For once, I'm not talking about the anti-choice movement. American Sexuality magazine has a piece describing one young woman's travails in finding a doctor willing to perform a tubal ligation on her. She's in her early 20s, and absolutely, positively, 100% certain she never wants children. Never.
Seems perfectly logical to me that she'd want her tubes tied. After all, birth control is expensive. And can be a nuisance. If you know you won't want kids, why wait another 10 years to have this surgery? Maybe because doctors are refusing to perform it on her:
“[Planned Parenthood of Boston**] said it was much too permanent and weren’t going to give it to me, plus my insurance wasn’t going to cover it,� recalls Green. What’s more, according to Green, “It was all and only about my age.� She was twenty-two at the time.Green’s experience is not that unusual. Though no actual laws have ever been put into place, most OBGYNs refuse to provide women under thirty with permanent forms of contraception. Dr. Daniel Wiener, assistant professor of obstetrics and gynecology at McGill University in Montreal, is one such doctor.
With thirty plus years of medical practice, Dr. Wiener finds no good reason for putting otherwise healthy patients in surgery: for one, there are anesthetic risks involved. Plus, tubal ligations are considered elective surgeries (assuming the patient can use other, less invasive forms of birth control). More pressing, still, is the fear that a patient may one day change her mind. Sound familiar?
Yes, actually it does. The last time I heard the "we must protect women from their future selves" argument, it was being proffered by Justice Anthony Kennedy.
Over at Broadsheet, Tracy Clark-Flory says, "It's an issue of reproductive choice and freedom, to be sure. But making medical and ethical judgments like whether to tie a woman's tubes (or whether someone is prepared for a sex change) is a doctor's right and, arguably, an essential part of the job description." Um, what? Is it a medical professional's job to "protect" women from their own decisions? Is it a pharmacist's right to make medical and ethical judgments like whether to dispense contraception? If you're a doctor who's happy to provide tubal ligations to older women, it seems totally out of sync to deny them to younger women who are equally certain they'll never want to reproduce.
It's not hard to believe the stigma that the woman in the article says she faced in pursuing the surgery. After all, I've seen this story about the increasing demands of 20-somethings for tubal ligations (or vasectomies) crop up a few times in the past year. The simple fact is our society still has a hard time accepting that some people just aren't interested in spawning.
So what should doctors do when faced with a patient in her 20s who requests a tubal ligation? I think Justice Ginsburg's advice in the wake of Gonzales v. Carhart applies to this situation quite nicely: inform women of their options, the attendant risks, and the likely outcomes. Then let them make the decision for themselves.
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By Mithras Invicti American Sexuality Magazine:“[Planned Parenthood of Boston] said it was much too permanent and weren’t going to give it to me, plus my insurance wasn’t going to cover it,� recalls [Lauren] Green. What’s more, according to G... Read More
A good friend of mine has a host of learning disorders and abnormal body chemistry issues, and is positive that even if she wanted to have kids (she hates them), a pregnancy would either kill her or make her literally insane, not to mention the damage her body would do to the fetus. But she still can't get her tubes tied. Because she might "change her mind."
I have an idea. Let women get the bleeding operation (no pun intended), and /if/ they change their minds later (not outside the realm of possibility), there are thousands of kids in the system who need parents to adopt them. It's a win/win.
i bet if she told them she didn't want to have her own children but adopt instead, they would do it. as long as she's wants to be involved somewhere in the furthering the species then the doctor will 'know' she's mature enough to make her own reproductive choices.
It's particularly ironic to hear the decision to refuse to allow adult women (I feel the need to emphasise this because it seems vaguely important) to undergo the short-term risks of tubal ligation while leaving them no real option but to be subject to the long-term risks of hormonal contraception.
This is a profession that performs equally (or even more) risky elective procedures like rhinoplasty all the time, with no concern for anything but the patient's solvency, and yet when it comes to things like tubal ligation (and sex reassignment surgery, as the article mentions), suddenly they have scruples. Could it be that cosmetic surgery is often about meeting society's expectations, while tubal ligation, SRS, and the like contravene those expectations?
Yeah, this is one thing that really gets to me. I'm only 21 and am absolutely sure that I don't want kids, and I've always known this wouldn't be an option for me. Assuming I could even find a doctor who would be willing to let me have this simple surgery, there's no way an insurance company would cover it unless I were older or had a bunch of kids already.
It's incredibly frustrating, but this is the prevailing attitude of the medical community. And come to think of it, it's the prevailing attitude of everybody. I can't count the number of times I've been told, "Oh, just wait until you're older!" after telling someone that I don't want to have children.
At what point am I old enough to make decisions for myself and be trusted not to change my mind?
But to be fair, I think a man my age who wanted a vasectomy would face exactly the same problem.
The balance of harms is NOT equal. If you mistakenly get your tubes tied, you can adopt, use a surrogate, get IVF, or hope that, in 10 years, there will be technology to reverse it.
If you don't and you get pregnant, congrats - your life is forever changed.
I wish they would discuss the risks of abortion and/or pregnancy when talking about the risks of tubal ligations.
Only 7% of women regret their tubal ligations, yet some 40% of women will abort during their lives. (I'm using that as an absolute baseline of women who experience unwanted pregnancies.)
But making medical and ethical judgments like whether to tie a woman's tubes (or whether someone is prepared for a sex change) is a doctor's right and, arguably, an essential part of the job description."
Doctors are not robots. It is part of their job to analyse the health effects of anything they may do - you know, "first, do no harm."
Nevertheless, the appropriate method for dealing with a patient who wants her tubes tied is not to patronise her. Explore other options - including the potential health hazards of those, examining her reasons, and, if you still disagree, referring her to someone else who will do it.
It should not be easier to get plastic surgery than a tubal ligation.
IMHO, what we should really aim for is for this procedure to be treated exactly like any other.
A friend of mine, who had every severe reproductive disorder known to science and was a female-to-male transsexual on top of that, ran into this bullshit recently in Utah when asking for a hysterectomy. The doctor, a fundamentalist, said he wouldn't perform the procedure (which was medically necessary on multiple levels) because my friend hadn't given birth "yet".
That's the whole fucking point!
(Not to mention that, even had my friend not been FTM and had he actually wanted to get pregnant one day, the pregnancy probably would kill him, if the severe pain and haemorrhaging didn't do it first.)
Am I retarded, or can't you reverse a tubal ligation? Yeah, it's expensive and there's some risk (as there always is going under general anesthesia), but my understanding is that getting your tubes tied does not mean you will never, ever, with absolute certainty, ever, be able to change your mind. I think only hysterectomies are *really* permanent.
And anyway, regardless, even if it were permanent and you did change your mind -- adoption is an AWESOME option (and one I'm a huge fan of -- I myself intend to adopt at least two if and when I ever meet a suitable partner in crime).
But, yeah -- um, doctors perform breast enhancement surgeries every fucking day. Those have the potential to be just as damaging to aspects of motherhood as a tubal ligation, yet you never hear doctors objecting to those because "well, she might change her mind. You know, when she screws her head on straight and wakes up to the fact that she's a person and not boobs on legs." Because, well, MEN would not be happy about THAT!
Green’s experience is not that unusual. Though no actual laws have ever been put into place, most OBGYNs refuse to provide women under thirty with permanent forms of contraception. Dr. Daniel Wiener, assistant professor of obstetrics and gynecology at McGill University in Montreal, is one such doctor.
Incidentally, that's when fertility declines. "You can't get this done when you're as fertile as a bunny rabbit, sorry; just wait until it's harder to have kids even if you want them."
Count me among those who cannot get MDs to understand that I don't want kids.
Re: vascetomies. Not in agreement. Men can lie - they can say that they have three kids already. It's pretty obvious when a woman has never had kids.
"I can't count the number of times I've been told, "Oh, just wait until you're older!" after telling someone that I don't want to have children."
When people/parents tell me, "Oh, you'll change your mind!", I like to ask them (with a serene smile): "Did you change your mind about wanting kids?"
I've had people telling me I would change my mind since I was in high school. I'm nearing menopause, and I never did. I agree with Oenophile: it should be treated like other elective surgery. Elise is on the money as well.
Controlling women's reproductive health choices is part of the tradeoff that allows the AMA to remain the strongest union in the world.
Am I retarded, or can't you reverse a tubal ligation? Yeah, it's expensive and there's some risk (as there always is going under general anesthesia), but my understanding is that getting your tubes tied does not mean you will never, ever, with absolute certainty, ever, be able to change your mind. I think only hysterectomies are *really* permanent.
No, you're not retarded. There are two types of ligations: those in which the tubes are twisted and tied, and those in which they are also cut. I believe that the former are reversible.
Is it interesting how so many people think nothing of talking to grown women as if they were 10 year old girls wanting to dye their hair purple?
And vasectomies, of course, are even more easily and cheaply reversed.
I am 21 years old as well and face similar issues when it comes to making decisions regarding my reproductive future.
I have come to the realization that I will not be able to get a tubal litigation any time in the near future, and so must run the risks of hormonal birth control until then. I definitely do not think it is fair or even makes a lick of sense in terms of economics, overpopulation, and strain on resources.
If I could afford the surgery, and could find a doctor who would perform it I would do it tomorrow. I understand that someday in the future I might change my mind (highly unlikely) but I also understand the women who won't and are quite sure of it.
The way I see it is, even if I had the operation and changed my mind, I would still be able to raise children through adoption or mentoring which would be a more selfless beneficial to the world than having one myself.
The argument I frequently hear is "what if your husband wants to have biological children" as if the hypothetical desires of someone else outweigh personal lifestyle decisions. I just know that if I get married, it is going to be with someone who shares my values and if we decide to raise children we can do so through adoption. If my "husband" would leave me for a more open minded uterus, we clearly were not meant to be together. Of course, if he wants to pop one out, I would be supportive XD
My husband got a vasectomy at 23. It took us over a year to get it. He dragged me to all sorts of different doctors so I could show them my engagement ring and talk about how I'm adopted and how I'd like to adopt one of the many kids in foster care someday and I'm really not keen on the idea of being pregnant, and almost all of them still denied us. One of them even scheduled him for the vasectomy, and then when he came in they told him they don't do those anymore! Finally we got one to do it. It's worth it, if you want it keep fighting for it.
I think that you will find that for women of color, low income women, or immigrant women, this issue is completely different. Rather than having trouble getting sterilization surgeries, they are being FORCIBLY sterilized.
There is a long history of this in the United States. In the 1970s, it was discovered that hundreds of Mexican-origin women were being unknowingly sterilized at an LA hospital. They were being told the operation was reversible and given forms they couldn't read (because they were in english) to sign.
These abuses promoted a campaign by a group called CESA (committee to end sterilization abuse) that was able to pass federal guidelines regarding sterilization--requiring forms in the person's native language, and a waiting period to give consent. Many times these women were being asked if they wanted the procedure while in labor.
This created an outrage among white feminists, for exactly the reasons Ann mentions above--they felt it was an infringement on a woman's right to choose sterilization and was a barrier to her access.
It's a great example of when the feminist movement gets divided along racial lines--white women and women of color are experiencing this issue in opposite ways.
Just to add to this discussion.
psst, it's not a question of surgical sterilization v. hormonal contraception: behold, the humble barrier method! the diaphragm and cervical cap! Or, lo, the non-chemical IUD!
If you've been denied a surgical sterilization, you needn't put chemicals into your body if you don't want to!
(me, I'm happy with my chemical-ridden body-helloooo NuvaRing!--but I know others don't want to go that route)
I feel torn about this. OTOH, the theoretical hand, it's a no-brainer that this should be up to the patient. OTOH, the practical hand, I have lost track of the number of friends I have who have sworn up and down, over a period of many years, that they never wanted to breed, only to completely reverse their decision in their late twenties or early thirties. They far outnumber the people I know who have remained blissfully without kids (and they also outnumber those I know who have always wanted to have kids--I think it's very common to change one's mind on this issue).
Normally we want doctors to take the long view--not prescribing drugs or treatments that will cure short-term problems by creating long-term ones. Even if the surgeries are reversable, that puts the patient under the knife twice instead of zero times--and surgeries, even routine ones, carry serious risks. Based on my own anecdotal observation, and without any data to the contrary, I would feel very uncomfortable performing this procedure on younger women based purely on a desire not to have kids (as opposed to a medical condition that would make pregnancy dangerous). Not because I want them to have kids--gestating, birthing, nd parenting are too much damn work to be foisted on anyone who doesn't want to do it--but because there are nonsurgical, nonchemical ways of achieving the same end, and a current doctor has a responsibility to both the current and future patient.
The reasonable, thing, though, would be to go out and do some solid research on how stable individual decisions re: childbearing are over time, because if I'm wrong, then hey, tubal ligations for everyone.
Long-time reader, first-time commenter (usually no need as there are always much more articulate people saying what I would have tried to).
But I just wanted to briefly step in and say that it really sucks to see otherwise progressive, sensitive, politically attuned people throwing around the word 'retarded' like this. Oppression and marginalization take many forms, as we all know, and the mentally ill and developmentally disabled are certainly among those we need to resist marginalizing. Using 'retarded' to mean 'stupid' is not helpful...
Sorry. Genuinely not snarking, just upset to see this.
and thanks, quickening, for that. I got too caught up in my typing and neglected it. It bothers me, too, to see that word used here.
quickening, my last comment isn't showing up for some reason, but thanks for that.
radicaldoula, you beat me to it!
just think, some women can't get sterilized if they beg for it, but for low income women, woc, or drug users--orgs are willing to PAY you to get sterilized or use long term bc.
remember CRACK (now known as the much more innocuous sounding Project Prevention)?
My husband and I are friends with a couple. Both he and his wife knew they didn't want kids. After about ten years of marriage, they decided the vasectomy route was the way to go because it was an easier procedure (compared to tubal ligation) and it was permanent. Cut to 8 doctors later and a one finally agrees. Nine years later, they very happy with the permanent results. And at least one doctor came right out with why he wouldn’t do it…(paraphrasing) “You might want to leave your wife and find one that wants to have kids.�
These people had been married for ten years and they were both in their mid-thirties at the time! I know where I’m from, it’s difficult for anyone who is childless and under 40 to get elective tubal ligations and vasectomies. Someone brought up that a man could just lie, and that is true if he is private paying, but I’m not sure he could get away with it if insurance was paying for it (in this man’s case, his did). I further agree with the above posters, adults should be able to make their own reproductive choices, that includes whether or not to be sterilized.
kmg…who cares if your friends changed their minds? So did I. That’s not a rationale for denying Kate21 or lilaeden or marle’s husband or anyone else that option.
Based on my own anecdotal observation, and without any data to the contrary, I would feel very uncomfortable performing this procedure on younger women based purely on a desire not to have kids (as opposed to a medical condition that would make pregnancy dangerous).
That's only because, to you, an unwanted pregnancy isn't a harm of not performing this procedure.
I don't want kids; I don't even find them to be cute. I cannot take the Pill. I find IUDs to be morally problematic (and, by the way, I like my light, cramp-free periods and refuse to give that up). Nevertheless, under your theory, I wouldn't get a TL until my 30s (when it doesn't matter much anymore). Why?
There are risks associated with every surgery imaginable. When I had a non-cancerous breast tumour, my doctor removed it - despite the fact that the surgery was risky and painful, despite the fact that it posed NO short-term harm, and despite the fact that yearly biopsies could monitor it. There were other, non-surgical solutions, but none of them worked as well. The risks of NOT having surgery were really high - turns out the tumour doubled in size before they could get it out.
The risks of NOT having TL when you don't want kids are really, really high. If you are morally against abortion, or just don't want to make that decision, or don't want to give your kid up for adoption, why shouldn't you be able to get a TL? If you are a med student yourself and will be in school until you're 35 and can't afford to get pregnant, why risk it?
There are medical and psychological risks associated with NOT having this procedure. It is completely disingenuous to talk only about the risks of any surgery - a standard under which no surgery would ever be performed - a standard under which my lumpectomy would never have been performed.
"psst, it's not a question of surgical sterilization v. hormonal contraception: behold, the humble barrier method! the diaphragm and cervical cap! Or, lo, the non-chemical IUD!"
OTOH, what if new IUDs are unavailable when and where you need to have your current IUD removed and a new one put in? I'm reminded of how abortions and birth control pills are becoming less available in some areas...
One advantage of sterilization is that it can't expire or be taken away from you once you get it.
kmg…who cares if your friends changed their minds? So did I. That’s not a rationale for denying Kate21 or lilaeden or marle’s husband or anyone else that option.
Shelby - good point. After all, the fact that many women opt out of practicing law shouldn't be a rationale to deny us all admission to law school, right?
(Add me among the "never wants kids" category.)
I know a woman who gave a child up for adoption at 17, had another child at 20, twins at 21, another at 23, and was pregnant with her sixth child at 25. She did actually use birth control after the first unplanned pregnancy but she's one of those super fertile types who gets pregnant from looking at her. Before her fifth pregnancy (sixth child), she had been begging for TL and was denied because of her age. Despite the number of children she'd already had, they told her she might want more and they wouldn't do it. The sixth child was actually the product of a marital rape and she has moral issues with abortion. Too bad she couldn't be trusted with her own body so when someone else decided he had the right to it, she got stuck holding the ball.
I've had this same experience. I've been seeking a tubal ligation for a *decade* (Christ I'm getting old). I gave up when the last place I went insisted on receiving my husband's *permission.* PERMISSION. P.E.R.M.I.S.S.I.O.N.
OTOH, the practical hand, I have lost track of the number of friends I have who have sworn up and down, over a period of many years, that they never wanted to breed, only to completely reverse their decision in their late twenties or early thirties.
Did they try to get sterilized? Because I feel like the groups "don't want kids" and "are so certain they don't want kids that they actively seek a tubal ligation" might not be the same group.
Oeneophile, can I ask why you find IUDs morally problematic? (I've never heard anyone say they felt this way and I'm curious).
Here's what sickens me about this kind of stuff:
There are more doctors willing and ready to do breast implants, liposuction, C-sections, and episiotomies on young women than tubal ligations.
And which operations are more dangerous or harmful for the women?
According to every doctor I've ever talked to (and that's quite a few lately), they don't like to to IUDs on young, childless women, either. Part of the rationale for that is that apparently a uterus that has never contained a fetus (and a cervix that has never pushed one out) might be smaller and therefore have more issues and more risk of infection with an IUD, but it also goes back to the whole "you might change your mind" thing.
"And at least one doctor came right out with why he wouldn’t do it… (paraphrasing) 'You might want to leave your wife and find one that wants to have kids.'"
Interestingly enough that was my Mother's worry when my father got his vasectomy. She had complications with her IUD, and not wanting to have any more children, my father opted for the procedure. Her major worry was that for whatever reason they may part and he might want more kids.
Please note that it was my PARENTS that had this worry and this conversation in PRIVATE. Not with the freakin' doctor. It shocks and disgusts me that any doctor would assume that much knowledge about a relationship or presume he knows better than the partnership.
Oeneophile, can I ask why you find IUDs morally problematic? (I've never heard anyone say they felt this way and I'm curious).
Sure. Some of them work by preventing fertilisation (via hormones, but that wouldn't be an option if you're trying to avoid the hormones in the Pill), which is fine, but many of them work by preventing implantation. Even if implantation is successful, the presence of the IUD will result in a spontaneous abortion.
The idea of conceiving every month bothers me. I mean, I really understand that the Pill, or nature, or whatever, will occasionally cause conception but not implantation, or a very early spontaneous abortion, but I really dislike the idea of bringing that about every single month.
There are doctors out there who are willing to sterilize women who are in their 20s and have no children. I found one myself and had the Essure procedure done at 24. I'm surprised no one else has mentioned this procedure yet in this posting thread, but it is worth considering for any woman wanting to get sterilized. It is a fairly new alternative to tubal ligations that involves metal implants being put into the fallopian tubes to block sperm. It's as effective or even better than tubal ligations. It also doesn't involve any surgical incisions into the body since the implants are put in by going through the cervix.
As I've learned in the past and am reading here, many young childfree women have trouble getting this procedure approved, but if you really have made up your mind and want it done you should keep pursuing it and not give up. The first doctor I approached was willing to do this, and I may have gotten lucky, but I'd like to offer some advice for how I picked the doctor that I did:
1)I looked for a facility/doctor who I thought would be pro-choice. Sometimes you can't tell, but if the facility performs abortions then you know they're pro-choice right there. NARAL may also have a list of doctors/practices in your state that are pro-choice. Pro-choice facilities are much more likely to respect any decisions you've made about your own body.
2)I picked a female doctor. I'm sure there are male doctors willing to perform this procedure, but I felt more comfortable having a woman doing it and also I felt I had a better chance of finding a woman willing to do this than a man.
Good luck and don't give up!
Cassandra, I cannot speak for Oeneophile, but I also have moral issues with the IUD-some prevent implantation, after the egg has been fertilized and conception has occured. This is a problem for me, so I choose the pill or condoms.
In reference to the original posting-I take a cyncial view and wonder how much this is about money. OBGYNs are having such a hard time now with malpractice insurance, I wouldn't be surprised if they were worried about future lawsuits.
Why do some many *men* feel the need to deny women's healthcare needs-from the pill, to EC, to this? Why does it always have to be about having babies? Why can't we view these from the perspective of women having 'medical needs' that require the pill, or TL?
Mathari,
You're pretty much right about my issues with IUDs. It's not anything I would ever want outlawed, but that idea makes me really uncomfortable.
I'm in the "young and want to be child free" situation. Nobody accepts it and i mean _nobody_.
I'm suffering a lot of pressure from both family and friends to be a mom. Being the only daughter isn't helping nor is my family's culture.
Any help/advice would be appreciated.
There actually is a good reason to delay tubal ligations -- the 10 year failure rate for tubal ligation when performed on someone under 30 is MUCH higher than if you wait till after 30. It's something like 7 or 10 percent I wanna say. Too high for my liking. That's why my OBGYN told me I'd be better off with an IUD and then getting a tubal after 30. More effective.
Of course, this is not the reason most women are denied tubals, just wanted to put that out there.
"Is it interesting how so many people think nothing of talking to grown women as if they were 10 year old girls wanting to dye their hair purple?"
You said it. Living in a Nanny State is bad enough.
Julianne - I mentioned earlier that I've known that I didn't want children since high school. It's never changed. Just be brave and know your own mind. People just cannot believe that young women are smart and confident enough to do other things. I trust you to know your mind, and I don't even know you. Maybe you should tell them you might do something more important than produce a child. Write a brilliant book or find some important scientific breakthrough. It's really up to you.
JustAnotherJane,
Why is the failure rate higher? Is it because doctors are performing more reversible, but less effectual tubal ligations?
http://www.babycenter.com/refcap/preconception/fertilityproblems/6155.html
Or, is it that your chances of becoming pregnant in a given year in your 20s are well above 80%, while your chances of becoming pregnant at age 35 are 50%?
Reduced fertility alone would account for a large part of that discrepancy.
The failure rate for tubal ligations is 0.5%. Over 10 years, that amounts to 4.88%.
----
I'm in the "young and want to be child free" situation. Nobody accepts it and i mean _nobody_.
I'm suffering a lot of pressure from both family and friends to be a mom. Being the only daughter isn't helping nor is my family's culture.
Any help/advice would be appreciated.
Julianne,
I've spent my entire life hearing that. As I've gotten older (now sliding towards my late 20s), with no signs of changing, it's gotten better. I don't know how old you are, but it does improve.
Some of it is that I also just ignore it. When people say, "When you have kids..." I just smile and let it slide.
I was harassed a LOT when I was a kid and a teenager. Some of it is age, now - I haven't changed my mind yet. Some of it is that I'm very clear that I'm looking for a man who doesn't want kids, or who is on his second time around and has older kids (elementary-school aged).
Sometimes, people get obnoxious. My favourite (ha!) was when someone smugly said, "Oh, you can't always plan for them! They come anyway." I really wanted to say, "I'm freakin ABSTINENT, and if I get knocked up, it's because the Second Coming of Christ is imminent, and you're going to have a lot more to worry about than my desire to avoid miniature humans that resemble extras from the X-Files."
(Really - are these the same numbnuts who think that I should have sex anyway, because birth control never ever fails?)
When all else fails, try sarcasm: "You mean that I should have a baby RIGHT NOW? My hormones are raging. Screw college; I want to sit at home and nurse and sing lullabies...." (Would go on, but making self nauseous.)
oenophile
Mom would do things like buy me baby dolls etc when i was little - i also got pushed into babysitting which i didnt really want to do - my heart doesn't melt if there's a tiny baby in my arms etc.
both her and my grandmother and aunts are none too subtle about how they see my future - mother and wife of course.
I just feel terribly alone and not sure what to do.
Julianne M, if it seems like no one in the world agrees with what you're doing, it's a sign you're on the right track. Your friends and family want what they *think* is best for you, which is not always what is *actually* best for you.
I personally don't plan on having children. If later I want to raise children, I'll adopt a child from Africa or China.
What is the crux of the issue is one of who decides. Who decides whether or not you can make an informed decision for your own life, based on what you want, what is best for you? We are in a society that holds womens choices as suspect, open to questioning and judgement at every turn. This isn't news. How do we subvert it? What action do we take to make our observations about the oppression of women more than just belly aching and instead a path to change the way we view our own choices and the way others view the right of women to make those choices.
by the by, I heart my IUD, its the best thing ever - for me. Because I'd never had a child, it took me two years and 8 doctors before I was able to get it. Preventing implantation is it's M.O. FYI, my period is super light with it (Mirena, if anyone wants to ask their doc) - it's a great option, just incredibly difficult to get if you've never had a kid. There are slightly higher risks associated with women who get them without having given birth, but I accepted those risks. My doc talked to me about what the risks were, gave me some literature and explained they don't typically like to give them to women at increased risk, but in my situation (I can't take hormonal birth control) it just made sense. It was an incredible feeling to finally have validataion -this is what I'd been saying for two years.
It's crazy that this is such a common experience for women. So what action can we take to change the way doctors treat women's health decisions?
There are even those who would try to pressure seven year old in to haing kids!!
I'm sorry for crying at the computer - i just feel so alone.
I'm in the "definitely don't want kids" category. I think the first time my doctor ever offered me the opportunity to have a tubal ligation, I was in my early 20s. I'm Canadian, which may make a difference. At the time, I'd just recently had surgery and I said I wasn't interested in going under the knife again soon.
I've actually now come to the conclusion that having a TL would be a waste of time, since my hormones are so messed up I pretty much have to be on hormonal birth control (hellooooo patch!!) just to keep from being miserable. Having a period that goes AWOL for a few months with an attendant six weeks of PMS is just an unhappy thing. Why go under the knife yet again (it would be my fifth surgery) for basically nothing?
Should 18 yr olds be allowed to opt out of 'Social(ist) (In)Security' and/or 'Medi(S)care'?
Probably not... they 'might' regret it later in life.
I'm 23, and I've been on a waiting list for a tubal ligation for the past two years. In Canada, doctors technically cannot discriminate regarding tubals on the basis of patient age. That said, they can condescend and give the run-around as much as possible, it seems. I've gotten the "what if you met a man who wanted kids?" (said to me knowing full well I'm in a relationship) as well as innumerable "but you'll change your mind!" refrains.
The "oh, there's always condoms and HBC!" is often trotted out. I use both now, and though the former is always a plus, I fail to see why I should have to deal with the latter for no apparent reason, when I could get sterilized now, and not have to worry about decades of hormones or fundamentalist pharmacists trying to keep me from being able to take care of myself.
And to Julianne M: You're not alone at all. I promise. There's a lot of people who don't want kids ever.
Thanks Becca. I want to talk about it all but am not sure where to start. I hope you all can help me with what to do.
Do not to listen to other people (who, if they weren't your friends/family, I might call "dumbasses") who think they have some kind of inside line on what you really want. You have the inside line on what you really want, and they're just trying to generalize from their own experiences (at best, that is; otherwise, they're just trying to pressure you into a certain life because they themselves never considered an alternative). Look, I desparately want children and have wanted them for years--that has to do with my character and desires.
My local news just ran a several-minute-long segment on a shocking story. Apparently, there are some people who don't have children, and don't want them, and enjoy their lives without them. But at the same time there are actual other people who have children, and are enjoy their lives with them. Go figure.
Apparently, this somehow counts as news. The follow-up will no doubt be a piece about how some people enjoy roller-skating, while others enjoy reading military histories. I guess it's a good thing that roller skates don't require a doctor's permission.
Julianne-- you're not alone. The numbers of childfree individuals are rising, and most of us have experienced the kind of judgment you're facing.
I know it's difficult to be the "one voice" that is different in your circle of friends and family, but stay strong. Only you know what is best for you. Personally, I was very angry after I realized I had a choice-- that I could opt NOT to have children-- and I too felt very alone, and very ostracized by everything and everyone around me. It was like I was walking in a different direction than the crowd, and people kept hollering at me to "stay in line".
It will get easier. It helps if you are confident in your decision, and if you're able to research the reasons why people do and don't have children. Also, it's useful to develop a number of catch phrases or practiced responses:
Like oenophile, I usually just smile and let it slide when strangers say "When you have kids...". Sometimes I say, "We aren't having children," and leave it at that. If they push it further and say "You'll change your mind", I ask if they changed their mind about wanting kids ("No..." "Well, then why do you think I will?"). When people tell me I *should* have kids, I ask: "Don't you think children should have parents who won't resent them?"
My close friends and family all know where my husband and I stand on the matter, and don't press the issue because: a) they know we can defend our choice (although we shouldn't have to) b) they agree with it (our two best friends are also childfree), or c) they simply respect the fact that it's our decision to make.
I'd recommend trying to find some Childfree communities online. Trust me-- though it may not feel like it, you have plenty of people who agree with and support your decision.
Julianne, don't let it get to you. No one knows you better than yourself-just keep that in mind and ignore the rest. Hell, I'm 38, never married, don't date, and honestly find nothing appealing about children-and I still get the occasional 'You'll change your mind! One day you'll want a husband and children!'.
Well, no, I won't. It probably helps that I don't like people that much, either. :)
I was wondering if, in regards to the denials of TLs, there wasn't another reason doctors and clinics might refuse to perform them-sexual freedom. I'm not saying that I believe a woman will get a TL and then go to town, but considering some of the nonsense 'moral' doctors spout with regards to birth control, does it make sense that some might oppose a TL because they believe a woman will start sleeping around?
Anywho, it comes down to this: it's my damn body, and I should have the freedom to do what I want with it. I'm tired of being a second-class citizen.
cest.la.vie and Wolf
where are some good online places to go?
It's especially hard with a family like mine - and being the only daughter.
I'm bitter that my brothers get none of the pressure, lectures and remarks that i have to face.
Again I'd like to talk about it but am not sure where to start. G*d I'm sorry for crying - i feel soo stupid :(
It's a "nanny state" if you're rich, white, and (preferably) male. Then the state takes good care of you. For the rest of us, it's a bit more of a bully state.
Then he can get his own ass pregnant.
The thing that often gets lost in discussions in this topic (and the topic of pharmacists imposing their religious tastes on those who require their services) is that health care professionals simply neither have the ethical duty, nor the ethical right, to impose their personal taste (as opposed to a rational medical judgment that a particular medication or procedure presents a substantial danger to the patient) on a mentally competent adult patient. If they want to deprive an adult patient of her autonomy, they can make an application to have her declared mentally incompetent. If there's no basis for believing the patient is mentally incompetent, then the patient's right to autonomy prevails.
Julianne, a quick Google search I just did turned up a site, www.child-free.com, that seems to be a good place to start. And don't think you have to apologize for your feelings, there's nothing wrong with them or with you for feeling them. I know it's hard, particularly if the people around you aren't supportive, but it is your life and your choice period.
Personally, I've always wanted children, biological and/or adopted, and I know my brother does too. But my youngest sister is 11 and says she doesn't want kids ever. I've never said to her "you'll change your mind" or "when you're older, you'll feel differently" I just say "Fine, you'll make a great Aunt for the kids L and I will have" and then tease her about all the free babysitting she'll do (she never even wants to babysit). If she wanted a tubal ligation in her early 20's I can't think of any reason why she shouldn't get one. It's disgusting to think that she could be denied that autonomy over her own body because other people might think they know better then she does what she wants. If I went out and asked for a set of D-cup implants, no one would take me aside to point out that having a 30D after being a 30A naturally might cause shoulder pain or chronic back problems, they'd just say "Great!" and take my money. Gross.
Julianne-- there are quite a few childfree communities online, although they pop up in different places. I know there are a few on livejournal.com. There's also a childfree community on sparkpeople.com (a site geared towards nutrition, healthy eating and weight loss). And on Indiebride, there are many childfree members who I know would be more than happy to talk to you (though the site is geared towards people getting married, or who are already married). These are just a few of the places I've found. The sparkpeople.com one was the most supportive, in my opinion.
Honestly, I think if you started searching for "ChildFree forums" on google, you'll find some that match your interests.
Genny is there anyway to contact you off-blog?
Thank you for caring.
Julianne-- there are quite a few childfree communities online, although they pop up in different places. I know there are a few on livejournal.com. There's also a childfree community on sparkpeople.com (a site geared towards nutrition, healthy eating and weight loss). And on Indiebride.com, there are many childfree members who would be happy to talk to you (though the site is geared towards people getting married, or who are already married). These are just a few of the places I've found. The sparkpeople.com one was the most supportive, in my opinion.
Honestly, I think if you started searching for "ChildFree forums" on google, you'll find some that match your interests.
Julianne,
I am a new reader, haven't posted anything until now, but just know that you aren't alone. I knew at a young age that I didn't want children, and that didn't sit well with some people. Once, when I met someone very special, I tried to convince myself that I could have a child and I'd be happy. But I was lying to myself. I was a big crying, nauseated mess, because deep down I knew it would be the worst choice I could make. After that episode, I decided that I would never allow others to dictate what I would do with my body.
You'll always have people who think they can force you into fitting their ideals, but listen to what your heart says, and always follow. Good luck.
PS sorry to "post and run," but it's midnite and I can barely keep my eyes open. But I will check back on this thread.
Thank you both.
What should i say to my family and friends - nothing's worked so far and the problems from my family really hurt. They are a lot more traditional (and conservative) than me which probably hasn't helped.
i had a friend in michigan who wanted a tubal ligation after having her first child. it was unplanned, and she hadn't wanted children in the first place. she and her boyfriend decided that they would embrace it. she asked to have a TL following delivery, since it would be a good time to do it. her doctor said no because she was too young. he told her in no uncertain terms, that he would not do any such thing until she had three children or was 35.
she gave birth to twins less than a year later. (she doesn't believe in abortion) she had been using HBC.
when i was stationed in monterey, california, my primary care manager (the doctor military people are assigned to for their care) recommended an non hormonal IUD to me, as HBC would complicate some other medical issues i was being treated for. the ob/gyn on board there refused me b/c i was unmarried, and b/c she said it went against her moral beliefs, even though it WAS RECOMMENDED BY MY DOCTOR! i was outraged. i had to wait until i pcs'ed to another location to get it done. (btw, i had cramps for two months, and since then, for the last year and a half, i have been fine! i LOVE my IUD.) all of this, and i already have a child, am in a mutually monogomous relationship, and we want to wait until one of us is out of the military to have more children, if we decide to do it at all. it was unheard of that i would want to have sex and not procreate. (oh the shame!) being a parent in the military is tough, i couldn't bear doing it w/ two.
the point to all my babble is that it is ridiculous to be denied health care, told what to do w/ our bodies, and looked down upon for our reproductive choices. personally it enrages me. the people who make these policies and laws have no regard for our health. even when i was told that HBC would be bad for my health, i was refused. my friend, turned away b/c she was too young w/ not enough children to decide. (apparently just b/c you are old enough to be a parent doesn't mean you are old enought to decide what to do w/ your own reproductive system) it is an outrage. what do we do to fight for our repro rights?
how do we convince them that our bodies are our own?
I've been thinking about this issue, and though this is kind of a joke answer, what about saying to the doctor "I am sick and don't trust myself with children". Wouldn't they then feel obligated to? Might work better for males though.
Also I'd like to know how well bribery works.
A couple of notes on IUDs:
My local PP changed their protocol for IUD insertion within the last six months. Previously, to be a candidate for an IUD, you had to have had at least one pregnancy carried to at least 20 weeks. It was the issue of the size of the uterus that formed that protocol. The new protocol states that the candidate simply has to understand that the IUD lasts X number of years and that your risk of contracting PID from an STD is higher with one in place. The only absolute qualifier is that your uterus be at least six centimeters deep, to fit the IUD.
If anybody's interested in placement, I would recommend contacting the Planned Parenthoods in your area. Protocols vary from clinic group to clinic group.
Also, for Oenophile: I can't find the citation at the moment, but I remember quite clearly reading new research from Europe about the mechanism of IUDs. Several studies found that women with either type of IUD in place (hormonal or copper) had no ova in their tubes (they used a lavage process to find this out, which is skeevy in itself). Further, the simple fact that you have something in your uterus seems to redirect your immune system locally so that it destroys sperm. The monthly fertilization-and-failure to implant scenario has lost ground as a hypothesis for IUD action.
I'm childfree by choice and in my late 30's. For a number of reasons, I didn't feel comfortable getting a tubal ligation or occlusion. I *love* my IUD, hard. Now that it's again available to nulliparous women in the US (as it has been in Europe and Canada for some time), I think we'll see a lot more women trying it out.
The good news is though evolution wants us for more than just reproduction.
Is there any legal action that can be taken on this? On one hand, it seems pretty clear-cut that a physician/surgeon saying that he or she just doesn't want to do the procedure has no legal standing and is discrimination. But then there also isn't any ground for patients simply being able to demand any procedure at all (I'm thinking of the disorder where people want to have limbs removed).
Also a fan of the Mirena IUD here. I looked into it a lot, and as Jo just wrote found that it really prevents conception rather than implantation based on the available studies.
It's not necessarily any easier for you after you've had kids if you haven't hit the magical 30. After my second, which included a lovely episode of PPS, I wanted my tubes tied/cut promptly.
The FEMALE doctor who was taking over the practice of my OB/GYN refused to do a tubal on anyone under 30, regardless of circumstance. I've never felt so betrayed. I was referred to another MALE doctor with no qualms about doing it.
Apparently wanting to kill your children just isn't enough of a reason to prevent childbearing for some people.
Julianne - there's a great community of supportive childfree folks (men and women) hanging out at http://www.wekidyounot.org. I've been a member of that community for several years and they're a great bunch - and extremely supportive and helpful.
Thank you Emma!
OK, I am probably going to get flamed for this but hear me out. Let me clarify up front that if a woman wants her tubes tied, she should have the right to have it done.
That said (here comes the possible flames), I spent about a year trying to find a Dr. to give me a tubal ligation when I was in my mid-20s. I was in a long-term relationship and we planned to get married. We were both perfectly content to be childless and were very focused on our future careers – I was starting law school the fall after graduation. I felt very sure that I was going to be a hard charging public defender with no time or desire for a fussy child and I was furious that none of my Drs would do the surgery.
1 year later the guy cheated on me and our relationship fell apart. I spent a few years traveling and decided I didn’t want to go back to law school, began working on my PhD in anthropology and indigenous human rights. Traveling and seeing the world made me reevaluate what I personally wanted out of life and I decided that, if I met the right man, I might actually want kids. Fast forward 6 more years, I’ve finished my degree, have a successful career doing what I love, and met the man I actually want to reproduce with and I am glad I didn’t have my tubes tied.
Obviously there are many, many women who never want kids. Most of my friends fall in that category and they are perfectly content to never reproduce. All I am saying is that it isn’t outside the realm of possibility that life will change you. I guess I’m just saying that I don’t think it is entirely unethical for a Dr to have a serious, challenging conversation with a young woman about getting her tubes tied.
That said, of course if she is sure, then she should have the right to control her own body. Just putting my story out there because I think it actually illustrates what some of these people are concerned about.
JulianneM---LiveJournal (http://www.livejournal.com) has interest-based communities, and several of them are childfree in nature---you can type "childfree" into the interest-search feature and you'll get a list of communities and users who also have that in their interests.
I am aware of one at http://community.livejournal.com/childfree and as I recall there are others.
What should i say to my family and friends - nothing's worked so far and the problems from my family really hurt.
Julianne, it breaks my heart to read this. I'm going to offer some advice, with the caveat that it may not be the right advice for you.
I think the first, and most important thing, to accept is that you can't change your family's and friends' minds. You've already told them that you don't want to have children, and for some reason, they won't accept that. You can't argue them into respecting your decisions. What you can do is refuse to entertain any more of those discussions. If the topic comes up, and you make some reference to your future life without kids, and they say something like "But you'll change your mind! How can you not want kids blah blah blah," what you can do is to say calmly "I've made up my mind about this, and it's not up for debate. Let's talk about something else." If they persist, give them one more warning, something like "I've said I don't want to talk about this with you," and if they don't stop, put an end to the conversation. Whatever you have to do--hang up the phone, leave the room, pull out a book and start reading--end the conversation. Part of what keeps these people going is that they get a reaction from you, and stopping that may be the only way to curtail their rude behavior.
It's hard to do, because it feels rude, and because family and friends can be so important, but they're the ones being rude, which you can point out to them if they get snitty ("How could you hang up on me like that! That was so rude!" (calmly) "I told you twice that I didn't want to debate my personal decisions, and you ignored me--that seems very rude to me.").
Family is one thing, but friends should be supporting your decisions. Better friends may be in order as well.
You know what really bothers me about this? Since I was 18, I knew I didn't want children. I'm in my early 30s and it hasn't changed for a moment. Yet otherwise perfectly liberal, logical, reasonable friends and family insist on telling me that my body will *make* me want children one of these days, it's just "biology," I won't be able to help it, and so I had better not be too hasty. In other words, it's not about changing our minds as if we are capable of rational decisions, it's about being a victim of our hormones and therefore unable to *make* rational decisions.
Sound familiar?
The argument I frequently hear is "what if your husband wants to have biological children"
My response would be "Do you think it's acceptable for him to force me to have children for him against my will?! What the hell is wrong with you?!"
"What if you met a man who wanted kids?"
Me: "Then having the tubal would help make him take me seriously about not wanting kids; it'd make sure he didn't assume that what I want will be discarded whenever it inconveniently conflicts with what he wants. There's a huge problem with people discarding women's desires to not have children" (hint hint) "and a man might mistakenly think I'm the right woman for him and will give him kids despite what I say, and assumptions like that will cause him a huge disappointment when it becomes apparent that I won't. A tubal he'd have to take seriously even if he wouldn't take me seriously." (Never mind, for the moment, that a man who doesn't take me seriously is automatically disqualified on that basis alone.)
http://community.livejournal.com/childfree_zone/
That one's even better. Just discovered it.
"We were both perfectly content to be childless..."
There is a huge difference with "being content to be childless" and being adamantly, seriously, and unwaveringly childfree.