When Young Women Don’t Want Children and Abortion Is Outlawed, Why Won’t Doctors Agree to Sterilize Them?
Mariah Marsh, 28, had known since she was a teenager that she didn’t want children. In her hometown in Indiana, it was taken for granted that everyone would eventually raise a family. Marsh dreamed of a thriving career and living on her own, but she never felt the same pull towards parenthood.
"Everyone around me was like, ‘When I have kids.’ I never heard the phrase, “If I have kids,’ or ‘I never want kids,’” she says. “I spent a long time thinking that not wanting children was just another thing that was wrong with me.”
As she grew into adulthood, Marsh became even more certain that she didn’t see children in her future. Last month, on the day before her birthday, she went in for a surgery she’s been wanting for years: a bilateral salpingectomy, which removed both of her fallopian tubes. Now recovering at home, Marsh says she feels relieved that she never has to worry about an unwanted pregnancy ever again.
Marsh is one of the hundreds of thousands of people who opt for permanent, non-reversible sterilization surgeries every year. Although these procedures have been proven safe and straightforward, obtaining them often requires women—especially young, childless ones—to go up against reluctant families, skeptical doctors and, oh yes, generations of ingrained societal expectations about what a woman’s life should look like (motherhood required). But in an era where abortion is criminalized in large parts of the country, some women are feeling a renewed sense of urgency to have their bodily autonomy respected.
Sterilization is more common than you might realize. According to the most recent data, an estimated 18 percent of U.S. women rely on some form of surgical sterilization—either bilateral salpingectomy or a tubal ligation, in which the fallopian tubes are cut, tied, or closed—as birth control.
But that number is likely to rise. Following the overturn of Roe v. Wade last summer and abortion becoming outlawed or severely restricted in 14 states, doctors around the country are reporting an increase in requests for these surgeries.
Dr. Leah Tatum, an OB-GYN with Austin Regional Clinic in Texas—the epicenter of so many abortion battles—has seen a marked uptick in interest. “I would guess I am at two times the number of sterilizations as I was doing two years ago,” Tatum says.
When working with patients, Tatum says her goal is to understand their perspective and engage them non-judgmentally—divorced from any preconceived notions about how women should feel about children.
“Oftentimes, I will ask the patient how long they've been considering [sterilization] and try to understand the reasoning behind that,” explains Tatum. “Nobody in our office feels like you have to have children for some reason. Choosing to be child-free is a patient's choice.”
But not everyone shares Tatum’s view. While many patients have the surgeries immediately following delivery, young, childless women often face an uphill battle finding a doctor willing to do the procedure. Hesitant providers sometimes point to research suggesting that post-sterilization regret is highest among women under 30. Yet studies also show that the vast majority of women—regardless of their age at the time of their sterilization—do not later regret their decision.
The American College of Obstetricians and Gynecologists Committee on Ethics stresses in their guidelines that while patients should receive counseling that emphasizes the procedure’s permanence, their desires must be centered. Still, the choice to perform the procedure is left up to the doctor’s discretion.
While most of Tatum’s recent patients have been considering becoming sterilized for some time, she thinks the current political climate has pushed many to finally pursue surgery—which, as contraception, is covered by most insurance companies—over other long-term birth control options, such as an IUD.
“I am seeing a lot of our patients that have been considering sterilization for a long time and have always known that they wanted it, but have felt maybe more of an urgency to pursue that just based on what's happening in Texas,” Tatum says.
That rings true for Lauren, 28, who lives in Miami and is unmarried with no children. The fall of Roe propelled her to seek out a doctor willing to perform a sterilization surgery. Like Marsh, Lauren received a bilateral salpingectomy—often called a bisalp—earlier this year.
“All of a sudden, the consequences of living in a world where you don't truly have access to your own body became real,” Lauren says. But Lauren emphasizes that while the Supreme Court’s decision might have catalyzed her decision, her choice came after years of careful reflection.
“Understanding the type of career I want, what I want to do in my free time, what I don't want to do in my free time, the kind of lifestyle I want to live—nothing included children in that,” she says.
And while she has that clarity, it’s been harder for others to accept it. “I think society really pushes back against women who don't want children. We've been taught that the family is the foundation of American life, but it's also been a way to keep women disempowered,” she says. “I think there's nothing scarier to a lot of folks than a woman who has absolute 100% control over her body and her destiny.”
Her decision has even become a sticking point in her dating life. “Dating straight men, I’ve had some experiences where they were very upset when I would disclose that I don't want to have children,” Lauren says. “I get pushback from them being like, ‘Oh, well, I want kids and you don't. So we're not compatible.’ And I'm like, ‘Well, we could be?’ I don't know why these theoretical children are taking precedence.”
And it’s not just the occasional Bumble date to whom women have to justify their decision.
For Ashley Morris, 34, the journey to becoming sterilized was a decades-long effort. She first started asking doctors about options in her twenties, but at every appointment, she was met with resistance.
“It was like they thought they knew what I wanted better than I did,” she says. Once she turned 30, she’d hoped her request would finally be taken seriously.
“That did not happen,” said Morris “I was told flat out by my OB-GYN that she would not do this procedure on anybody without children. She said that I would end up regretting it and that there could be legal ramifications for her. She didn't want to perform it on anybody.”
Discouraged, Morris decided to stick it out with her IUD, but this summer something changed. “When they overturned Roe v. Wade, I thought, ‘Oh, my God, I can't go home now,” says Morris, who is originally from Texas, where abortion is banned at any point in the pregnancy. “I felt like there was no possible way I could go back into that state with a functioning reproductive system,” she says.
Emboldened, Morris, who now lives in Chicago, started doing her own research. Using a list of childfree friendly doctors on Reddit, she found a doctor in her area who explicitly stated she would perform the surgery on people who didn’t have kids. Morris had a bisalp to remove both of fallopian tubes last December.
Her decision to pursue permanent sterilization is “not always met with the same sort of ecstatic attitude that I have about it,” but Morris is ready for those reactions. “I'm polite but blunt,” she says. “This is what works for me. I'm making decisions that make me happy. And if you can't be happy for me, then that's your own problem.”
For Marsh, it took years to come to terms with what she really wanted. When she was 18, she finally felt accepted when she told her sister.
“She said it was okay. You can do whatever you want to do with your life,” Marsh remembers. “That simple validation allowed me to let go of the shame and fear and dread I felt when I thought about having kids. I got to make the decision on my own, based on what I felt and knew about myself, not on what everyone else expected.”
Ultimately, for Marsh, the hardest part of her decision wasn’t the surgery or the post-op recovery—it was telling her parents. “They are disappointed that I'm not having children and that they’re not having grandchildren,” Marsh says. And while they’ve supported her decision, the implications of her choice are still hard for them to accept.
“Me still being only 28 and particularly, still being single makes this a little harder for them to wrap their head around,” Marsh says. “They’re concerned that one day I will find the one and he will want kids and that will make me want kids.”
But ultimately, none of the women Cosmopolitan spoke with for this story had any regrets about their decision. “If I was going to have a second thought, it would have happened already,” says Marsh. “And at this point, it’s not something I'm even thinking about. The first day after my surgery I was like, ‘Yes! This is done!’ But now I'm just moving on to the next thing.”
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