The Fight for Elective Sterilization

My mother got pregnant for the first time when she was 24 and was congratulated for stepping into motherhood. I got my tubes removed at 24 and I was chastised by medical professionals for being irresponsible to my future husband. It’s time we address the ethical shortcomings of medical professionals when it comes to bodily autonomy, and the right of women to be angry regarding their treatment by said professionals.

I don’t want children. I have never wanted children. As a child, I was often tasked with caring for my older brother despite being younger because I was more responsible. Society wanted me to be responsible for others; to be drawn into caring roles naturally as preparation for my future as a mother. And if I’m being honest, I am more caring, whether as a product of my socialization or natural disposition. However, from the time I was old enough to understand what being a mother entailed, I proudly declared I did not want it. I first did so at 7 and have ever since. Every time I said it, the adults in the room would chuckle and assure me that once I’m older I would change my mind, which made me angry. I’m older. I have not.

The kind of anger I felt and still feel is difficult to conceptually understand, as it is not the kind of anger that compels someone to throw their fists through drywall or scream at another. This anger is something else entirely. Dr. Amia Srinivasan, the Chichele Professor of Social and Political Theory at All Souls College, Oxford University, has written explicitly about the anger I have harbored for years. She says: “What makes anger intelligible as anger…, is that anger presents its object as involving a moral violation: not just a violation of how one wishes things were, but a violation of how things ought to be” (Srinivasan, 128). From a young age, I understood that there was a moral violation being committed by the adults in my life who insisted I would desire children. While I don’t believe they did so maliciously, the conditioning they were subjecting me to was systemic, rooted in the patriarchy. These kinds of ideologies led us as a society to believe that all women want children; that they will do so even if it means giving up their work; that the joy of having children will always overshadow the physical and mental burden, financial considerations, and concern for the world you bring them into; and that women who do not wish to have children are unwell. These ideologies on paper are upsetting, but when they seep their way into your right to access healthcare, they’re downright anger-inducing.

When I consulted an OB/GYN about sterilization, I knew I would be fighting an uphill battle. I knew that many women who desired to have this procedure done were often denied due to being either unmarried, without children, too young, or assumed to be mentally unwell. The OB/GYN I met with was an older man, seemingly reasonable and pleasant. We sat down and I provided my laundry list of reasons I do not want children. These reasons include, but are not limited to climate change, impending agricultural collapse, sociopolitical climate, the creeping threat of anti-abortion legislation, lack of desire to carry a child, desire for financial freedom, prospective careers, philosophical disagreement, mental wellbeing, and primarily the lack of any yearning for a child. He asked several follow-up questions: What if you find the perfect guy and he wants kids? What if climate change doesn’t happen? What if you change your mind? What if you haven’t spent enough time thinking about this? Do you feel this way because you’re depressed or anxious? What if you regret it? Am I going to get sued for signing off on this if you do?

Srinivasan says that in “such conflicts — where victims of oppression must choose between getting aptly angry and acting prudentially — themselves constitute a form of unrecognized injustice, what I call affective injustice” (Srinivasan, 127). At this moment, I understood what affective injustice felt like. I wanted to act out, to yell, to laugh in this doctor’s face at the absurdity of his questions. But I couldn’t. If I did, he wouldn’t sign off on the procedure because I will have become the emotional woman stereotype. This is how injustice is perpetuated throughout our society. We delegitimize the anger of those facing unjust treatment by insisting that they be rational, even when provoked. “If a rational politics has no room for anger, then it has no room for one of the few weapons available to the oppressed. Thus, the invocation of ‘rationality’ (like the invocation of ‘civility’) becomes an invocation of the status quo” (Srinivasan, 141). But when challenging the status quo and allowing anger condemns them to being refused their rights to healthcare, they become trapped in a moral dilemma.

I responded politely: My perfect guy wouldn’t want children either; climate change is real; if I change my mind I can adopt, foster, undergo IVF, or hire a surrogate; that I have rejected the burdens of motherhood since the age of 4 when I was nicknamed “little mom” by my family; that I am neither depressed nor anxious, and disagree with those disqualifying someone from receiving sterilization; and I would waive my right to sue if I was approved.

When I went in for my second consultation, he informed me that he had spoken to colleagues about my request. He said his colleagues warned him against allowing me to come back to the medical practice, as I was clearly mentally unhinged and presented too high a risk for lawsuits. I was apparently meant to feel lucky that I had gotten such a “reasonable” doctor instead of one that would refuse to provide me further healthcare. I did not feel lucky. During this second consultation he continually reminded me that the sterilization I was requesting (bilateral salpingectomy) was permanent, and that I would never conceive a child. This language of permanence around sterilization is used to scare women away from pursuing these procedures, as if a child is any less permanent. In truth, which he eventually admitted, I would be able to have my own biological child through IVF or surrogacy, which are entirely normalized and effective practices. The only hurdle I would face conceiving a child after sterilization would be financial, as these procedures cost money. He requested I do another consult with a colleague of his. The process had to be started over, and I was forced to swallow my anger, explain my reasons, defend my credentials, and answer patronizing questions while maintaining a respectful composure as my right to healthcare was decided by another older male doctor.

I was ultimately granted approval for my surgery. Since my surgery, mere months ago, numerous states have attempted to pass some of the most restrictive abortion bans in the country. Many of these do not include exceptions for rape and incest. In June, the Supreme Court will decide whether they will be upholding Roe v. Wade, which grants federal protection for those seeking abortion services. If overturned, the fate of women will fall to the states, where it will be decided whether the victims of rape and incest, abuse, accidental pregnancy, or women like me who do not want children will be legally forced to carry them to term. Those who elect to undergo abortion procedures after these laws are in place will risk being imprisoned on felony charges, as will medical professionals who provide such services. Access to sterilization and contraception is likely to be next on the women’s rights chopping block.

I have never been happier to be sterile. The anger I feel now is different. This anger is directed towards medical professionals across this country who refuse to reflect on their hostility towards the very concept of childfree women. Policing the bodies of women and condemning them to reproduction against their wishes is a cruel practice. For the medical community, here’s a general rule of thumb: if you would not ask a pregnant patient a question, don’t ask someone seeking sterilization that question. Would you ask the pregnant woman if they could see themselves regretting having their child? Would you ask them if they know what they’re doing is permanent? Would you ask if they believe life with a child would be fulfilling for them? Would you tell them you believe they’re too young to make a serious decision? Would you ask them if they understand that their “perfect” partner might not want to be with them because they have a child?

No? Then don’t ask me. They’ve made their decision and I’ve made mine, and neither of us owe you an explanation.