There are some people who don’t want to have kids. Then there are some people who really don’t want to have kids. As we learned in a recent Double X series of essays exploring this choice, some men and women never heed (or even feel) the tick of the biological clock. But others are more proactive. Monica Trombley is in the latter camp. As described in her piece, Trombley decided at the age of 26 that permanent sterilization by tubal ligation—a procedure colloquially called “getting your tubes tied”—was the right choice for her.
But as Trombley quickly learned, many gynecologists disagreed. After consulting a number of doctors who tried to dissuade her for what she describes as “paternalistic” reasons, Trombley finally became so exasperated that she actually considered inventing dangerous and unavoidable family members in order to convince a doctor that she could not live in an environment fit for children. (In the end, she found a specialist who required less cajoling.)
“Why should an adult woman be forced to lie to her doctor about why she wants to be sterilized?” she asked.
Trombley’s article inspired many, many readers to write in with similar tales of medical odysseys. Often, these women complained of being referred from physician to physician, only to receive a version of, “You’ll change your mind” or, “You’ll regret this later in life.” While some were ultimately successful in their tube-tying quest, others simply gave up, settling for a partner’s vasectomy or contraception. All expressed anger at the resistance they encountered in getting what they assumed to be an uncontroversial and wholly elective—even socially responsible—procedure.
Victoria Amrhein, a 23-year-old living in Jacksonville, Fla., detailed her frustration in an email:
Each doctor I went to had the same story—the new ones straight out of med school or the ones who'd been around the block for 30 years. I discussed the fact that getting abortions is much more dangerous than being sterilized and the fact that every time I got pregnant I could get one, but I am unable to get sterilized. It amazed me that they were OK (well at least open) to the fact of having abortions, but not of permanent sterilization which would prevent my ever needing an abortion! … I do believe I faced quite a bit of discrimination.
But is it discrimination for a gynecologist to recommend against or even refuse to provide sterilization? Partly, the issue is one of perception. The American Congress of Obstetricians and Gynecologists recommends that doctors provide in-depth and “individualized” counseling of patients seeking sterilization (including a thorough discussion of permanence and other available options). So what some patients take as a condescending lecture or arm-twisting might actually be an OB following professional guidelines.
Ultimately, though, the advisory organization does not recommend discouraging or refusing the procedure to anyone who is otherwise medically fit and of the age of consent. It is, after all, a legal procedure. Various forms of female sterilization have been legal in the United States since 1972, when courts removed restrictions that had previously required a medical threat. And according to a 2008 treatment review in Obstetrics and Gynecology, “[A]lmost all women are candidates for these minimally invasive procedures.” So what’s the problem?
From a doctor’s point of view, just because a patient can have a procedure doesn’t necessarily mean that she should. While Yekaterina Rabkin, a gynecologist who practices in Winchester, Va., has never outright refused to do a tubal ligation on a patient who’s qualified, she does everything she can to encourage an alternative course of action.
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