Desperately Seeking Sterilization: the politics of privilege

Originally posted in Community Blog

My post-collegiate boyfriend was an affable Dane who later became a public school teacher. Children loved him, and (I think) he loved children, but he didn’t want to have any of his own. That was his story, anyway. He spoke loudly and often about not wanting to breed, or parent, or do anything involving the permanent presence of children. It may have had something to do with the fact that he was an active alcoholic who could barely take care of himself. It may have had something to do with his age, or it may have been that he simply, unequivocally did not want children.

He once told me a story about going to his doctor at twenty-five and requesting a vasectomy.

I think that you should give it some time, the doctor demurred, wait until you’re a bit older, you might change your mind.

That’s the problem, my ex-boyfriend said, I want it done now, while I’m still thinking clearly.

Was the story true? I have no idea. At the time I remember thinking, of this man I loved so irrationally and so much, this is obviously not going to work out. Someday, my socially constructed biological clock is going to start to tick.

Five years later, after having a baby who subsequently died, I found myself in an obstetrician’s office, asking to be sterilized.

But my obstetrician wasn’t going to just sterilize me willy-nilly. She made me beg for it.

I might want to have sex again, I said, but I don’t think I’ll ever want to have another baby.

It would be a great tragedy, she said, tapping her pen to my medical chart, for you never to have another child.

It would be a great tragedy, I replied, to have another baby die.

Now is not the time to make that decision, Adina, she scolded, but if in two years you still feel the same way, then by all means, we can do it. But you are not going to be sterilized. You are going to have more babies, and they will be healthy, and they will not die.

You don’t know that, I replied. You have no basis for making that statement. I am not irrational.

No one’s accusing you of being irrational, Adina, she replied. It’s just that – you obviously wanted children at some point, and there’s a very good chance that you will want to have more children in the future. You have the right to have another baby.

I wanted Talya, I said. I wanted that particular child. I don’t want another one.

This exchange went on for ten or fifteen minutes. In the end, of course, the doctor refused to sterilize me. Maybe this is for the best; maybe I am too wounded at the moment to make these kinds of permanent decisions. Inconceivable as it seems to me today, it’s possible I will want to have another baby biologically in the future. And a daughter of the reproductive rights movement, I want to retain that choice.

Yet. I wonder about the politics of my OB visit: despite heightened risk status due to the death of my first child, I am apparently a good candidate to have another baby. In fact, I “deserve” to have another baby. I read between the lines: I am like her, and therefore worthy to breed. I am white; I am Jewish; I have an advanced degree. I dress professionally. I’m ostensibly middle-class, and arrive to my appointments early, with private health insurance and a copy of the The New Yorker to read while I wait.

My doctor’s intentions were good, I am sure; ultimately, she sought to ensure that I did not make an irreversible decision in a state of heightened emotion. She shielded me, in part because my right to reproduce is self-evident. In the court of public opinion, even though my daughter died, I am worthy to parent again, to reproduce, to raise a child or children. As a function of capital, I am protected in ways that many mothers who lose babies are not. The institutions will protect me, because I know how to negotiate them. My right to reproduce will be guarded, because I embody something resembling “appropriate” womanhood.

I think about the sterilization I did not really want, and why it was denied me. My demand for sterilization was rejected, out of a paternalistic medical determination that I should retain my right to choice, so long as I choose reproduction or its possibility. It’s a dubious entitlement, and a constraining one. It’s a strange thing, also — to realize, paradoxically, that even in the context of my daughter’s death, I am privileged.

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10 Comments

  1. Posted March 14, 2011 at 3:39 pm | Permalink

    I’m very sorry for your loss. I’ve never lost a child, so I can’t imagine it, but I hope you heal as much as possible.

    Your doctor may have genuinely had your best interest at heart. That said, I have to present a cynical view of this phenomenon.

    When I got a tattoo, the tattoo artist made me sign 5 papers, saying I was sober, that I wanted this tattoo, etc; basically, saying I couldn’t sue them if I regretted it. Tattoos are much less permanent, and have a much less serious impact on your life than sterilizations. Tattoo parlors MUST provide tattoos if they want to stay in business. For all of that, the tattoo parlor was willing to risk driving my business away with those forms, to avoid lawsuits.

    Doctors, on the other hand, don’t have to sterilize you to stay in business. Doctors have basically nothing to lose by saying, “no”, and potentially a lot to lose if they say “yes” and then you sue them. So it’s in their own self-interests for doctors to refuse sterilizations all the time. So the medical and medical-lawsuit systems have created a situation that makes sterilizations extremely hard to obtain, at the cost of patients’ reproductive freedom.

    Reason number three billion why we still need planned parenthood, in my opinion.

    • Posted March 14, 2011 at 4:54 pm | Permalink

      jss, I agree w/ your assessment…I remember reading in my Feminist Philosophy class as an undergrad that doctors refuse younger, childless women sterilizations all the time. We read the case studies of two 20 something women going to numerous doctors searching for someone to perform tubal ligations to no avail.

      The doctors’ fear was that the women would change their mind and sue. The underlying implication is that a young woman obviously can’t know if she’ll want children and isn’t capable of changing her mind. While this notion is insulting and sexist, I can also somewhat understand it, given out litigious society.

      To the OP: I think race and standards of who should/shouldn’t parent do play a role. And like the above commenter, I also offer my sympathy for your loss, for what it’s worth.

  2. Posted March 14, 2011 at 7:13 pm | Permalink

    I’m sorry, but being denied for sterilization or a vasectomy is the norm for all young people of all races, at least in the US. And I say that recognizing the history of sterilization and racism in this country.

    So basically this article is about you thinking your OB is a bit of a bigot, since what she did was pretty standard, regardless of the reasons why. Either way, there’s no obvious privilege here other than what you think your OB’s view is.

    And I have no quams about sterilization. I plan on getting a vasectomy myself. Never wanted kids, never will.

    • Posted March 15, 2011 at 3:02 am | Permalink

      So ageism is okay, as long as it’s standard? Even if you discount the classism and racism that I also see in this situation, her doctor’s refusal on the grounds that “you’ll want to have kids again someday” is still problematic. I hear this attitude all the time whenever the subject of having kids comes up.

      At 19, I know that someday, at the right time, I want to have children. I have friends who know, with just as much certainty, that they will never have children. Why should they be doubted when nobody ever says to me, “Are you really sure? Maybe you’ll change your mind someday, you don’t want to decide anything irreversible when you are so young.”

      There seems to be a general attitude that someday every woman’s biological clock starts ticking, and no matter how averse you were to the idea of having kids before, all you can think about now is giggling babies. Some people just don’t want to have kids, and they know so at a young age. Whatever their reasons, they should have access to sterilization. Suggesting that they don’t know what they really want is ageist.

  3. Posted March 14, 2011 at 11:25 pm | Permalink

    Speaking as a medical student, refusing a sterilization to a person in a heightened emotional state is bioethics 101. For someone who is not in a heightened emotional state, making major and irreversible changes to one’s body is still a serious issue. I wouldn’t consider it a “right to choose” (as long as you choose babies) issue. It’s actually one of those circumstances that calls into question the role of physicians–is it their job to guide their patients to the “right” decision, or is it their job to do what a patient asks for and cover their asses legally?

    As far as bioethics go, sterilization goes in the same category as plastic surgery, or sex changes, or even people who identify with, for example, the deaf community or amputees, and want healthy limbs removed or hearing destroyed. For survival, it is nonessential, but it may play a huge part in their quality of life and bringing them to peace. At the same time, it may be a huge, irreversible mistake, and if it’s unwanted it’s essentially assault. Since most doctors become doctors because they want to help people, they would hate to play a part in harming their patients. It goes far beyond just not wanting to get sued.

    Speaking as a person, I’m just so sad about your daughter.

  4. Posted March 15, 2011 at 1:13 am | Permalink

    Adina, what a journey, and I am sorry for the loss of your daughter.

    This is timely for me; a definite source of interest this week as I plan to once again request sterilisation.

    Almost two years ago one of my best mates (a male) and I both decided to be sterilised. Both of us are healthy, both of us have had two children, have university degrees in the same field and are a year apart in age (I was 33 at the time). He was “granted” a vasectomy. I was refused sterilisation and received an appointment for an IUD, even after discussing my why’s (I’m done, single parent, 2nd child has a disability, don’t want more children, finances and building a future). I was considered too young and healthy to have it done, and the golden-you may want more children rhetoric was brought out.

    I felt done and I still do as I near 35 this year. I feel it deeply and keenly, in the same way many of the women I know, can feel the space in their arms for another child. I know for practical reasons, and I also just “know”. I have been a mother for almost 16 years (14 of those years unpartnered), I know what it takes, and how much energy/resources I am prepared/able to put into motherhood,and how much energy I want to pursue social causes and my life, beyond my daughters. This is my body, and my reproductive life, and I want to be able to call the shots. I want to do this on my terms.

    Yes, I may change my mind. Yes, there is the reality that some day, post sterilisation, something will stir in me that calls for motherhood, and I would have to process that and own it. I would have to grieve this, and give birth to a new place for that energy and love (maybe the world, other children (I’ve fostered before), or even myself). Is it appropriate to place the weight of that decision on someone other than me? Is it even about me as a client at all? Or about possible future children that do not exist? Or about, as someone mentioned, law suits.

    Though my male friend and I went through different doctors, it does disturb me that he was considered fully able to own that decision at that point in his life, with it’s full weighty implications, yet for me as a woman the lens was skewed towards my role as a mother of a possible future child. What about the children who already exist and have needs, and the me who already exists, wants, needs and knows a fair bit about her self and the realities (including economic) of the world she lives in.

    As you stated: “My demand for sterilization was rejected, out of a paternalistic medical determination that I should retain my right to choice, so long as I choose reproduction or its possibility. It’s a dubious entitlement, and a constraining one.” Thank you for articulating that and for your post.

    • Posted March 15, 2011 at 12:11 pm | Permalink

      Wow. That is quite a story. Especially considering that you were much closer to the end of your reproductive cycle than a male of the same age would have been. And, with one child with disabilities and considering your age the risk of disabilities for another child would be significant. I’m sorry you were made to feel that way. :(

  5. Posted March 15, 2011 at 3:05 am | Permalink

    why would it be a tragedy for you to not have another baby

    wow, what a close minded doctor.

  6. Posted March 15, 2011 at 12:05 pm | Permalink

    I would say that doctors’ fears may be well-founded and not at all related to classism and racism. I think the idea is that what a person wants now is not the same as what a person might want in 5 years. The surgery is expensive, always comes with risks, and especially for women, permanent. To risk lawsuits on top of that I think makes your doctor’s response a fair one. In her mind, there are probably less permanent solutions for preventing pregnancy that could be used for a couple years and if her patient remains adamant for two years about wanting to be sterilized, then she will approve the surgery.

  7. Posted March 15, 2011 at 12:54 pm | Permalink

    What a horrible experience to go through. I am no authority on this subject, but it does seem clear that there is some targeting of women as the pre-destined vehicles for birth going on in our country, hello conservative mission. That being said, the comments about doctors fearing prosecution seem valid, as well as the fact that your doctor worried that you were not in a balanced state of emotional health to make such a large decision. However, “Two years!” how is your doctor to decide what length of time it will take you to be emotionally ready to make this decision? That’s highly patronizing.

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