Are You Being Denied the Best Birth Control?

Marie Claire, May 2004

FACT: Tubal ligation is the country's most popular form of birth control. Nearly 10.7 million women rely on it, compared to the 10.4 million who take the Pill.

Monica
29, self-employed

I like kids, but after babysitting my 27 cousins for most of my life, I've already done enough child-raising not to want any of my own. So when I fell in love with the man who is now my husband, I was thrilled to learn he didn't want kids, either. As we planned our wedding, I decided that having my tubes tied would be the best way to start our future together.

I knew asking for a tubal ligation at 24 wouldn't be easy, but I didn't expect to be treated as if I had a mental illness! The first gynecologist my HMO referred me to told me -- via a medical resident -- that he wouldn't perform a tubal unless I underwent a psychiatric examination first. I filed a complaint with my HMO and demanded another referral. This time, the doctor turned me down flat, claiming he'd once tied the tubes of a woman my age who later killed herself out of regret. I left his office in tears of fury, feeling like he'd tried to scare me.

Women don't have to see a psychiatrist before getting pregnant! Men aren't sent to therapy when they want vasectomies! Why was I being treated like I was incapable of making decisions about my own body?

The next week, I wrote to my HMO with my reasons for wanting my tubes tied. I also pointed out that the HMO says it does not discriminate in delivering treatment on the basis of age, and that tubals are included in my coverage. I faxed it to the head of the gynecology department, who happens to be a woman. A week later, she called me. And listened. By the end of our conversation, she agreed to do the surgery herself. It took eight months and three doctors, but I finally got my tubal -- without having to have a psychiatrist prove that I'm sane.

HOW TUBALS STACK UP
Tubal ligation - Failure rate: 5 pregnancies per 1000 women
The Pill - Failure rate: 50 pregnancies per 1000 women
Condoms - Failure rate: 140 pregnancies per 1000 women

Kimberly
42, director of finance

With four kids between the ages of 10 and 17, I thought my diapering days were over. But five years ago, I discovered I was pregnant again, and I decided to get my tubes tied right after the delivery. Little did I know what a hassle it would be.

I had a high-risk pregnancy, so I had to give birth at a Catholic medical center in my area -- the only nearby hospital that had the specialized equipment and expertise my doctor needed in case I had complications during labor.

As it turned out, I had to have an emergency C-section, during which it would've been easy for my doctor to tie my tubes on the spot. But I was in a Catholic hospital, and Catholic doctrine says sterilization is a sin. If my doctor had done the tubal, the hospital would have revoked her admitting privileges -- which would have put all her patients with difficult pregnancies at risk. She didn't have a choice. She stitched me up, sent me home, and told me she would perform the tubal at the community hospital later.

It took six months for my abdomen to heal enough to tolerate more surgery. In one year, I had to go through everything twice -- full anesthesia, surgery, and recovery -- the second time with an infant to care for. I'm still angry that the hospital put its religious rules above my health and forced me to choose between getting a tubal and having a safe delivery.

STERILIZATION: why your doctor may say no

The "regret rate" isn't zero. Studies show that the younger a woman is when she has her tubes tied, the more likely she is to ask about reversing the procedure later, says Amy Pollack, M.D., M.P.H., president of the family-planning organization EngenderHealth. Remind your doctor that nearly 9 out of 10 women who have been sterilized are satisfied with their decision.

Tubal ligations can be reversed about a third of the time in women under age 40 (but a new procedure called Essure can't be reversed at all). Some sterilized women have had children through in-vitro fertilization.

Doctors want to avoid surgery. Your doctor will ask you to consider less-invasive alternatives first -- oral contraceptives, the patch, the ring -- says Michael Grodin, M.D., director of medical ethics at Boston University School of Public Health.

Marcia
38, writer

My husband and I decided our family was complete after our second child was born. I'd been on the Pill for years, but when the negative reports about hormone replacement therapy started coming out, I started feeling uneasy about taking any hormones at all. Yet I didn't want to give up our spontaneous sex life.

In my annual exam last summer, I asked my gynecologist about sterilization. She told me I should put off anything permanent until my husband and I were both well into our 40s. Then, she immediately changed the subject and told me to consider an IUD. She clearly didn't want to discuss sterilization. By the time I got home, I was really angry that I had let her steer the conversation and didn't get the information I wanted. I was denied the chance to hear about all my choices. I assume she thinks I'll reconsider when I hit my 40s and realize it's my last chance to have another baby. But I'm certain I don't want more children -- and that's my decision to make, not my doctor's.

I'll bring up the topic again at my next appointment. If she doesn't agree to help me, I'll get another gynecologist. If a doctor doesn't believe I can make my own decisions at age 38, she doesn't deserve my business.

Copyright 2004 by Fawn Fitter.
Not to be reproduced or distributed in any way without the written permission of the author.