A few weeks ago, the Huffington Post ran an article about the obstacles encountered by young women interested in permanent surgical sterilization (e.g. tubal ligation):
The first time Bri Seeley told her doctor she wanted to be sterilized, she was 24 years old. … Motherhood, she knew deep in her bones, was not for her.
But the naturopath whom Seeley saw for her annual exam told her that because of her age, she was not a good candidate for permanent sterilization. The following year, Seeley asked again — and was rebuffed again. Next year, the same thing.
“Every single year she would say to me, ‘You will never find a doctor to do that for you,'” said Seeley, who is now 31 and lives in Los Angeles, and who has blogged for The Huffington Post about her experience. Though her desire for the procedure only grew, she said, the anger she felt after her initial rejection gradually gave way to a kind of numbed resignation.
The issue is that doctors are concerned that women, and particularly younger women who have never given birth, will regret being sterilized:
A major area of focus for ACOG, and the OB-GYNs it seeks to counsel, is the question of regret. A comprehensive 2008 review looking at sterilization in the United States found that patient regret is the most common lasting complication of sterilization, and one that disproportionately affects women: Up to 26 percent of female patients say later that they regret the procedure, according to statistics cited in the study, compared to less than 5 percent of men who have a vasectomy. And age, the researchers concluded, is the top predictor of regret. Women who were under 30 when they were sterilized were twice as likely as their older counterparts to say they had later misgivings.
As one ob/gyn put it, “In some ways, it’s very difficult to see a 22-year old make a decision for the 35-year-old she will be someday and not have major concerns that she might regret that decision.”
Naturally, as I read this, my mind immediately went to the topic of post-abortion regret. Abortion, obviously, is also permanent. A 2008 meta-analysis in the British Journal of Psychiatry found that abortion is associated with an 81% increased risk of mental health problems. And I realize that this is a matter of intense ideologically-driven debate, but even if you disagree with the meta-analysis and refuse to accept that abortion is associated with mental illness, it is absolutely, at minimum, associated with regret. (Witness the explosion of women-led support programs that have emerged in the vacuum of official silence/reluctance/opposition.) If regret is a “complication” of sterilization, there is no defensible reason not to treat it as a complication of abortion as well.
Where is the concern from physicians that the 22-year-old obtaining an abortion is “making a decision for the 35-year-old she will be someday”—the woman wondering about the child who would have been on the cusp of his or her teen years?
If a childfree young woman wants a tubal ligation, and she has been fully informed of the one-in-four chance that she may later regret it (along with the obvious risks attendant to surgery), she should be able to obtain a tubal ligation. In addition to helping the majority of patients, a policy of open access to sterilization would also have the happy side effect of preventing unintended pregnancies and abortions.
Conversely, ob/gyns and women’s health advocates should not be so cavalier about the chances that a woman will one day say that she regrets her abortion. (Often, as with sterilization, the regret won’t come until years later, which is why I’m thoroughly unimpressed by research emphasizing that relief is the most common immediate reaction to an abortion.)
I don’t wish to diminish the experiences of women who regret their tubal ligations. But they at least have options: some tubal ligations can be surgically reversed, sterilized women can become mothers through adoption, and one of the women quoted in the HuffPo piece was a stepmom. In contrast, there is nothing that can replace the unique daughter or son lost in an abortion.
The medical community has this completely ass-backwards.