On Childfree Sterilization: Shifting from Paternalism to Reproductive Autonomy

childfree sterilization

I sure like seeing more pieces out there these days on childfree sterilization in popular women’s publications. A recent piece in SELF on this topic deserves mention. After Deputy Editor Nina Bahadur relays a few women’s frustrating experiences and describes what male and female sterilization procedures involve, she gets into the ethical issues that need more talking about.

Doctors’ Paternalistic Thinking

As many childfree know and have faced, doctors commonly refuse to do the procedure because they think women will change their minds and look back and think they had made a mistake. Docs buy into pronatalist assumptions like all women will want to eventually become mothers. Bioethics expert Lisa Campo-Engelstein, Ph.D. speaks to this dominant “cultural norm” and “ideas like the biological clock.” I italicize these words with glee, as their usage reflect getting past the pronatalist thinking that somehow these kind of assumptions are based on truths.

Yet Dr. Mary Jane Minkin, M.D. indicates a change of mind can come as a result of life circumstance. She has seen the most common reason for seeking a reversal later in life as coming from “a change in relationship like divorce or [becoming widowed].” But what does research tell us?

Childfree Sterilization Research

As Bahadur rightly points out, the little research we have on post-sterilization regret “mostly focuses on women who were sterilized after having children. So it’s hard to know whether childfree women would be more or less likely to experience regret than women who have children.” Exactly.

A bit of research exists that indicates the percentage of regret will be low for those who had never given birth when they had the sterilization procedure. In a survey done some time ago of over 11,000 women ages 18 to 44 who had tubal sterilizations between 1978 and 1987, the researchers found of “women who had never given birth and were 30 or younger when they were sterilized, only 6.3 percent reported regret.”

While researcher Karina Shreffler, Ph.D., says “there is evidence that some childfree women later change their minds about wanting children, especially if they have new partners who want children,” Bahadur fittingly points out “ it’s difficult to predict if a particular woman will change her mind.”

The Doctor’s Role

Regardless of the difficulty of predicting a change of mind, Bahadur gets to the crux of the ethical matter, which exists outside the realm of potential regret. She asks the important question, “At what point is it ‘justifiable for a physician to refuse to perform the surgery?’” Thankfully, medical organizations like the American Congress of Obstetricians And Gynecologists (ACOG) have begun to take more formal actions like releasing opinions that urge ob/gyns to “respect their patients’ wishes and reproductive autonomy.” Yes!

Finally, Signs of a Shift

In addition to more articles and op-eds in newspaper publications, we are also seeing more articles by medical ethics and law experts on ethics pertaining to the sterilization of women who have never given birth. They lay out the conditions by which childfree sterilization is ethically defensible and most importantly, that potential regret should not be a factor in a doctor’s opinion of whether sterilization is in a patient’s best interest. In practice, while childfree sterilization has a ways to go, we are seeing signs of a shift from a paternalist, pronatalist position to one that puts a value on reproductive autonomy first.

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