Doctor no: The women in their 20s being refused sterilisations

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Image: vicky leta / mashable

LONDON — When Holly Brockwell first went to doctors four years ago — then aged 26 — asking for a sterilisation, she was refused for being “too young” and told she would one day change her mind. 

Now aged 30, Brockwell — who has never wanted children — has finally been sterilised after a four-year battle. 

Her struggle to get access to the procedure prompted an outpouring of support — as well as scorn — on social media, and other women came forward to share their experiences of being refused sterilisations during their twenties. 

Although Brockwell succeeded in her fight for the procedure, her case — and that of many other women who were also refused — begs the question: why are women in their twenties being refused sterilisations? 

“The first several times I asked, I just got a blanket ‘nope.’ No discussion and no flexibility, just no,” Brockwell told Mashable

She says that doctors told her she was too young at 26 years of age, despite her boyfriend having been offered a vasectomy at the age of 24. 

“They said I’ll change my mind and that I don’t have a crystal ball to see what I’ll want in the future. That’s true, but surely the same goes for people who are having children?” she says.

Not an isolated incident

Brockwell is not the only woman who has had this type of experience. Kirstie, 32, first inquired about sterilisation when she was in her early twenties.

“I was told I was too young and no one would want to take away the possibility of children in case I changed my mind,” Kirstie told Mashable.

“I’m a grown woman yet my autonomy is still in question.”

“While I’ve been angry, I’m really more tired of people not taking me seriously. I’m a grown woman yet my autonomy is still in question,” she says.

Kirstie continued to ask doctors for the procedure, but it’s only recently — after an infection from an IUD brought on a medical condition — that her doctors are considering her request “valid.”

Clare has been asking for the procedure on and off since the age of 18, and has been repeatedly told that she is “too young” to consider it.

“The doctor at that point said that I was far too young to even be considering the procedure as a viable option, which I can sort of understand, but it still felt as though the issue was being completely dismissed,” Clare says of her first attempt at asking for the procedure. She says that her doctor said no medical practitioner would consider her for sterilisation until she was at least 32 years of age.

“My experience has been mostly negative, to the point where I’m now debating if it’s worth trying to fight for it, or just resign myself to the fact that I’ll not be able to have what is basically bodily autonomy.”

In late 2015, Clare — who’s now 23 — last asked a doctor, who was “very keen” to encourage her to use other contraceptive methods like the pill or an IUD, for a sterilisation.

“I’ve been on two different pills, and they’ve both affected my mental and physical health quite badly,” says Clare.

When she explained her situation and her wish to be sterilised, she was told that she would change her mind.

“Who’s to say that someone in their early 20s is making a less responsible choice than someone in their 30s?”

“[The doctor] told me words to the effect of ‘women always change their minds, you’re far too young to make this decision, and we just need to find the right pill or method for you.'”

“I find it ridiculous that I am expected to believe this nonsense that my biological clock will magically start ticking and tell me that I must have a baby,” Clare continued.

When Annie first asked doctors for a sterilisation at the age of 27, she was met with “an outright no.”

“I wanted a second opinion and was told ‘I can guarantee you no surgeon in the UK will agree to this,'” she told Mashable.

While Annie has never wanted children, the motivation behind her desire to get a sterilisation also comes from the chronic pain caused by polycystic ovary syndrome, which she says is ruining her life.

“He [her doctor] was also patronising about my life choices, suggesting I may change my ideals ‘when I settle down.'”

“Kids are great but they’re not for me. When I said all this to my doctor, he said ‘wait until you get married,'” Annie continued.

Amanda, who has two children, has requested sterilisation three times. When she was 28 years old, she approached doctors for a sterilisation, but was refused because she was “too young” and warned she could “get broody later in life”.

Amanda says that doctors told her that “if one or both of my children died, I would want to ‘replace’ them.”

“My answer was no I love them very much and could never replace my children they are very much irreplaceable!”

What is ‘female sterilisation’?

In the UK, two main types of female sterilisation are used; tubal occlusion — the most common procedure, where fallopian tubes are blocked using clips or rings — or hysteroscopic sterilisation, which involves using implants to block the fallopian tubes.

According to the the NHS, Britain’s national health service, female sterilisation “can be a fairly minor operation, with many women returning home the same day.”

“Female tubal clip sterilisation is difficult to reverse and the Essure [hysteroscopic] method cannot be reversed,” Dr Kate Guthrie, spokesperson for the Royal College of Obstetricians and Gynaecologists (RCOG) told Mashable.

“As with any operation, female sterilisation does carry risks including the operation being unsuccessful in one in 200 women (tubal clip) to one in 500 (Essure), increased risk of ectopic pregnancy should the operation be unsuccessful, changes in menstruation, infection and injury,” Guthrie continued. 

Is there an age restriction? 

The short answer is once you’re an adult, no. But the reality, as many women have discovered, is more complicated. 

NHS advice states that “surgeons are more willing to perform sterilisation when women are over 30 years old and have had children, although some younger women who have never had a baby choose it.”

Guidelines set by the UK’s General Medical Council (GMC) state that healthcare professionals “should assume every adult patient has the capacity to make decisions regarding their treatment/care.” 

Image: Bob Al-Greene/Mashable

In England, Wales and Northern Ireland, individuals aged 18 and over are considered adults, while in Scotland people aged 16 and over are deemed adults.

A spokesperson for the National Institute for Health and Care Excellence (NICE) told Mashable it does not issue guidelines about eligibility for sterilisation services, so best practice guidance does not make mention of any age restriction when it comes to sterilisation.

Meanwhile the UK’s Medical Eligibility Criteria for Contraceptive Use, which is based on guidelines adapted from the World Heath Organisation, places young and childless women seeking sterilisation under category C meaning “caution,” but not category D meaning “delay.” Young and childless men seeking vasectomies are also placed under the “caution” category under these guidelines. 

The ‘risk of regret’

According to the RCOG, “additional care must be taken when counselling individuals under the age of 30 years or individuals without children who request sterilisation,” a statement echoed in NICE guidelines, which say doctors must assess the “risk for later regret” in people under 30 and those without children. However, these guidelines are not mandatory. 

“Research has found that regret is common, particularly if women are sterilised before the age of 30, if they are childless, or if there is conflict between a woman and her partner,” said Guthrie. 

However, one of the studies cited by RCOG in its guidelines about under-30s states that “most women who choose sterilisation do not regret their decision”. 

“Most women who choose sterilisation do not regret their decision.”

The RCOG issues best practice guidelines for female sterilisation consent, which are distributed to all NHS trusts. These guidelines outline how female sterilisation should be discussed by doctors, but the RCOG does not have the authority to enforce this guidance. 

Under these guidelines, doctors must explain to people requesting sterilisation the risk of regret, the difficulties in reversing the procedure and other associated risks; all of which are reiterated in a consent form requiring the signatures of the patient and doctor. 

But even with these steps in place women still feel like they’re not being afforded the opportunity to make up their own minds.

Following Brockwell’s high-profile case, women’s rights organisations have weighed in, with some arguing that social attitudes towards childless women play a role making the sterilisation option less accessible. 

The Fawcett Society’s Chief Executive Sam Smethers told Mashable that mothers are judged harshly by society and those who choose not to become mothers are judged the “harshest of all.”

“The choices women make should be a matter for them, yet our society feels the need to preside over them,” she says.

“Women should be free to choose. Including free to choose sterilisation.”

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