I started this journey sure of myself, and my decision. I had no idea of the obstacles I was about to face.
My leg is trembling as I nervously tap my foot on the well-worn carpet of the waiting room.
I’ve never been so anxious before a doctors appointment before – you can tell by the amount of effort I’ve put into my outfit (modest and smart, the clothes of a ‘respectable lady’, minimal makeup, and neatly tied-back hair). The feminist in me is furious I’ve even had to think of these things, but given what I’m about to ask, I’m hyper aware of the need to come across as serious and mature.
When the doctor calls my name, I take a deep, grounding breath and stand up. It takes everything I have to walk confidently towards his treatment room and not turn on my heels and sprint out into the street.
The door shuts behind me, and I sit down.
“Kassandra,” he starts, peering at me over his glasses.
“Do you mind if a student doctor sits in on our appointment today?”
I notice the young man seated in the corner, laptop perched on his knees. He gives me a small wave.
“Not at all,” I reply, mainly because I want to seem as friendly and accommodating as possible, in the hopes the doctor remembers it when I tell him why I’ve come to his practice today.
You’re in for a treat, Student Doctor, I think to myself.
“Great, thanks. Now, what can I help you with today?” he asks, as Student Doctor begins rhythmically tapping away at his keyboard.
“I never want children, so I’d like to get a tubal ligation,” I respond.
My doctor’s eyes suddenly widen. The tapping sound stops behind him; Student Doctor is now looking at me with a poorly concealed smirk.
I make stoic eye contact with the doctor to let him know that, despite my young appearance, I am, in fact, deadly serious, and certain of my choice.
A tubal ligation, or TL, is the clinical term for a procedure most often referred to as ‘getting your tubes tied’. The surgical sterilization involves clamping, blocking, or sealing off a woman’s fallopian tubes in order to prevent eggs from reaching the uterus to eliminate pregnancy.
In the US, the average age of a woman undertaking this procedure is 33. I am 24 – so I’m prepared for a rebuff.
“You’re very young for such a permanent procedure…” my doctor begins, glancing over at the computer to verify my age.
“…even if you are sure you don’t want children right now.”
I get it. I don’t fit the bill for the average woman seeking tubal ligation; I’m not married, I’m under 30, and I’ve never had children. Still, I wonder if I’d come in asking for assistance in having a child, if my doctor would have responded the same way.
Young, wild and baby-free
Regardless of how unique my case might seem, I’m far from alone. In fact, according to the Centers for Disease Control and Prevention (CDC) 62 percent of women of “childbearing age” like myself (15-44) use some form of contraceptive, and of this number, 25.1 percent – around 9.4 million women – use sterilization as their main method, making it the second most popular form of contraception, behind the oral pill.
While many women use contraception to avoid falling pregnant before they’re ready to begin having children, there’s a growing number of women who are choosing never to have kids. Today, almost one in five of us are remaining childfree – up from one in 10 in the 1970s. And this increase spans across all education levels, ethnic groups, and relationship statuses.
In fact, the rate of women choosing to forego motherhood has almost doubled in the past decade, prompting the term, “the childless generation”. And for good reason.
While traditional mothers espouse the idea that having children enriches one’s life, the research paints a different story. Researchers from the Council on Contemporary Families analyzed data from studies on happiness and parenting from 22 countries and found that people in the US had the largest “happiness gap” between parents and non-parents, with those who had kids being far more unhappy than those who were childfree.
And in relationships? Numerous studies have found marriages suffer once kids come into the picture. A 2013 report found childless couples have happier marriages, are more satisfied with their relationships, and more likely to feel valued by their significant other than those with children.
Childfree by choice
With more people choosing to be childfree, there’s a growing number of support groups and communities forming online. Beth Moore* is one such woman who knew from a young age she never to have children but was feeling alone in her decision, and so she created the Childfree by Choice Facebook group in 2007.
“I didn’t know anyone who felt as I did. All my friends were having their first child but I figured I couldn’t be the only one who felt like this. I needed to vent, and have someone else understand first hand what I was feeling so I wondered ‘If I created a group on social media, would I find others who were childfree by choice?’ My intention and goal were always to create a forum and safe place where CFBC people could connect, share and support each other.”
Those who call themselves ‘childfree’ generally prefer the term over ‘childless’, because the latter implies they are without something they want. But those who are ‘CFBC’ are satisfied and happy in their personal decision not to procreate.
“There are many different reasons a person chooses to be childfree but for many people, like myself, being childfree wasn’t really a choice. I compare it to a person who is born with a certain sexual preference. They can’t choose to be attracted to a woman if they are only attracted to men. It would be forced and uncomfortable. I always knew I didn’t want to have children. It was an innate feeling, not a decision or a choice but a knowing,” explains Moore.
Outside of the group, Moore was facing a great deal of discrimination from her family, co-workers, and friends about choice. “These kinds of interactions haven’t happened for many years now for me, but when they did, I often got the impression from others that they thought something was wrong with me. I also had many people respond to my childfree status by saying I would change my mind. At times, people would even make the large and erroneous leap that I must not like children. It was as if they just couldn’t accept that I didn’t want and wasn’t having children.”
She isn’t alone in facing criticism about choosing to not procreate – something she sees all the time in the group, which has grown from 30 members to over 2,700 since 2008.
“Seeing the group grow so much is amazing to me. I never imagined it would grow so large. Having a safe space like this isn’t as important to me now, given I feel more grounded with my choice, but it’s nice to have a community of people who share the same lifestyle. Having the support and connection of other CFBC people can help someone feel less alone and provide much-needed validation that they are normal and honoring their true self, and aren’t damaged.”
A permanent problem
Back in my doctor’s office, I’m asked, “What about other less permanent contraceptives?”
“I’d recommend the Mirena, then. It lasts for five years.”
Clearly, he thinks in five years I’ll have magically developed a maternal instinct, and be back in his office for ultrasounds and pre-natal care, laughing about that time I foolishly thought I didn’t want to fall pregnant and raise children of my own.
I try again.
“Okay, but what would I have to do to obtain a tubal ligation?” I ask.
“Any doctor you see will be reluctant to tie the tubes of someone your age, but if you’re married and sure of your choice, I can refer you to a specialist. You’ll have to sign a consent form and then we’ll move forward. But you’ll need to think about it first. Maybe talk to your partner about your options.”
I leave the office with a forced smile at the shell-shocked student doctor and no new information on tubal ligation, already Googling other nearby doctors for a second opinion. I decide to see a female doctor this time.
That same day just a couple of hours later, I’m sitting in her office, finishing reeling off my pre-rehearsed monologue on why I need TL. Her expression doesn’t change the entire time. Moments pass between us before she gives a cursory glance at the computer screen and patronizingly mutters “… 24…” before looking back at me. Deja-vu sets in, and my heart sinks.
“Even though you’re sure you don’t want kids right now, I’m going to tell you to wait before making this decision, just in case you change your mind. You can always get the surgery when you’re older,” she lectures.
“I won’t change my mind,” I insist.
“Have you considered the Mirena device? It protects against pregnancy for a few years, so will give you time to make a decision,” she persists.
The Mirena is a long-lasting, but less permanent alternative to TL, and as such, most gynecologists are quick to recommend it to a younger patient like myself. The intrauterine contraceptive is placed in the uterus and lasts for five years. And just like all other contraceptives, the list of side effects includes spotting, headaches, weight gain and mood swings.
The fact I’ve already made my decision is, once again, lost in translation, and I leave the appointment without even a brochure on tubal ligation to flick through on the subway ride home.
History repeating itself
The US is fairly progressive compared to the rest of the world when it comes to reproductive rights (although I’ll add that it’s a constant battle to try to hold onto these rights). There are many contraceptive options and abortion is legal (for now), and yet, CFBC women who pursue permanent sterilization still face barriers to governing their own bodies.
Until 1969, the American College of Obstetricians and Gynecologists endorsed a policy that stated doctors should only consider sterilizing a woman if her age, multiplied by the number of children she already had, equaled 120 or greater – so a 33-year-old woman with four kids could have her tubes tied without contest, but a woman the same age with only three kids? Forget it.
While this stipulation is long-gone, it’s still common for doctors to refuse to discuss the procedure — usually because of a woman’s age, or current child count. A 2011 study published in Human Reproduction found that between nine and 70 percent would “attempt to dissuade her depending on her characteristics”.
Back home from my appointments, feeling frustrated but not yet defeated, I decide to try my luck with one final doctor. I make an appointment for later that week, with my regular GP.
“There’s just no need for someone your age to have it done”, he sighs, as I finish my well-worn spiel.
“It’s not best medical practice to give such a permanent, expensive and potentially risky procedure when there are so many safe, long-term contraceptive options available. It’s just really unnecessary.”
At least in part, he has a point. There are risks with tubal ligation, just like any surgery. Some of the complications can include damage to the bowel or bladder, improper healing or failure of the procedure, resulting in an unwanted pregnancy and higher risk of an ectopic one. And while one can technically have a tubal ligation reversed, only around 50 per cent of women can fall pregnant after the reversal and it is extremely costly.
The biggest risk, though, is regret. A 2016 study found around five percent of women over 30 regret their sterilization, and that number jumps to 20 percent for those 30 and under. Historical cases of sterilization as a form of eugenics and continued involuntary sterilization among minorities and the poor contributes to the hesitation of doctors to do the procedure on every woman who asks.
I understand all of this.and have still decided that tubal ligation is the path forward for me.
I’ve struggled my entire adult life to find a contraceptive which works for me. The pill caused the standard negative side effects of weight gain, spotting, lowered libido, additional discharge and I also got almost daily headaches and bi-weekly migraines ‘with aura’. When I first told my doctor about this, he took me off the pill immediately, as the combination of those kinds of migraines and the pill almost doubled my chances of having a stroke.
However, I’m not fairing much better with the Implanon now either, a form of contraceptive implanted into the arm, lasting for three years. I’m on my second attempt, and the problems just keep getting worse. I bleed almost constantly, suffer chronic fatigue, and my sex life is all but a faint memory now. My PMS is worse than ever, and my doctor is leaning towards diagnosing me with Premenstrual Dysphoric Disorder, or PMDD, a form of depression linked to your cycle.
“How about we try the Mirena?” my says. I’m getting the Deja-vu again.
Why have three consecutive doctors all pushed this device on me? Feeling defeated, I go home with a booklet on it and decide to consider it as an option.
As it turns out, spotting and weight gain aren’t the only risk factors of having a Mirena device inserted. The device can fall out of place, become ’embedded’ in your uterus, or go through the uterus wall and end up near the intestines.
As of 2017, there have been over 47,000 complaints to the FDA about the Mirena. Around 45 percent of these relate to ‘expulsion’, around 21 percent complain of more bleeding, and around three percent complain about perforation. While 47,000 complaints may seem alarming, every form of birth control has a similar amounts of complaints, even the common contraceptive pill, which can also be dangerous. One of the more common pills, Yaz, leads to 10 in 10,000 women each year developing a blood clot, which can be fatal if it reaches the heart or brain.
Where to from here?
Birth control has always been a point of contention. As transformative as it has been for women’s sexual and reproductive health, everyone’s bodies react differently to the hormones the drugs use to prevent pregnancy. For years, the Essure was the gold standard procedure for non-surgically sterilizing women, and until Erin Brockovich’s anti-Essure campaign took off in 2014, was hailed as a safe alternative to the tubal ligation procedure I started this journey seeking. A procedure that, after three separate doctors appointments, I’m unable to attain so much as an information pamphlet on.
I began this quest naively; I honestly thought it would be easier than this.
Perhaps Moore has it right when she points out that, while we live in a culture devoted to advancing gender equality, women’s reproductive autonomy remains one of the final frontiers, left largely ignored.
“I still see childfree by choice women struggling with discrimination from people who are convinced they will change their mind, and the continued pressure they face from the medical profession to “rethink” their decision,” Moore tells me.
“While there are more CFBC people today, I don’t see the attitudes in society changing much.”
For my sake, and for every other young woman out there like me, I hope it’ll change soon.
Images via Little Woman Goods, pexels.com and tumblr.com. *Name has been changed.
Comment: Have you encountered difficulty seeking tubal ligation?
Kassi is SHESAID's Global Editor, a passionate and opinionated tea-drinker and cat-lover. She's always sleepy, loves politics and lives for writing about social issues. Follow Kassi on Twitter, Instagram and Facebook.