed to do so. It's the 21st century, not the medieval period.

She's also allowed not to want to be risking a pregnancy which has to be terminated if she doesn't want a child. Why should a woman go though that when she could just as easily be listened to and respected with regards her contraceptive choices?

Have as much sex as you like but do it responsibly. Oh wait, they won't LET you be responsible So the alternative is no sex. How very...puritan.

What really pisses me off about the "debate" around regret rates for sterilisation, is they go on about high regret rates when it's not true.

In women who choose sterilisation as permanent contraception, the regret rate is 2.4% for women aged 30-34 and 4.3% for women aged 20-24. If you dig deeper into the study, women who already had children were more likely to regret than those who didn't.

Overall, that's 95.7% happiness with the decision for 20-24 year olds and 97.6% happiness for women aged 30-34.

https://www.sciencedirect.com/science/article/pii/S0015028216543015

I was sterilised in my 30s after a long battle, despite my female GP being very supportive. Even then I was told to come back when I was over 40. Just sexism on the part of the male doctors. Never regretted it.

I do know that some young women say they don't want children and go on to change their minds. But this isn't about women in general, this is about women actively seeking permanent sterilisation. If we're old enough to say we want a baby, are we not old enough to say we don't?

I'm also aware this is a study from 1991 and talks about tubal ligation rather than more modern procedures.

I'm 37 now, I've had two pregnancies and one child, and was told I should think very hard about having a sterilisation as I might regret it. I ended up having a copper coil inserted under general anaesthetic. I suppose that was a compromise, but one I was happy with. If I'd been asking for ten years I may feel differently though, as that is ridiculous.