The overturn of Roe vs Wade has inevitably led to discussion about birth control methods. Previously I wrote about long-term birth control aimed at cis males, this time I’m going to talk about sterilization.
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Accessibility to sterilization is dictated by the same health inequalities as any other form of healthcare, particularly preventative and elective Healthcare. Though socialized Healthcare Systems are designed for equal access, we know that these issues are prevalent within those too. The fact that sterilization involves the topics of parenthood, sexual liberty and bodily autonomy means that access is further restricted by societal attitudes.
What this means in practice is that people seeking sterilization are screened for suitability depending on factors like their age or whether they’ve had children already. Many people are rejected for not meeting the criteria. These people may go on to have undesired pregnancies. Some of which will result in the birth of a child. Even if they do not go on to experience a pregnancy, they have to cope with frankly unnecessary anxiety around the potential of an undesired conception.
The rationale for gatekeeping access in this way is to avoid people regretting the procedure. Regretting the procedure can lead to litigation against the provider for a lack of informed consent (hard to prove in most cases but not impossible); it can lead to seeking reversal (perhaps at the cost of the state) and it can lead to personal anguish (both distressing and even costly). Currently, very few people regret being sterilized.
So, in the name of “Regret Avoidance”, some groups in society will find it easier to access sterilization. I’ll talk a bit about these groups and why they are seen as generally lower risk.
People with physicians who agree
The real key to accessing sterilization is seeing a physician who agrees that you get to choose whether or not you’re sterilized. You need a physician that acknowledges you may regret it, but who allows you the freedom to make choices you may regret.
In a litigation heavy society, it’s hard to totally dismiss the possibility of someone seeking to sue for a sterilization to which they consented. In fact, it’s probably already happened.
Happily Married Folks
Research into sterilization regret shows an unstable relationship as a risk factor. Both men and women who went on to break up with a partner after the procedure and/or went on to form new relationships showed an increased likelihood of wishing they didn’t have it done.
Cohabitation vs marriage showed an increased tendency to experience regret.
Conversely, people who made the decision while unpartnered were less inclined to experience regret in some studies.
Older People
Being under 30 was also identified as a risk factor. It’s a cliche that young people may change their minds, but it seems as if research does support this and it was often cited as the sole significant risk factor for experiencing regret.
White People
It goes without saying that white people receive better standards of Healthcare than their counterparts. So let’s get this straight, white people have better outcomes around sterilization because we live in a racist society. I use “outcomes” because research shows that Black people are more likely to experience sterilization regret. This is more likely to be due to factors connected to racism than anything else: poorer counseling, coercion, worse patient care, inadequate pain relief, the list is endless.
But just being non-white means that your practitioner is less likely to believe you’re making an informed decision that is correct for you. They think you don’t understand it properly and will change your mind like those other non-white people in the research. What is dismissed is that some of those who reported regret may not have independently sought sterilization to start with.
Queer and/or BIPOCs
Yes, it’s a double whammy of sorts. Policies that coerce BIPOC and queer people into permanent sterilization exist. This ranges from everything between forcibly sterilizing people, withholding other treatment unless they agree to sterilization, or simply being more agreeable to BIPOCs seeking sterilization than anyone else. This coincides with the underlying value that more white babies aren’t the end of the world. Even if they’re dirt poor.
Being a man
While young cis men have shown similar rates of regret to young cis women, overall, men seem to have lower rates of sterilization regret. However, research into how men feel about vasectomy is rare and not rigorous in its methodology. We can’t be sure there aren’t more men who regret vasectomy. But as it stands, you’re more likely to be able to access sterilization if you’re a man.
This also goes for trans men who are often coerced into sterilization for reasons related to societal and legal acceptance of their gender identity.
High/Low Income
People from lower socio-economic groups are vulnerable to policies and politics that would prefer they didn’t procreate. So a poor person who seems to show the “good sense” to stop themselves conceiving is more likely to bypass gatekeepers than those who don’t suffer financial hardship.
At the same time, someone who is relatively wealthy can access private care where there is less rationing and greater overall reverence towards the rich.
So your income, at either end of the spectrum, can sway a healthcare practitioner into allowing you past the threshold.
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How to (maybe) get snipped
Doctors generally do not want to harm their patients. There is a ton of philosophy that critiques a paternalistic approach to Healthcare where the patient has little say in what they can access. It depends on expert individual and general medical views on what would be best for them. As well as how much society values their lives.
Overall, most people actually agree that there should be some limitation to what a patient can demand from Healthcare Practitioners. You can’t just ask for whatever you like without an evidence base that supports its benefit outweighing any harm to the user or others. Very few of us agree that people should just be given whatever surgery or treatment they ask for, regardless of whether they pay for it directly or not.
As (potential) sterilization patients, we have to acknowledge that we may regret what is a permanent birth control method and consider life paths that may be uncomfortable or even morbid. The breakdown of a marriage. The death of a partner. The death of existing children. We can’t fix a broken Heathcare System as service users. But we can at least advocate for ourselves by showing that we understand choice and consequence.
References/further reading
Understanding Sterilization Regret in the United States: The Role of Relationship Context
Although one fourth of sterilized reproductive-aged women in the U.S. express a desire to have their sterilization…
www.ncbi.nlm.nih.gov
Ethics in practice: Sterilisation of young, competent, and childless adults
Ethics in practice Is it ethical to sterilise a young woman who is determined she never wants children, even if there…
www.ncbi.nlm.nih.gov
Research focuses on sterilization regret | 2008-12-01 | AHC Media:…
Research focuses on sterilization regret Black women who undergo tubal sterilization to prevent future pregnancies are…
www.reliasmedia.com
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This post was previously published on medium.com.
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You may also like these posts on The Good Men Project:
 White Fragility: Talking to White People About Racism |
 Escape the “Act Like a Man” Box |
 The Lack of Gentle Platonic Touch in Men’s Lives is a Killer |
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Photo credit: Tim Mossholder on Unsplash
