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Respecting women’s choices for permanent contraception

The last few years have seen some interesting trends regarding women, birth control, and motherhood. Pregnancy has become just as much a role to be performed as a massive physical experience. The number of long-acting reversible contraceptives (LARCs) available to women of all ages has increased. Motherhood continues to be touted as the ultimate experience or measure of success for a woman and is still expected. But there is one trend that hasn’t changed. Society continues to shame and look down upon an intentionally childfree woman seeking permanent contraception.

Our society still has major issues with the idea that there are women who choose to live their lives childfree. These women experience varying levels of judgment from their peers, their elders, even their family and friends. Why? Because they dare to buck the expectation that a woman is supposed to be a mother. If a woman isn’t spawning tiny humans our society seems to think she isn’t deserving of basic dignity and respect. Which, when you look at it spelled out that way, seems ridiculous. But women who choose the path that doesn’t lead to motherhood know very well that it’s true way more often than it isn’t.

This attitude that childfree women are a lesser kind of woman is so pervasive and contentious that you can run a search on “childfree woman” on almost any news publication and come back with a myriad of results supporting or condemning these women. Even when the qualitative research and anecdotal evidence clearly demonstrate that way more often than not those who chose a childfree life continue to be content in that choice without regrets as the years go by. More women than ever are making the choice to pursue a life without motherhood. And there’s nothing wrong with that. Just like there isn’t anything wrong with the women who make the choice to become mothers. The whole point is for women to be able to make informed choices about their life and reproductive journey with the agency, autonomy, and respect that they have earned simply by being human.

Yet our society continues to dance around the subject of childfree women seeking voluntary sterilization.

If a woman has not had a child, and knows that she does not want to have any children it is a gargantuan feat to find a medical professional who will respect that decision and carry out a sterilization procedure. The reasons OB/GYNs are hesitant to perform these procedures on women in their 20s and early 30s can reek of paternalism and a general lack of respect for a woman’s autonomy.

“In some ways, it’s very difficult to see a 22-year old make a decision for the 35-year-old she will be someday and not have major concerns that she might regret that decision,” Dr. Eve Espey told HuffPost. “On the other hand, at what point do you say, ‘Of course the woman is autonomous and can make her own decisions about her reproductive health’?”

However, there are medical professionals who will listen to younger women who are pursuing permanent contraception because they are childfree. And two such women have shared their stories about their own journey to voluntary sterilization with me: Sarah Eckerd and Allison Klem.

Allison’s experience

Allison first realized that there was an option for her to live a life that was childfree when she was 16. Up until that point, she just assumed she’d live her life and eventually get married, have kids, you know, typical ‘American Dream’ stuff. But once she realized her life didn’t *have* to be that way, she knew that at least as far as the having kids part was concerned she was uninterested. This desire to be childfree is something she still has at 31. When she was 23 she asked her gynecologist about permanent contraception during an annual appointment. The doctor so vehemently shut her request down that she never thought anyone would ever listen to that request again, much less take her seriously. She continued using daily birth control methods (because in the early 2010s LARCs were only for women who had already birthed a child) for many years.

In the fall of 2016, the pressure was on. She was still steadfastly childfree, and the fear was increasing that with the possibility of a Republican in the White House she may not have the opportunity to get sterilized for many years (if ever). She went in for an annual exam and asked her gynecologist, the same one she’d seen for several years and had built a pleasant rapport with, about long-term contraception. The doctor responded with the variety of IUD options currently available. Allison then asked about permanent contraception. Her doctor responded saying the only procedure she offered for that was tubal ligation, and went into more detail about it. She also gave the counsel that the biggest complication with this procedure can be regret.

Allison told her that she doubted regret would happen, but if it did in the future she was prepared to deal with it. She then asked what she needed to do to start the process to get a tubal ligation. Her doctor simply said, “Just ask.” By the end of that visit, she had a surgery appointment set up a few weeks out, and the procedure went smoothly. She has been vocal about her decision to get voluntarily sterilized at the age of 30 and sharing her experience with other women seeking sterilization.

Sarah’s experience

Sarah never really wanted to have kids. She first asked a gynecologist about permanent contraception when she was 17. Despite seeing a gynecologist who is vocally pro women’s choice, Sarah was told she was too young to be considered a candidate for sterilization. She made a point to ask about sterilization at each of her annual appointments, accompanied by an ever-growing list of reasons she wanted to remain childfree. She moved in her early twenties to a larger city in North Carolina, and every time she went to see any one of the country health services gynecologists, she was told she was too young. Even after adding a terminated pregnancy in her mid-twenties to the list of reasons why she wanted to get sterilized, medical practitioners refused to listen to her request.

A little over a year ago Sarah moved to Alabama. She scheduled her annual exam with county health services. Once again she brought up her interest in sterilization and shared the myriad of reasons on her list. This time, the doctor listened to her and recommended the silicone band method. She now had the additional hurdle of needing state approval for the procedure, because she was on state funded insurance. The clinic staff fast-tracked her papers and assured her that these requests are typically quickly approved. Only a few short weeks later she was scheduled for surgery. After 12 years (and asking for it 20+ times), Sarah was finally sterilized at 29. Sarah has been vocal about her experience and is passionate about helping other women through this process.

The hoops women in our society have to jump through to have their agency and autonomy respected in a request for voluntary sterilization is ridiculous! There is no reason an adult woman, with enough lived experience to know motherhood isn’t a good fit for them should have any issue in procuring a voluntary medical procedure. Especially one that would be the only way to be 100% she would not end up with an unplanned, unwanted pregnancy. Our society and healthcare practitioners have got to do better for women. They deserve it.


Bubble Bordeaux is a body positive advocate, writer, and burlesque performer on a mission to help people discover the vibrant beauty in their bodies and themselves. When she isn’t focused on body pos and fat acceptance she’s advocating for feminism, polyamory, and bisexual people. She recently became a Brand Ambassador for Livi Rae Lingerie, a body positive lingerie boutique in Atlanta committed to helping every woman find her own sexy.



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