As an OB/GYN and a reproductive justice advocate, my work often centers around the fundamental right of people to control their own reproductive lives. A critical component of this is voluntary sterilization, the choice to prevent pregnancy permanently.
Sadly, I’ve seen how unnecessary barriers keep patients from accessing sterilization procedures, especially if they’re younger or have not yet had children.
Understanding Bodily Autonomy
Bodily autonomy is our inherent right to make independent decisions about our health and reproductive choices. For healthcare providers like me, respecting autonomy means trusting patients to know what’s best for themselves without me interfering or gatekeeping. This principle is at the heart of my practice and advocacy.
Yet, when it comes to voluntary sterilization, bodily autonomy is routinely undermined. The needs and wishes of patients often come up against dismissive attitudes, paternalistic barriers, and outright refusals—especially when they are young or childfree.
Common Sterilization Procedures
Tubal ligation, commonly known as “getting your tubes tied,” involves laparoscopic surgery to block or seal the fallopian tubes. It’s a quick procedure, often done right after childbirth or as an outpatient surgery, and it doesn’t affect my patients’ hormones or menstrual cycle.
Salpingectomy involves completely removing both fallopian tubes. Not only does this procedure ensure permanent contraception, but it also significantly reduces ovarian cancer risk, as many ovarian cancers start in the tubes.
Either procedure can also be performed at the time of a cesarean delivery. Both represent safe, effective ways for patients to exercise control over their fertility. Yet despite clear medical guidelines that respect autonomy, barriers persist.
Reasons Women Choose Sterilization
Patients choose sterilization for deeply personal reasons, all valid and deserving of respect. Many simply never want children or feel their family is already complete. Others would like a permanent, reliable birth control method without the ongoing expense of hormonal side effects.
Medical considerations also play a role. For example, patients at higher genetic risk for ovarian cancer may opt for salpingectomy as preventive care. A study in Sweden found that the procedure reduced ovarian cancer risk by around 65%.
Political and social concerns are growing factors. After the fall of Roe v. Wade, many sought sterilization out of fear that they might be limited in their future reproductive care options. A national study published in JAMA Health Forum found that the rate of certain sterilization requests doubled following the Dobbs decision. Among adults aged 18-30, tubal ligations rose by about 58 in 100,000 people, while the rate of vasectomies tripled.
Celebrating Sterilization
I smile when I hear about parties that openly celebrate voluntary sterilization. Patients invite friends and family over to affirm their decision to remain child-free. For example, Dani Marietti’s friends in Montana threw her a sterilization shower with playful signs that read “See Ya Later, Ovulator.”
Patients also share their sterilization stories on social media platforms. The growth of these communities acknowledges that choosing not to have children is just as worthy of celebration as announcing that you’re pregnant.
Arbitrary Age Restrictions: A Legacy of Paternalism
Despite progress, historical restrictions continue to limit access to voluntary sterilization.
A notorious historical example is the Rule of 120, once recommended by the American College of Obstetricians and Gynecologists (ACOG). This outdated guideline required a woman’s age multiplied by her number of children to equal at least 120 before approving sterilization.
Today, similar barriers persist when providers try to impose their own opinions about a patient’s maturity or potential to bear children. Additionally, Medicaid requires a 30-day waiting period and a minimum age of 21 for sterilization, creating extra burdens for lower-income patients.
I’ve read many stories in the media about women who never want to have children, but could not access either of the procedures above.
For instance, Coco Miletti-Hall, a 32-year-old woman from Ohio, was repeatedly denied voluntary sterilization. Doctors told her she was “too young” and that some hypothetical future partner might want children. Her experiences reflect a deeply entrenched paternalism.
Another powerful example is Kasey Peterson, who now works as a property manager in Oceanside, California. She began requesting sterilization at age 18. She faced consistent refusals until she was 25, each doctor dismissing her maturity and autonomy. Peterson’s case highlights how physicians impose their biases rather than respecting patient choice.
Refusal as a Violation of Bodily Autonomy
I believe that denying sterilization violates patient autonomy. ACOG now criticizes age- or parity-based refusals and urges respect for patients’ reproductive decisions. They tell those in my profession that a fully informed adult’s decision should be honored without paternalistic restrictions.
Legally, while the right to have children is constitutionally recognized, there is no explicit constitutional right not to have children. People who choose this route are subject to bias from some healthcare providers, placing undue burden on a patient’s reproductive freedom. Legal scholars argue this represents a significant ethical failing that must be corrected.
A Call for Change
Healthcare providers and policymakers must respect a patient’s choice to seek voluntary sterilization. We must tear down unnecessary barriers and honor informed reproductive decisions.
I will continue to champion this cause, trusting and empowering individuals to make independent reproductive choices that are right for their own lives.
