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Tenacious justification of choice does not equal freedom

SassyWho

I will be turning 30 this year and it seems every time I go to a social function another friend is announcing her belly is full of baby. For me it still seems so grown-up and I still prefer to sit at the kids table during Thanksgiving dinner. A few months ago one of my girlfriends had her first and only biological child. She married a high school teacher who had 2 other children from his previous marriage and they agreed that they did not want more children.

I was dismayed, although not surprised to hear how difficult it was for her to convince her doctor to perform a tubal ligation after the birth. Feeling that their family was complete, she insisted from her very first appointment that she wanted to have permanent birth control. Her physician simply would not consider it, and I am sure if it wasn’t for her pushy insistent nature she would not have been granted the procedure. Her choice was constantly challenged, not only by her doctor, but nurses, hospital staff, family and friends. You would think that by limiting herself to one biological child she was robbing herself and humanity of a messiah.

It is infuriating that women still have to “convince” doctors that we know what is right for us in regard to our reproductive choices. Considering the recent Supreme Court decision, it’s not shocking to discover that many still believe women to be fickle about our decisions that impact whether or not we reproduce. Medical and judicial establishments have a long history of pernicious dominion of women’s physical autonomy, not limited to abortion. When women have to be tenacious in justifying their choices to those who dictate and “grant permission” it is a reminder that emancipation is an illusion.

The fact that my friend is young(30), white, and married should be of no surprise that she may need to plead with her physician to allow her to have a permanent form of non-hormonal birth control, while other women are bribed to do such:

Hartford was the third stop on their nine-state summer road trip with a controversial mission – promoting birth control, including sterilization, for drug addicts and alcoholics.

A billboard on the side of Harris’ 30-foot RV read: “Attention Drug Addicts and Alcoholics. Get Birth Control & Get $200 CASH. Call 1-888-30-CRACK.”

It is impossible to ignore the racial and class undertones when discussing the differences in treatment by the medical community when comparing the experiences of white/middle class women and either Woc or different socio-economic status. Although no one endorses alcohol and/or drug use during pregnancy there are serious discrepancies in reporting/prosecuting maternal substance abuse despite no apparent racial differences:

Studies show that a growing numbers of infants are entering the foster care system due to maternal alcohol and drug use. Moreover, conscious or unconscious stereotypes of African-Americans may lead many professionals to be more likely to report African-American women for substance abuse. For example, in one study of drug use during pregnancy, although white and black women were almost equally likely to test positive for drugs, physicians were ten times more likely to report African-American women to health authorities after delivery than other women.

The medical community may be more diversified than ever but that does not erase the centuries as a male dominated space. It is going to take more than legislation to put an end to compulsive birth or sterilization, women need to act as medical consumers calling out systemic racism, classism and sexism and support others who do so.

cross-posted @ Sassywho

63 thoughts on Tenacious justification of choice does not equal freedom

  1. A friend of mine had a tubal after her 3rd child was born and she’s pregnant again. I think she should sue.

  2. I lived with my husband for years, got married at 27 then waited until I was 30 to have our first kid. This confused my father, who couldn’t understand why we didn’t just hurry up and get married when I was 23 and start spitting out the grandkids.

    It’s infuriating when an adult woman isn’t listened to by her own family- by a medical professional would be grounds for a lawsuit in my book.

  3. I’ve had a few female friends who have had their requests for tubal ligations refused by doctors. Why? Because they were “too young”. They were all in their mid-to-late twenties when they asked about the procedure and were told that the doctors (all different doctors) didn’t perform the procedure on single women under thirty because the women may just change their minds.

    Mind you, these were women in their mid-to-late twenties. They had already made informed decisions to never, ever have children. They were all on prescription birth control. But because they were single and under thirty, it was just assumed that each one of these women would change their minds as soon as their marital status changed, or as soon as that birthday cake accumulated a few more candles. Because women? Whether you know it or not, apparently we’re shifty and mercurial enough to not be trusted with our own reproductive decisions.

  4. Every time I hear this, I’m tempted to throw caution of stereotypes to the four winds and suggest asking how many abortions she has to have before he’ll give her the tubal.

  6. I can’t tell you how many times I’ve heard this story of women being denied tubal ligation. Are doctors actually TAUGHT in medical school not to trust women? Or have the just seen too many movies with female characters whose “biological clocks” kick and make them baby-crazy? It’s completely ridiculous. And I’m sure they don’t give men who come in wanting vasectomies such a hard time. Because when men make decisions, they make them with a clear head. Argh.

  8. Unlike you and your friend, the doctor and the nurses have seen young children die.

    And this is relevant… how?

    I may be totally missing the connection here, but are you saying that Sassy’s friend’s child may die, in which case she’ll want to replace the kid with a new model?

  9. Tracey, it’s important to remember that it is certain women who are told to “think about it”. And yeah, being reduced to infants kinda makes the case for parenthood a little silly.

  11. “Do men face this crap when they ask for vasectomies?”
    No, they can have it reversed cheaply! (Or so say numerous billboards I’ve seen…) I haven’t seen any billboards advertising reversal of having your tubes tied.

  12. Unlike Bloix, I don’t believe that all children are interchangable and that just going down to the pound OB’s office to get another one will make the death of a child ok.

  13. “It is infuriating that women still have to “convince” doctors that we know what is right for us in regard to our reproductive choices….When women have to be tenacious in justifying their choices to those who dictate and “grant permission” it is a reminder that emancipation is an illusion.”

    While I’m sympathetic with part of your argument, I don’t agree with your implication, which seems to be that this phenomenon is sexist, and that it’s a barier to women’s emancipation.

    In fact, young men who want vasectomies are faced with the exact same quandary – there are very few doctors willing to perform vasectomies on men younger than 30. Doctors typically refuse to perform vasectomies on young men for the same reason they refuse to perform tubal ligations on young women- they’re worried that one day the man whill change his mind, wish to have children, and slap the doctor with a malpractice lawsuit for having performed the irreversable procedure.

    For men, the lack of the option to undergo sterilzation is arguably even more devastating than for women, because unlike women, who have birth control pills, diaphragms, and abortion to prevent an unwanted childbirth, men only have condoms – which of course can break or slip off.

  14. My partner got a HUGE lecture by the urologist he first saw about a vasectomy. And he was in his mid-late thirties at the time. So yeah, men get shit. He opted to go with another urologist, surprisingly enough.

  15. Some guys do get vasectomies pretty easily. They also change their minds later. So shouldn’t doctors give them an equally hard time? If they did, I wouldn’t argue about doctors giving women the same hard time.

    But I don’t think they do. My sister is getting married soon to a guy who had a vasectomy a few years back. He’s 30. Now he wants to get it reversed because guess what, they want to have a baby together.

    Drat those fickle, fickle men. They really don’t know their own minds.

  16. And I know a guy who walked into the doctor’s office when he was 18, said he wanted a vasectomy, and was sitting on a bag of frozen peas that afternoon. I don’t know any woman who went to her first GYN and said “I’d like a tubal” and was scheduled that day for laproscopy.

  17. A Dude, the phenomenon is sexist because of the difference in hardships of an unplanned pregnancy, as far as I know not a single man has died from pregnancy complications. I agree with you that men should have the ability to choose what works best for them.

  18. Thanks for pointing out the role of race in this. Taking a good hard look at the different experiences of women of color should alter our understandings of reproductive justice beyond the simplistic white liberal “choice” model.

  19. When I moved to my current hometown about 8 years ago, I had to get my Depo set up. I was 22 at the time. I talked with the Dr about getting a tubal (by now I was in a committed relationship with someone who also does not want children, and is several years older), and he told me it was generally not done for women under thirty for the EXACT REASONS LISTED ABOVE. He even asked me if I thought *I* would change my mind. When I told him the only way I would change my mind is if they would let me sell the children for 40 grand apiece, then I would want a child. He looked at me for a very long time and said, “well, I think your mind is made up.” DUH.
    Still haven’t done it – stayed on the Depo (going on 10 continuous years, 12 off-and-on) – because the idea of (relatively) major surgery and potential for the tube to re-fuse freaks me out, but it’s not like I’ve changed my mind. I’d get Mirena, but there’s no one around here to do the procedure. Sigh.

  20. “the phenomenon is sexist because of the difference in hardships of an unplanned pregnancy, as far as I know not a single man has died from pregnancy complications. ”

    I don’t mean to belittle the difficulties women go through pregnancy- pregnancy is no trivial matter. But the fact is that a man can be forced to spend 18 years of his life supporting a child he never wanted to have simply because the condom he was using broke- that’s no trivial matter, either.

  22. This has been happening for far too long, and it’s ridiculous. My (single) sister asked for a tubal when she was 24 and got denied. Her doctor actually told her she might meet a man who she wanted to marry that wanted kids! Sis said back, “the man i want to marry WON’T want kids.” One year later, she got accidentally pregnant and had the baby. She immediately went back to the doctor for a tubal, only to be denied AGAIN. The cherry on top? She finally got cleared for one after our father called the doctor and demanded that his daughter be allowed treatment.
    i shit you not.

  23. But the fact is that a man can be forced to spend 18 years of his life supporting a child he never wanted to have simply because the condom he was using broke- that’s no trivial matter, either.

    Unless you hail from the land of Free Abortions For All in Every Town, the fact is also that a woman can be forced to spend 18 years of her life supporting a child she never wanted to have simply because the condom broke, too.

    Oh, plus pregnancy.

  24. I find a good way to respond to a doctor claiming s/he won’t perform the surgery because you’re too young is to state your age, then ask the doctor at what age, medically, you are an adult capable of making informed decisions about your body.

  25. A Dude,
    That is true, and I absolutely support men using vasectomies as a form of control for themselves. But there are actually 2 different motives that are apparent in the medical community, for one men of race and class backgrounds have been forcibly sterilized as well… and the experience is very different than men who “elect” it.

    the other is that the motives between encouraging men to stay virile and women are based on the same patriarchal ideas… so while men are affected as well it is usually women who pay the ultimate costs.

    I hope that clarifies my position a little.

  26. I am saying that a women who loses a child might choose to have another. Not as a replacement for the dead child or because she wants this year’s model but because she has the desire to have a child. Physicians and nurses have seen this happen. Women with newborns generally have not. Any doctor who said to a woman with a newborn, “you should behave as if your child might die” would of course be acting in an extremely callous and insensitive manner. And yet, when the issue is tubal ligation, the doctor is put in the position of having to suggest to the new mother that she should act as if the child might die.

    Has SassyWho’s friend considered what she would want if her child were to die?

  27. yeah, Bloix, I’m sure that that’s why doctors deny adult women this procedure.

    you dont make any sense. reasonable people don’t replace babies like they do lightbulbs.

  28. Bloix, I would like to point out that she does have 2 step-children…. that she was happy with that to begin with.

    and therapy would be advised for anyone who suggests not getting your tubes tied because your child may die.

  29. Bloix, people who have tubal ligations know what they’re doing. If you don’t think they do, you obviously don’t have a lot of respect for women’s capacity to make choices.

  31. Come on, people, if “an heir and a spare” are good enough for royalty, they’re good enough for the rest of us! You never know when the little one’ll kick it and you’ll find yourself wishing you had a quick and easy replacement. My philosophy is to pop out a good half-dozen before you poop out; that way, you’ve got a steady supply and plenty of free child care.

  32. I think something women need to be told to do time and time again by their friends and relatives is to doctor shop.

    At your next annual, ask your doctor if s/he prescribes emergency contraception. If so, get a scrip now if you think you might need it. Ask your doctor if they perform abortions, whether or not you are pregnant. Ask your doctor whether or not s/he would perform a tubal if you asked him/her to, whether or not you want one. If your doctor — now, while it’s not an emergency, while it’s not something to which you’re emotionally connected — won’t support your values and your choices, do two things: (1) inform your doctor that s/he doesn’t share your values and you’d like a referral to one who might, and (2) change doctors.

    I recognize that some people don’t have the luxury of being able to choose among several doctors, and so this might not be practical advice for everyone. But to the extent that it is, we need to make the best that we can out of the health care marketplace, and we need to make clear to doctors what our values are and why it will correlate to more business for them. Some doctors won’t change, of course, but others might if they hear from enough of us.

    We’re not taught to stand up for ourselves. I was refused the patch by a gyno who said it wouldn’t do anything to stop the nausea and vomiting caused by my taking the pill orally. She was patronizing and annoying, and I didn’t fight her on her attitude or her refusal. I just came back the next month and saw a different doctor in the practice, said the pills she gave me made me sick, and said I really wanted the patch, which I got and loved for the next three years (until I got off it to get pregnant and was happy to do so given the increased health risks associated with the transdermal method of hormone delivery). I’ve always regretted not standing up for myself, and I learned my lesson to make sure that I’d get what I wanted from my medical care providers from that point onward.

  33. Absolutely.

    I knew a woman in college, she was about 22. She’d had four kids already and wanted her tubes tied. Four out of five doctors refused to do it saying things like, “What if your new husband wants more children?” or “What if you get divorced and your next husband wants children?”

    What
    The
    Fuck?

  34. I’m extremely interested to know if people of color have the same troubles accessing permanent birth control as European Americans do.

    While I realize that there are many examples of people of color (especially low-income people of color) being sterilized against their will, I wonder if they are turned away when they seek sterilization at the same rates as middle-class white people.

    Somehow, I doubt it. I have a sneaking suspicion that medical authorities are only too happy to offer permanent birth control to people of color who share the same age, number of existing children, and health conditions as their white counterparts, only they happen to have lower incomes. As with all other things, however, I could be wrong.

  35. “Come on, people, if “an heir and a spare” are good enough for royalty, they’re good enough for the rest of us! You never know when the little one’ll kick it and you’ll find yourself wishing you had a quick and easy replacement. My philosophy is to pop out a good half-dozen before you poop out; that way, you’ve got a steady supply and plenty of free child care.”

    —

    LOL. Good points. Plus, you can accessorize them to match! And think of the fun you’ll have choosing names! Hee hee. A vagina is so like a Toys-R-US factory for adults!

  36. Some Doctors and even some women’s clinics still insist on holding oral contraceptives hostage to the pap smear, although cervical cancer is completely unrelated to oral contraception. Same principal is in effect: women’s bodies are under the control of the (coded male) medical / pharmaceutical complex. I agree major surgery is something to think about, but I’m sure they don’t deny all the women going in for elective plastic surgery or tell them, they’ll change their minds about having a smaller nose or bigger boobs. Nope – just on the reproductive issues do they go all parental.

  37. Freedom and control of your own decisions means that you also have to deal with the consequences of your decisions: if you have a tubal and discover that you regret it later well too damn bad.

    It is better to have the freedom to decide these things for yourself. Being free does not guarantee your life will be perfect. It only means you will have a greater ability to control it.

    Anybody who says otherwise is, as they say, selling something.

  41. A Dude – Repectfully, get stuffed. I’m male and the MRA stichk get old after thd first repeat.

    As for the Big V — When Ledasmom and I decided that the crop we had was enough, the decision as to which one of us got snipped was pretty easy — even though I opted for an in-patient stay for the procedure, many men do have the snip done in an outpatient clinic.

    Now, when I went to the doctor’s office, I got this quiz, as if I didn’t really know what the desired purpose of the operation *was.*

    We went through this whole song and dance that I’d have to make another appointment and come in with a signed “permission” slip from my wife.

    I looked at him and pointed out the facts in front of him from the history he just took — I’d been married twice, had two children in each mariage, I did *not* want any more, I was over 50 years old and fathering more children at my age was show to have significant possibilities of certain types of birth defects.

    And when I asked him what ws the actual legal justification for asking for the “permission slip,” he looked at me and said, “Oh, well, I guess you really do know what you want.”

  42. Some Doctors and even some women’s clinics still insist on holding oral contraceptives hostage to the pap smear

    I usually just lurk, but I had to comment on what Saffron mentioned. I just came from my university’s health center, where I was denied more than three months of birth control, until I “came back for a full exam.” Now, I am not in any sort of risk group for cervical cancers, etc., etc.,…all my exams forever have been judged “perfect,” and I had an exam just over a year ago.

    Now I not only have to pay more for my prescription (stupid laws!), but I have to pay for (a) a second dr’s visit, and (b) a Pap Smear. Of which,(a) costs $10 (b) costs $60, which is a lot more than it was on my private insurance….Oh, and I still had to pay $10 for original visit, to get a sheet of paper that says I can get a pill that should be OTC.

    This is all sending me the message *someone* thinks trying NOT to be pregnant is a scary and costly and horrible thing to do…

  43. They’re reluctant to perform the procedure if a woman is having her first child, and/or only has one child, and is young. My mom wanted this procedure after her second daughter, my little sister Angel, but the doctor, because she was only 23 or so, convinced her to wait until Angel was at least a year old. My little sister died after two months, and from the shock my mom just didn’t think about it again until she got pregnant with my sister Sabrina at 30. Obviously we wouldn’t have missed Sabrina if she’d never been born, that’s not the point. The point is there are no guarantees when children are born, and the first year is the riskiest. My mother finally had the procedure the day after Sabrina’s birth, but by then I was almost 12 and she was in her thirties.

    Doctor’s have good reason to make women consider such a permanent decision carefully. It’s not one to be made lightly, and children don’t always survive their first year. Especially considering our poor health care and high infant mortality rates (for a Western country).

  44. If they can’t trust us with making this choice, how can they trust us to properly raise a child?

    Well, see, women just naturally /know/ these things. I mean, it’s all those natural drives – hormones and stuff like that – that lead us to having children, so obviously we must know what to do with them once we’ve got them!

  45. My OB/GYN rotation in med school was my radicalizing experience, That’s then I realized I was a feminist, and began to see the world and my own experiences through a feminist lens.

    Physicians are taught not to trust patients in general. The infantalization of women that’s present everywhere else in society then is added on to that to produce the charming mix we’ve all run into. And classism and racism are stirred in as well.

    Docs are also not encouraged to be at all reflective, and so will often project their own personal opinions and biases on to their patients without realizing it.

    But if docs weren’t so paranoid about lawsuits in the US this would be far less of a problem than it already is.

  48. Well, see, women just naturally /know/ these things.

    Magical baby hormones turn all reluctant women into loving supermoms.

    I know you guys are being sarcastic here, but honestly I was kind of expecting that to happen. It totally didn’t.

  49. Maybe those gynecologists who are so concerned about women later changing their minds could more profitably spend their time working on making tubal ligations easily reversible, rather than on just saying no.
    For what it’s worth, two of the women I’ve known since undergrad, who swore for years they would never have children, changed their minds in their early thirties and had a child. So it does happen. Personally, I’m a big believer in preserving my options. But vasectomies are fairly easily reversible as I understand it.

  50. TinaH – My dad’s an andrologist, and apparently in this country it’s standard practice to treat men who want vasectomies like infants too. Doctors refuse vasectomies to men who aren’t already in a ‘stable’ (read marriage) relationship (because they might change their minds when they meet someone, apparently), and don’t already have children. There was a news story a couple of months ago about couples who chose not to have children (gasp!) and one prominent doctor was talking about the men whose requests for vasectomies he’d turned down like he was proud of it. Bizarre, really.

  51. I was thrilled to be able to walk into Planned Parenthood and get an IUD put in without any of this nonsensical wibbling (I’m twenty and have no children, so I’m in prime “you don’t know your own mind” territory), and I shall definitely ask for a reference from them if/when I decide to get my tubes done, as I’ve heard incredible numbers of horror stories and I just don’t want to deal with that while I’m getting the medical care I’m paying for.

    I have such a hard time reconciling the forced sterilization of “undesirables” with the difficulty young white women like me have getting the same. It’s almost like there’s a consistent policy of discrimination and subjugation to keep a very specific group in power…oh wait.

  52. Hector, the thing is, that when I found a doctor who wasn’t so interested in saving the white race, he admitted that tubals are not as difficult to reverse as people make them out to be. It’s not a guaranteed surefire procedure, but this idea that having one means that you’ll never, ever be able to have a baby is overblown.

  53. but this idea that having one means that you’ll never, ever be able to have a baby is overblown.

    Especially because you could, you know, adopt.

    Although that has its own whole set of complications too, I guess. Never mind.

  54. I had no trouble getting a tubal after my fourth child.
    Of course, the fact I was in my 30s, had four kids, and we were not middle class in wealth made it all that much easier.

    My OB was actually urging me to after the third. (He didn’t like me and didn’t want to deal with me again) But I get the feeling he’s the old-school sort who sterilizes the poor regardless of consent. He certainly attempts to intimidate with the antique forcept collection on the waiting room wall.

    My cousin was 20 when she tried getting her tubes tied. She had one kid, didn’t want a second and was scraping to make it. The doc said no.

    My mother, 28, went through all this crap in 1974 after my sister was born. I think they required her to have signed permission from her husband.

  55. My boyfriend and I were at a Planned Parenthood, and even the doctor there was taken aback at first when we inquired about vasectomies. He’s 26, I’m 25, and we don’t want children. If we change our minds, there’s always adoption.

    Granted, after a few minutes of being slightly flustered, she told us all about the procedure and gave him a brochure. I am pretty sure he’d be able to get one, no problem, and I’d love to not be on the pill anymore.

  56. This whole “you might change your mind/the child could die and you’d want a replacement” enrages me.

    Tough shit.

    Being free means that you make decisions and live with the consequences, even if you regret. Regret that abortion, fine, but that’s no excuse to deny that freedom to others. Regret that tubal ligation cuz your newborn died and you married a man who wants children? Too bad, adopt or deal. Still no reason to deny freedom to others.

    Freedom does not mean protecting people from their own decisions.

    Just as an aside, I’m not a big fan of fertility clinics where people spend three kids college educations, in an attempt to get pregnant. The capacity to love and raise a child does not magically appear with pregnancy. I support people who have difficulty getting pregnant, and who may need to consult with a doctor, but anything can be taken to extremes.

    But then I’m a big fan of adoption, and plan to open my home to foster children one day(I want to foster teens, and am waiting until my daughter is older).

  57. This whole “you might change your mind/the child could die and you’d want a replacement” enrages me.

    While it doesn’t excuse doctors’ denying people sterilization, child “replacement” happens too. Witness Elizabeth Edwards having kids at ages 49 and 51 after her son died.

  58. Why can’t people understand that birthing babies is not the highest and best goal of all women?

    Is a woman still not much more than a uterus?

  59. Hector,

    I love Elizabeth Edwards, and somehow, I get this feeling that if their efforts weren’t successful, they would have adopted.

    I just don’t understand this desire to have some genetic attachment, that actually overrides your desire to raise and love a kid. Single women & GLBT people I can understand, they face many uphill battles in an attempt to adopt, fertilization is much easier, and probably costs about the same.

  60. Some doctors need to mind their own f*cking business. I want what I want when I want it and you are sure as hell not going to deny me. Jackasses.

  61. Tubal ligations and vasectomies are not easily reversed, for a physiological reason. The tubes in your body are not like the “series of tubes”; they’re living tubes, interacting with the content. The hairs and the peristalsis of the Fallopian tubes are necessary to propel egg, sperm and zygote to their destinations. (Which is why gonorrhea and chlamydia infections, even when treated, are a major cause of infertility.) The vas deferens is also a peristaltic organ, and cutting the vasa often means that the blood supply is cut off, so even if the vasectomy is reversed, the vasa are just dead tubes.

    If you want to talk about having biological children after sterilisation, IVF is the way to go. The ova are taken from the ovary with a needle (so no need for tubes), and sperm can be taken directly from the testes.

  62. That’s a great point Therese, when faced with one over the other… vasectomies are a much easier/minor surgery and even in my friends case that was what I suggested. Of course that was assuming that for the rest of her reproductive life the only man she would be with would be him…. I’m sure that was not her motive but I can understand.

    Yes, I’ve read the best way would be IVF and hopefully a better choice in the future would be to freeze ova and sperm before versus having to fish for them years later. (for some reason this freaks people out, the “normal” way is so much better????)

  63. I’m forced to agree with Therese. If one really wants children later, there are always options, and the racial argument has me convinced that access to the procedure is a real issue.

    But I still understand doctors who deal with desperate men and women later who want their sterilisations reversed, and IVF is expensive. They can’t read minds, so they just adhere to their code. I can’t fault them for it and I won’t call sexism (which I’m not afraid to do when it’s warranted).

    Maybe some resistance is reasonable, but total denial is definitely not.

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