All products are independently selected by our editors. If you buy something, we may earn an affiliate commission.
Thighs clinging to the polyester of my chair, I sat waiting for the OB-GYN to enter my exam room, feeling somehow sticky in spite of the cranked-up AC. It was summer in Tennessee, and between my dual gigs at a local BBQ restaurant and my college’s student newspaper, I, at age 21, was prepared to put into words something that at this point had felt right to me for years — I was going to ask to have my tubes tied.
For as long as I can remember, I’ve found the idea of conceiving biological children deeply unsettling. It’s an aversion one could say borders on tokophobia, a chronological fear of pregnancy that’s largely rooted in the condition’s physical aspects: in the prospect of something alien attached to my insides, feeding off them; in the rips, tears, and literal excrement involved in expelling that being into the world; and, above all, in the loss of bodily autonomy. For many women and womb-owners, pregnancy is a beautiful, deeply rewarding experience, in spite of or even because of its physical sacrifices. I knew early on, however, that despite my true admiration for those womb-owners, I was not going to be one of them.
Growing up in the Catholic school system in the Bible Belt, the messaging I received on pregnancy from grade school on was that bearing children — if I was physically able and planned on one day having (married!) sex — was a divine mandate, signed, sealed and delivered by the Bearded Sky Man himself. I remember, on a few occasions, anti-choice pins being passed around the classroom for us to pin onto our school uniforms; they were gold and looked like two small feet, posed in a V shape. These feet, we were told, were the same size as the feet of an unborn child (never make the mistake of calling it a fetus) 12 weeks into pregnancy. “Three months, and the baby already has 10 toes — isn’t that a miracle?” I remember my religion teacher asking.
I never found the tiny metal toes miraculous (this was, after all, the beginning of a human body we were talking about — what would it have if not toes?). What I did find the pins indicative of was a biological process intended to continue our species; and, as a piece of science, it was not something I had any designs to personally participate in.
It’s not that I don’t adore children — I absolutely do. I’m all-too aware of the amount of love I have to extend to children of my own one day, and the purpose and fulfillment that I know I will find in helping a small human grow. But that future child, or children, will not be coming from my womb.
Which is why I found myself sitting in the OB-GYN office that summer of 2014. A nurse practitioner entered, clipboard in hand, to discuss with me my birth control options. We went over my medical history for a few minutes before I was asked which method of birth control I was interested in receiving. Feeling bolstered by my own sense of agency, I drew in a breath and said that actually, I was wondering whether it would at all be possible for me to get my tubes tied?
“You’re too young,” the nurse said in an even tone. There was one doctor in Tennessee, she added, who had been willing to do the procedure on someone my age before, but her practice was located hours away, and there was no guarantee that she would actually agree to perform it on me. The reason I could expect difficulty in finding an obliging doctor, she said, was that it was highly probable I would change my mind about having biological children when I was older and come to regret the procedure.
Rattled, I resigned myself to allowing the conversation to move on to which pill I would be prescribed. But later, dissatisfied with what felt like the partial version of the truth I’d been presented, I did some digging. I learned that the law in Tennessee stipulates 18 as the required age minimum for a patient to receive tubal ligation (had I been on Medicaid, the minimum would have been 21). Outside of age requirements, the Church Amendment, passed after Roe v. Wade, also allows providers to object to performing sterilization surgeries for religious reasons — meaning that in areas where the only accessible institutions are Catholic-affiliated, as 10 of the nation’s 25 largest health systems are, finding a doctor willing to perform a tubal ligation is that much harder.
Ultimately, though, I was still left confused by my experience and unsure what options were actually open to me. After all, I’d met the age requirement, the OB-GYN I had gone to was not religiously affiliated, and nothing about the potential for spousal approval was mentioned. And yet I was to believe that there was perhaps only one doctor in the state of Tennessee this nurse knew of who would take my desire to have my tubes tied seriously, maybe?
As it turned out, I’m far from alone in the obstacles I encountered.
Brie Ripley was 18 when she first brought up her desire for tubal ligation to a doctor. Now a social media producer for a radio station in Seattle, 26-year-old Ripley had experimented with multiple methods of birth control as a teenager — and unanimously experienced negative side effects, including with her IUD.
“At the time, I was in a monogamous relationship where it was like almost two weeks out of the month, I wasn’t feeling like having sex,” Ripley said. “That was frustrating, and it made me feel like my body was out of control. Eventually, my body proved itself to be more out of control than I initially thought it was because it expelled the Mirena IUD during a period.”
It was then she decided she needed to start having some “serious conversations with doctors about what options were available that they weren’t talking to me about, including sterilization.” So, she brought up tubal ligation to an OB-GYN — and was immediately met with laughter.
“They told me there’s no way a doctor would sterilize someone so young, and that I should come back after my first child,” Ripley, who later produced a podcast about her experience, said. “It was really strange to be laughed at by a doctor in such a vulnerable situation, when I’m sitting on a table with paper over my bare legs after my legs were just in stirrups. It didn’t feel normal.”
Over time, Ripley would go on to ask a dozen other doctors to sterilize her and said she was continually met with the same array of assumptions: that she was having straight sex (she identifies as queer); that to “family plan” meant to plan for a hetero-curated idea of biological families; and that, as a young woman, she wasn’t capable of knowing fully what she wanted.
“Reproductive medicine should be about helping people, no matter if they’re straight or queer, have what they want for their bodies in order to empower their sense of agency over their lives,” she said. “But a lot of doctors were just not giving me a lot of nuance, compassion or understanding.”
Lauren Larry, a yoga instructor in Kansas, has had a similar experience. Though she’s known since she was a child that she doesn’t want to become a biological mother, it wasn’t until she was 27 that she found phrasing for her feelings, when she stumbled upon blogs dedicated to people living a “child-free life” online.
“I thought, okay, maybe this is for me,” Larry said. Knowing that her husband also didn’t want kids, she began doing research around permanent methods of birth control before settling on tubal ligation as what seemed like her best fit.
“I did my research for months and then went back to the doctor — he had a reaction almost like I’d asked him to give me a unicorn horn or something,” she recalled. “He was full-on belly laughing, and was like, ‘No, you’re too young. You and your husband should talk about it, you kind of owe him a child.’”
Larry added that while it’s difficult not to get upset when facing situations like this, she feels she has to moderate her reactions if she wants to maintain even a hope of eventually getting what she’s after, especially as a woman of color.
“A lot of the time, as a woman of color, when you’re going into the doctor’s office there’s a weird catch 22 happening,” she said. “It’s: I can’t be too emotional, but I need to be firm, but I can’t be so firm that I’m the angry Black woman demanding a procedure’… It’s almost like they egg you on to get you hysterical, but you know that if you do get hysterical, then they’re really not going to take you seriously.”
Cori Carl, a 34-year-old managing director at The Caregiver Space and a recent Toronto transplant, has been trying to find an OB-GYN for 14 years who will take her desire for tubal ligation seriously. She said that at one point shortly after college, she printed out a list of every doctor she could find in New York, New Jersey, Connecticut, and, she thinks, Pennsylvania that would perform a tubal ligation.
“It was a list of about 60 to 75 different doctors’ offices. I wasn’t going to go to 75 doctors to hear 75 no’s, so I explained on the phone that I’d already been told ‘no’ by other doctors because of my age and asked if they had a policy,” Carl said.
At this point, she said, the answers reluctantly came, without exception, as “some combination of ‘we’ll only do it if you’re over 35 or if your husband agrees or if you already have children;’ the answers were so similar, it was like they were scripted.”’
Carl, like myself, was told these requirements were necessary to “protect” her from the likelihood she would one day come to regret such a procedure, something she found “incredibly patronizing.”
“Legally, I’m an adult and can do all sorts of other potentially regrettable things, like signing up for $100K in student loans or whatever, and having children is certainly more irrevocable than not having them,” she said. “It’s demeaning that, in the United States, I don’t have the ability to make decisions about my own health care, and that these things I theoretically have access to and these choices I’m proactively trying to make about my own health are being taken away from me because of some hypothetical problem.”
Sheila Chhutani, an OB-GYN practicing in Dallas, Texas, believes in the importance of listening to her patients. But there are a few situations in which, even still, she isn’t willing to perform a tubal ligation procedure, in part because of what she hears while listening.
“When I’m counseling a patient, if someone says, ‘Oh, I could get (the tubal ligation) reversed if I wanted,’ I say, ‘Wait, time out, no — there’s nothing to reverse at that point,” Chhutani explained, adding that the procedure today often involves taking out a larger chunk of the Fallopian tube than it once did, making reversal less likely. “So it’s about digging down and making sure the patient is absolutely, 100% sure, and protecting them from that regret if they aren’t.”
Beyond patients who make an explicit reference to reversal possibilities, Chhutani admitted she sees women and uterus-owners who don’t already have biological children as having a higher likelihood for regret.
“If someone tells me ‘I am positively sure I don’t want more kids’ at 25, if they’ve got kids, I’m more apt to do it,” she said. “If you don’t have kids and you want a tubal, I’m like, can we please just do a long-term reversible form of birth control and give it a little more time? We can lock it up for a while, but we don’t have to throw away the key and bury it at the bottom of the ocean.”
Chhutani is one of many doctors who point to studies, including a well-circulated one published by the Center for Disease Control and Prevention in 2010, showing that younger women and uterus owners are statistically likelier to regret sterilization than older folks who receive the procedure. One commonly cited statistic from a 1999 study indicates that the probability of regret for sterilized young women is 20.3%. But this number leaves out the other side, according to Wendy K. Leung, an OB-GYN and clinical instructor at Yale School of Medicine, where she is Family Planning Fellow.
“One study showed that 20% of women younger than 30 at the time of the sterilization may regret their decision later in life,” Leung explained in an email. “However, the majority (80%) of these younger women are happy with their decision. Interestingly, the lowest risk of regret among younger women is for those who never had children.”
Leung, who maintained that “age should not be the main deciding factor in this conversation,” said that “doctors’ most important ethical principle is respecting patient autonomy, which means putting patients’ needs first.”
“I would perform the procedure as long as a woman (of any age) understands the pros and cons of tying her tubes and has thought about other options,” she wrote. “Women should be presented with accurate medical facts, and physicians should trust that women can make the right decisions for themselves.”
And, sometimes, this is the scenario that plays out. After hitting many dead ends, Ripley found a doctor willing to tie her tubes two years ago, when she was 24. She calls the procedure “the most empowering choice” she’s ever made.
“I feel a lot closer to my partner and also a lot closer to myself, now that I can have sex without this weird shadow of pregnancy lurking in the background,” Ripley said. “I have this whole new perspective of the way my world works now that I have total agency over my body. I feel really lucky, but also frustrated that other people are still running into roadblocks.”
Ultimately, I myself remain in that category. My most recent inquiry into tubal ligation, discouraged for both feasibility and financial reasons, ended instead in a botched IUD-insertion (which, yes, was as excruciating as it sounds). I’d love to say I have an answer as to what my next move will be, but really, I don’t — just a hope that one day, this feeling of having total agency over one’s own body is something I’ll know for myself, too.
