Why my sterilization is political in the age of Trump
They say the personal is political, but sometimes it’s both really political and really personal.
I’ll be getting a tubal ligation in about ten days, and throughout the process of arranging it — well, actually, for most of my adult life — I’ve been pondering the many ways in which America has made what would seem to be an individual personal reproductive decision into a political concern.
That has become more and more the case over the years, to the point that reproductive autonomy is now more of a contentious issue, I think, than it has ever been since Roe v. Wade was decided in 1970.
And it’s not just about abortion — it’s about reproductive choices, generally. Politics is about power, and there is a struggle over who should be allowed to have power over the reproductive choices of each individual, but primarily individuals with uteri. I say that in a non-sex-specific way because there are definitely individuals with uteri whose reproductive choices are being judged or blocked on the grounds that they are viewed as female but are, in fact, male. (I want to acknowledge this up front for its own sake, but also because the remainder of this piece will be very cisgender-focused, being largely personal).
But since I mentioned abortion, let’s start with that.
Abortion
I have had no abortions. But I would get one, without hesitation, if I found myself pregnant.
To my knowledge, however, I have not ever been pregnant. That is because I am lucky. I have been on “the pill” in one form or another for most of my adult life, but when you’re taking a pill every day for around twenty years, the likelihood is high that you’ll occasionally miss a day, and I definitely have. About five years ago I switched to an IUD, and while everything about that (aside from the original implantation, which felt like a small burrowing-type animal chewing through the upper wall of my uterus) has been great, it’s not 100% effective at preventing pregnancy. Neither is sterilization, for that matter. No birth control is foolproof, aside from a complete hysterectomy, I suppose— therefore, even a person who uses birth control correctly all of the time still runs a risk of getting pregnant.
I have been told that by choosing to have sex while accepting this risk, I have accepted the possibility of getting pregnant. When I analogize this to making the decision to drive a car and therefore accepting the risk of a vehicular accident, people get offended. They don’t see unwanted pregnancy as equivalent to an unwanted collision between automobiles. Well, for me, it would be. That I have, a few times in my life, missed taking my pill, no more counts against this than the fact that nobody is a perfect driver all of the time counts against them. They are not “asking” to get into an accident. They do not “deserve” to get into an accident. In the event that accident should occur, they are not obliged to accept their broken collarbone, go home, and live with it — that is not how one “takes responsibility” for having made the decision to drive in the first place. In the same fashion, there is no sense in which forcing me to carry out a pregnancy would cause me to “take responsibility” for having sex.
If I were a lesbian (who slept exclusively with cis women), or past menopause — or, once the procedure is performed, sterile — I could literally have sex with a different person every day, multiple times, inside or outside of marriage, in weird positions or whatever other ways you want to morally judge someone for their consensual sexual habits, and not have to worry about the possibility of pregnancy. So where’s the cosmic punishment for that “immoral” behavior? How is it that a condition that one had little to no control over protects them from being “punished,” for the exact same behavior that carries “punishment” for the fertile?
Maybe it’s not really about punishment for “immoral” sex?
But now, rather than belaboring that point, let’s get into the other power differentials at play here.
Healthcare
You may be aware that mandatory complete contraception coverage (for women, at least) became a thing with Obamacare. The contraceptive mandate, as it’s called, took effect in August of 2012. Republicans have been chipping away at it ever since, rather successfully as in the case of Hobby Lobby, and in 2017 Trump’s administration issued a ruling permitting insurance or employers from covering contraception if doing so contradicted their “religious beliefs” and/or “moral convictions.”
I got my IUD under this contraceptive mandate — otherwise I probably wouldn’t have been able to afford it, even with insurance. The same is now true with sterilization. Originally when I talked to my doctor about it, she recommended a laparoscopic removal of an adnexal mass, which in this case means removing the Fallopian tubes entirely instead of just burning the ends of them, as in a tubal ligation. The advantages to this would be threefold — in addition to reducing the risk of accidental pregnancy even further, it would effectively eliminate the possibility of an ectopic pregnancy, and also reduce the risk of ovarian cancer. I was on board — if we’re going to do this thing, let’s do it all the way!
My insurance, however, had a different view of things. Through multiple messages, exchanges of procedure and diagnostic codes, and phone calls, it was determined that while a tubal ligation is completely covered (no copay or coinsurance, no deductible to meet), laparoscopic removal of an adnexal mass is not. Or rather it’s covered, but not like contraceptives — you still need to meet your deductible, and after that point a certain amount of the costs for the procedure are covered (which, I was told, runs from about $50,000 up to $120,000 if there are complications), and you’re on the hook for the rest. They also at one point mistakenly told my doctor’s “finance person” that a deductible still applied for tubal ligation, but it turned out that the person she spoke to was thinking of a vasectomy. Which, come to think of it — why isn’t that covered by the contraceptive mandate?
So, no laparoscopic removal of adnexal mass (honestly, I prefer “Fallopian tube removal”) for me. Just the tubal. And the process for figuring that out was lengthy, confusing, and anxiety-ridden, because I knew that if someone told me the wrong thing at any point, that something was covered when in fact it wasn’t, and I went ahead with it, I’d be the one on the hook for that — not them.
Access
I’m the baby of my family, the third child of three. When my mother became pregnant with me, she knew that she was ready to stop, so she planned to get a tubal ligation at the time of childbirth, which in my case was Cesarean (breech baby, here). It makes sense to do it at that time, rather than having a separate surgery altogether.
But her doctor scheduled her childbirth at a Catholic hospital, who wouldn’t perform a tubal ligation for “moral” reasons. It apparently hadn’t occurred to my mother’s (male) doctor that this would be an issue, but she put her foot down and fortunately there was another, non-religious, hospital where I could be, and was, born. And she got her tubal ligation.
I don’t believe that religious hospitals should get to deny these procedures. I don’t think, for that matter, that religious hospitals should exist — healthcare should not be in the hands of people with “religious beliefs/moral convictions” against providing certain forms of treatment. They shouldn’t have that power.
My mother and I were incredibly fortunate that there was another hospital for her to choose, nearby. I would say that everyone should be so fortunate, but this isn’t something that should be left up to the whims of fortune — it’s something our country absolutely can, and absolutely should, deliberately implement. Thus far it has chosen not to, but let there be no mistake that this, the status quo, was chosen. And as I often say, the first step in progress is the realization that things don’t have to be this way, while the failure to do so is its greatest impediment.
Racism (replacement theory)
If you’re not familiar with replacement “theory” (I think classifying it as a theory lends a little too much suggestion of credibility, but that’s what it’s called) now’s the time to learn! I tried to sum it up in a cartoon I drew last August. I referenced Donald Sutherland’s character in the 1978 film Invasion of the Body Snatchers, because that’s what kept creeping into my mind while reading about this topic.
Replacement theory is a narrative supporting a host of bigotries and horrible sentiments. It underlies the “You will not replace us” chant by torch-wielding Nazis at Charlottesville. It was cited explicitly by the suspect in the mosque shootings in Christchurch, New Zealand. It has been endorsed by Obria, the pro-life organization seeking to replace Planned Parenthood and which doesn’t provide contraception, let alone abortions, yet received $1.7 million last year in Title X funding from the Trump administration. Title X, if you’re not familiar, is the only federal grant program dedicated to providing individuals with “comprehensive family planning and related preventative health services.”
Let me briefly quote Obria’s founder and CEO, Kathleen Bravo:
Few realize that it has had a devastating impact on our society, and threatens our culture’s survival. Take the example of Europe. When its nations accepted contraception and abortion, they stopped replacing their population. Christianity began to die out. And, with Europeans having no children, immigrant Muslims came in to replace them, and now the culture of Europe is changing.
The US faces a similar future. In only two of the past 40 years have we replaced our population. We’re on the same track as Europe. The church and family are in crisis. Children are at the core of the family; in fact, without children, we don’t need families. In a few decades we’ll be in the same place as where Europe is today. And, economically we’ll be in crisis because we’ll have so few young people working.
That’s replacement theory — the idea that white Christians must be “replaced” with more white Christians in a country, or on the planet generally, or else somehow the balance of everything will be thrown off. Actually, not “somehow” — it’s quite clear that for adherents of this ideology, the balance is thrown off by diversity. The mere presence of people of other colors, other cultures, other religions (or no religion at all), living and engaging in their own pursuit of happiness alongside white Western Christians, is what violates the natural order of things in their eyes.
So how does one prevent this “replacement” from occurring? However one can, apparently, up to and including mass shootings of those feared to replace. On a slightly less extreme but still horrific level, we have demonization of immigrants (but really, mostly just the brown ones), the refrain that “diversity is white genocide,” and the opposition to any kind of access to any kind of birth control, for anyone.
As an answer to an aging population and birth rate decline, Canada has adopted a policy of welcoming immigrants with open arms as workers and contributors to the country’s future, but this solution is no solution at all to a replacement theory advocate — rather, it’s their worst nightmare.
In 2014 Senator Ted Cruz expressed concern over America’s dwindling “labor force participation” rate, but did he propose relaxing immigration restrictions as a response? Take a wild guess. Did he propose expanding access to contraceptives and reproductive care generally? Nope; he called it a “nonsense issue,” though I will give him the small credit of asserting that “I have never met anybody, any conservative, who wants to ban contraceptives.” It’s a very small credit indeed, however, considering that while he may not have met them, such people do exist and are gaining power over the country. Five years after making that statement, I wonder if he would acknowledge having met such people, because he absolutely has.
Now, you may smirk — yes, but these replacement theory folks are fringe extremists! I’ll happily grant the “extreme,” but as for them being fringe, I would ask: Are you familiar with the president’s senior policy advisor?
It should be noted, of course, that I’m white. I’m the color, at least, if not the religion, that replacement theorists want to see continue ad infinitum in the West. But the racism that favors me does not help me, because as with many forms of bigotry this brand of white supremacy punishes white people too. It doesn’t help a white person who is pregnant and doesn’t want to be, to know that this is because white supremacists want to ensure that she “replaces” herself. That is being considered quality breeding stock, not a person with goals, aspirations, and desires of their own.
Misogyny
Misogyny is certainly tied up with replacement theory, as I think would be clear by this point, but I felt that it deserves its own discussion when addressing the politics of sterilization because misogyny goes well beyond replacement theory and is, as the enforcement arm of patriarchy (per Kate Manne), the basic, foundational category of hostility toward women’s autonomy.
I like Manne’s conceptualization of misogyny because it makes it about behaviors and effects rather than beliefs and ideologies. In her framing, sexism is the ideology (the role of women in society is this, whereas the role of men is that), whereas misogyny is reflected in the systems, the messages, the judgments, etc. that perpetuate sexism. That’s why she calls it “enforcement” — regardless of what you may be thinking when you engage in misogyny, it is rightly called misogyny when what you’re doing is enforcing sexism.
(The difference between “who you are” and “what you said/did,” by the way, was illustrated in this video by Jay Smooth on the topic of how to tell someone they sound racist, and I think it works equally well in the discussion of sexism/misogyny, which is also about “what you said/did.” And as Jay noted, the benefit is that if you focus on impact rather than intent, then you have an objective thing to point to (the thing done/said) rather than having to engage in endless back and forth about “Do you think that’s who I really am? What’s in my heart of hearts?”, accusations of mind-reading, etc. It also neatly gets at the distinction between shame (a “who you are” emotion) vs. guilt (a “what you did” emotion). )
I see examples of misogynistic speech/behavior, especially surrounding reproduction, nearly every day, so I hesitate to provide (more) specific examples here because I don’t want to give the impression that they’re somehow isolated incidents. Still, I do think it’s worth pointing out a couple more for purposes of illustration:
- Gab, a social network apparently for people who have been kicked off other social networks, recently tweeted a cartoon from reactionary Christian web site Caldron Pool by Ben Davis depicting actress Michelle Williams with her Golden Globe award, standing next to another woman who is smiling down at the baby in her arms. Williams skeptically gazes down at her award but declares “I won!” To which the woman with the baby replies “No. You didn’t.”
This cartoon enforces sexism by saying that Williams (who does have a daughter, and is reportedly pregnant) didn’t accomplish anything by winning the Golden Globe — that the real accomplishment for a woman is reproducing. Something that not all women can do, and which nearly half do by accident or otherwise without planning to every year in the United States, is apparently not only our greatest accomplishment, but the only possible one. As bad as this message is generally, imagine how this sounds to someone who was impregnated via rape, or someone who has tried desperately to conceive but can’t, or who has miscarriages. My initial reaction to this cartoon as a person who has never wanted to be pregnant or have children was to roll my eyes, but that is a reaction that should not be expected from someone who has either bought into the idea that childbirth really is the only accomplishment women can hope for, the only point in being a woman, or who is surrounded by people who have bought into this idea.
2. Stefan Molyneux is best known for being a white supremacist and possible cult leader of the alt-right, but he is also an MRA (so-called men’s rights activist) who especially recently seems to spend most of his time on Twitter telling women that they owe it to themselves to find a good man as soon as possible, during their most fertile years, and bear him many children so that they don’t end up past their childbearing years alone, undesirable, bitter, and either in possession of, or seeking, several cats.
Oh, and (shocker) he’s also a replacement theorist:
My reasons for not wanting to be pregnant or bear children are manifold. They cannot be easily summarized, much less boiled down to a single overarching idea. Nevertheless, nothing seems to make me want to verify the efficacy of birth control, or now sterilization, more urgently than being lectured with a dedicatedly prurient level of interest and perseverance that the only way to be truly happy as a woman is to become the most efficient baby-producing machine possible, as early in life as possible, by a 53-year-old white supremacist with nearly 500,000 Twitter followers scheduled to host “The Mansplaining Event of the Century” this May and whose therapist wife was allegedly censured for professional misconduct for advocating for a practice called deFOOing, or disassociating from one’s family of origin (hmm).
The other day after watching The Witcher on Netflix, I asked friends about popular modern fiction in which a female hero or protagonist is either sterile and happy about it, or chooses to become sterile and is, and stays, happy about it. Some examples were produced from literary fiction, but really nothing from mainstream TV shows or movies. It is, on the other hand, incredibly easy to find stories of women who are infertile and struggling to become mothers.
I don’t think it would be disparaging to the latter group to tell the stories of the former group as well. It says something about our culture that we don’t.
Privilege
Above, in a few places, I’ve referenced being lucky or fortunate. In this final section I want to be explicit about those aspects of privilege. Following is a very partial list:
Education: I learned about various forms of contraceptives at a young age. I was not subjected to “abstinence-only education,” though part of my sex education took place in church and there was definitely an emphasis on waiting until marriage (which, if you don’t want children inside or outside of marriage, ceases to matter so much. I’ve also never been married.)
Family: My family always been supportive of my childfree status. My older brothers both have two children each, and I love my nieces and nephew dearly. I have the luxury of being the “cool aunt,” at least in theory — now that my older nieces are in high school and college respectively, perhaps not as cool as I used to be.
Affluence/ability: I’m by no means wealthy, but I have a job with “good” insurance, and I can perform it capably and consistently. In America, that is really the only way to have access to halfway-decent healthcare unless you qualify for Medicare. My mother has commented that I should’ve gotten sterilized when I lived in Denmark, and she’s got a point.
Cis status: Nobody is confused, or pretends to be confused, about the contents of my body or why I want to do what I want to do with them. Well, aside from the standard “confusion” about why you’d bother being female if you didn’t want to bear children.
Metropolitan location: I do not live in a big city, but I live in a big enough city (the same one now where I was born, in a hospital that was not Catholic) that if a doctor were to refuse my request for sterilization, as is not uncommon, I could go somewhere else. It’s not as big of an issue, granted, now that I’m 42. But I’ve known that I didn’t want children since I was 12 or so, and one of the reasons for not pursuing sterilization as an adult was the assumption that I’d be denied because “What if you meet a man, and he wants kids?” as I’ve heard so many stories of precisely this happening.
I have also been to Planned Parenthood, many times, and patiently answered questions about whether I’m in an abusive relationship (I have been, but not regarding reproduction thankfully) or am otherwise experiencing pressure regarding my choices with respect to contraception.
I am also keenly aware of the dark history of forced sterilization in America for those with physical or mental disabilities as part of a eugenicist agenda, and am disgusted that associations of pro-choice advocacy with eugenics have reached the level of the Supreme Court. (Eugenics is about enforced top-down population regulation, not individual choices. Denial of individual choice is, ironically, a lot closer to eugenics.)
I am also a fierce supporter of the right to abortion, and reproductive choice generally, and drew a comic about how abortion provider Dr. George Tiller was assassinated in my family’s church in 2009.
But here’s the thing — you would think that opponents of abortion would be 100% on board with women who don’t want to get pregnant deciding to get sterilized. They’re not, for reasons described above. Equally, it’s not sufficient to describe their motivations as simply “wanting to punish women for being promiscuous” or “wanting to restrict intercourse to within the bonds of marriage” (never mind that 95% of Americans have sex outside of marriage).
The political desire to control our reproductive choices goes much deeper than that, and it’s for that reason that I felt the need to write this. The politics of reproduction in America in this age of Trump are rooted in deeply- and in some cases internationally-held beliefs about national, racial, religious, and gender/sexual identity, and I’ll admit that part of the reason for wanting to get sterilized is the fear that in the event of accidental pregnancy, there will be no recourse in the very near future.
In that light, sterilization is a selfish solution — it only “saves” me, in the way that picking up and moving to another country to avoid America’s dumpster fire of a political climate is a selfish decision. But selfish decisions do not (usually) preclude advocacy for freedom for everyone, for everyone’s equal right to pursue happiness in the way they see fit. And regardless of my personal decisions, that is not something I will ever cease fighting for.
