A Defence of Voluntary Sterilisation

Abstract

Many women identify sterilisation as their preferred form of contraception. However, their requests to be sterilised are frequently denied by doctors. Given a commitment to ensuring women’s reproductive autonomy, can these denials be justified? To answer this question, I assess the most commonly reported reasons for a denied sterilisation request: that the woman is too young, that she is child-free, that she will later regret her decision, and that it will lower her well-being. I argue that these worries are misplaced and hence insufficient reasons for denying a request. I also argue that even if concern for patient welfare provides doctors with a valid reason to withhold sterilisation, this is overriden by respect for patient autonomy and the importance of enabling women’s reproductive control. Consequently, I suggest that adequately informed, decision-competent women should have their requests for sterilisation agreed to, even if they are young and/or child-free. In addition, I examine the impact of pronatalism on how women’s requests are understood and responded to by doctors. I show that the equation of women with motherhood can make it unjustifiably hard for them to access sterilisation, especially if they are child-free. Consequently, part of ensuring women’s access to sterilisation involves challenging pronatalist beliefs and practices.

Challenging Pronatalism Is Key to Advancing Reproductive Rights and a Sustainable Population

“…While medicalised pronatalism fuels a sense of urgency among women who may be ambivalent about having children, it is also used to police the fertility of women who want none. These women may find themselves unable to locate a doctor willing to perform sterilisation, instead finding only practitioners who paternalistically assure them that they will regret having made that choice (Lalonde, 2018;McQueen, 2019).…”

Voluntary sterilisation of young childless women: not so fast

“…Sterilisation is sometimes analogised to euthanasia,29 especially in respect to weight that is given to patients’ autonomy compared with other considerations. However, euthanasia requests, in countries where euthanasia is legal at all, face a number of significant obstacles before the procedure is completed.…”

Explaining sex discrepancies in sterilization rates in the United States: An evidence‐informed commentary

“…There is an abundance of anecdotal evidence that women seeking tubal ligation, especially those who are white, have been turned away by providers due to their age, their relationship status, or because of the number of children they do or do not have. 14,15 This is typically explained as attributable to the permanence of the procedure and health care providers' desire to protect patients from experiencing regret later. However, health care providers' reluctance to perform sterilization may not extend to other groups of women, as those living on low incomes and having insurance coverage through Medicaid are significantly more likely to undergo tubal ligation, suggesting that "voluntary" sterilization might not be truly voluntary in some cases.…”

“…However, often the greatest obstacle surrounding tubal ligation for some groups of American women is finding a health care provider to perform the surgery. There is an abundance of anecdotal evidence that women seeking tubal ligation, especially those who are white, have been turned away by providers due to their age, their relationship status, or because of the number of children they do or do not have 14,15 . This is typically explained as attributable to the permanence of the procedure and health care providers' desire to protect patients from experiencing regret later.…”