"you’re too young, you’ll change your mind...how can you be so selfish?"
January 28, 2015 6:44 AM Subscribe

Holly Brockwell has requested voluntary sterilisation four times in the last three years, and she's been refused every time because she's under 30 and doesn't have any children.

The UK clinical excellence guidelines do suggest caution when giving fertility counselling to a woman requesting sterilisation who is under 30 and/or childless, but being a member of either of these categories isn't listed as an insurmountable barrier to surgery. It's being repeatedly interpreted as such by physicians, though, with the uncomfortable implication that they are better placed than the individual making the request to know what is right for them in terms of family planning.

This isn't just a UK issue. Medical providers on both sides of the Atlantic are refusing to offer the procedure to otherwise fit and healthy legal adults for reasons that aren't strictly medical.

It's an attitude that Monica Trombley (third link) describes as "paternalistic", and, given that it fundamentally questions the ability of women to make decisions about their own lives and fertility, and to know their own minds, she's kinda got a point.

posted by terretu (305 comments total) 52 users marked this as a favorite

Maybe the right wing would be more accommodating if it were rephrased more evilly. "She doesn't want to bear children? Obviously she's mad, and must never be allowed to reproduce for the good of society! She must be forcibly sterilized at once!"

Seems to me that everybody gets what they want that way.
posted by Faint of Butt at 6:51 AM on January 28, 2015 [11 favorites]

Doctor hacks: If your doctor has vague, bullshitty objections to giving you an IUD, start talking about wanting sterilization. Suddenly the Mirena is A MUCH BETTER OPTION FOR SOMEONE LIKE YOU.
posted by almostmanda at 6:53 AM on January 28, 2015 [97 favorites]

I know someone who had three kids this way, all before age 23, despite asking to be sterilized after each birth. It wasn't until the third that they agreed.
posted by looli at 6:54 AM on January 28, 2015 [3 favorites]

Paternalistic is exactly what it is. God I hate this bullshit.
posted by kyrademon at 6:55 AM on January 28, 2015 [42 favorites]

Here's how it went down for me when I (Canadian, male, married, no kids by choice, mid-'30s at the time) had my vasectomy:

My family doctor: "Are you sure? Okay, here's a referral to some other doctor."
Doctor #2: "Are you sure? Okay, here's an explanation of what's going to happen and a referral to the doctor who's actually going to operate on you."
Doctor #3: "Are you sure? Okay, let's schedule a date for the operation."
Doctor #3 on the day of the operation: "Are you still sure? Okay." *snip*

I got a bit annoyed when Doctor #3 asked me yet again if I was sure and he told me that he understood, but that I would be surprised by how many guys in their 20s scheduled appointments after a pregnancy scare with their girlfriend. I would imagine all of this questioning is, as so many things are, worse if you're a woman.
posted by The Card Cheat at 6:58 AM on January 28, 2015 [3 favorites]

The word 'selfish' is a flag for me.

Selfish means: self-focused to the point of disregarding others. It does not mean simply the first half, 'self-focused'.

It would be selfish of me to have children, because I am not interested in them. I expect that I would disregard them to the point of a very lacking upbringing. That would cause them harm.

It is selfish of other people to project their desire for children onto me: it disregards and harms my own autonomous being, and again, if I had children, it would harm them.

So it is interesting that the term selfish comes up here. Its definition reveals its use, to insult and gaslight women.
posted by Dashy at 7:01 AM on January 28, 2015 [109 favorites]

The Card Cheat, I don't mean to diminish your experience and what you took from it, but that all sounds pretty reasonable to me. (Canadian, male, approaching 30, etc)
posted by Evstar at 7:02 AM on January 28, 2015 [7 favorites]

When I was 36, I asked my gyno just for more information about Essure, and the following conversation took place:

Dr. Jackass: What? Why would you want that? You don't want that!
Me: Well, neither of us has ever wanted kids, so...
Dr. Jackass: Oh, I didn't realize you were married!
Me: I'm not, but I'm in a domestic partnership.
Dr. Jackass: Oh, well, your next boyfriend might want kids.

I was too shocked to respond to that. I switched doctors, but even my next doctor was very hesitant to even give me more information about it. And I was 36! How old do I have to be before they believe me?
posted by amarynth at 7:03 AM on January 28, 2015 [54 favorites]

Reminds me of the odyssey described by The Misanthropic Bitch a decade or more ago. Which reminds me that I'm still wondering what became of her.
posted by richardh at 7:04 AM on January 28, 2015 [5 favorites]

A friend of mine who got cut around 19/20 had a priest (via the hospital) try to persuade him not to do it. The priest failed. Men and women know full well the implications of getting it done. It's their choice.

It would be interesting to see how many people want children and how many people do not, particularly with ever declining incomes for most people. I still get the feeling that a lot more want then not and if you're on the not want side, you're potentially thought of less favourably by some. The attitudes to those who do not want are rather unfortunate.
posted by juiceCake at 7:06 AM on January 28, 2015 [2 favorites]

I have broached this subject with doctors in the past and it is fucking infuriating to be told "Oh, you'll change your mind," "what if your future husband wants children?", "you're too young to know that you don't want kids."

I am 38 years old now. I still want that procedure done, but nope, it's all same shit before only I have a husband who feels the same way and that is still not good enough.
posted by Kitteh at 7:08 AM on January 28, 2015 [13 favorites]

I'm sure leaving this up to the judgment of individual doctors doesn't play out in ways that are obviously, undeniably racially biased.

Yep, totally sure.
posted by almostmanda at 7:08 AM on January 28, 2015 [23 favorites]

"Trust women" -- Dr. George Tiller
posted by hmo at 7:11 AM on January 28, 2015 [76 favorites]

Do the same standards apply with vasectomies? Do any UK men have experience of asking for a "don't want kids" vasectomy in their 20s?

I'm trying to figure out if this is "you don't know your own mind, you're a woman" or "you don't know your own mind, you're too young". Probably both, tbh.

I'm looking around for stats on what percentage of men and women go on to request reversals, but can't find anything. If it's stupid-high (which I doubt) I can see why doctors would be wary of performing the procedure.
posted by Leon at 7:11 AM on January 28, 2015 [2 favorites]

I realize that this is an extremely simplistic attitude to take, but has anyone ever tried this: when the doctor is challenging you about "but what if you change your mind and want kids someday", just answer, "well, adoption is still a thing, isn't it?"
posted by EmpressCallipygos at 7:12 AM on January 28, 2015 [14 favorites]

Doctor hacks: If your doctor has vague, bullshitty objections to giving you an IUD, start talking about wanting sterilization. Suddenly the Mirena is A MUCH BETTER OPTION FOR SOMEONE LIKE YOU.

This works everywhere. If you say "Hey, I'm trying to do this thing in OSX and I can't figure it out", you'll get no help. If you say "OSX sucks because it can't do this thing, and Linux can", you'll learn all there is to know.

Back on topic - Before my vasectomy, the doctor wanted to meet with my wife before he'd agree to do it. Which I sort of get - not everybody is great at teamwork with their spouses and it is for the best to make sure everyone involved is on board. Or whatever. Still, I was a bit put out by it.
posted by Pogo_Fuzzybutt at 7:14 AM on January 28, 2015 [9 favorites]

Ah, found this.
posted by Leon at 7:15 AM on January 28, 2015 [1 favorite]

From the Slate article (third link):

The 14-year cumulative probability of requesting information about a reversal is 14.3 percent (40.4 percent among women 18-24 at the time of sterilization), but only 1.1 percent of women will actually request the procedure.
posted by cooker girl at 7:16 AM on January 28, 2015 [10 favorites]

If I go to my doctor and say "Doc, I want a surgeon to cut my completely healthy right arm off," I would expect him to question my sanity, attempt to put me off of the idea, and require four other doctors, a team of psychiatrists and Hugh Laurie to all sign off on it before authorizing the surgery, because all of the above will sincerely believe that I am out of my freaking mind to request such a body alteration.

That's the problem here. Too many people sincerely believe that "I do not wish to have children, and I want to be proactive about it" is just as pants-on-head crazy as "De-limb me."
posted by delfin at 7:23 AM on January 28, 2015 [43 favorites]

Back on topic - Before my vasectomy, the doctor wanted to meet with my wife before he'd agree to do it. Which I sort of get - not everybody is great at teamwork with their spouses and it is for the best to make sure everyone involved is on board. Or whatever. Still, I was a bit put out by it.

Since sterilisation is usually a choice made by a couple (if you're IN a couple) then I can see why the doctor would want the spouse/partner to be made aware. I don't believe you should need the consent of the spouse/partner, because it's your body, but I do believe it should be disclosed.
posted by Hazelsmrf at 7:23 AM on January 28, 2015 [5 favorites]

As a very intentional parent with a very intentional vasectomy these stories make me furious on the behalf of these people whose agency is not being respected. The decision is too permanent? Having a child is fucking permanent too and your chance of surgical reversal (should you change your mind) is 0%. Yet so many people jump (or fall) into parenting with scarcely a thought and indeed with enthusiastic kudos from most corners of society.
posted by nanojath at 7:25 AM on January 28, 2015 [47 favorites]

To be fair..... vasectomies can actually be reversed most of the time. Not that it's supposed to be used as a method of temporary birth control, but I think some of the reason doctors are more willing to do them is the knowledge that if need be, the procedure could likely be reversed.

But yes, I do think that probably a greater share has to do with:

Man: I don't want kids and I'd like a vasectomy.
Doctor: Of course, kids are an enormous responsibility and might interfere with your goals.

vs.

Woman: I don't want kids and I'd like to have my tubes tied.
Doctor: But ... you're a woman! What else are you going to do with your life?

I wonder how this would work out:

Woman: I don't want kids and I'd like to have my tubes tied.
Doctor: But what if you change your mind someday?
Woman: Do you have kids?
Doctor: [Let's assume "yes"]
Woman: What if you change your mind someday?
posted by Asparagus at 7:26 AM on January 28, 2015 [51 favorites]

> The Card Cheat, I don't mean to diminish your experience and what you took from it

No worries; the point of my story was that while I kept getting asked if I was sure I didn't want kids, there wasn't any paternalistic edge to the questioning and certainly no indication that the treatment might be refused.
posted by The Card Cheat at 7:26 AM on January 28, 2015 [2 favorites]

I don't understand what all the hullaballoo is about, what with the wealth of accessible and legal avenues American women have to terminate a potential pregnancy, and the comprehensive social safety net that will reach up to cradle them and their new families if they end up with a child they can't handle
posted by threeants at 7:28 AM on January 28, 2015 [126 favorites]

I am going off the assumption that the same people who make self-sterilization difficult are also in staunch support of abortion rights and social welfare, right guys

right guys

love, a person who has critical thinking skills but has never read the news before
posted by threeants at 7:31 AM on January 28, 2015 [36 favorites]

Doctor hacks: If your doctor has vague, bullshitty objections to giving you an IUD, start talking about wanting sterilization. Suddenly the Mirena is A MUCH BETTER OPTION FOR SOMEONE LIKE YOU.

This is actually a very effective tactic in any negotiation.
posted by indubitable at 7:32 AM on January 28, 2015 [13 favorites]

Do the same standards apply with vasectomies?

I got much talking to and suggestions to put it off until late 30s when I inquired about in my mid 20s. Which was fine in my particular case.

But as a seeming systematic thing that doctors actually prevent women from doing? That's just flat out wrong. Unless there's a medical emergency, it's reasonable for doctors to say "Well, we're not going to do it today, but come back in six months and if you're still sure, then yeah." But that's about the only reasonable doctor inference I think should happen.
posted by Brandon Blatcher at 7:33 AM on January 28, 2015 [3 favorites]

In fairness, these doctors probably see people every day asking about reversal, and that colors their perception.

Much like an ER doctor would probably vastly overestimate the odds of a kid being in an accident that requires a bike helmet.

Though FWIW, I got a vasectomy in the USA at 24 while childless, and my experience was similar to The Card Cheat's. From a urologist who remarked, during the surgery, "I'm not Catholic, but I respect their pro-life positions." (We were taking about how vasectomies are [edit: were] illegal in France.)
posted by Hatashran at 7:34 AM on January 28, 2015 [7 favorites]

My gyn gave me a Mirena and told me to come back when I'm 35. Luckily for him, I love the Mirena and it's worked out well.
posted by roomthreeseventeen at 7:35 AM on January 28, 2015 [1 favorite]

Anecdata, but everyone I know who sought this procedure in their 20s now has kids or are trying to have kids in their 30s.
posted by sid at 7:37 AM on January 28, 2015

Yup, that's anecdata alright. Doesn't mean other women aren't positive they don't want kids. Like me.
posted by agregoli at 7:40 AM on January 28, 2015 [62 favorites]

First sought out vasectomy at 16, and was turned away. Tried again at 26 and had it done with minimal hassle after a mandatory waiting period. Almost 40, still have not changed my mind.
posted by idiopath at 7:43 AM on January 28, 2015 [3 favorites]

I realize that this is an extremely simplistic attitude to take, but has anyone ever tried this: when the doctor is challenging you about "but what if you change your mind and want kids someday", just answer, "well, adoption is still a thing, isn't it?"

Empress, there are a lot of things (A LOT) that I wish I had said to Dr. Jackass, but I really was too shocked at the time to think of them. I'll try to keep the adoption thing in my back pocket in case I ever decide to look into it again.
posted by amarynth at 7:45 AM on January 28, 2015 [1 favorite]

Plus, aren't vasectomies reversible and sterilization isn't? So it's not a direct comparison.
posted by Brandon Blatcher at 7:46 AM on January 28, 2015

everyone I know who sought this procedure in their 20s

You don't know me.

Try this shit in TEXAS. It was unpleasant and insulting and instead I got a prescription for what I affectionately call MURDER EVERYONE pills - it sounds funny, but MURDER EVERYONE is an unacceptable side effect.
posted by louche mustachio at 7:49 AM on January 28, 2015 [17 favorites]

It is a shame that medical science has not found a way to implant dials on human gonads, where setting it at 5 is "I'll take my chances," 1 is "SEAL OFF ALL DOORS, NO ONE GETS OUT" and 10 is "I am secretly Leslee Unruh."
posted by delfin at 7:49 AM on January 28, 2015 [3 favorites]

My vasectomy was done by a doctor in his office, as he's not allowed to do the operation in his working hospital, as it's all Catholic and stuff.
posted by parki at 7:49 AM on January 28, 2015 [2 favorites]

Oh, hello, FPP OF MY LIFE. I've been requesting sterilization every year since I was 18, am now 32, and am also not any closer to actually getting it. When I was partnered in a long-term relationship with someone who is also childfree, the doctors told me we were too young and that we might change our minds; in the years since I've been single, their paternalism has morphed into a concern that I might eventually wind up with someone who feels entitled to use my body as a temporary storage space for their spawn.

For real, I've had this conversation with grown-ass adult health care workers MULTIPLE TIMES:
HCW: "What will you do if your next partner wants to have children?"
dbr: "Well, that won't happen, because I purposely don't ever date men who want to have children." [Taylor Swift voice] "Like, ever."
HCW: [long pause] "But what if you do?"

So for my 33rd birthday, I am going to get a sterilization. I just am, I don't care if I have to rummage around in my abdomen with a pair of rusty scissors by my damn self. My therapist said she would write me a note of recommendation affirming that I've been steadfast about my desire to never have children for my entire life, in hopes that her professional heft will lend credibility to my wishy-washy dumb woman desire. I got knocked up in my early 20s (after several years of requesting a sterilization at every annual gyn visit, natch) and the handful of weeks before I terminated caused such a body horror in me that I can't imagine ever going through it again. Gross. Wrong. Awful. Do not want. Cannot have.

I don't want an IUD, I don't want the implant or a diaphragm or to go back on the pill, I need to be permanently incapable of pregnancy, and the depth of that need hasn't wavered at all since I was old enough to know that I even had the ability to get pregnant in the first place. The day all of that nonsense just goes away forever with a few swipes of a surgeon's scalpel will be the happiest day of my life.
posted by divined by radio at 7:49 AM on January 28, 2015 [106 favorites]

Brandon Blatcher: about 30% success rate after 10 years, and some risk of complications.
posted by idiopath at 7:50 AM on January 28, 2015

Many years ago I was turned down for a vasectomy by Planned Parenthood because I was under 30. I never went back there. When I was 40 I had it done through my med plan.
posted by BlueScreen at 7:57 AM on January 28, 2015

Get the refusal in writing, get pregnant, sue, and request the courts force the doctor to pay for it's upbringing. Repeat that a few times, and I'm pretty sure the medical establishment will change its tune.

Your suggestion is to bring an unloved child into this world just to prove some stupid point? I think they should have you sterilized for that idea!
posted by sour cream at 7:58 AM on January 28, 2015 [14 favorites]

Anecdata, but everyone I know who sought this procedure in their 20s now has kids or are trying to have kids in their 30s.

I sought this procedure all throughout my 20s and was denied over and over. I am in my 30s. I do not have kids. I am not trying to have kids. I will not ever be trying to have kids. I am partnered with someone who has the same (lack of) desire for children as I do. Which is one of the reasons were are successfully partnered.

There. You may adjust your anecdata accordingly.
posted by slipthought at 7:59 AM on January 28, 2015 [19 favorites]

This is actually a very effective tactic in any negotiation.

Perhaps my reproductive health should not be a process similar to buying a new car?
posted by almostmanda at 7:59 AM on January 28, 2015 [42 favorites]

This is *absolutely* sexist bullshit. If it were actually about liability, it would be possible to put together a mandatory waiting period and/or a waiver for it. Part of being an adult is that we are old enough to make mistakes and have regrets, including, "Damn, I wish I'd had kids ten years ago." There are plenty of legal mechanisms to place the liability for our potentially disastrous actions squarely on us.

We shield *children* from that kind of crap. This is about treating women like children, full stop.

Anecdata, but everyone I know who sought this procedure in their 20s now has kids or are trying to have kids in their 30s.

Then make yourself useful: find out which doctors did those procedures, and maybe hook some folks here up.
posted by mordax at 8:01 AM on January 28, 2015 [19 favorites]

The years it took me to find someone to finally give me an IUD (pro tip: go to your local reproductive health clinic and the paternalism gets dialed down 99% and it's amazing) have left me with such a backlog of fury at medical professionals that I'm apparently still working through it several years later. I had intended to just keep doing IUDs until it's no longer an issue, but I was a bit taken aback recently when a friend of mine had her sterilization procedure. (In her late 30s, after years of fighting to get it.) I was surprised by how envious I felt and how strongly I longed to be in her position. Apparently the vast peace of mind my IUD provides me is overlaying some continued anxiety about the small-but-real chance of failure.

So I have a few years left on the Mirena but I'm thinking very hard about trying for the for-real-100%-no-takebacks-sterilization when it's done, at which time I'll be around 37. The thought fills me with such a deep sense of relief and rightness. I will throw a damn No Babies For Me, Ever! party.
posted by Stacey at 8:01 AM on January 28, 2015 [18 favorites]

I will throw a damn No Babies For Me, Ever! party.

I have been wanting to do this forever. But I feel like nobody will come, which is deeply unfair considering the 2,374 baby showers I've attended before the age of 33.
posted by We put our faith in Blast Hardcheese at 8:06 AM on January 28, 2015 [36 favorites]

I will happily attend any and all No Babies for Me, Ever! parties and bring dessert.
posted by Kitteh at 8:07 AM on January 28, 2015 [37 favorites]

I will throw a damn No Babies For Me, Ever! party.

That sounds awesome, and should be A Thing.
posted by mordax at 8:08 AM on January 28, 2015 [30 favorites]

Doctor hacks: If your doctor has vague, bullshitty objections to giving you an IUD, start talking about wanting sterilization. Suddenly the Mirena is A MUCH BETTER OPTION FOR SOMEONE LIKE YOU.

I asked my gyno about getting an IUD or sterilization when I was 24 and had had a pregnancy scare; he told me both those options were "far too permanent for someone as young as you are." I said, "I'm pro-choice and if I ever have a birth control failure, I'm getting an abortion. End of story."

I'd never seen the blood drain out of someone's face in person before! It was kind of neat!

TL;DR: I love my Paragard.
posted by none of these will bring disaster at 8:09 AM on January 28, 2015 [62 favorites]

When I was lying on the operating table for my vasectomy, prepped and ready to go, I asked the doctor if he'd ever had anyone bail at that point. He laughed and said no, but everyone asks that.
posted by The Card Cheat at 8:09 AM on January 28, 2015 [5 favorites]

I would totally go to a No Babies party. I'll bring the scotch.
posted by idiopath at 8:09 AM on January 28, 2015 [17 favorites]

New rule: No Babies for Me, Ever! parties get posted on IRL and all nearby MeFites must attend. I'll bring the brownies for any such party held in Pittsburgh. Everyone plan to come to mine in the general vicinity of spring 2017.
posted by Stacey at 8:10 AM on January 28, 2015 [55 favorites]

I will attend any and all "No Babies for Me, Ever!" parties within a 20 mile radius of Seattle.
posted by dotgirl at 8:12 AM on January 28, 2015 [11 favorites]

Then make yourself useful: find out which doctors did those procedures

... and it's weird to be quoting myself, but I just realized those friends didn't actually get the procedures. My bad. Some of us are genuinely that excited about the prospect of never having children though. Grr.

Carry on making No Babies Ever party plans. I'd love to attend one.
posted by mordax at 8:14 AM on January 28, 2015 [3 favorites]

Adjust your anecdata: I was sterilized at 23 and am 37 now, happily childless. My former wife also got sterilized a few years back. Neither of us ever wanted kids, and the Canadian medical system thankfully sterilized us both with only a very minor amount of "you're sure?" pestering.

Also it was never posed as a couple's decision. It was treated as an individual choice about our own bodies.
posted by ead at 8:14 AM on January 28, 2015 [12 favorites]

HELL YES. I will come to any NBFME! parties that are thrown anywhere from Minneapolis to Chicago, and happily send baskets of booze and treats in my stead to any that are held elsewhere. Mine will be this summer, mark your calendars!
posted by divined by radio at 8:14 AM on January 28, 2015 [13 favorites]

Best friend has been a vocal anti-population growth advocate since her teens. Best friend got cancer and had a sizeable quantity of her leg cut out. Best friend discovered she (and her died-young father) may have a whole new kind of cancer syndrome that means she might as well schedule GET CANCER at regular intervals on her calendar. Genetic counselor advises hysterectomy by age 35.

Fast forward a year, to massive abdominal pain and bloating. "Oh, we'll just keep an eye on it" says [our] (VERY MUCH FORMER) gyno, who also misdiagnosed our friend's massive cervical cancer. Bullshit is called, new doctor (head of department at world-renowned hospital) found. Scans show enormous, fast-growing lump of tissue. They can't tell if it's cancerous, so need to operate. She asks if they can do the hysterectomy at the same time, since it appears the TISSUE WAD™ might be attached to her bladder or uterus or both.

*crickets*

*more crickets*

"Oh NO, YOU don't want THAT. What if you want kids someday?"

"I have never wanted children and my husband got a vasectomy when my cancer made it impossible to stay on hormonal birth control."

"But what if you change your mind?"

NOT EVEN KIDDING. Fortunately BFF is a force of nature, told them to get bent, and got the operation (tissue thankfully wasn't cancerous). That she had to endure all that while fearing for her fucking life AGAIN is so beyond the pale, I can't even stand it.
posted by bitter-girl.com at 8:22 AM on January 28, 2015 [37 favorites]

Anecdata, but everyone I know who sought this procedure in their 20s now has kids or are trying to have kids in their 30s.

Some people will change their mind and regret the decision, but that's true of every single decision we make in life. I regret pursuing a degree in theater. There was no doctor to refuse to let me enter the program, and I would have been outraged if there was.
posted by maxsparber at 8:23 AM on January 28, 2015 [52 favorites]

it is fucking infuriating to be told "Oh, you'll change your mind," "what if your future husband wants children?", "you're too young to know that you don't want kids."

I did.

I went to my first serious long term birth control appointment, and they asked me to take a pregnancy test because it could fuck up any kids you were going to have. I said it didn't matter, I didn't want to have kids, I was fine, I would never bring it to term.

Now, in my thirties, I kind of shudder to think how wrong I was. I turned out to be pregnant, and kept it, until it turned into a best-beloved daughter, who I would not trade for anything, ever. And I want more. And if you told me, now, that my dumb early-twenties self had ruined it for me, I'd be furious and hate myself.

You can't know what you don't know. Maybe you won't change your mind. Maybe it is paternalistic. But don't pretend that these kind of mindchanging things, or things that occur with age, don't happen at all, to anyone. It's a big decision, to completely kill your reproductive faculties, and it is reasonable to demand a lot of counseling first - particularly when the same effect can be accomplished without permanent procedures.
posted by corb at 8:30 AM on January 28, 2015 [15 favorites]

At least one of my male friends got a vasectomy with no interrogation at all, whatsoever.

No questions asked, I found out all about it when he sent me an email with the subject "OW, MY BALLS!"

Apparently he also loudly announced on the table "MMMM SMELLS LIKE BARBECUE!"

Also, he had purple dreadlocks with gears and wingnuts in them. Sounds like they couldn't sterilize him fast enough.
posted by louche mustachio at 8:31 AM on January 28, 2015 [18 favorites]

But don't pretend that these kind of mindchanging things, or things that occur with age, don't happen at all, to anyone.

Number of posts in this thread in which someone pretended that these kind of mindchanging things don't happen at all to anyone: zero.

It's a big decision, to completely kill your reproductive faculties, and it is reasonable to demand a lot of counseling first

Number of women in this thread complaining that they had to get counseling before they were sterilized in their 20s, as opposed to complaining that they were simply not permitted to be sterilized: also zero.
posted by ROU_Xenophobe at 8:35 AM on January 28, 2015 [90 favorites]

You can't know what you don't know.

You also can't know how much thought someone else has already put into their decision before making a statement in this thread.

But don't pretend that these kind of mindchanging things, or things that occur with age, don't happen at all, to anyone.

Okay, let's make a deal - we won't start pretending that so long as YOU don't assume that people are just talking out of their ass about their own experience.

Deal?
posted by EmpressCallipygos at 8:46 AM on January 28, 2015 [24 favorites]

And if you told me, now, that my dumb early-twenties self had ruined it for me, I'd be furious and hate myself.

Now you wouldn't, because your child wouldn't exist, you wouldn't have known her so you wouldn't miss her and shrug and go on with whatever life you were living before the crazy person from Earth-corb-1 came around.
posted by MartinWisse at 8:47 AM on January 28, 2015 [37 favorites]

Is it too much to just simply have a law saying "aw shit Doctor, unfortunately you failed at your fucking job, so you can no longer be a Doctor. Hope you paid off your medical school debt because you no longer have a license to practice anywhere in your country."

I have a feeling if I ever had this discussion with a doctor ("oh, sorry, we won't let you control your reproductive organs") it would end with me being dragged away by police because I was causing a disturbance and scaring the shit out of everyone.

(I'm fucking pissed as shit just reading this thread).
posted by el io at 8:48 AM on January 28, 2015 [9 favorites]

It's a big decision to accidentally have a kid, then die of cancer before the kid turns 5, leaving your husband who's a dozen years older than you to raise said kid neither one of you intended to have, too, corb. A kid who's probably going to inherit your cancer jamboree. If THAT person can't get sterilized without a fuss, what chances do the rest of us have? It's like the pro-life protesters who don't care what happens once a baby is born so long as it's born. None of these doctors are on the hook for their actions, but the women are.

No one asks "what if your next husband doesn't want kids?" to a married woman at a pregnancy checkup. Everyone presumes on behalf of the women asking to be sterilized that nonexistent future partners have a say (which is kinda disrespectful to the current partner, no? "If you die, or leave, the next person she shacks up with might think differently so we gotta be prepared!")
posted by bitter-girl.com at 8:50 AM on January 28, 2015 [43 favorites]

I really believe that with some amount of counseling and heavy-duty liability waivers, people absolutely should be able to get sterilized if they want to -- but I do wonder if that also implies that people should be able to get a limb or other body part removed if they want to as well? Or be medically blinded or deafened? People do occasionally seek doctors to do such things. But I find I believe that doctors probably shouldn't agree (and they mostly don't.) And yet I find myself unable to articulate any relevant moral difference between that scenario and the "please sterillize me," scenario, except that many more people value their sight (say) than their baby-making ability. But if someone doesn't value their sight, and wants to get rid of it..?

I also agree that it's probably a lot sexism but also at least a little bit "has seen a lot of patients hoping for reversals" that makes doctors say these things.
posted by OnceUponATime at 8:51 AM on January 28, 2015 [1 favorite]

It's a big decision, to completely kill your reproductive faculties

It's a bigger decision to have a child. A big huge enormous irreversible life-changing decision that can go wrong at any turn, in any number of ways. If any reproductive decisions require counseling, it should be the decision in favor of having children. If you choose sterilization, the worst that can happen is that you later change your mind and regret what might have been, but your life otherwise stays the same, and the only person affected is you. It is entirely possible to have a child and regret it, and it happens more often than people care to admit. It's a much worse position to be in, in every possible way.
posted by Metroid Baby at 8:51 AM on January 28, 2015 [89 favorites]

It's not about me perhaps one day changing my mind.

We all make decisions in our lives that we can't reverse. We can't go back from certain decisions. Most of us behave like adults, accept that we made a wrong choice, and move on with our lives. This is about respect. Respect me to make my own decisions.

I have a friend who has horrible crippling Endometriosis. She can't hold a job because she can't stand or sit for long. She spends the great majority of her time in bed. She's on disability. There isn't a point in her life where she is pain free enough to even go out on dates - let alone have sex. She has requested a hysterectomy many many times. No one will give her one, for the same bullshit excuses. I never thought anything was more fucked up then being denied a hysterectomy for a uterus that is making her life unlivable. They took my gallbladder out because it caused me pain, it should be the same for her.
posted by royalsong at 8:51 AM on January 28, 2015 [63 favorites]

Before I got pregnant with my first child, I was adamant that I didn't want kids. Never going to happen, nuh-uh, not me. But it did, and I liked him and I had another and I like her, too (okay, they're the Most Amazing People Ever, to be fair).

BUT.

If I had requested a sterilization and had been treated with the shit you people have been met with? Livid wouldn't even come close to touching my feelings. So the fuck what if I had regretted it later? That would be MY problem, not the medical community's. This paternalistic bullshit enrages me, and so does every anecdote of "Welllllll, I didn't want kids and then I did so everyone must be the same as me!!"

Yes, I changed my mind. No, that does not mean that you will. To be fair, I've always been pretty mercurial. Would I miss being a parent if I had never been one? How the hell could I know that?! I'm pretty sure I would have gone on with my life, getting career advancements, traveling, having a blast with my nieces and nephews; in short, not missing what I didn't have in the first place. Do I love my children? Yes. More than my own life. That does not mean, in any way whatsoever, that adults shouldn't be able to make their own reproductive choices, regardless of how permanent those choices are.
posted by cooker girl at 8:52 AM on January 28, 2015 [37 favorites]

And yet I find myself unable to articulate any relevant moral difference

What you're missing is that being pregnant isn't a natural, happy, risk free condition, but is actually fscking scary dangerous and in other situations where a simple medical procedure could drastically decrease the health risks a person is subjected to, we have no problems proscribing it.
posted by MartinWisse at 8:54 AM on January 28, 2015 [16 favorites]

And to return to my initial point - if people do get sterilized, but then change their mind, adoption is still a thing.
posted by EmpressCallipygos at 8:55 AM on January 28, 2015 [13 favorites]

He'll, I have a kid and the endless "rah-rah-reproduce" I hear from my kid-having friends drives me freaking nuts. Kids are hard enough without having to listen to people I know are thigh-high in diapers tell me how happy they are. The 50s are over guys, we're allowed to be honest about what a thankless slog this usually is.

I am furious about this too. No doctor has ever interrogated me about anything like this except one, who tried to discourage me from getting an STD test because he said, "What would you do if it's positive? Stop having sex?" I fired him right there and then.
posted by 1adam12 at 8:55 AM on January 28, 2015 [11 favorites]

Not to mention it's somewhat insulting to compare a sterilisation to being made blind or have a limb chopped up because these are actually very different things it turns out. If your morality system can't comprehend that, time to look out for a new one.
posted by MartinWisse at 8:56 AM on January 28, 2015 [22 favorites]

And yet I find myself unable to articulate any relevant moral difference between that scenario and the "please sterillize me," scenario, except that many more people value their sight (say) than their baby-making ability.

It's a lot easier to adopt a child than to recreate a functioning arm or set of eyes.
posted by almostmanda at 8:57 AM on January 28, 2015 [6 favorites]

My bum ovaries are the only medical problem I've been grateful for, because they kept me out of this situation for a long time. Of course, when they finally went cancerous, I wanted to try just an oophorectomy to keep the surgery as minimal as possible, but the surgeon said - without performing any tests to see how far it had spread, mind you - "I'm going to do a radical hysterectomy/oophorectomy, and you should be thanking me for it. No woman over twenty-five really needs a uterus anyway, and I won't charge as much as your doctor back in New York." So if any of you MeFitesses are looking for a pro-sterilization OB/GYN, I can recommend a guy in Bluefield, West Virginia.
posted by The Underpants Monster at 8:58 AM on January 28, 2015 [14 favorites]

> I really believe that with some amount of counseling and heavy-duty liability waivers, people absolutely should be able to get sterilized if they want to -- but I do wonder if that also implies that people should be able to get a limb or other body part removed if they want to as well?

Please let's not walk down any slippery slopes.
posted by Monochrome at 9:00 AM on January 28, 2015 [2 favorites]

Also, Mom says that way back in the Dark Ages, her doctor talked her out of a tubal ligation after three pregnancies (even though he specifically told her she shouldn't get pregnant again for health reasons), but was happy to recommend a doctor to do Dad's vasectomy.
posted by The Underpants Monster at 9:01 AM on January 28, 2015 [4 favorites]

Sign me up for the Pittsburgh NBFME! party for Stacey (and anyone else that wants one). Childless by choice at age 55, no regrets.
posted by miaou at 9:01 AM on January 28, 2015 [5 favorites]

Perhaps my reproductive health should not be a process similar to buying a new car?

That's kind of my point.
posted by indubitable at 9:03 AM on January 28, 2015 [1 favorite]

Stipulated that pregnancy can be dangerous -- but that argument doesn't apply to men. Why should men be allowed to sterilize themselves but not to remove any other bodily capability?

If you don't like the comparison to missing limbs or senses, then perhaps some less dramatic kind of elective surgery -- should we allow elective appendectomies (I suppose so?) or single kidney removals (I'm less comfortable with that...)

Again, I agree with the conclusion. People should be allowed to be sterilized if they want to be.

It's just that I'm not comfortable with the contradictions between believing that and not being okay with these other things. I'm genuinely asking for help resolving those contradictions, not arguing that telling people they can't get sterilized is okay.
posted by OnceUponATime at 9:04 AM on January 28, 2015 [1 favorite]

My spouse is naturally infertile. Barring an act of god, we will never bring a baby into this world via regular sexual intercourse. But I, as an independent adult and grown woman, still want to be sterilized. I've asked various OB/GYNs (at least six individual male and female doctors, by my count) over the last decade and they consistently side-eye and deny my request. I see the gears working in their heads: "You're a healthy woman. Why would you want to be sterilized if your husband is infertile? Are you lying about his condition? Is your marriage not stable? Are you cheating on him? You're too young to understand the future."

Honestly, I just don't ever want to have to worry about my fertility again. I could still become pregnant. There's rape; there are acts of god. There are dark possibilities that I don't like to consider, such as the death of my spouse while I'm still fertile. One would be silly to think that I haven't considered this from every possible angle. I really want to settle things once and for all; I want my fertility to be a non-issue for the rest of my life. From childhood, I've known that I have never want to be a parent. My not wanting to produce my own children appears to be one of a very few fixed points in my personality, and if that hasn't changed for over half of my fertile years, I can't see it changing in the time I have left. Even if it would change, I'd no doubt adopt. I've made no plans for kids, have not treated my body in a way that encourages a healthy pregnancy, have not financially planned in the long term for raising a family, have made no career moves with the intention of becoming a parent and those close to me know all that it's not in the cards. Bearing all this in mind, and even with an infertile husband, my own fertility is still a specter that hangs over my life.

It is solely the fault of sexist policy and entrenched cultural attitudes toward fertile women that prevents me from consensual sterilization. Women are able to choose to cut up their bodies every day, in far more invasive manners, to feel more comfortable or desirable under the male gaze. But this body cutting is totally for me, and that's why nobody will do it.
posted by theraflu at 9:05 AM on January 28, 2015 [27 favorites]

Let's assume for a moment that we buy the case where an extreme amount of prying into someone's personal motivations, beyond the basic informed-consent stuff that should always be done for a medical procedure, is appropriate here.

Even in that case, I feel like the discussion should have stopped at the point in time at which I have said "I have a serious, albeit intermittent, mental health condition. My partner has a more serious, deeply life-affecting mental health condition. Individually or together we would not be good parents, and frankly, the simple fact of being pregnant would very likely badly exacerbate my mental health problems and if I could not procure an abortion I might jump off a bridge rather than carry a child to term." That? That is not enough to convince someone that I might not just wake up one morning and decide that I should have babies and that would be a good life choice that I should be encouraged to make.

I have no problem with the notion that counselling is appropriate to the extent any surgical procedure should be well understood by the person undergoing it. My problem is that my experience with doctors has thoroughly convinced me that here is no answer anyone could ever give where the end result of that counselling is "okay, you've thought this through, let's schedule you." It's a rigged game. No matter how high you jump through the hoops, there will be more hoops.
posted by Stacey at 9:05 AM on January 28, 2015 [13 favorites]

I have an ex who never wanted kids, and when horrible, reproductive-capability-disrupting fibroids made a hysterectomy look like a possibility, she still had to go through two or three doctors before she found one who agreed - at 28 she was too young, the others said. In spite of the fibroids, in spite of the scar tissue the docs acknowledged would make pregnancy extremely difficult if just the fibroids were excised.

She changed her mind about kids a few years later, and she and her husband adopted, and they all seem very happy.
posted by rtha at 9:08 AM on January 28, 2015 [5 favorites]

Sterilization is more like getting a supernumerary limb removed. Imagine having a third arm that you don't really use and that gets in the way whenever you put a shirt on, and every surgeon you consult refuses to amputate it because one day you might need to open a tricky pickle jar. Don't be ridiculous, everyone loves pickles! Oh, it's different when those pickles are your own.
posted by Metroid Baby at 9:09 AM on January 28, 2015 [57 favorites]

I tried to get a partial hysterectomy a several years ago.

My child bearing years were behind me according to the social data presented in this thread. I apparently have an acceptable number of children to not be turned down on that score.

My (new to me) gyn was not in favor of the notion. At the time, I was probably sterile due to in-office uterine ablation** by a previous OB/GYN, but still suffered from regular cycles and significant attendant pain and migraines.

I mentioned the pain and the migraines and the desire for complete surety of sterilization either by conventional laproscopic methods and or a partial hysterectomy (keep the ovaries), and he told me I should have my spouse get a vasectomy instead. Just shut down the discussion.

I wasn't really expecting a no (he even told me to bring my spouse to the next appointment and he'd tell my spouse he should get a vasectomy "for me") but I wasn't expecting quite that reception (he'd come highly recommended by a colleague in the healthcare industry in the then-new niche of "boutique medical care").

Eventually the doc simply wrote out a prescription for a procedure to verify my sterility (OUCH) and said we could discuss it again after the results came in.

I'm sterile (yay), though I'm not free of the [expletives deleted] cyclical migraines. My PCP recently suggested I have that partial hysto next time they need to go in the main body cavity for any reason and I'm totally on board. Now to convince the insurance company to pay for it ....

** several female friends reported having ablation after their GYNs had been given proof their husbands had had vasectomies. As a condition, per the doc, of getting ablation.
posted by Buttons Bellbottom at 9:18 AM on January 28, 2015 [3 favorites]

Wow I'm surprised at just how angry this makes me.

I'm over 40 with no kids. I was always an if my life works out that kids make some sense fine, if not no biggie. Never firmly for or firmly against having them. I'm perfectly fine with not having them and most days glad I don't. Sure I sometimes wonder 'what if I had had...." but it's always coupled with 'well this wouldn't have happened or this or that type thinking'. I would have been a great mother. I'm just as great not being a mother.

Holy %^&^% though. If when I was younger and my whole kid thing was less apathetic I would be right royally pissed to be treated like that. Hearing about this crap just sort of triggers every sort of paternalistic and patriarchal crap that I've dealt with over my life. Somehow encapsulates so much.

Screw you. I'm allowed to decide what I want when it comes to reproducing. I'm allowed to decide something and regret it later on. I've made tons of less then stellar decisions in my life. I've made not so stellar decisions that have led to a permanent change and found myself regretting them. I'm an adult. I suck that sort of thing up. Personal responsibility yadda yadda.

Gah. sorry. this has made me all ranty
posted by Jalliah at 9:18 AM on January 28, 2015 [6 favorites]

I second the Canadian and/or male experience, although maybe I was just lucky that my doctor was a no-bullshit type. We had one child, that was enough for me, but we waited three years just to be sure. I was sure, my doctor could see that, and I got the referral right away. That was 22 years ago.
posted by Mogur at 9:20 AM on January 28, 2015

I'm trying to figure out if this is "you don't know your own mind, you're a woman" or "you don't know your own mind, you're too young". Probably both, tbh.

I've always figured this is part of a much wider effort (including anti-abortion legislation) to tell women that:
a) we have no power and cannot be permitted to make choices for ourselves
b) we are supposed to be constantly getting pregnant and raising kids (read: and staying in the home, and not participating in government and politics, and not working, and always being dependent on men)

i.e. it's about preserving the status quo wherein power resides in the patriarchy. That's why you so rarely find people who are anti-abortion/anti-sterilization but highly pro-sex education, pro-condoms, etc. (Hmm, and why strong maternity leave policies are also not supported by those people. Doesn't anyone else think that's weird?) It's never been about saving the babies, at least not at the level of the people in power.

Something I think would be really awesome is a list of providers who are known to approve and/or perform female sterilization, so that women could easily find someone in their state. Does anyone know of such a thing online anywhere?
posted by capricorn at 9:23 AM on January 28, 2015 [21 favorites]

Also, just realized that in my mind it goes without saying but maybe not obvious - this doesn't even consider queer identities, for instance someone who is assigned female at birth but doesn't identify as a woman and wants to be sterilized so that they can stop having intense body dysphoria, or a lesbian couple where one partner is interested in having kids and one is not.

This is because queer identities inherently erode the patriarchal power dynamic between man and woman, since you create the opportunity for families without that dynamic. Same reason that being strongly against same-sex marriage is part of the same right-wing socially-conservative package. Not about saving the babies, not about family values.
posted by capricorn at 9:29 AM on January 28, 2015 [12 favorites]

Ablation FYI.

That bit about the third arm is interesting. But it still lacks something for me.

Maybe it's like in that episode of Firefly? Out of Gas. Kaylee removes the reg couple because it just gets in the way. People come with reproductive organs, a lot of the time it works fine, but sometimes it just gets gunked up and in the way and don't really need it.
posted by Buttons Bellbottom at 9:29 AM on January 28, 2015 [2 favorites]

Oh, it's different when those pickles are your own.

You say you don't like pickles now, but everyone's tastes change over time. What if you end up wanting pickles ten years from now? I can't imagine what my life would've been like over the last ten years if I hadn't been able to open pickle jars — and surely my inability to reason about pickle counterfactuals is good grounds for an argument about everyone else's potential future pickle-influencing decisions.
posted by RogerB at 9:32 AM on January 28, 2015 [11 favorites]

corb: You can't know what you don't know.

I'm sorry you were wrong about something when you were younger. The error, however, was entirely yours and says nothing about anyone else. It is not "reasonable to demand" anything of anyone else just because you somehow failed to know yourself during your adulthood.
posted by spaltavian at 9:32 AM on January 28, 2015 [17 favorites]

OnceUponATime: I also agree that it's probably a lot sexism but also at least a little bit "has seen a lot of patients hoping for reversals" that makes doctors say these things.

Then they are too stupid to be doctors, as only 1.1% of women request the procedure.
posted by spaltavian at 9:36 AM on January 28, 2015 [7 favorites]

If the paternalistic 'what if you change your mind' tut-tutting was actually based in concern over irrevocable decisions, it would apply both to men and women because there is no guarantee that any given vasectomy can be reversed, and in fact the reversal failure rate is substantial.

The success metric used for vasectomy reversal is evidently the percentage that result in pregnancy. By this metric, 24-70% of the time, depending on how long it's been since the original procedure, vasectomy reversal fails.

Yet the amount of grief men have to go through in order to secure surgical sterilization pales next to the doctor's veto women get. This has nothing to do with trying to protect someone's future self from the bad decisions of their past self, and everything to do with how culture sees women not as people with the right to make decisions about their own bodies, but as objects that need to be kept always available for baby-making.
posted by amery at 9:37 AM on January 28, 2015 [4 favorites]

I can't even imagine the hue and cry if we decided as a society that people were going to be required to undergo counseling and repetitive questioning of their decision-making abilities if/when they wanted to have a baby as opposed to if/when they (we!) wanted to be sterilized.

Metroid Baby said it best: Having a child is an infinitely bigger deal than not having a child, up to and including any steps you might take to permanently ensure you will never have to have one. If you get sterilized but regret it, you can always adopt, but once you give birth, no matter how much you might regret the decision to have a child, guess what? You're always going to have a kid! They're still going to be your responsibility for the next couple decades, give or take, even if you flat-out hate them. My mother's regret over having me manifested in her spending years and years trying to convince me to kill myself, and when that didn't work, she started taking me to court and trying to have me put in a foster home for no other reason than because she absolutely loathed me. The matriarchs of my family have all hated kids, but I'm the very first one of us to decide that a deep and abiding discomfort around children means I SHOULD NEVER HAVE ONE, not that I should have one and then try to convince myself to love it because having babies is Just What Women Do.

Since it's considered rather gauche to ask someone why they decided to have a child, why do people always feel so entitled to ask me why I've decided not to? Having a baby will undoubtedly affect your life, your work, your family, and your community, and if they're born in a position of power, they can even go on to affect the entire world. But not having a child will affect literally no one on the planet except me, so why on god's earth do I need to defend my decision so tirelessly? I would be a terrible mother. I know this, I've always known this. Why the hell do doctors want me, a person who doesn't want children and admits that she would be a terrible mother, to stay perpetually open to the idea of having children anyway? Why would anyone want that?!

I have no problem with the notion that counselling is appropriate to the extent any surgical procedure should be well understood by the person undergoing it. My problem is that my experience with doctors has thoroughly convinced me that here is no answer anyone could ever give where the end result of that counselling is "okay, you've thought this through, let's schedule you." It's a rigged game. No matter how high you jump through the hoops, there will be more hoops.

YES. It reminds me way too much of the anti-choice activists who have decided that a good way to convince women to carry unwanted pregnancies to term is to force them to view pre-abortion ultrasounds and, if they don't care to look, listen to tedious explanations of the appearance of the ultrasound instead. The end goal of this sort of counseling isn't to get you to understand the ramifications of your decision, it's to convince you that you're wrong, that you don't know your own mind after all. There is no purpose to this sort of counseling except to encourage you to come to the conclusion that of course you don't want to be sterilized.

Oh, and all the single dudes who don't want kids: Are you out there? Because you're kinda tough to find, so I'm really hoping to see you at one of these NBFME! parties. [makes awkward, feeble 'call me' gesture]
posted by divined by radio at 9:40 AM on January 28, 2015 [52 favorites]

Of course people change their minds. I picked a stupid useless college major. That is not a good justification to force all undergraduates to get a degree in one thing, or make people wait until they are 50 to go to college.

Additionally, my stupid degree didn't actually stop me from making a career (in the thing I should have studied, no less) or having a life or generally forging a path for myself in the world. Everyone lives with reduced options all the time - I cannot live in London and Los Angeles at the same time, I cannot be a nurse because I didn't get a nursing degree, I don't have the experience of parenting because I chose not to have children.

Law schools get applicants who want a "reversal" of their art degrees all the time, and that doesn't mean we shouldn't have art degrees or that art degrees are inherently regrettable.

People who point to their own children as the reason everyone should be forced to have children are unwilling to concede the possibility that, if they had not had children (or not those specific ones) they might be ten times happier or safer or healthier or more productive to society today. But they can't know what they can't know.
posted by Lyn Never at 9:42 AM on January 28, 2015 [15 favorites]

Maybe the right wing would be more accommodating if it were rephrased more evilly. "She doesn't want to bear children? Obviously she's mad, and must never be allowed to reproduce for the good of society! She must be forcibly sterilized at once!"

Sadly, the way things are going right now, I think the response may soon be "She should be FORCIBLY INSEMINATED! THAT'LL TEACH HER NOT TO WANT KIDS!"
posted by TheWhiteSkull at 9:43 AM on January 28, 2015 [7 favorites]

This argument seems to be missing a key point: elective sterilization surgeries are way more complicated on women than vasectomies are on men. It's not surprising to me that Ob Gyns are reluctant to perform a surgery when there are so many effective non-surgical options.

Consider IUDs, which are now considered perfectly safe in all women, whether or not they've had children. IUDs are safer, present few side effects, and don't require surgery. And for those 14.3% of women who want a reversal (as mentioned above), they can be removed.

Oh, and IUDs are now considered the best birth control for teens.
posted by fremen at 9:46 AM on January 28, 2015 [5 favorites]

I've never understood what is "selfish" about not having kids. Is it that we're depriving people of the right to be born? But they will never exist, so they will never know what they're missing. Kind of hard to wrap my head around the twisted logic there.
posted by Beethoven's Sith at 9:52 AM on January 28, 2015 [8 favorites]

The insertion procedure for Essure is pretty similar to that of an IUD.

I will evangelize for IUDs any day of the week. I love my Mirena. That doesn't mean I know what's best for anyone else.
posted by almostmanda at 9:52 AM on January 28, 2015 [6 favorites]

fremen, that's a good point, but people get elective surgery all the time - and sometimes manipulated into reproductive-related surgeries they do not want and may not strictly require - and surgeons cash those checks just fine.

Ultimately, the one thing that gives a woman the maximum amount of control is sterilization. We must allow women the final say. An abusive partner can force or manipulate a woman to have an IUD removed - and I sure don't hear about all the GYN's asking half a dozen times if a woman's suuuuuure she wants it removed - in order to control her fertility.
posted by Lyn Never at 9:53 AM on January 28, 2015 [4 favorites]

fremen, that's not what the posters above are reporting. They are reporting that they were told they would change their minds. If any were warned about complications, or offered the alternative of sterilizing their husbands/partners instead, I missed it.
posted by Mogur at 9:54 AM on January 28, 2015 [1 favorite]

This argument seems to be missing a key point: elective sterilization surgeries are way more complicated on women than vasectomies are on men.

I'm not sure what you're on, there. Mine took 30 minutes in my GYN's office and they didn't give me anything stronger than a Valium. I had to have a followup nuclear xray three months later. Easy peasy.

It's worth noting that my doctor did it the second time I asked about it. The first time, I was 34 and got 'you'll change your mind'. The second time, I was 35, and the same doctor said 'let me call your insurance to check on the coverage'.
posted by joycehealy at 9:54 AM on January 28, 2015 [4 favorites]

I've never understood what is "selfish" about not having kids. Is it that we're depriving people of the right to be born?

I think it's not so much that it's selfish not to have kids - it's that for some people, the reasons they give for not wanting to have kids sound selfish or self-centered. People who are concerned they won't be good enough parents, or they have severe medical conditions? No one accuses those people of being selfish. People who say "I just don't want my body to change and get heavier/stretchmarks, and I want to spend all my money on me rather than something else that might not be as fun!" do kind of come off as a bit selfish.
posted by corb at 9:56 AM on January 28, 2015

Fremen, let me copy & paste for you:

The 14-year cumulative probability of requesting information about a reversal is 14.3 percent (40.4 percent among women 18-24 at the time of sterilization), but only 1.1 percent of women will actually request the procedure.
posted by Dashy at 9:57 AM on January 28, 2015 [1 favorite]

People who say "I just don't want my body to change and get heavier/stretchmarks, and I want to spend all my money on me rather than something else that might not be as fun!" do kind of come off as a bit selfish.

OK, so why is that any more selfish? Because it's a woman's duty to have children? Is there another reason you could articulate?
posted by TheWhiteSkull at 9:58 AM on January 28, 2015 [44 favorites]

joycehealy - Interesting. I was under the impression it was a much more elaborate procedure. It looks like things have changed since the days of tubal ligations. If sterilization is no more complicated or dangerous than IUD insertion, then pick whatever option works best.
posted by fremen at 9:58 AM on January 28, 2015 [3 favorites]

fremen: Consider IUDs, which are now considered perfectly safe in all women, whether or not they've had children

The main piece addressed IUDs; and those "few" side effects are a doozy. In any case, that is not why women are told they can't get sterilized; that's the "key point".

And for those 14.3% of women who want a reversal (as mentioned above)

No; the 14.3% figure is of those who request information about a reversal, only 1.1% request a reversal.
posted by spaltavian at 9:59 AM on January 28, 2015 [2 favorites]

No, I absolutely have been told, by medical professionals and by relatives, that not wanting to have children, because of my medical condition and because I do not feel I would be a good parent, is selfish. That is a thing that happens.
posted by Stacey at 9:59 AM on January 28, 2015 [21 favorites]

It's normal to be selfish with regards to one's own life. In fact, healthy. What's unhealthy (at least for my blood pressure) is applying selfish to the decision not to have kids...its opting out of the number one role for women, and THAT'S what people have a problem with.
posted by agregoli at 10:00 AM on January 28, 2015 [9 favorites]

corb: People who say "I just don't want my body to change and get heavier/stretchmarks, and I want to spend all my money on me rather than something else that might not be as fun!" do kind of come off as a bit selfish.

They don't at all, but do you want to make any guesses about how you come off?
posted by spaltavian at 10:00 AM on January 28, 2015 [28 favorites]

Maybe it happens because I am not apologetic enough? Because I admit I probably wouldn't want a child even if it weren't for these factors? I don't know. And it doesn't matter. Because there is no reason we can't be selfish about our own lives and bodies and wishes and dreams, especially when they are about something this important.
posted by Stacey at 10:01 AM on January 28, 2015 [5 favorites]

People who say "I just don't want my body to change and get heavier/stretchmarks, and I want to spend all my money on me rather than something else that might not be as fun!" do kind of come off as a bit selfish.

Wait...what??

I absolutely get to have a say on what fun I want to have, how I want to spend my money, or anything at all that comes to my body. I'm glad that for you parenting a kid turned out to be the best thing ever, but if I or any number of women want to opt the hell out, you sure got some serious judgypants happening for calling us selfish.
posted by Kitteh at 10:03 AM on January 28, 2015 [44 favorites]

Consider IUDs, which are now considered perfectly safe in all women, whether or not they've had children. IUDs are safer, present few side effects

Perfectly safe in all women? Uh, no.
posted by desuetude at 10:06 AM on January 28, 2015 [25 favorites]

Stacey: Maybe it happens because I am not apologetic enough? Because I admit I probably wouldn't want a child even if it weren't for these factors?

It happens because people believe that it is everyone's, or specifically women's, responsibility to have children.

Look at the things corb labeled as selfish. "I want to spend my money on me". Well, that's only selfish if you owe it to someone to spend money on children. Corb isn't saying it's selfish not to spend money on supporting, say, butter sculptures, because she doesn't think it's your responsibility to do so. But kids? You'll wear those stretchmarks with pride.
posted by spaltavian at 10:06 AM on January 28, 2015 [19 favorites]

I asked my gyno about getting an IUD or sterilization when I was 24 and had had a pregnancy scare; he told me both those options were "far too permanent for someone as young as you are."

This is completely amazing to me, and you're not the only one in the thread saying it. Is there some valid medical reason to be reluctant to give young women IUDs? It's immediately reversible.
posted by gerstle at 10:06 AM on January 28, 2015 [1 favorite]

"I just don't want my body to change and get heavier/stretchmarks, and I want to spend all my money on me rather than something else that might not be as fun!"

Extra data point: I sometimes throw out reasons like that, that might seem comparatively flippant. They're the reasons that get the least pushback from random strangers who are nosing about my uterus. You should keep in mind that not every woman is going to be honest about her real reasons for not wanting children, especially if they're sensitive family/medical/money/etc. matters.
posted by almostmanda at 10:07 AM on January 28, 2015 [6 favorites]

(I mean, I know you know that. I'm saying ..... I don't get it.)
posted by gerstle at 10:07 AM on January 28, 2015

Consider IUDs, which are now considered perfectly safe in all women, whether or not they've had children. IUDs are safer, present few side effects, and don't require surgery.

OK, get ready to have your mind blown: I have considered an IUD, and have still come to the conclusion that what I really need is to be sterilized. I do not want my body to have the ability to become pregnant under any circumstances, which is an assurance an IUD (or any other form of temporary birth control) simply cannot provide. Knowing that my body can become pregnant creates a level of dysphoria in me that is difficult to convey using anything but a wordless howl. This is how strongly I feel about the possibility: I've chosen to be celibate until I can get sterilized. Sounds intense, huh? Well, apparently it's not intense enough to get a doctor to take me seriously when I ask after the only safe, legal, and incredibly common medical procedure that will ease my mind.

Mine took 30 minutes in my GYN's office and they didn't give me anything stronger than a Valium.

Adiana has been discontinued! It seems like they basically got sued out of existence for making a silicone version of Essure. Adiana is absolutely, positively what I want -- I'm allergic to nickel, so Essure has always been a no-go -- but I can't find anywhere that still has Adiana in stock. I'd be totally willing to travel to get it done, so if anyone knows any providers that still offer it, please drop me a MeMail!

People who say "I just don't want my body to change and get heavier/stretchmarks, and I want to spend all my money on me rather than something else that might not be as fun!" do kind of come off as a bit selfish.

I actually haven't met a single woman who has used any reason remotely like this as her inspiration for being childfree, but even if she did, so what? I get that many (most?) parents believe their children allow them to access a kind of love that childfree people will never know or even comprehend, but do you really want a woman who feels this way to have children anyway?

Besides, I always wonder why society seems to hold back on any kind of accusation of selfishness when it comes to the scads of people who use their children as extant fashion accessories, and will readily admit to having kids for no other reason than because they're just so enamored of the idea of creating "a little version of me." If that isn't the dictionary definition of selfish, I don't know what is.

Is there some valid medical reason to be reluctant to give young women IUDs? It's immediately reversible.

Historically, IUDs were contraindicated in nulliparous women.
posted by divined by radio at 10:07 AM on January 28, 2015 [24 favorites]

I mean, it comes down to one very simple test for me: Do I support a woman's right to reproductive choice? If so, she has a right to decide to have an operation that prevents her from having children, ever. She has that right the moment she has the right to make any other informed decision about her reproductive health -- and, for me, that's the moment she is capable of having a child.

Might she regret it later? Sure. That's also her right. She might regret not doing it later. I don't know what she will or won't regret. It shouldn't matter to me. If I support a woman's right to have a child, I support her right not to have a child, and I support her right to make whatever choice regarding that seems the best at the time she makes the decision. Period, end of conversation, etc.

Note that I don't have to agree with her decision. As it happens, I don't have feelings one way or the other, but if I really thought, oh, man, she might regret it, and it's permanent, and she's so young to be making that decision. Doesn't matter. All sorts of people have a right to do all sorts of things I personally disagree with, and their right is far more important than my opinion.
posted by maxsparber at 10:08 AM on January 28, 2015 [29 favorites]

People who say "I just don't want my body to change and get heavier/stretchmarks, and I want to spend all my money on me rather than something else that might not be as fun!"

I, too, would like to apologise for not having chosen to buy a car. I'm sure it's selfish of me given that it's because I'm better off without a car and look good after cycling.
posted by jaduncan at 10:08 AM on January 28, 2015 [18 favorites]

Oh, I didn't know that. Thanks.
posted by gerstle at 10:10 AM on January 28, 2015

People who say "I just don't want my body to change and get heavier/stretchmarks, and I want to spend all my money on me rather than something else that might not be as fun!" do kind of come off as a bit selfish.

I think this is moot, because...I just don't think people actually say that.
posted by kitcat at 10:12 AM on January 28, 2015 [5 favorites]

Extra data point: I sometimes throw out reasons like that, that might seem comparatively flippant. They're the reasons that get the least pushback from random strangers who are nosing about my uterus. You should keep in mind that not every woman is going to be honest about her real reasons for not wanting children, especially if they're sensitive family/medical/money/etc. matters.

That's definitely a real thing. But I think honestly it comes as part of a package deal. If the person you're talking to is compassionate, spends time volunteering or campaigning to make the world better, and then they throw off something like that, I'm not going to assume that's the real reason, I'm going to assume it's a throwaway.

But if the person I'm talking to is kind of the epitome of conspicuous consumption - which is a real thing that I've seen, those reasons I mentioned above - and they say something like "Well, I"m worried about my ability to afford artesanal cheese and fancy ruin-porn vacations, and god, I don't want my body to be ugly.." then yeah, you bet I'm going to judge this as just another instance of their extreme selfishness, which is a thing that permeates the rest of their life.
posted by corb at 10:14 AM on January 28, 2015

To clarify: I don't think people give those as reasons for wanting to be sterilized.
posted by kitcat at 10:14 AM on January 28, 2015 [3 favorites]

People who say "I just don't want my body to change and get heavier/stretchmarks, and I want to spend all my money on me rather than something else that might not be as fun!" do kind of come off as a bit selfish.

Some women have some pretty severe body image issues. I went through phases where even the smallest weight gain would set off days-long crying jags.
posted by LindsayIrene at 10:15 AM on January 28, 2015

Yes, show your work. Because if you can't, you are totally judging in the women in this thread for not being as good a person as you claim to be.
posted by Kitteh at 10:16 AM on January 28, 2015 [14 favorites]

The only reason I can think of that is actually selfish regarding reproduction is the one where someone says "I want ALL THE BABIES and NOBODY CAN HAVE BABIES BUT ME."

Everything else is just a difference of priorities.
posted by maxsparber at 10:16 AM on January 28, 2015 [13 favorites]

People who say "I just don't want my body to change and get heavier/stretchmarks, and I want to spend all my money on me rather than something else that might not be as fun!"

a) Why do you say people when you mean women,
b) These straw women sure sound like excellent mothers.
posted by sukeban at 10:16 AM on January 28, 2015 [32 favorites]

In-office female sterilization: I have had most of this procedure, about five years before I moved and asked the new OB/GYN for permanent sterilization/partial hysto.

I was given some kind of relax me pill, but mostly it was like a somewhat painful period around the specula and angle of a pelvic exam. The pain was mostly because the thing they did to numb up my cervix (trying to remember, maybe a shot?) started to wear off.

Once they'd dilated my cervix, they put the camera in there and took a look around but ultimately didn't place the Essure (my uterine structure precluded that).

Given my later in life allergies, it's probably for the best. I wish I could have gotten either the Essure or the Adiana ... if it had been a problem maybe I could have talked them into a partial hysto then.
posted by Buttons Bellbottom at 10:17 AM on January 28, 2015

Because if you can't, you are totally judging in the women in this thread for not being as good a person as you claim to be.

Where would you get that from? I am talking specifically about a subset of childfree women, not all of them. Many women have excellent reasons for not wanting to have children, and I support them in their choices. If the shoe doesn't fit, don't wear it.
posted by corb at 10:19 AM on January 28, 2015

Dashy and spaltavian, 14.3% request information and 1.1% actually request the procedure. We don't know why the remainder don't proceed. It could be anything, but most likely they learn the chances of reversal are low, the risks are too high, or it's too expensive.

What I see here is that 14.3% of women who have been sterilized have enough interest in reversing the procedure to ask for more information. Of those women who ask, most are dissuaded. Only a small fraction of them are either rich enough or desperate enough to go further.

The real damning statistic here is that the 14.3% statistic jumps to 40.4% among women who were in the 18-24 cohort at the time of sterilization. That lends STRONG support to the notion that a not insignificant number of young women who ask for sterilization are likely to change their minds.

So think about it from the Ob's point of view. They know that among young women who they sterilize, 40.4% are likely to be interested enough in a reversal at some point to ask for more information on the topic. It's no surprise that doctors think young women will change their minds - from their perspective, 40% of them do.

And before I'm misconstrued here, I'm not making any arguments about a woman's right to choose or whether or not she should be allowed to have whatever procedure she wants. I'm just saying to look at it from the doctor's point of view. IUDs are safe and can be reversed. Side effects are low (and there are side effects with any medical procedure). Sterilization can also be safe, but can't be reversed. Is it any surprise doctors are reluctant to perform sterilizations given the alternatives?
posted by fremen at 10:19 AM on January 28, 2015 [4 favorites]

you bet I'm going to judge this as just another instance of their extreme selfishness, which is a thing that permeates the rest of their life.

So? Go right ahead. You're better than them, yay! Probably they're better off not raising kids, but...I'm sorry, how is it these people are hurting you?
posted by Lyn Never at 10:19 AM on January 28, 2015 [38 favorites]

The last time I went to the doctor about birth control, talking about how none of the options have worked for me, his response was "Welp, let's get yer tubes tied then?" I felt really lucky.
posted by bleep at 10:19 AM on January 28, 2015 [3 favorites]

What on earth is selfish about buying what you want and eating fancy cheese? How is that at all related to being a parent? Its bizarre to judge people this way. Are you implying that people who don't have kids are getting away with something, skipping some sort of responsibility? What responsibility IS that? Not trying to pick on you, but I think you should examine your presumptions.
posted by agregoli at 10:20 AM on January 28, 2015 [28 favorites]

As a guy, I often say that I don't want kids because I like having a lot more money, and sleep, and I do a lot of drinking. I say these things literally all the time. Am I selfish?

Also, my family is a vortex of auto-immune disorders, and I would also make a terrible parent for a number of other reasons.
posted by TheWhiteSkull at 10:21 AM on January 28, 2015 [18 favorites]

What on earth is selfish about buying what you want and eating fancy cheese?

Frankly, it's a sin not to eat fancy cheese.
posted by maxsparber at 10:21 AM on January 28, 2015 [23 favorites]

In order for a decision to be considered "selfish," there needs to be an other whose needs/wants are being neglected in favor of the selfish person. Who's the "other" in the decision not to have children? The not-yet-conceived, purely hypothetical offspring who may never exist anyway?
posted by Metroid Baby at 10:21 AM on January 28, 2015 [45 favorites]

Anyway who cares what someone's reasons are for not having kids? Any time the end result of something isn't a suffering person we should all feel good about that.
posted by bleep at 10:22 AM on January 28, 2015 [5 favorites]

To be fair - I do believe that corb is not pulling a story out of her ass when she says that there are women who decide not to ever have babies because they are afraid of stretch marks. I would not be surprised that there are such people in the world.

However - corb, while I do not doubt that such people exist, I strongly doubt that they exist in such numbers to the point that every other woman's decision about her own fertility needs to be therefore second-guessed to the point that you seem to be implying.

Let me put it this way - it'd be like actively preventing all straight people from obtaining marriage licenses because "what if you're actually gay? Are you sure you're not?"

You know? You're making an assumption about a huge group of people based on the actions of a very SMALL group.
posted by EmpressCallipygos at 10:22 AM on January 28, 2015 [15 favorites]

Many women have excellent reasons for not wanting to have children, and I support them in their choices.

There does not need to be a reason. Not wanting to have children is the reason. All women (and men) should be supported in their reproductive choices without judgment.
posted by blurker at 10:28 AM on January 28, 2015 [49 favorites]

You're making an assumption about a huge group of people based on the actions of a very SMALL group.

I'm not trying to, but it does seem to be being read that way. I was trying to respond to the people who were asking "Why could anyone ever consider that decision selfish?"

I don't think women shouldn't be able to access sterilization because some women have those reasons for not having children. I do think that there should be a higher bar for sterilizations in that 18-24 range mentioned above that has a 40% rate of wanting it undone, based on the fact that you are still developing your brain, your ideas about yourself and what you want to do in life, and figuring out who you are at that time. I know I am far from the only person who didn't know what they wanted to do with their life in their early twenties, and I think there are enough mistakes that penalize us without adding another one.
posted by corb at 10:28 AM on January 28, 2015 [2 favorites]

This thread is making me very, very glad to be a transwoman. I have never been a Womb-Bearer whose Womb is far more important than myself to some people; the fact that I'd rather make comics than have kids is nobody's business but my own.
posted by egypturnash at 10:29 AM on January 28, 2015 [6 favorites]

I was trying to respond to the people who were asking "Why could anyone ever consider that decision selfish?"

And then you gave reasons why you would think that decision would be considered selfish, which many people here would like to interrogate further.
posted by TheWhiteSkull at 10:31 AM on January 28, 2015 [9 favorites]

Actually, you know what? Here's what you wrote:

then yeah, you bet I'm going to judge this as just another instance of their extreme selfishness, which is a thing that permeates the rest of their life

Yeah, fuck that.
posted by TheWhiteSkull at 10:33 AM on January 28, 2015 [10 favorites]

It's the weird overblown hysteria around all this that is offensive. Dear doctors: For your patients, realizing that they regret their sterilization later in life might be painful! It will not kill them, though. Nor will it ruin everything good about their lives. They will get over it. If they feel any at all.

And honestly, next to that regret they might feel, you can put "Ok, what if they had a kid and it was a nightmare decision for them and also ruined a kid's life?" because there are plenty of examples of that happening all around, also.

Considering how many fucked-up families that medical people see, with abuse and drug use and general dysfunction, (going by all the stories I've heard from them), it's weird that so many are so eager to make sure there is never a door closed that could lead to a baby. The world is full of babies. We aren't going to run out. If someone says to you "Babies: not for me," you should fucking listen.

Or look at it this way: The worst that happens with a regretted sterilization: one person, or maybe a couple, is sad.
The worst that happens with a pregnancy that occurs to someone who really shouldn't have kids because you didn't sterilize: lives ruined.
posted by emjaybee at 10:33 AM on January 28, 2015 [20 favorites]

corb: But if the person I'm talking to is kind of the epitome of conspicuous consumption - which is a real thing that I've seen, those reasons I mentioned above - and they say something like "Well, I"m worried about my ability to afford artesanal cheese and fancy ruin-porn vacations, and god, I don't want my body to be ugly.." then yeah, you bet I'm going to judge this as just another instance of their extreme selfishness,

Again, this is only "selfish" if you think it is their moral responsibility to have children. The problem is that you have this belief, not that they don't fit it some arbitrary standard you have decided you can set for them. You wouldn't call me selfish for preferring the color blue to the color red; as there's no imperative here, you do not foist a moral responsibility on my preference. But since you have decided there is a moral dimension to having children, you think you are free to say incredibly silly things. Sure, you'll give a pass to "the good ones", but you're still judging through this archaic metric.

Because if you can't, you are totally judging in the women in this thread for not being as good a person as you claim to be.

Where would you get that from? I am talking specifically about a subset of childfree women, not all of them. Many women have excellent reasons

They're getting it from your arrogance in deciding which reasons are "excellent" and which are selfish.
posted by spaltavian at 10:37 AM on January 28, 2015 [41 favorites]

I think I object more to strangers making judgments about me based on my reproductive goings-on than to "selfish" specifically. Like, even if you thought me going childfree was NOBLE or HEROIC--what do I even do with that opinion? Is it really something someone not-very-close to me needs an opinion about?
posted by almostmanda at 10:37 AM on January 28, 2015 [5 favorites]

fremen: Dashy and spaltavian, 14.3% request information and 1.1% actually request the procedure.

Yes, I'm aware. That's why a corrected you when you misquoted the numbers.

We don't know why the remainder don't proceed.

Yet you're willing to follow this with a long post pretending you do know.
posted by spaltavian at 10:37 AM on January 28, 2015 [4 favorites]

a 40% rate of wanting it undone

A 1.1% rate of wanting it undone, as has been reiterated several times in this thread. 40% rate of inquiring about reversal, which is a completely reasonable thing to ask when you are in the decision-making process, especially when a certain number of people first exposed to the concept of sterilization may not be reproductively educated enough to know that sterilization implies irreversibility. One should ask the same of any contraceptive - hell, that's how they used to threaten us not to get IUDs, that you'd get an infection and not be able to perform your sacred obligation as a woman.

Many many more people have children they can't take care of - and not just like "we should have better social services" kind of can't take care of. Ask any Child Protective Services investigator. Don't plan to sleep well for a while. Those stories stick with you.

Anyway, I didn't have kids because I didn't want to. 100% legitimate reason, full stop, and none of your business what the details are. Don't want to, shouldn't have to.
posted by Lyn Never at 10:37 AM on January 28, 2015 [19 favorites]

You don't know me.

Try this shit in TEXAS. It was unpleasant and insulting and instead I got a prescription for what I affectionately call MURDER EVERYONE pills - it sounds funny, but MURDER EVERYONE is an unacceptable side effect.

Eh, not if you can spend all your time in the company of the people who pushed you into taking them. (I kid so I don't scream)
posted by phearlez at 10:40 AM on January 28, 2015

Frankly, it shouldn't matter what the reasons a woman has for wanting to be sterilized. I'm okay with somewhat more thorough questioning than for other procedures since it's a more involved surgery than something like a vasectomy and it's harder to reverse. There are other, reliable ways to prevent pregnancy.

It's not like some of the people getting breast enhancements or face lifts or other unnecessary cosmetic surgery are doing as an act of selflessness.
posted by VTX at 10:44 AM on January 28, 2015

I'm trying not to jump on corb, because there is some validity to her assertion that a very young woman may possibly change her mind over the course of her life (I'm thinking about teens here, but people mature at different rates, of course). Any woman that requests sterilization will go through some amount of counseling, but this should not be in a condescending, "you're too young to know what you want" sort of way, it should be similar to any pre-surgical procedure counseling session, explaining the possible side effects, long-term issues, and risks. This is a responsible interaction between doctor and patient, and it happens all the time.

However, that "selfish" comment is really rankling. I am not going into my personal reasons for not having children, because they are personal. But, what if they are because I don't want to change my body, and I want to be able to spend my money on myself and my partner. What if I never volunteer, or give money to charity, or any of the things that makes you think I'm a good person? Then I should not be able to eliminate the possibility of having children, which I clearly do not want? How does that make sense?

I don't mean to sound nasty, corb, I'm truly trying to understand your position.
posted by blurker at 10:44 AM on January 28, 2015 [16 favorites]

All this judgement on selfish women. Last time I checked, selfish women have the right to choose too. How unfortunate that there exists the earnest belief that the medical establishment should use policy to curb selfishness in women.
posted by theraflu at 10:46 AM on January 28, 2015 [28 favorites]

I'm trying not to jump on corb, because there is some validity to her assertion that a very young woman may possibly change her mind over the course of her life (I'm thinking about teens here, but people mature at different rates, of course). Any woman that requests sterilization will go through some amount of counseling, but this should not be in a condescending, "you're too young to know what you want" sort of way, it should be similar to any pre-surgical procedure counseling session, explaining the possible side effects, long-term issues, and risks. This is a responsible interaction between doctor and patient, and it happens all the time.

Okay, then let's approach this from a different perspective:

Assuming that this IS something that a person could potentially change their mind about, then can anyone explain why men don't get the same degree of pushback on this that women do? If this really is a going concern, why don't men then get this same degree of counselling and persuasion not to rush into it?

I mean, a very young woman may change her mind over the course of her life, but so can a very young man.
posted by EmpressCallipygos at 10:48 AM on January 28, 2015 [3 favorites]

If I had to articulate the major reason I don't want to try to slip a kid into my life before the biological window closes for good it would be exactly....I don't want to have the financial responsibility for looking after a kid.

I'm happy spending what little I have to spare from basic living expenses on me and things that I like. All of that would be gone with a kid. That's reality. Yes I would like to spend my spare money on graphic novels and computer games. I would rather keep spending my free time, reading and studying and playing those computer games. I would rather not have to be tied down more then I am now with having 2 dogs and 3 cats to make sure to keep breathing.

I work at a cheese factory and get excellent deals on artisinal cheeses. I want to keep taking advantage of them.

My colleague and friend has a young boy. I know what her life is like. Her kid is awesome. She gets to do and experience awesome things that I don't. She doesn't get to do awesome things that I do. Like barely at all. I don't want her life even though it's a certain type of awesome. Even thought of having to live that life makes me squirm and feel upset.

This is a judgement about me fitting into her type of life. Not on her type of life which I know is awesome for people like her.

Me knowing that having cheese and time to play video games would make me be happier in life then having a kid is not selfish.

It just means that my cheese, video games and kids with regards to life priority are different then other women's life priorities.

Women are not all the same.
posted by Jalliah at 10:49 AM on January 28, 2015 [34 favorites]

Assuming that this IS something that a person could potentially change their mind about, then can anyone explain why men don't get the same degree of pushback on this that women do? If this really is a going concern, why don't men then get this same degree of counselling and persuasion not to rush into it?

I mean, a very young woman may change her mind over the course of her life, but so can a very young man.

Exactly. This is (IMO) clearly about sexism and patriarchy. That this attitude is so common among medical professionals, who have complete control over whether or not they perform the procedure, is horrific.
posted by blurker at 10:52 AM on January 28, 2015 [2 favorites]

Answering questions offline so as not to make this an extended back-and-forth solo.
posted by corb at 10:53 AM on January 28, 2015

I work at a cheese factory and get excellent deals on artisinal cheeses. I want to keep taking advantage of them.

You might as well have just come into this thread and said I am the sovereign of a magic island and ride solid gold ponies all day long.
posted by maxsparber at 10:55 AM on January 28, 2015 [53 favorites]

Assuming that this IS something that a person could potentially change their mind about, then can anyone explain why men don't get the same degree of pushback on this that women do? If this really is a going concern, why don't men then get this same degree of counselling and persuasion not to rush into it?

This is tough because a vasectomy is a much more simple procedure and can be reversed easier. I don't doubt that there is a ton of patriarchy but I don't think comparing the experience to men getting a vasectomy is the best way to show it.
posted by VTX at 10:55 AM on January 28, 2015 [1 favorite]

Is it common for men to be called 'selfish' if they say they don't want children?

Can't say it is in my experience. Wondering if others have experienced it.
posted by Jalliah at 10:56 AM on January 28, 2015 [2 favorites]

Fast forward a year, to massive abdominal pain and bloating. "Oh, we'll just keep an eye on it" says [our] (VERY MUCH FORMER) gyno, who also misdiagnosed our friend's massive cervical cancer.

What do you call the person who graduated last in their class from medical school?
posted by phearlez at 10:57 AM on January 28, 2015 [4 favorites]

Our very much former gyno?
posted by blurker at 10:59 AM on January 28, 2015 [6 favorites]

I would also add "bitchface life-ruiner," but that's me, eponysterical to the end.
posted by bitter-girl.com at 11:00 AM on January 28, 2015 [3 favorites]

I had endometriosis for years. It was very painful and debilitating and messed with my moods. When I finally got care at 28, I made clear to my gynecologist that it was fine if she sterilized me, because I'm don't want kids and even if I did, I'm queer and don't get people's obsession with biological children.

She put me on hormonal birth control. Five kinds in sequence, all of which had intolerably nasty side effects. I wasn't able to stay on it and started acupuncture, which I didn't expect to work but helped a lot.

Several years later, I decided to start trying to sell my new gynecologist on giving me a hysterectomy. I got all my arguments together, because I figured it would be a process: I don't want kids, pregnancy is serious body horror stuff to me, I'm likely to not be able to have kids with a partner because I mostly date women, I have a number of genetic traits I don't want to pass on, I'm in pain. She tried me on tramadol, I tried to give it back to her because it was terrible. She asked about the mirena and I pointed out that I'd already failed levothyroxine once and didn't want it again. She shrugged and said that I'd failed other treatment and she'd give me the hysterectomy. I was 34. She was pregnant at the time.

At 38 I was diagnosed with rheumatoid arthritis, which I would really not want to pass on and would not be able to medicate during a pregnancy. Additionally I've got massive student loan debt, a demanding career, a partner who likes children even less than I do, I have hobbies, and there are more than seven billion people on this planet so it's hardly going to be a problem for species survival if I opt out.

I've had a number of people suggest that I'd be a good mom or insist that "you never know!" or that I'll change my mind or blah blah blah kids blah, and it's all I can do to explain in detail why I'm not having kids, or just say that I miss when my friends wanted to have fun instead of having babies.
posted by bile and syntax at 11:01 AM on January 28, 2015 [8 favorites]

My mom asked, after my first brother (second child), to have her tubes tied. She was refused on the grounds that she was "only" 26 and my dad might want more kids.

My dad. MY DAD.

She asked after my my second brother (her third child), and was refused for the same reasons (except this time she was 31).

After my third brother (fourth child), she basically said, "I am not leaving this hospital until you shut the baby factory DOWN!" and finally got it.

Just insane.
posted by dotgirl at 11:01 AM on January 28, 2015 [8 favorites]

Is it common for men to be called 'selfish' if they say they don't want children?

I've never heard it, and I'm on my way to 50 with no kids in sight.
posted by maxsparber at 11:01 AM on January 28, 2015 [7 favorites]

(I should have left the practice the time she poked me with the magic mascara wand and said, LOUDLY, "hmmmm, THAT'S not good," but I was too busy worrying about my family history of young, deathy reproductive cancers, me).
posted by bitter-girl.com at 11:03 AM on January 28, 2015 [1 favorite]

Jalliah: Is it common for men to be called 'selfish' if they say they don't want children?

Can't say it is in my experience

It's happened to me several times. However, I usually get more of a "maturity" angle. In that, it's less of a personal failing, and more that I'm in a normal male phase, and once I grow up and settle down I'll of course become a respectable person.

It's the only scenario in which I've been called "immature". I have a house, job, wife and bills, I'm not sure how much more "settled" I'm supposed to get, really.

So, while I think I have been judged as a bad person at times, I feel it's usually more of a "boys will be boys" thing. Not always, though. I'm not at all discounting sexism because women get it worse, but there's more to it there, because some people really do take my preference personally for some reason.
posted by spaltavian at 11:04 AM on January 28, 2015 [6 favorites]

can anyone explain why men don't get the same degree of pushback on this that women do? If this really is a going concern, why don't men then get this same degree of counselling and persuasion not to rush into it?

I think you're probably right that it's about sex stereotypes, because men are stereotyped as okay to be playboys and clearly desirous of being playboys forever, while women are stereotyped as being baby crazy.

I think probably, if you were being medically conscientious, men should still get the same pushback (though I understand vasectomies are more reversible, but it's still a serious procedure) and I would probably push for it as well, if I cared about men even half as much as I cared about women. Which I honestly don't at this point. Someone else can defend the men, my time and energy is on women.
posted by corb at 11:04 AM on January 28, 2015 [1 favorite]

As far as I know my mom, who got her tubes tied in her late 30s after having two kids and a divorce, never got any crap from her doctors about that decision. It infuriates me how few women seem to get that courtesy.
posted by Holy Zarquon's Singing Fish at 11:05 AM on January 28, 2015

To add: I also get a lot of "but you'd be a good father" as if I was worried about my competence. Like, I just needed a pep talk to realize I could be as good as you.
posted by spaltavian at 11:06 AM on January 28, 2015 [3 favorites]

I have mentioned this here before but it took me literally 1/2 of my current life of active relentless self-advocacy to get rid of my fucking hellpit uterus. 18 years of asking at every single gynecologist appointment if I could have my tubes tied yet. 18 years of shopping around, carefully maintaining a non-emotional front about it, calmly and reasonably laying out my thoughts, occasionally failing and just crying a lot. 18 years of having to reassure doctors that I was not an abuse victim reliving childhood traumas, 18 years of being condescended to by men and women alike, 18 years of biting back my considerable fucking temper so as not to have to deal with someone grumpily doing a pap smear and being less than careful with that fucking awful wire brush.

It wasn't until I almost died from having my period for 109 days and having 70% of my hair fall out and old healed wounds reopen and old fractures rebreaking and teeth falling out that I got a doctor who was like HELL YES LET'S FUCKING DO THIS.

The best side effect of this all is that I can now look at the toddlers of my friends and family and say "yeah, they are objectively cute" without having to weather yet another fucking round of "so when are you having kids?". It is also nice to have a 100% bulletproof counterargument to "oh, you'll change your mind when it's one of yours!" when I express horror or revulsion for the terrible terrible things that often erupt from small children in surprising quantities. I don't WANT people to feel bad for me, because I sure as hell don't, but it's better than having my lifelong beliefs smugly questioned by people who apparently know fuckall about me.
posted by poffin boffin at 11:07 AM on January 28, 2015 [43 favorites]

One of my sisters got the procedure done recently (in Canada) and wasn't obstructed, but she does already have a couple of kids. It does seem that they lay into you more if you're young or childless (regardless of whether or not your a male or female) in Canada. My sister did say she absolutely had a great time on the drugs they gave her for recovery.

I am not surprised the question is asked. That's fine. Doctors are part of helping you make medical decisions, large or small. But once you've verified your decision then there should be no obstruction. The doctor's opinion on it is irrelevant that point.

Is it common for men to be called 'selfish' if they say they don't want children?

In my experience yes. Also, loose (in that you want to juice as many ladies as you can without the pregnancy risk), irresponsible, cold, heartless, inability to share, inability for empathy, lazy, etc.

People who have/want or do not have/want kids can have all those qualities, or not. I think it's part of this obnoxious "families first" bullshit from the conservative movement.

I would say that in my experience the medical profession mirrors much of society in its treatment of women. I've spent 5 years trying to get treatment for a woman (just pleading the case, helping out with taking to appointments, etc.) for something not pregnancy related and it has been a nightmare that ultimately led to the street, which is it's own kind of nightmare. The treatment itself is clear and documented but no one will do it mostly because of lack of respect and judging the patient poorly.
posted by juiceCake at 11:13 AM on January 28, 2015 [1 favorite]

corb: I think probably, if you were being medically conscientious, men should still get the same pushback (though I understand vasectomies are more reversible, but it's still a serious procedure) and I would probably push for it as well, if I cared about men even half as much as I cared about women. Which I honestly don't at this point. Someone else can defend the men, my time and energy is on women.

Oh Christ, yes you want women treated as frivolous idiots who owe explanations for their most personal decisions because you're defending them.
posted by spaltavian at 11:15 AM on January 28, 2015 [30 favorites]

it's ironic because if i'd never come to the US i would have ended up forcibly sterilized by the government just like the rest of the women in my age and ethnic cohort. none of my doctors ever found it amusing when i pointed out that i would've gotten better service from actively genocidal assholes.
posted by poffin boffin at 11:17 AM on January 28, 2015 [25 favorites]

What do you call the person who graduated last in their class from medical school?

Our very much former gyno?

I assumed everyone knew the joke: the answer is "doctor."

Is it common for men to be called 'selfish' if they say they don't want children?

Can't say it is in my experience. Wondering if others have experienced it.

Oh, I heard it any number of times. I usually responded with "Refusing to bring an unwanted child into the world doesn't match my definition of selfish." Mostly that shut people the fuck up. Sometimes they'd persist about the next generation etc and I'd ask them if they really thought there was a shortage of people having children and if the human race was on its way to dying out. On one occasion that led down a path revealing a pretty fucking awful racist/classist line of dialog so I guess that was a plus in helping me to discover I shouldn't ever associate with them again.

My experience was that the majority of people are just parroting a line without critical thought and it really boiled down to the "that's just what you DO."

Personally I ended up a parent; I decided I could be happy either way (which actually would not have been true before 30) and my spouse was very pro-parenting. A relatively benign medical condition on her part meant birthing was a bad idea and we adopted. So if I'd pushed and been sterilized it not only wouldn't have made a difference in my life it would have made the rest of our life easier too. So put that in your anecdotia pipe and smoke it. I love my son more than I could ever have believed possible and the state of my man plumbing wouldn't have changed that a bit.

Hand-waving about oh well there's IUDs pretty supremely glosses over how under-utilized they have been by medical professionals for the last twenty years. You can point to recent articles about how they're considered great choices now even for women who have not given birth but that doesn't obviate the fact that doctors have long been resistant due to ignorance or lack of training. So this resistance to sterilization went hand in hand with a twenty year decline in the availability of termination and failure to provide good birth control options to women.
posted by phearlez at 11:19 AM on January 28, 2015 [8 favorites]

Here's a question none of these medical professionals seem to be interested in: what would it take to come up with a process for female sterilization that was reversible?
posted by mikurski at 11:22 AM on January 28, 2015 [7 favorites]

My God, the stories in this thread are truly a horrorshow.

I do want to bring up something that I'm surprised hasn't come up yet*, which is the global history of using sterilization as a tool for eugenics. It's not something that you can overlook, and the idea that you should be able to get a permanent sterilizing procedure without significant questioning** does not sound like it would be a net positive to me. I can just imagine under-educated women thinking they were asking for birth control or an IUD, and less-than-ethical doctors who are more than willing to agree.

I imagine that something actionable would be to make a standard system for elective sterilizations, maybe something like guidelines issued by the AMA, and a directory of physicians who are capable of providing the procedure.

Here's a question none of these medical professionals seem to be interested in: what would it take to come up with a process for female sterilization that was reversible?

That's basically what an IUD is, though, like sterilization, it's contraindicated for some women.

*aaaand Poffin Boffin on the preview
**I fully understand that this is not the view of most people in this thread!
posted by fermezporte at 11:24 AM on January 28, 2015 [1 favorite]

I think the "selfishness" conversation is a huge problem. No matter what a woman does, she gets judged for it, and no matter what choice she makes, someone will be out there ready to tell her that her choice was wrong and unwomanly. Most people do judge, and most of those people judge for reasons that are "accepted" among their social groups, meaning their judgments have more weight when they speak up among their group. And the thing is, women are expected by society to be more selfless. Selflessness is a key descriptor for motherhood in general.

Calling a woman selfish is a hot button pretty much across the board of fertility. No kids? Selfish. Stopping after 1 kid? Selfish. Two kids of the same gender and no interest in 'trying for' the other? Selfish. Four or more kids? Selfish. Kids born too far apart? Selfish. Give your kid up for adoption? Selfish. You can't win.

People have the right to be selfish. Women have the right to be selfish. And yes, people have the right to judge them for being selfish, sure. But that doesn't mean that we get to (or should) limit women's choices, to somehow protect them from that judgment. It's gonna come regardless.

If people weren't allowed to make other medical decisions they would later regret, there would be no elective plastic surgery. Until that's the case, a person's "selfishness" should have no bearing on this sort of decsion, period.
posted by Mchelly at 11:26 AM on January 28, 2015 [32 favorites]

To add: I also get a lot of "but you'd be a good father" as if I was worried about my competence. Like, I just needed a pep talk to realize I could be as good as you.

My response to that was always "I'm a great ditch-digger too but I don't want to do it for a living." And yes, I am in fact a fucking awesome dad. In no small part because it was my decision and my timetable; a financial and physically luxury so many people don't have.

And it's fucking gross that such matters are a luxury.
posted by phearlez at 11:28 AM on January 28, 2015 [7 favorites]

I work at a cheese factory and get excellent deals on artisinal cheeses. I want to keep taking advantage of them.

Will you adopt me as your child and feed me the cheeses?

No? SELFISH.
posted by JanetLand at 11:30 AM on January 28, 2015 [28 favorites]

I got my federally subsidized (Thanks Clinton!) vasectomy with no attempts to try to talk me out of it when I was 28. The county health department folks were almost too delighted. "We almost never get men in for this!"
posted by Cookiebastard at 11:30 AM on January 28, 2015 [3 favorites]

fermezporte: I do want to bring up something that I'm surprised hasn't come up yet*, which is the global history of using sterilization as a tool for eugenics. It's not something that you can overlook, and the idea that you should be able to get a permanent sterilizing procedure without significant questioning** I can just imagine under-educated women thinking they were asking for birth control or an IUD, and less-than-ethical doctors who are more than willing to agree.

How do you logically allow forced or coerced sterilization programs/incidents to color your view of women requesting voluntary sterilization? The hypothetical problem of a racist doctor who is willing to perform surgery on someone without their consent would be a problem with a doctor, not with women not getting questioned enough when they request sterilization. Making it harder for the women who are asking for it is not going to stop this hypothetical doctor.

If there was a doctor out there going around a removing gallbladders for no reason, would you say men who come in with severe gallstones need to get questioned more significantly?
posted by spaltavian at 11:31 AM on January 28, 2015 [11 favorites]

The thing is, vasectomies are pretty easy to reverse... But we live in a world where we can grow ears on the backs of mice, yet nobody's thought 'gee, how can we make this whole tubal ligation thing reversible?'

I see something like this and it makes me think of how the period-controlling aspects of birth control were just discarded because... well... women.
posted by mikurski at 11:35 AM on January 28, 2015 [5 favorites]

Which is worse: Not having children and then regretting it after the fact, or HAVING children and then regretting it after the fact?
posted by The Underpants Monster at 11:36 AM on January 28, 2015 [7 favorites]

I think this is moot, because...I just don't think people actually say that.

I mean, I guess I do, amongst other things? I never wanted to deal with having some moving, growing, kicking creature inside of me, the very thought it unbearably repulsive to an extent that I can't begin to describe without freaking out. The thought of the flood of mood-destroying hormones is also horrible to me. I don't want to deal with hemorrhoids and weird food cravings, I don't want that one hormone that loosens your joints, maybe forever, because I probably have hypermobile EDS and something like that would literally destroy my body even more than life already has. I don't want the backaches and swollen legs, and I sure as fuck don't want to squeeze a screaming volleyball out of my vagina.

And yeah, fuck that, I totally want to spend money on things for myself that I would enjoy, and not childcare and preschool and private school and tutors and college and god knows what else. I have no interest in raising a tiny human into an adult, I want a PS4 and a summer home somewhere nice and a comfortable mattress and a tv big enough that my shitty eyesight can see the subtitles without binoculars.

Does this make me selfish? Idk, and nor do I care. I can't think of anyone's opinion that would matter less to me than someone who would call my personal decision to not have children, for whatever reason, which will never affect them in any way, "selfish".
posted by poffin boffin at 11:39 AM on January 28, 2015 [35 favorites]

I see something like this and it makes me think of how the period-controlling aspects of birth control were just discarded because... well... women.

I often lead my Mirena pitch with "For starters, I haven't menstruated in six years.." I didn't even know that was a possibility when I got it. If I ran Bayer, that would be the focus of a whole ad campaign.
posted by almostmanda at 11:41 AM on January 28, 2015 [14 favorites]

As a now-sterilized guy (Previously, at 18, at 20, Speaking more directly on weird and troubling things people've said to me in response.),
A. I am *all for* No Baby Forever parties. Anyone's in the Seattle area and wants a party, I'll help throw a party.
B. I've basically been against personally having kids as long as I can remember. footnote 1 So I'm highly invested in supporting whichever organizational advocacy I can to make it easier for everyone, but especially women, because the above horror stories are bullshit. I thought I had to push through trouble, but... ye gods. Is there nothing that paternalism & patriarchy can't make worse, even when the state in general isn't great.
C. Is there any way to metaphorically set the "What about your future partners/parents/siblings wishes?" line on fire? Because that one in particular is *extremely* grating.

1. Long-standing "Parenting should be reserved for the people who *really want* kids. The kind who had it as part of their concept of future-self growing up. Anything less than a strong YES is a hard NO" policy. Plus some genetic stuff) At 18, I figured that I should give it until I was 21, to see if *anything* would come up to sufficiently convince myself otherwise. (That was my first Ask MeFi question, I think) Handily, after that, a state grant funding sterilization (Go Oregon!) kept it from being *as* much of an issue as it would've been.)
posted by CrystalDave at 11:41 AM on January 28, 2015 [4 favorites]

Okay, I feel like this thread is a good opportunity to tell my rage-inducing encounter with an OB-GYN story.

When I was about 27, I asked a (female) OB-GYN about getting and IUD. I said something like, "My current method of birth control is condoms, but I'm in a monogamous relationship and my partner and I have both been tested and I'd like to use something else. I can't take the Pill because hormones and chronic depression are a bad mix for me."

And she gave the line that IUDs aren't a good choice for women who haven't had children, and besides besides, how long have you been with your partner? And I was like, a year. And she's like, well you never know wtih men! You might think it's monogamous but as I say "until you have a ring..." And I'm just thinking that whether or not my boyfriend might cheat on me should be my business but also: "Huh? So married men don't cheat? If anything, I'd think there'd be less of a risk of cheating in a dating relationship vs. marriage because if my boyfriend wanted to have sex with someone else, HE WOULDN'T NEED A LAWYER TO BREAK UP WITH ME."

And then her despite her view that all women should use condoms until they're married, she still tried to push the pill on me even after I told her Hormones + Pre-existing Chronic Depression = Bad Idea (I know, I've tried), and told me I just needed to find the right kind and sometimes it takes a few months for those pesky mood swings to sort themselves out, as if major depression is just a little minor side-effect.

/rant
posted by Asparagus at 11:42 AM on January 28, 2015 [11 favorites]

Just to throw my two cents in here, I had a tubal ligation at 37 after asking for it several times in my 20s and being poo-pooed. I'm now at an age in which people don't tell me I'm going to change my mind, but over time, I've had people freak.the.fuck.out when they found out I made that decision. Like it was a whim? I mean for God's sake.

Oh look here's something I wrote about this in 2000:

When I was 18, convinced that I did not want children and not convinced that I wanted to use the birth control pill, I tried to arrange for a tubal ligation & my doctor wouldn't do it, because he was sure that I would change my mind. I didn't. Years later I one day awoke to the fact that I was old enough to be taken seriously and I got the ligation. In California, there is a legal requirement that consent to a tubal ligation be given at least 30 days prior to the surgery. This is in order to prevent coercion (there was some evidence that women -- particularly poor women with more than one child -- were being coerced into receiving ligations against their will or with impaired consent, during childbirth related procedures by doctors who presumptuously believed themselves to be doing these women a service. The 30 day requirement also provides women who make the decision suddenly, because of mishaps in their lives, some cooling off period during which they can change their minds). So I went for my initial consult with the surgeon who would perform the surgery, and she asked me my rationale for the ligation. I gave it to her, much more succinctly than I usually express myself on these boards, and she said, "You sound like you've thought this through a lot more than many women I see. Let's see, shall we schedule the surgery for 30 days from now?" I walked out of her office feeling as though I had been heard, really heard, for the first time.

All those years people would say to me "Oh, you'll change your mind." Think about something that you know about yourself. Just any old opinion that you've held consistently all your life. Like, let's say, you love strawberries. Or you love to read fiction. Or you feel strongly about the rights of the accused. Now imagine that any time the question arose -- and it wouldn't come up all that often, but it would come up every now and then -- and people were expressing their opinions and asking yours, whenever that happened and you said, "I love to read fiction" imagine if EVERY TIME that happened, someone said to you, "Oh, you'll change your mind about THAT as you get older."

Every time. I got to wondering at some point who I would be if I were a person who wanted children. I mean, it's not the only thing that defines my personality, but it is a part of me. Who would I be if that changed?

Having that experience repeated often over the course of years taught me a lot about respect and empowerment.
posted by janey47 at 11:47 AM on January 28, 2015 [18 favorites]

To add: I also get a lot of "but you'd be a good father" as if I was worried about my competence. Like, I just needed a pep talk to realize I could be as good as you.

I get that all the time. When I get it, I smile and think they don't know me very well.
posted by delfin at 11:52 AM on January 28, 2015 [1 favorite]

The individual right of any patient should be sacred. If a person asks a sterilisation I see no reason to refuse. Even if this person is young or childless. Potentially, in young and childless people a short waiting period should be set to make sure this is not decided easily. Paternalization in the medical profession remains a serious problem.
posted by jpbogers at 11:55 AM on January 28, 2015 [1 favorite]

I feel like it's an unspoken but probably not mean barb at me when family sees my husband playing with our nieces or nephew or godchildren and says to me, "He would have been a wonderful father." I don't really read too much into it, but sometimes it can sting.
posted by Kitteh at 11:57 AM on January 28, 2015 [2 favorites]

It's as stupid a comment as someone watching a toddler run 3 feet across the playground and saying "welp that one's a born athlete!".
posted by poffin boffin at 12:00 PM on January 28, 2015 [12 favorites]

I have a lot of Thoughts on this topic, but I will be brief. I would love to be sterilized, but it needs to be in a way that removes any possible signals for "time for menstruation!" from my system, because that triggers a bunch of stuff, even if menstruation doesn't actually happen. (yay mirena!) As I've mentioned elsewhere on mefi, I was raised mormon. I was literally told that "the greatest calling a woman can have is to be a wife and mother". For a lot of years I'd hedge when people asked if I wanted to have kids, but being married (in a potentially procreative coupling) for 6 years didn't change my mind, and post divorce I'm even more solid on NOPE NO BABIES FOR ME EVARRRRR, so my next gyno appointment will once again start the journey toward sterilization. I did notice my new insurance explicitly covers voluntary sterilization, so that's exciting.

This came across my fb feed as I am reading this thread, and it seemed appropriate, especially for the "but it's so permanent!" crowd: Why You Should Never, Ever, Ever Get A Tattoo (but Having a Baby is Fine)
posted by HermitDog at 12:01 PM on January 28, 2015 [5 favorites]

The Underpants Monster: "her doctor talked her out of a tubal ligation after three pregnancies (even though he specifically told her she shouldn't get pregnant again for health reasons), but was happy to recommend a doctor to do Dad's vasectomy."

Tubal ligation is abdominal surgery, though, requiring spinal anesthesia; while a vasectomy is an outpatient procedure with local anesthetic. Around here, for married women in their 30s (i.e., my peer group), if you ask the doctor to tie your tubes while he is performing a C-section, no problem, since the abdominal surgery is already happening -- totally routine. However, if you want your tubes tied at a different time, the same doctor will suggest vasectomy for the husband as a preferable option, as it's a less-risky, less-invasive procedure with a shorter recovery time and fewer complications.

Of course the couple can make the decision with their doctor (as married women in their 30s with a couple of kids already don't get quite so much guff about wanting a tubal ligation), but it is fairly common for couples who know they are done having kids to decide in favor of a vasectomy instead of a tubal ligation (assuming there are no other complicating health issues). My ob/gyn said he's in fact really surprised on the rare occasions when a couple opts for the tubal instead, and he assumes probably the husband is a wimp about medical procedures because it's so unusual a decision.

---

On the larger point, I think there would be a lot less frustration and anger if women were given a clear path to sterilization. Like if when you requested it you got a brochure in a terrible font that say "So You've Decided To Never Have Babies!" and it outlined the steps you have to go through. Most women would understand if a hospital's policy was, "You have to talk to our reproductive health counselor about the risks and impacts of this surgery and its irreversibility; you have to wait six months so we can be sure this isn't a passing desire; we need to feel comfortable you're not being coerced by an abusive partner or parent; you need to sign a super-huge liability waiver."

I don't think it's unreasonable for hospitals to say, "Whoa, this is major elective surgery, that is life-changing and permanent, we really want you to be SURE, and we really really don't want to be sued!" But they need to clearly outline for you, then, what steps you need to take for you to show them that you're SURE, so that it's not just a guessing game of "I hope today's doctor isn't dismissively patriarchal!" but a clear set of steps of "Here's what I have to do to qualify for this surgery."

(Obviously these additional steps and counseling should be constructed and paid for in such a way that they do not exclude poor women or minority women from accessing the same services as wealthy or white women.)
posted by Eyebrows McGee at 12:02 PM on January 28, 2015 [25 favorites]

I'll share this only because I feel it's important. I'm one of those women who don't want children for selfish reasons. I once told people who asked me why I didn't want children that it was because I was too selfish to have a child. I want my life to be about me. I want to spend my money on my hobbies. I don't want the responsibility of raising a child. I had decided all of this from 16 years of age.

Then I hit 27-28 and that biological clock hit me like a ton of bricks. I remember sitting in a waiting room watching a kid play and being mildly annoying and thought .. "awww maybe a kid wouldn't be so bad"

The logical part of my brain spazzed the fuck out at that thought. I was like, "holy shit hormones wtf. This is what people meant when they said I'd change my mind!"

I'm still dealing with those feelings. It's this mental war going on in my head where part of me doesn't want kids and still doesn't think I'd make a good mother and this other part of me that says kids are cute and it wouldn't be so bad and lookit that baby and imagine the impact you could have on a little person! They could take care of you in your old age..

It's that second voice in me that feels out of my control. If I got pregnant tomorrow, that side would argue against the automatic abortion I always thought I would get. I know it scares the hell out of me because a part of me really doesn't want to be a mother and I'm worried that the Hormones will win.
posted by royalsong at 12:04 PM on January 28, 2015 [15 favorites]

You can't know what you don't know. Maybe you won't change your mind. Maybe it is paternalistic. But don't pretend that these kind of mindchanging things, or things that occur with age, don't happen at all, to anyone. It's a big decision, to completely kill your reproductive faculties, and it is reasonable to demand a lot of counseling first - particularly when the same effect can be accomplished without permanent procedures.

Fine, and if my SUDDEN desire to have children right at the end of my reproductive abilities after decades of not wanting them turns out to be hormonally driven and not a rational, well considered choice, and the SUDDEN change of heart turns out to have been completely wrong, will you take my children off my hands since you're the one who assumed that the SUDDEN choice is smarter than the well-considered ones? No? Oh, right, I didn't really think you would.
posted by janey47 at 12:09 PM on January 28, 2015 [8 favorites]

Royalsong, one of the loveliest things about having a tubal ligation is that I can see a baby and think "oh cute" and NOT have to wonder whether this means I need one of my own. It's actually been very freeing for me. I enjoy kids much more now. (not that I didn't enjoy them before)
posted by janey47 at 12:11 PM on January 28, 2015 [7 favorites]

At the age of 28, I had an extremely high-risk third pregnancy (after terminating the second ten years before, because of anaencephaly.) I had developed a pituitary disorder that made it unlikely to get pregnant, or to stay pregnant. Somehow, after that ten years, I got pregnant. My husband and I were like, ooooh, excite! It was unexpected but so very welcome!

Except, my disorder made it that aforementioned high-risk pregnancy. The previous neural tube defect made it a high risk pregnancy, so I had an amnio at 20ish weeks in. It did not come back normal. On account of a chromosomal defect, my kid had a cardiologist, a nephrologist, a geneticist and an endocrinologist before she was born. As for me, and my incompetent pituitary gland, I spent the last four months on bed rest because I was losing amniotic fluid.

When the baby started to lose weight in utero, the doctor figured it was time for an induction-- which I had. Successfully- Wee still has a chromosomal disorder and some physical disabilities, but all of her parts were in all the right places.

Now. I had gotten pregnant unexpectedly after a long bout with infertility, yay. But considering the previous pregnancy had to be terminated, and this pregnancy was a disaster for me and the Wee, I asked my doctor for a tubal. And despite the baby's disorders, my disorders, my history of disorders, and my oh-so-luxurious four months on bed rest, did my doctor say, "Of course! Makes total sense!"

Nope.

And he said, "I'll do it, but I want to wait at least six weeks after the baby is born. God forbid, something should happen to her, and you want another."

So yeah, I had to incur a second trip to the hospital and a second bill from the hospital, after a wildly disastrous third pregnancy, because hey maybe with all my history of genetic defects, incompetent pregnancies and intermittent infertility, I might still change my mind. On a whim or something. You know how us ladies are.

/spit
posted by headspace at 12:13 PM on January 28, 2015 [12 favorites]

Tubal ligation is abdominal surgery, though, requiring spinal anesthesia; while a vasectomy is an outpatient procedure with local anesthetic.

Laproscopic tubal ligation information.
posted by Buttons Bellbottom at 12:14 PM on January 28, 2015 [8 favorites]

If I decided to make the world a better place for all of you and yours by ending my line and reducing generations worth of future population pressure, does that go in the "selfish" category?
posted by ead at 12:18 PM on January 28, 2015

SMELLS LIKE BARBECUE!

No, it smells, albeit briefly, like an entire head of burnt hair. Just how revolting that may be is an imagination exercise best left to you, dear readers.

Also, the specialist who did it told me he gets paid less for this procedure by government health care than a vet charges to spay a cat.
posted by CynicalKnight at 12:24 PM on January 28, 2015 [2 favorites]

Both the Guardian and the Slate articles briefly mention malpractice lawsuits related to "wrongful birth" or post-sterilization regret, but don't really discuss them; I'd imagine that avoiding malpractice suits is a much greater part of the calculus on the doctor's part than these articles present. It doesn't matter if the suits are successful or not. If you are a doctor, then you will be sued at least once in your career. Generally, hospitals prefer to settle out of court, whether or not the lawsuit has merit, because it's cheaper than going to court. This has the effect of having a malpractice settlement on a doctor's record, and also cranking up the rate of malpractice insurance for that doctor. Ob/gyns, as you might expect, generally have the highest malpractice insurance rates.

Paternalism is an issue, but practical calculations about lawsuits can dominate these decisions on the part of doctors.
posted by Existential Dread at 12:24 PM on January 28, 2015 [2 favorites]

If I decided to make the world a better place for all of you and yours by ending my line and reducing generations worth of future population pressure, does that go in the "selfish" category?

HISTORY'S GREATEST MONSTER

Seriously, if more people who want kids have to adopt, why is that a bad thing? The foster system is so overburdened that they gave my late-50s deadbeat father and his late-60s equally-incompetent wife six goddamn kids to raise. But yes, we need more people procreating naturally! Dear God, what if you regret it later? WHAT THEN?!
posted by Holy Zarquon's Singing Fish at 12:26 PM on January 28, 2015 [2 favorites]

Buttons Bellbottom: "Laproscopic tubal ligation information."

Yes, laproscopic tubal ligations are a vast improvement on older methods, but they are still considered "major surgery," they still take place in your abdomen, and they still require spinal (or general) anesthesia, not local. They still take place in an operating room, while a vasectomy can be done at an outpatient clinic.

I'm not saying women shouldn't get them if they want them ... I'm just saying what Underpants Monster's parents' doctor might have thought a vasectomy for dad was a better option than a tubal for mom, to suit the need of "wanting mom not to get pregnant again." Most ob/gyns do counsel couples in permanent relationships as a couple when discussing things like sterilization or pre-pregnancy genetic testing or fertility treatments, where part of what you are deciding is which of the two partners should have procedures done. It's not crazy for an ob/gyn to say to a couple who say "we don't want [any more] kids," "The least-risky form of permanent sterilization for a heterosexual couple is a vasectomy, here are the pluses and minuses of that; here are other options in order of riskiness."
posted by Eyebrows McGee at 12:27 PM on January 28, 2015 [2 favorites]

can anyone explain why men don't get the same degree of pushback on this that women do?

Anecdotally, if you hang about on forums which discuss men's-health-type issues, you will find threads of men complaining because doctors have refused to perform a vasectomy without the consent of their partner. Not a "your partner should be informed", or a "have you talked to your partner", but a "without actual in-person consent from your partner, I will not perform a vasectomy on you".
posted by hrwj at 12:42 PM on January 28, 2015 [4 favorites]

I actually think that rather than hypothetical limbs or crucial senses, a better analogy for tubal ligation is preventative mastectomy for women who an inherited high risk of breast cancer.

A huge majority women have a genetic pre-disposition to fertility and most are at high risk of pregnancy. There are several possible outcomes with pregnancy, including chemical and surgical options for termination, and it carries a number of health risks up to and including death.

A much smaller number of women have a detectable breast cancer risk. There are several treatment options for breast cancer, including chemical and surgical options. Breast cancer is highly treatable and has a good survival rate, so prevention isn't strictly about avoiding death, it's also about avoiding the pain and discomfort as well as additional health risks related to cancer treatment.

It's not about comparing kids to cancer (I have a kid, she's great!), it's about comparing the impact of each on a woman. They both have an enormous effect on a woman's health and wellbeing, her income and savings, etc. And, you know, people practically threw a ticker tape parade for Angelina Jolie when she had her mastectomy. I doubt, somehow they'd do the same if she decided to have her tubes tied (even though she is an adoption proponent!).

I think tubal ligation and mastectomies also hit all the same notes about femininity and womanhood as well as the pre-occupation we have with policing women's bodies.
posted by looli at 12:51 PM on January 28, 2015 [11 favorites]

The term selfish in this context really riles me. Selfish is creating children you don't want and don't care for. Selfish is bringing unwanted children into an already over crowded world.

I am glad I live in a time and culture where I can opt out of having children. There are far too many of us as it is.
posted by Gwynarra at 12:52 PM on January 28, 2015 [10 favorites]

I ran across this issue yesterday in Killing the Black Body by Dorothy Roberts. She recounts many instances of mostly poor, black women and teenagers being coerced or tricked in to sterilization procedures and contrasts that with how very difficult it can be for a white woman to even get access to these procedures. Apparently there is/was an informal "rule of 120" used to refuse sterilization to women who's age multiplied by their number of children equals less than 120.

I was about to mention the race issue. It seems like even the least fit to be a parent White woman is going to be given 'reasons' not to be sterilized, while it's a highly encouraged operation for Black, or Native American or visibly mixed race women.
I think that is several orders of fucked up.
posted by Katjusa Roquette at 1:00 PM on January 28, 2015 [9 favorites]

I'm one of those women reaching the end of her reproductive years without ever having heard a single peep out of my supposed "biological clock." I'm glad I was never pressured to have kids. This is a Western luxury and I know how privileged we are to even be having this conversation.

I always sort of knew I wasn't into kids, even when I was a kid myself. And I've dealt with spates of body dysmorphia that had an impact on my decision as well. When you're already sort of grossed out by your own body, you definitely don't want saggy boobs and stretch marks because you would feel like a monster.

And the money thing? I never felt pressured to have a high-wage career because I knew I wasn't going to have to feed kids. So I chose to do stuff I wanted to do. None of it paid very well and I made mistakes along the way, but I thought that it was the better choice for me. One reason is because I know that I do not handle stress, and overextending myself, very well at all. I shied away from ALL on -call, 24-7 type jobs, not just motherhood. I'm not a doctor or entrepreneur either. I'm not mentally and physically constituted to be constantly on the go with very little sleep.

My reasons would probably come off as "I want to keep my figure and my money too" to some. I've certainly had my body dysmorphia dismissed as vanity time after time, and been accused of being irresponsible for not trying to find a cushy job.

Corb, I really wish you would bring your discussion out into the open instead of in MeFiMail. You're entitled to your opinion. It won't hurt my feelings or make me wonder if I'm selfish. But I am interested in seeing this debate brought out into the open, in general. I chose not to feel silenced when you (unknowingly) intimated I was one of the selfish ones.

For those saying, "no one REALLY has those reasons!" I guess you're mistaken because my body image and time expenditure (and time equals money) really do factor into it. I don't consider myself selfish or shallow. I know exactly why I don't want my body affected and exactly why I think kids are too expensive for me. I bet if you dig a little deeper into other women who use the body/money reason you're going to find that it's more than just "oh tee hee, I want to keep my girlish figure and all my bling!"
posted by Beethoven's Sith at 1:01 PM on January 28, 2015 [24 favorites]

Young men certainly get pushback from urologists, and I had several friends get rejected multiple times when we were in our 20s. One of them, instead of the "you'll change your mind" lecture, got "You're not monogamous and I won't give you an excuse not to wear condoms" (this was the 90s when AIDS was still a death sentence) which...could certainly have been phrased as information to consider rather than a reason to refuse, but I do get his point.

I am fairly certain my husband's urologist said something in passing about "your wife's okay with this?" but I suspect if my husband had shrugged and said no, it wouldn't have stopped anything.

Anyway, all the regret policing is such bullshit. Everyone makes decisions every day that they might regret later, and if you do something today that you regret in the future (without killing someone else or ruining someone else's life), so fucking what? Live with it. Figure out another way to accomplish the thing. Go on the road telling people how much you regret it, if that makes you happy, but you don't get the right to grant or deny permission to me because you're fickle or more risk-averse than me.
posted by Lyn Never at 1:02 PM on January 28, 2015 [6 favorites]

Eyebrows McGee: Yes, laproscopic tubal ligations are a vast improvement on older methods, but they are still considered "major surgery,"

Good point. I had laproscopic gall bladder surgery in a "surgical clinic" of some sort now that I've turned on my memory machine. Friends who have had it described it as an easy surgery (also did a c-section and some cosmetic surgery), I may have overlooked the GA/spinal aspect.
posted by Buttons Bellbottom at 1:07 PM on January 28, 2015

Hilariously, I listened to the first episode of the Dear Sugar podcast on the way home today without reading the episode description, and a big chunk of it is about a woman with two children trying to decide if she's a selfish monster for not wanting a third. This cultural pressure stuff about How To Be A Woman Properly is really, really pervasive.
posted by Stacey at 1:26 PM on January 28, 2015 [4 favorites]

I basically like my (male) gyno, but even he tried to push back on me a few months ago when I wanted to schedule a tubal ligation.

Since I'm almost 50 and rarely run the risk of pregnancy, his reasoning may have been "why bother, use something else instead"... until I told him truthfully that my mom had her period into her sixties. At that point he started checking his surgery schedule.
posted by Sheydem-tants at 1:27 PM on January 28, 2015 [2 favorites]

Here's my little no-kids anecdote - I never wanted kids. And then I hit 28 and I still didn't want kids. And then I moved in with the man I eventually married, and I turned 35 and I didn't want kids. And then we got married when I was 37, and I still didn't want kids. I could go on to present day, but I assure you it gets repetitious.

As someone who fairly recently had elective major surgery, this resistance to sterilize women who ask for it is even more frustrating than ever to me.

Here's how my conversation went:

Me: I would like a breast reduction.
Doctor: Here is some information about breast reduction.
Me: Yes, good, I want that.
Doctor: I have examined you and you are a good candidate. Your insurance will pay. Let's schedule the surgery.

And then I had general anesthesia and 4.5 POUNDS of flesh and ducts removed. That's some serious surgery right there.

No counseling, no asking permission from my husband or insisting I "inform" my husband, no boo-hoo about breast-feeding, no fucking around with regrets or whether I was really sure. And thankfully, no fucking around with trying to make me lose weight to prove I was worthy.

All around it was such a lovely experience of body autonomy and being treated like a rational adult who knew what I wanted.

I am enraged that women cannot have the same autonomy over their reproductive choices.
posted by Squeak Attack at 1:30 PM on January 28, 2015 [15 favorites]

Oh and also yes, women who decide not to have children can only be considered selfish for that choice if you think they are otherwise OBLIGATED to have children (barring a super-duper, iron-clad, morally righteous reason.)

Obviously, that's about as un-feminist a viewpoint as I can possibly imagine.
posted by Squeak Attack at 1:36 PM on January 28, 2015 [16 favorites]

I am another who has no children and is now entering the menopausal years and has never felt a single twinge from the biological clock. So fucking sick of the "selfish" argument.

But if the person I'm talking to is kind of the epitome of conspicuous consumption - which is a real thing that I've seen, those reasons I mentioned above - and they say something like "Well, I"m worried about my ability to afford artesanal cheese and fancy ruin-porn vacations, and god, I don't want my body to be ugly.." then yeah, you bet I'm going to judge this as just another instance of their extreme selfishness, which is a thing that permeates the rest of their life.

So if you place two overconsumers of equal lifestyle next to each other, and one has kids and one doesn't, do you see the childless one as automatically more selfish? What about if they take the kids on their vacations? What about if they bring their children up to live the same over-affluent lifestyle? Let's take a person who epitomises conspicuous consumption, but who does choose to have kids, because they can afford nannies and plastic surgery to sort out the baby body and artisanal cheeses even after that. Does the mere act of having children make them somehow less selfish than the childfree person?

I find myself unable to articulate any relevant moral difference between that scenario and the "please sterillize me," scenario, except that many more people value their sight (say) than their baby-making ability.

The difference is that if you are a human being who has grown up with all your limbs and senses working, and are living a productive and participatory lifestyle, you almost certainly rely on all your working limbs and senses in your daily life. My reproductive organs are not things I rely on to live my life. In fact, at times they impede my life.

Also, my eyes aren't capable of producing a new human being who will be dependent on me for the next couple of decades.
posted by andraste at 1:40 PM on January 28, 2015 [9 favorites]

I'm one of those women who don't want children for selfish reasons.

I hope that you will reconsider this language, after this thread. You are not harming anyone by feeling or choosing not to have children. Therefore, your reasons are not selfish.

The word selfish is a label and insult that our male-dominant society has applied to women for not complying with what it thinks a women's role is (barefoot, pregnant, obeying, deferring judgement on all Important Matters such as our own bodies). It is, in fact, selfish of society to expect all women to bear children. That results in harm to others.

By using the term to describe yourself, you are both showing that you have internalized this sexism, and you are spreading those sexist values to others.

So I hope you will consider another way to describe yourself.
posted by Dashy at 1:44 PM on January 28, 2015 [5 favorites]

Many women have excellent reasons for not wanting to have children

I've given this some thought, because it stuck in my brain. The thing that I kept wondering about was: are there any bad reasons for not wanting children?
And the truth is, I can't think of any. Not even if I try with both hands.

Absurd reasons? Dumb reasons? Reasons that make no sense at all? Frivolous reasons? Selfish reasons? They're all fine. Or do we really want to see children born to mothers who are that absurd, dumb, frivolous and selfish and make no sense? What good would that do, who would it benefit? No one.
Having a child is not inherently better than not having one.

No one needs a reason, good or bad, not to have a child. Not wanting one will do just fine.
posted by Too-Ticky at 1:49 PM on January 28, 2015 [22 favorites]

I'm glad that I'm 29 already--maybe if I decide at 30 I want to be sterilized, I might maybe maybe not face enormous pushback?

The idea that not having children is selfish is so ingrained in our society that I still worry that I'm selfish, no matter how much I intellectually know that I'm not and how many reassurances I read. Kitteh's comment about how people say her husband "would have been a wonderful father" really resonates with me--I can't shake a feeling that I'm going to let down my partner by not wanting kids. And yet, should I be expected to have a baby so as not to deprive a man of something? Ugh.

Also, on the note of reasons, I don't know that I really have reasons for not wanting kids. I mean, I can come up with some reasoning, and have told it to people, but really there is just this visceral sense that children aren't for me. For as long as I can remember I have never wanted a child. I don't think that women should have to have a good reason, or any reason, not to have kids; not wanting to should be reason enough.

(oops, jinx, Too-Ticky!)
posted by ferret branca at 1:56 PM on January 28, 2015 [5 favorites]

Because I'm fat (though in a chic way, I think), I already have the requisite, fashionable stretchmarks. But I would consider my life an unqualified success if I got to spend the rest of it traveling to various exotic destinations, eating artisanal cheeses, drinking fine wines, having delicious lovers, writing and never being burdened with anything resembling progeny. See also: why I don't particularly want to adopt a dog, buy a house or do anything that resembles "farming." Perhaps that's selfish, but if it makes you feel any better I'll always vote for better education and probably buy your kid's girl scout cookies (speaking of, I still need two boxes of Thin Mints, Brownie-breeders).
posted by thivaia at 1:57 PM on January 28, 2015 [12 favorites]

I might as well post the Bolivia link while we're at it. Someone might not have read it yet.
posted by Too-Ticky at 2:00 PM on January 28, 2015 [6 favorites]

I never wanted kids. I announced it at the dinner table at age 6. I also proclaimed that there was no god. I stand by those statements 40 years later. I don't know why I said it when I was so young. I had a great childhood.

I had cats as pets forever and then two dogs and decided (or confirmed) that was the level of responsibility for another living thing that I was comfortable with. Selfish? Maybe? So what.
posted by futz at 2:04 PM on January 28, 2015 [4 favorites]

I think what gets overlooked in these conversations are the ways choices we make (and those made for us) change who we become. The woman who requests sterilization at 20 and receives it with minimal fuss can potentially become a very different person than the woman who requests sterilization at 20 and is denied it. Same 20-year old woman, two life paths. Woman A now knows that she will never have her own biological children. She dates accordingly, screening more seriously for family-choice compatibility in partners, bringing the topic up sooner in the course of relationships. She may have different career paths open to her if she decides to disclose her fertility status at work or during interviews, as discrimination against women of childbearing age is pervasive and negatively impacts their opportunities for advancement in the workplace. Woman A is likely to mold her life around the decision not to be a biological parent, and to do so comfortably knowing that the deliberation and uncertainty is behind her, and she is now free to build the life she wants without looking back.

Woman B (denied her choice to elect sterilization at age 20) doesn't have to bring up children as early in romantic relationships, or if she does bring it up she is less likely to have her desire to remain childless taken seriously. She may well end up with a different partner, one who does want children. Woman B may opt to disclose her desire not to have children to bosses and potential employers, but if they are the kinds of bosses and employers who are likely to discriminate against women based on the possibility that they may have children then they are unlikely to take Woman B’s assertion at face value without a medical procedure to back it up. Woman B may be less successful in her career as a result, make less money, and have less job satisfaction. And with a partner who wants children and a less rewarding career, Woman B may well change her mind and decide to have children.

In no way does Woman B’s decision to have children later in life indicate that Woman A would ever regret her decision to be sterilized. They are two different people whose lives diverged based on the actions of their doctors. The choices we make, and the ways our choices are circumscribed by others, impact who we are. We really can’t make any assumptions about how a woman’s wishes to bear children will change after sterilization based on our knowledge about the childbearing wishes of women who are not sterilized. They are not the same people. And neither doctors nor women’s romantic partners nor the well-meaning public should have the power to override women’s decisions about what kind of people they wish to become.
posted by philotes at 2:07 PM on January 28, 2015 [26 favorites]

I guess I should also add, I suppose having a child for the sake of my male partner would arguably be the epitome of a non-selfish act. It would also be a recipe for disaster and resentment.
posted by ferret branca at 2:09 PM on January 28, 2015 [3 favorites]

Oh, and no sterilization for me becuse no doctor would believe me.
posted by futz at 2:09 PM on January 28, 2015

"Doc, I'm thinking about getting a tubal ligation. I've heard that it can prevent that sexually transmitted parasite that all of my high school class-mates seem to be getting for nine months at a time."
posted by VTX at 2:15 PM on January 28, 2015 [9 favorites]

Also, the specialist who did it told me he gets paid less for this procedure by government health care than a vet charges to spay a cat.

In fairness, I suspect few vasectomy patients claw the living fuck out of their doctor's forearms.
posted by phearlez at 2:27 PM on January 28, 2015 [19 favorites]

A good friend of mine is terrified of pregnancy and childbirth
I don't consider that to be the same thing as not wanting children. One can feel a strong desire to be a parent, and at the same time be scared to death of pregnancy and childbirth.
posted by Too-Ticky at 2:29 PM on January 28, 2015

I don't see the term of selfish as.. bad? I mean, i know it typically is spoken as a negative.. but to me it's my reason why I don't want children. I don't take the selfish remark as though it's wrong of me not to reproduce. I take it as ownership of ability to be a mother. I am very me-centered. That's not fair to a child to have a mother who's focused more on herself.

Ugh, I'm not sure if I'm actually making any sense. I understand what you're getting at, and I know there is some embedded sexism in me, but not over this particular topic.
posted by royalsong at 2:30 PM on January 28, 2015

28% of women express a desire for sterilization reversal when directly asked.
posted by fermezporte at 2:31 PM on January 28, 2015 [3 favorites]

A good friend of mine is terrified of pregnancy and childbirth

I hear adopting is a thing, or hooking up with someone who already has a baby, or if you're a woman who loves women seeing about whether your partner wants to get pregnant. I've always found the idea of being pregnant horrifying and I also don't want to raise kids, but I see these as two different issues.
posted by bile and syntax at 2:42 PM on January 28, 2015 [4 favorites]

28% of women express a desire for sterilization reversal when directly asked.

I've been looking for a percentage of people who express a desire for having their parenthood reversed, but oddly, no one wants to talk about that.
posted by Squeak Attack at 3:04 PM on January 28, 2015 [25 favorites]

About half of pregnant women incorrectly believe that hormonal contraception is more dangerous than pregnancy. The overall risk of death for young healthy nonsmokers using oral contraceptives (OC) is 240 times lower than the risk of death from pregnancy-related complications, according to the researchers.
posted by Squeak Attack at 3:09 PM on January 28, 2015 [3 favorites]

I find the discourse of "selfishness" completely revolting in this context. It's obvious that it's only a "selfish" decision if women are expected to have children and "owe" it to their husbands or society or their fathers of all people (I literally gasped aloud at dotgirl's anecdote, it made me so mad) to bear children. There is absolutely nothing wrong or selfish with deciding that you don't want to devote a huge proportion of your resources to having children, for any reason no matter what, full stop.

If we were in the midst of some global underpopulation crisis, the selfish critique might have some point. Since we're in the midst of the exact opposite, one could easily argue that it's the people having kids who are selfish. Invoking selfishness or conspicuous consumption when not having a child (or even just having one fewer child) has by far the biggest effect on your global resource footprint is completely foolish. "Under current conditions in the U.S., for instance, each child ultimately adds about 9,441 metric tons of carbon dioxide to the carbon legacy of an average parent – about 5.7 times the lifetime emissions for which, on average, a person is responsible."

Finally, this paternalistic bullshit framing about protecting women from their regrettably mercurial feelings is damaging whether or not some women actually do regret their decisions. If some significant portion of women do end up regretting their sterilization, that seems like it would be perfectly valid information for a woman to consider in her decision, and I could even understand some sort of counseling requirement before performing the operation. But it is absolutely not a valid reason for anyone to deny her whatever informed choice she wants to make, because unless we're talking about teenagers, these are adults with agency in their lives. They should be free to make decisions about their own bodies and we should assume that they are capable of dealing with the consequences, just like any other adult decision with far-reaching and often unpredictable consequences.
posted by dialetheia at 3:14 PM on January 28, 2015 [21 favorites]

I saw a billboard by the highway for a clinic that does vasectomy reversals. I thought, who the hell is driving, wishing there were more children in the car with him??
posted by Cookiebastard at 3:19 PM on January 28, 2015 [9 favorites]

I saw a billboard by the highway for a clinic that does vasectomy reversals.

I haven't noticed one in a while, but for a long time I would see billboards all over the US for a vasectomy reversal clinic in Houston. Clearly enough men want reversals to have made it worthwhile to do a national advertising campaign.
posted by Dip Flash at 3:25 PM on January 28, 2015

enough men want reversals to have made it worthwhile to do a national advertising campaign

It's the other way around; there aren't enough men in Houston who want reversals to support the clinic.
posted by localroger at 3:31 PM on January 28, 2015 [5 favorites]

I've been looking for a percentage of people who express a desire for having their parenthood reversed, but oddly, no one wants to talk about that

A handful of people have randomly admitted this to me when I talk about how happy I am to have been deuterused. One of them was my male gastroenterologist so I'm not sure if that counts or not.
posted by poffin boffin at 3:44 PM on January 28, 2015 [3 favorites]

I had a friend who was sterilized -- not sure what procedure -- in her 20s. In her late 30s or early 40s, she decided she wanted to have children with her new husband. So she adopted. And she said, in so many words, that she absolutely didn't regret getting it done. Of course this is just another one person's story, but it isn't the case that changing your mind about having children necessarily means regretting earlier decisions.
posted by jeather at 3:58 PM on January 28, 2015 [6 favorites]

I didn't have a strong feeling about kids one way or the other when I was young, but when I got divorced at 28, I was pretty sure that was going to be it for kids. (I didn't expect to remarry. I was wrong.) I had a good cry over closing that door and got on with my life. Later, when I had to stop taking HBC because of side effects, I was happy to be surgically sterilized and I have no significant regrets even now, more than a dozen years later. By contrast, I'm regularly happy that I don't have kids. People sometimes feel differently when they get older, but not always in the way you think.

I was lucky in that I was past 30 when I actually went to have the surgery done, my husband supported the idea to the point where we argued about who was going to get the snip, and the doctor who referred me was my family GP from childhood, who knew I was serious about never having kids. I didn't have trouble getting the surgery, but I'm aware I was fortunate. (Also: heritable health issues, which is not so great, but probably eased my way.)
posted by immlass at 4:20 PM on January 28, 2015 [3 favorites]

About "you'll change your mind." I did not want kids when I was young (teens-early 20s.) Then in my early 20s, I changed my mind. But what I never even considered for a second while I did not want kids was going to a doctor to ask to be sterilized. To me there's a huge difference between a woman who just doesn't want kids and one who actively seeks out sterilization. If someone feels strongly enough about it to try to schedule the procedure, that should be proof enough. That woman is not going to change her mind. And if she does, like so much else in life, oh well. It's not like no one ever lives with any regrets.

Yes - this exactly. There was a period of time in my late teens when I was fairly sure I didn't want kids. But, I wasn't 100% sure, and I wouldn't have considered sterilization, because I knew that I might change my mind. I wonder how many of the women who didn't want kids in their early 20s or so and later chose to have kids fit into this category - people who never would have considered sterilization in the first place.

And frankly, I don't have a problem with the idea that some women might choose to be sterilized and then regret it. We let 18-year-olds get breast enlargement surgeries. Some of them later regret it. We let 18-year-olds get large, visible tattoos. Some of them later regret it. It's certainly unfortunate when someone regrets a decision they made, but that in no way means that they shouldn't have been allowed to make the decision.

(Also, women who have had a tubal ligation can still carry a pregnancy using their own egg using IVF - expensive, yes, but possible.)
posted by insectosaurus at 4:54 PM on January 28, 2015 [4 favorites]

Hell, we let 18 year olds join the army without counselling and that can kill them. Compared to that, sterilization is as life-impacting as choosing to have ice cream for dinner.
posted by the agents of KAOS at 5:04 PM on January 28, 2015 [23 favorites]

Meanwhile we force kids under 18 to have unwanted children because, idk, some dude wrote a book 2,000 years ago or something.
posted by poffin boffin at 5:11 PM on January 28, 2015 [14 favorites]

I actually have given up on the pursuit of sterilization for the moment, due to finding a birth control that works fine and watching some family members deal with a cascade of unintended consequences from seemingly minor surgical interventions. (Basically, if it ain't broke I guess I won't try to fix it right now.) The worst part is having to convince my mother again and again that this (possibly entirely temporary!) shift in my thinking does not in any way mean that I'm giving her any grandkids after all.

What was said above about the freedom granted by making the no-baby decision early and solidly? Absolute truth. A fellow childfree friend (who actually did get the snip, and even though she Went Through Some Shit as a direct result, has no regrets at all) and I have often discussed how simple and straightforward our life-planning efforts seem to be in contrast to friends who want kids. And *especially* in contrast to our friends who are unsure, either of wanting kids or of being able to find a partner in time.

Sometimes it feels so luxuriantly awesome to have this choice that corb could call me selfish all day long and I'd still just want to hug her out of pure, childless joy. ;)
posted by We put our faith in Blast Hardcheese at 5:31 PM on January 28, 2015 [10 favorites]

Then I hit 27-28 and that biological clock hit me like a ton of bricks. I remember sitting in a waiting room watching a kid play and being mildly annoying and thought .. "awww maybe a kid wouldn't be so bad"

The logical part of my brain spazzed the fuck out at that thought. I was like, "holy shit hormones wtf. This is what people meant when they said I'd change my mind!"

I went through this in my early 30s, and again a couple years ago when all my friends were having kids. It kind of took my breath away, because I didn't want kids, so why was my brain all of a sudden baby crazy.

It's now passed or at least in remission, and I can say that I still do not want kids. But it was weird having this duality of something in me being tugged towards wanting a child and yet every time I sat down and really thought through what having kids would mean, I still came up with a don't want kids answer.

It was much easier after that; I was aware that the urge was either hormonal or social, but it wasn't really me. So I just enjoyed other people's kids without having the life-altering repercussions of my own. It was kind of surreal though knowing I was feeling a way that I also knew to be false.
posted by [insert clever name here] at 5:55 PM on January 28, 2015 [4 favorites]

There was an older lady in the town where I grew up, who used to talk about her "tubilation" surgery. It just sounded so happy and joyful!
posted by The Underpants Monster at 6:15 PM on January 28, 2015 [3 favorites]

Oh my gosh, I'm in my early 30s and this is exactly how I feel:
But it was weird having this duality of something in me being tugged towards wanting a child and yet every time I sat down and really thought through what having kids would mean, I still came up with a don't want kids answer.

I decided when I can successfully rear a puppy we can think about a baby. I don't think I could even get that far.
posted by bleep at 6:34 PM on January 28, 2015 [2 favorites]

It really wasn't until my early 30s that, when I ovulated, I was like "PUT A BABY IN ME NOW, WHATEVER YOUR NAME IS", and then "WAIT NOOOOO!"

It felt like such a betrayal, like I had no idea my body was so prepared to end-run my considered feelings on the subject. And I had so much trouble with contraception that I ended up charting just so my husband and I could abstain in the danger zone (sorry).

I have never asked for the full story, but my mother got her tubes tied when I (an only child, and allegedly a "chill toddler") was 3. That would have been in 1975 in small-town East Texas, and I have not ever asked my mom what she said/did to make that happen, but I am in awe of whatever she did (or whatever the hell I did). She really needed a hysterectomy, for crippling endometriosis, which she didn't get until I was 14.
posted by Lyn Never at 6:50 PM on January 28, 2015 [2 favorites]

You all are invited to my No Babies For Me, Ever party if I get the procedure this year. I have never wanted children. Even as a kid I found the idea of playing house or otherwise pretending to be a parent revolting. I wanted a tubal ligation at age 18. "But what if you regret it?" my SO whined. "Wait until your biological clock starts ticking."

That phrase still infuriates me. The idea of pregnancy fills me with such visceral body horror that I'm reminded of that scene from Alien.

I'm also genderqueer, I have several very heritable disabilities including chronic pain, I have delayed sleep phase syndrome so my days and nights are reversed, and my parents are abusive and dysfunctional and clinically insane. I would not subject a child to the hell that would be inheriting my genes.

I look forward to a life of comparative freedom over my travel plans, my hobbies, and my sleep schedule. Bring on the artisanal cheeses. (In fact, that sounds like a great gift for the No Babies For Me, Ever parties.)
posted by quiet earth at 7:11 PM on January 28, 2015 [5 favorites]

I would be happy to attend a NBFME party, but it must be similar to a baby shower in the following ways:
*Streamers and themed decorations in bright, cheery colors (baby animals preferred but optional)
*Baked goods with frosting AND sprinkles
*A gift registry with a wide array of options to choose from, so I can go practical, cutesy, snugly, or however else I feel
*All sorts of people in attendance I don't know and will never see again
*Just enough booze to make it seem naughty that we're drinking it
*Somebody has to wear an awesome big stupid hat
posted by ThePinkSuperhero at 7:51 PM on January 28, 2015 [6 favorites]

I have two kids and I totes go to "NO BABIES!" parties and bring cool presents. I also bring lots of alcohol to "YAY WE'RE DIVORCED!" parties.
posted by Eyebrows McGee at 7:58 PM on January 28, 2015 [5 favorites]

Many women have excellent reasons for not wanting to have children

Any reason a woman has for not wanting to have children is an excellent reason.

Don't want stretch marks? Excellent reason.
Heritable diseases? Excellent reason.
Cats are better than kids? Excellent reason.

The only non-excellent reason is coercion. The solution to that problem is, however, castration and not tubal ligation.
posted by feckless fecal fear mongering at 11:04 PM on January 28, 2015 [11 favorites]

The idea that there are selfish reasons for abortion is not one I have a lot of time for, but it is at least one I can see how other people might end up getting behind.

The idea that choosing not to have children could be a selfish decision - especially given that we don't right now have the resources to go round for all, you know, *existing* children - is baffling to me.

And further, just throwing in that you'd expect that selfishness to permeate the rest of those women's lives - jesus, that's just pointless shittiness.

Once again we've got people banging on women, shrouded in the thinnest veil of "polite" language. How long ago was the meta on this?
posted by ominous_paws at 11:54 PM on January 28, 2015 [10 favorites]

People who are concerned they won't be good enough parents, or they have severe medical conditions? No one accuses those people of being selfish.

Not true. I have been accused of being not just selfish for having exactly these reasons, but also wrong. Apparently I'm not just incapable of making my own reproductive decisions, but also of judging my own parenting capability. It's tempting to give those judgers all the gory medical and family history details, but that'd be a real downer and I try to be as courteous to others as I wish they'd been to me.

How many people have you seen swearing a blue streak at their kids with hate in their voices, or read about in neglect and abuse cases in the news? How many of your friends would admit in quiet confidentiality that maybe they would have been happy without kids, or would have liked fewer than they have, but were swayed by other people's opinions?

Maybe if we as a society treated parenting with real respect for the difficult and life-consuming work it is, we'd reverse the situation so that you'd have to jump through hoops to prove you wanted to have children, while there was plenty of easily-obtained and effective contraception and sterilisation for anyone who didn't or was currently undecided.
posted by harriet vane at 5:19 AM on January 29, 2015 [9 favorites]

Speaking of selfish motives, the idea of raising children seems so horrible to me that I have to suspect that people only willingly put themselves through it because they want to load their own failed aspirations onto the child, or because it's their retirement plan.

This is really offensive, as are some of the other comments along these same lines of "parents are actually the selfish ones."

Look, everyone has to find their own meaning in life. Some find it in travel and concerts and artisinal cheeeses, or their romantic lives, or their work, or helping the homeless and the abused, or all of the above. But some find it in their relationships with those snotty, screaming, squirming, helpless, trusting, adoring little explorers for whom the whole world. And who, if you're very lucky and very good at parenting, can grow up to be people who understand you in a way that no one else does and love you anyway, even after you're gone.

There are people out there who can't have kids for whom it is legitimately a tragedy, and I don't like the way comments like this trivialize their grief. (And even though no one in this thread has ever regreted their sterilization, some of those people are even people who gave up their fertility voluntarily.) There are people who don't miss their fertility any more than they would miss their appendix, but there are also people for whom it really is more like missing a limb.

And if I never hear the phrase "just adopt" again, it will be too soon. There is no such thing as an uncomplicated adoption. Adoption means someone is giving up their child. In the US or UK, this usually happens because the child has special needs or a traumatic past, often leading to behavior problems. With international adoption, healthier babies may be available, but the parents may not really be giving them up willingly. It's hard to truly know.

I'm a feminist and a working woman, and the last thing I want is a world where all women are forced into the roles of "reproductive specialist" and "childcar worker" whether they want to be or not. I'm a huge fan of birth control, and I get that sterilization is just the form of birth control that works best for some people. I get that, just as I don't want ten kids, some people don't want any. But I don't like the way threads about this subject treat infertility as no big deal. It's the right decision for some people, but it's still a big decision.
posted by OnceUponATime at 5:24 AM on January 29, 2015 [8 favorites]

I don't think anyone in this thread is out to trivialize infertility. Many people here are pointing out that claiming childfree women are selfish doesn't hold up logically, because you can make just as many similarly flawed arguments about women who have children. Maybe reproductive choices don't actually tell you anything meaningful about someone's moral fortitude or sense of altruism. Infertility is one more reason you shouldn't judge a woman's entire character based on her reproductive choices: you don't actually know if they were choices.
posted by almostmanda at 5:42 AM on January 29, 2015 [8 favorites]

Complaints about "trivializing infertility" in this thread is the equivalent of "what about the men?" in a feminist thread. I'm sorry only 99.99% of culture is massively pro-having children, but yeah, infertility is pretty much universally treated as a tragedy.

OnceUponATime: Speaking of selfish motives, the idea of raising children seems so horrible to me that I have to suspect that people only willingly put themselves through it because they want to load their own failed aspirations onto the child, or because it's their retirement plan.

This is really offensive, as are some of the other comments along these same lines of "parents are actually the selfish ones."

Is it really offensive, or is it just as offensive as saying requesting sterilization is equivalent to requesting to be blinded or having a healthy limb removed?

can grow up to be people who understand you in a way that no one else does and love you anyway, even after you're gone.

If not having children because you don't want them is selfish, then having children because you want them is selfish. The "offensive" post you quoted is simply responding to the "selfish" train of thought articulated above.

But I don't like the way threads about this subject treat infertility as no big deal.

The error is you conflating unwanted natural infertility with chosen medical sterilization. This is akin to saying we're not being respectful enough about the tragedy of miscarriage in an abortion thread.

Just like abortion might be a big deal for a Catholic, infertility is a big deal for someone who wants children or is conflicted. For people who don't want children, the "big deal" around sterilization is around logistics, getting a doctor who will do their job, and dealing with people who will judge them about not being properly feminine, reverent towards motherhood, regretful, etc.
posted by spaltavian at 6:08 AM on January 29, 2015 [10 favorites]

Yes, almostmanda, that's exactly what I was getting at. I don't really believe what I said above; it's just the conclusion I am pushed towards when I allow myself to reason within the frame of reproductive selfishness.

The problem is the frame itself. The more debates I participate, the more convinced I become that logic isn't very useful for settling them because the conflict reduces differing definitions for words.
posted by I-Write-Essays at 6:10 AM on January 29, 2015 [2 favorites]

I thought the subject of the thread was less "is it selfish" and more "shouldn't it be easier?" (Yes, I think it should be, but...)
posted by OnceUponATime at 6:18 AM on January 29, 2015

I am not sure anyone was really saying it shouldn't be easier (for varying notions of "easy," all of which are easier than "impossible"), and we got to discussing how to make it easier, and this led to the topic of how to dispel common rhetoric used for justifying it being difficult, such as the notion of selfishness.
posted by I-Write-Essays at 6:24 AM on January 29, 2015

The word "selfish" is right there in the thread title. It's a common accusation of childfree women and is absolutely relevant to this discussion.
posted by almostmanda at 6:36 AM on January 29, 2015 [9 favorites]

There was an older lady in the town where I grew up, who used to talk about her "tubilation" surgery. It just sounded so happy and joyful!

Kind of like "jubilation!" As in, how one feels while eating artisanal cheese while on a ruin-porn tour with a group of interesting adults.

(Haven't had the surgery, but sign me up for the NBFM festivities. I'll bring the Gruyere.)
posted by Beethoven's Sith at 7:27 AM on January 29, 2015 [4 favorites]

I am not sure anyone was really saying it shouldn't be easier

It was flat out said by someone that it's "reasonable to demand a lot of counseling first". This is certainly arguing that it shouldn't be easier. When you see people argue that sterilization is like requesting to be blinded or have a limb removed, and that doctor's a resistant because people change their minds (rather than sexism, beliefs that everyone should want children, etc), I can only interpret that as support for not making it easier.
posted by spaltavian at 7:30 AM on January 29, 2015

Major props to everyone posting here for helping me dig out some of my own latent internalized misogyny and come to grips with the fact that the only reason you ever need to not have a child is simply to not want to have a child. That's it! There are no "good" or "bad" reasons, let alone "selfish." Whatever your reasons are, that's all you need, and you don't owe anyone an explanation or justification under any circumstances whatsoever.

I hail from an overwhelmingly Catholic region of the upper Midwest, so culturally speaking, it's de rigueur to be married with at least one child before you hit 30 25 22. I've spent my whole adult life (my whole post-adolescent life, really) having to defend my decision to be childfree to nearly everyone I meet at one point or another. Carrying around this invisible load of defensiveness for so long appears to have gradually morphed into a deeply misogynistic belief that I need to give "good" reasons to support my decision -- "good" meaning "I think people are less likely to give me shit about being childfree if I say this" -- but this thread has made me realize that I don't ever have to give anyone any reason at all. Whee!

Who gives a tenth of a damn whether anyone else on earth thinks our reasoning or decision-making abilities are sound? Who cares if they disagree or want to accuse us of being selfish? Going all-in on a profoundly DGAF attitude about the whole to-do feels so great, and it wasn't until I read everyone's comments that I realized I had never really given myself permission to feel that way before. The Bolivia link Too-Ticky posted has rocked me to the core of my being. Thanks for the reality check, MeFi.

On a lighter note, while I'm afraid I won't be able to offer artisanal dairy cheese or animal-based charcuterie at my NBFME! party, as I am a longtime vegan who does not consider either of those things to be food, if you're all OK with artisanal cashew cheese and Field Roast grain meat charcuterie piled high atop fancy homemade crackers, we're good to go.
posted by divined by radio at 7:35 AM on January 29, 2015 [17 favorites]

It's a common accusation of childfree women and is absolutely relevant to this discussion.

It was made right here in this thread.
posted by poffin boffin at 8:12 AM on January 29, 2015 [3 favorites]

and cashew cheese is an abomination unto the lord.
posted by poffin boffin at 8:13 AM on January 29, 2015 [5 favorites]

Suggesting "a lot of counseling first" is in some ways offensive, but in other ways (at least to me) is very not much so.

Let me back up. In the state where I married my current spouse, you can get a marriage license and pay $X money for it and then a week or so later you can get married.

Or, you can get a certain number of hours of "spiritual counseling" (ugh ugh ugh, can I go to a football game with my atheist notary public instead) from the person who is going to perform the ceremony, pay less for the marriage license and get married the same day.

The reason I don't object to counseling or a waiting period for permanent sterilization is this: it's a damn sight better than going to several dozen docs over the course of several dozen years and be told no for one reason or another that has nothing to do with anything you feel is pertinent, but is for the doc.

And, if there is a statutory path that includes, say, two consults and a statutory pamphlet and like a six week to six month waiting period (with exceptions for those who have documented desire to be sterilized from someone like a therapist or who has an immediate medical need), then that's fine. It's better than going to several dozen docs over the course of the years etc etc and being told no for spurious reasons.

It puts it on par with folks who go in for weight loss surgery ... X documented length of time trying to lose weight and/or medical necessity plus a psych consult. (Yes, I know some folks who have Federal Employee BCBS does not have the waiting period for bariatric surgery but most other people do).

Right now, the path to sterilization is a whole lotta bullshit. Give me a bulleted list to follow and the rest of the world can go take a flying leap.
posted by Buttons Bellbottom at 9:12 AM on January 29, 2015 [5 favorites]

I think people may be reacting to the phrase "a lot of counseling first" by interpreting this as a lot more counseling than you might have for other surgical procedures. Counseling is a necessary step in the communication between doctor and patient when making surgical decisions, but this particular procedure shouldn't be any more difficult to schedule than anything else with similar risks and post-surgical needs. Making it so difficult to acquire a tubal ligation, including all of the continual hoops woman are asked to jump through as well as the aggressive questioning of motives, smacks of patriarchy and guardianship.
posted by blurker at 9:32 AM on January 29, 2015 [1 favorite]

It's strange to me (and suspect) that regret fuels so much of the discussion around this topic. Part of being an adult is making life-changing decisions. Many of these decisions probably lead to regrets for the people who made them. But how many of these decisions have elaborate frame-works built around them to protect the decision-maker from possible future regrets?

It seem insanely patriarchal to frame this entire conversation about future possible regrets of a minority of women who have the procedure, rather than on the non-regrets of the majority.

I work with undergrads at a large state university. It might make sense to have a counseling program and waiting period before these kids took on crippling debt for lousy degrees that won't make them employable but there isn't any such program. I talk to alumni and many of them have deep regrets for taking on so much debt. Is the entire system therefore built around preventing those regrets? Ha ha no.
posted by Squeak Attack at 9:36 AM on January 29, 2015 [10 favorites]

The study linked above by fermezporte, which states that 28% (a small minority) of women who undergo sterilization express a desire for reversal, is quite well conceived and well written. The patterns they found among the demographic characteristics of women who express regret speak to some of the considerations raised here regarding the ways in which poverty and lack of access to education muddy the waters of reproductive choice. The authors address this directly in their discussion section, and propose a course of action which seems sensible and affirming of women’s agency:

Recent data suggest that providers attempt to identify risk factors for regret and adjust their advice or recommendations accordingly. However, to some degree regret is inevitable, and we wonder if actively discouraging women who desire sterilization is appropriate, as it comes with the risk of thwarting patient reproductive autonomy and potentially jeopardizing the patient–provider relationship. For example, in one qualitative study with women who had either undergone sterilization or were considering the procedure, participants commonly reported that their providers attempted to dissuade them from getting the sterilization procedure or refused to do the procedure, citing their young age or low parity as too highly correlated with subsequent regret. These women expressed frustration that their providers did not respect their preferences. Providers who are counseling women requesting sterilization may certainly find it challenging to balance respect for women's reproductive choices with current regret statistics, especially in light of the availability of highly effective, reversible contraceptive methods such as intrauterine devices (IUDs) and implants. Sterilization counseling can be fraught with complexity because sterilization permanently ends a woman's reproductive capacity, because there has been a history of coercive sterilization in this country among low-income and minority populations, and because issues surrounding fertility and reproductive control remain politically and ethically charged. Perhaps instead of trying to identify women who will experience regret and persuading them to select another contraceptive method, clinicians should focus on providing comprehensive, high-quality counseling to all women to ensure that their decisions are as informed as possible at the time they are making them, recognizing that circumstances may change later.

[emphasis added]

To me it would appear that as we move towards integrated care, where mental health professionals work in tandem with medical professionals in primary care clinics, we may be able to lessen the paternalism which infects much of our health care system, while at the same time ensuring that patients are given adequate information and support in their decision making processes. Dr. Susan McDaniel, the president-elect of the American Psychological Association, is a leader in the field of health psychology and has stated that she aims to augment the training of mental health clinicians to prepare them to work in integrated settings and to be drivers of a movement towards patient-centered care. As Squeak Attack articulated above, ultimately regret should not be the central focus of fertility discussions. By incorporating mental health clinicians into primary care we can have greater confidence that we are meeting the gold standard of informed consent, at which point health care providers must defer to patient autonomy.
posted by philotes at 11:34 AM on January 29, 2015 [7 favorites]

I get that sterilization is just the form of birth control that works best for some people.

It is also worth noting that while this may be the case, it might, sometimes, just seem like that because of reasons of poverty, which can be alleviated easier than sterilization can.
posted by corb at 12:56 PM on January 29, 2015

It is also worth noting that while this may be the case, it might, sometimes, just seem like that because of reasons of poverty, which can be alleviated easier than sterilization can.

That seems like a thing where in theory it's true, but in practice I'd imagine the odds of successfully and permanently eliminating poverty are probably actually equal to or lower than the odds of successfully reversing a tubal ligation or vasectomy.
posted by We put our faith in Blast Hardcheese at 1:06 PM on January 29, 2015 [3 favorites]

(Also, sterilization procedures tend to be a higher cost up-front than other forms of birth control; if you have a cash flow problem you're probably more likely to opt to use the cheaper-in-the-short-term methods than to try and find $500 or what have you for a tubal. If there's actual data showing that impoverished women seek sterilization at far greater rates than the rest of the population, though, I take it back.)
posted by We put our faith in Blast Hardcheese at 1:09 PM on January 29, 2015 [1 favorite]

And if I never hear the phrase "just adopt" again, it will be too soon. There is no such thing as an uncomplicated adoption. Adoption means someone is giving up their child. In the US or UK, this usually happens because the child has special needs or a traumatic past, often leading to behavior problems.

I was the one who introduced adoption into this thread, I'll fall on this sword -

I do apologize if it looked like I was being glib. I took pains to point out that "just adopting" is a really overly-simplified concept.

However - I was actually suggesting using "I can just adopt" as a way for a woman wishing sterilization to shut down the "but what if you change your mind and what kids someday" busybody questions; because to my mind, an overly-personal question deserves an equally simplistic answer.

The people who are more likely to issue the "oh well you can just adopt" advice are equally as misinformed, just on a different issue. But that's an entirely different matter. I do understand that adoption is much more complicated than that, but....the people assuming a woman who's made up her mind about sterilization can be THAT easily talked out of it probably don't know that either, so it'd shut them up.

sorry for any inadvertent offense all the same.
posted by EmpressCallipygos at 1:14 PM on January 29, 2015 [2 favorites]

And if I never hear the phrase "just adopt" again, it will be too soon. There is no such thing as an uncomplicated adoption. Adoption means someone is giving up their child. In the US or UK, this usually happens because the child has special needs or a traumatic past, often leading to behavior problems. With international adoption, healthier babies may be available, but the parents may not really be giving them up willingly. It's hard to truly know.

Thank you. I mean, wtf. Human women's babies aren't widgets for people to reallocate their artisanal cheese budget to when reblochon gets boring. I understand that there are a lot of children out there who need parents. It would be awful if there were no more adoptions at all. Still, I find it massively anti-woman to be cavalier about benefiting from a system that depends on the coercion of poor mothers and dark mothers all over the world -- whether by life circumstances or predatory agents -- to give up children they might have chosen to care for themselves (or even aborted) if they were offered resources and options, rather than getting treated like burning buildings for wealthier people to dash in and rescue innocent babies from. Not when we know from research that so many of them suffer searing, lasting grief as a result. This is why the concept of reproductive justice is so important. Some women's control over their fertility can't justly interact with the exploitation of the fertility of other women.
posted by two or three cars parked under the stars at 1:21 PM on January 29, 2015 [4 favorites]

Throw out this generalization about adopted people "often" having behavioral problems.

I didn't mean "behavior problems" to be an insult and I didn't mean "often" to mean "in most cases" -- plus these problems can be temporary and aren't the kids' fault anyway. (I do apologize for seeming to contrast "healthy" with "special needs/traumatic past" though. You can have those things and still be healthy. I meant something like "less likely to suffer from these challenging conditions.")

But here's a study which does indicate that at least among some age groups with some types of adoption, they are more common than among non-adopted kids: http://www.lib.washington.edu/subject/Psychology/psych305/a.pdf

Being an adoptive parent can be a harder path, is what I'm saying. It's not a real easy answer to "What will you do if you change your mind?" even if it may be a quick way to end the conversation.
posted by OnceUponATime at 1:27 PM on January 29, 2015

EmpressCallipygos, just want to clarify that my last comment wasn't directed at your comment but at a general attitude reflected in a handful of comments in this thread, as well as in conversations I've had elsewhere.
posted by two or three cars parked under the stars at 1:28 PM on January 29, 2015

Yeah, but even though I didn't pull the pin on the stink bomb I was still the one who brought it into the room unawares.
posted by EmpressCallipygos at 3:01 PM on January 29, 2015

As one of the people who did make a "they can just adopt" comment, I'd like to apologize if it came off as trivializing the process. It's my experience that the foster system has more children than willing parents and makes decisions accordingly, but that's one person's experience with two states.
posted by Holy Zarquon's Singing Fish at 3:09 PM on January 29, 2015 [1 favorite]

Gerstle: This is completely amazing to me, and you're not the only one in the thread saying it. Is there some valid medical reason to be reluctant to give young women IUDs? It's immediately reversible.

Honestly, I think my doctor was expecting me to know less than I did. He genuinely seemed gobsmacked that I knew a) there were hormonal and non-hormonal IUDs, and b) that I had Opinions about what kind of birth control I needed and that anything hormonal was off the table.

I think it was a magical combination of sexism + ageism. He was in his 60s, I was 24. When I interrupted his first lecture about how the IUD was only supposed to be for women in monogamous relationships, and I said, "Yes, I'm in a monogamous relationship, but accidents happen, and there's always the possibility of sexual assault," he was shocked into silence for a solid 30 seconds. It was like he'd never thought of the fact that women walk around in the world constantly at risk unless we're pro-active.

Now I have an awesome gyno who's my age and is like "yeah no anything we can do to stop those painful periods and remove your baby-having-abilities, we're on it," but the insurance company is not on board. So there's yet another hurdle.
posted by none of these will bring disaster at 6:49 PM on January 29, 2015 [5 favorites]

I have one more apology to offer -- I shouldn't have said that in the US and UK children are "usually" available for adoption because of special needs or traumatic pasts.

"The majority of adopted children, 85 percent, were reported by their parents to be in “excellent” or “very good” health, however, nearly 40 percent of adopted children have special health care needs. [...] Children adopted from foster care are more likely to have a special health care need (54 percent) compared to children adopted privately from the United States (32 percent) or internationally (29 percent).

By the way, my own biological kids have a genetic disease (PKU) which definitely counts as a special health care need (though they have been treated since birth and are indeed in excellent health.)

Still, the rates at which these challenges occur are high enough, and the process long and hard and ethically and emotionally fraught enough, for me to stand by the general point that adoption is not a simple solution to infertility, voluntary or otherwise.
posted by OnceUponATime at 3:32 AM on January 30, 2015 [2 favorites]

OnceUpon ATime, I don't think anyone here would dispute that.
posted by Too-Ticky at 6:44 AM on January 30, 2015

But the problem is that no one ever suggested adoption is a simple solution to infertility, it was suggested as a way to shut down paternalistic doctors or judgmental friends and family. The other time it was brought up was in reference to someone who is terrified of birth, but not of having kids. It was never brought up flippantly, offensively or thoughtlessly.

This thread is not about infertility , it's about sterilization. To try to shame people about not being sensitive enough about adoption or infertility was a total non sequitur used as a cudgel. And it worked, because several people tripped over themselves to apologize for something they didn't do.
posted by spaltavian at 7:48 AM on January 30, 2015 [3 favorites]

To try to shame people about not being sensitive enough about adoption or infertility was a total non sequitur used as a cudgel. And it worked, because several people tripped over themselves to apologize for something they didn't do.

Despite the fact that the assertion was no more or less of a lazy backhand slur against a whole cadre of people than the "really offensive" comment it was in response to. But in fairness there's a notable difference in that one group quickly offered a multitude of apologies while mostly the other has offered quibbles about what the subject of the thread really is and a bunch of links to bolster or excuse the position.

Adoption is hard and complicated, in some ways inherently and inevitably. In other ways it's tough because of the same sort of genetic absolutism and anti-woman thought that permeates the culture and is also a part of this refusal to respect people's - mostly women's - rights to make their own reproductive choices and respect all choices as valid ones.

"Just adopt," glibly, is a bullshit suggestion. "Plenty of people manage to construct families without giving birth themselves" is simply honest. If it fails to entirely capture the complexity that the process may involve it's doing so exactly in response and proportion to the people who are hand-waving away the real and current issues people face when they're not allowed to use their own knowledge of their reproductive needs and desires to make decisions about their own lives.
posted by phearlez at 8:18 AM on January 30, 2015 [1 favorite]

"Adoption is complicated, draining, and might saddle you with a special needs or especially challenging child" still doesn't differentiate it from carrying a pregnancy in any meaningful way.
posted by almostmanda at 8:54 AM on January 30, 2015 [8 favorites]

Still, the rates at which these challenges occur are high enough, and the process long and hard and ethically and emotionally fraught enough, for me to stand by the general point that adoption is not a simple solution to infertility, voluntary or otherwise.

You wouldn't advocate a doctor saying "the reason I'm not going to sterilize you, even though you want that, is because you may change your mind, and adoption is difficult so it's better for you to keep your fertility just in case", would you?

Because that's the only way that adoption is entering this conversation.
posted by EmpressCallipygos at 12:16 PM on January 30, 2015 [1 favorite]

As I recall, adoption entered the conversation because people were saying that those who regretted sterilization "could always adopt", as though it were a perfectly acceptable solution.
posted by corb at 12:51 PM on January 30, 2015

And it is. It's just not easy or without complication. Like fertility and pregnancy and and and
posted by phearlez at 1:09 PM on January 30, 2015 [2 favorites]

corb: "As I recall, adoption entered the conversation because people were saying that those who regretted sterilization "could always adopt", as though it were a perfectly acceptable solution."

Luckily, there's no need to rely on fuzzy memory! Here is exactly how it entered the conversation:

I realize that this is an extremely simplistic attitude to take, but has anyone ever tried this: when the doctor is challenging you about "but what if you change your mind and want kids someday", just answer, "well, adoption is still a thing, isn't it?"

It wasn't "people who regret sterilization can just adopt". It was "When confronted by a patronizing medical professional who's refusing to acknowledge that you are an adult who's capable of making her own medical choices, consider pointing out that adoption exists."

There was no dismissive suggestion to "just adopt"; the suggestion was in the context of discussing voluntary sterilization, not infertility; and it wasn't addressed to someone regretting having been sterilized but to a hypothetical doctor instead.
posted by Lexica at 1:19 PM on January 30, 2015 [9 favorites]

Sure, but the followup /was/ addressed to people regretting being sterilized, or at least appeared to do so.
posted by corb at 2:56 PM on January 30, 2015

Sure, but the followup /was/ addressed to people regretting being sterilized, or at least appeared to do so.

If it appeared that way that was an error on my part.

Can we declare this a derail now, as this post is supposed to be about "people who don't want to have children and know that for certain, thank you very much"?
posted by EmpressCallipygos at 3:02 PM on January 30, 2015 [1 favorite]

I'm always surprised when people are surprised by this, because it was a frustrating fact of life for me from age 18, when I started asking doctors for sterilization, to age 31, when I finally found someone who would do it. And even then it was somehow permissible only because I was married at the time. I felt like I was supposed to be getting a signed permission slip from my owner, or something. The doctor reassured himself aloud that if I changed my mind later, there was always IVF.

This was in Seattle, by the way, where one might have expected a little more acceptance of bodily autonomy. But hey, at least I finally prevailed. And it only took twelve years.
posted by Because at 2:48 AM on February 1, 2015 [4 favorites]

There should be a referral system for pro-sterilization or pro-IUD medical providers. Quite frankly I'm surprised there isn't.
posted by calwatch at 3:23 PM on February 1, 2015 [1 favorite]

calwatch: "There should be a referral system for pro-sterilization or pro-IUD medical providers. Quite frankly I'm surprised there isn't."

Um. What exactly do you mean by "referral system"? Because according to the American College of Obstetrics and Gynecology, IUDs are currently recommended as best practice for avoiding pregnancy, even among nulligravida women.

IMO (and based on first-hand experience) there should be no more "referral system" required beyond "a medically-qualified professional has signed off". Referral system? For a goddamn IUD? In the most polite terms imaginable, fuck that shit in the ear.

You got scientifically-verified evidence that sterilization or IUDs are actually harmful? Please feel free to provide it! If not, this sounds like concern trolling.

(And if I've misinterpreted, my apologies.)
posted by Lexica at 6:00 PM on February 1, 2015 [1 favorite]

Lexica: a referral system for finding doctors who will provide IUDs or sterilization without the "it is your duty to breed" moralizing.
posted by idiopath at 7:08 PM on February 1, 2015 [2 favorites]

Reddit's childfree subreddit has a wiki of pro-sterilization doctors.
posted by almostmanda at 3:15 PM on February 15, 2015 [5 favorites]

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