Why Do Doctors Get to Decide When a Woman Is Old Enough to Have Her 'Tubes Tied'?

This article is reprinted from American Sexuality Magazine.

"I'm sending you this email as I can't sleep after the non communication we had after dinner ... I respect your decision not to have children but what I do not understand is why you get so defensive, you never give why? What's helped you make this decision? I could tell my friends and family 10 reasons why I didn't want a child or a husband [when I was your age]. You just place a high wall between us and make statements that I don't understand and you don't explain. IE, it will never happen I'm making sure of that??? Are you having surgery? Is your partner? Are you ill? What does this statement mean?  I make a statement, "Never say never," again you get upset. Lauren*, no one knows what life holds for them... There are some decisions you'll make in life that will live with you forever and I want you to realize this. I do understand this will come with time and maturity. I guess we'll always have a wall between us due to our strong wills and selfishness."

-- love mom (Mrs. Green*)

Ever since Lauren Green was a little girl, she knew she wasn't interested in motherhood. While other girls dreamt of dolls that peed, Green fixated on everything but: "I was going to get married as soon as I graduated college, and I would design my houses and I would design my wedding, but there were never any babies involved."

She's been dealing with the ardent disapproval of friends and family ever since. Especially from mom.

According to Green, now a twenty-five year old graduate student, not so cryptic emails like the above are standard between her and her mother, whose dreams of one day being called "nana" are radically out of sync with her daughter's choice to remain child-free.

"My mother just thinks I'll change my mind. I think a lot of people think I'll change my mind," admits Green, by now all too familiar with the weary, knowing smiles of those who think they know her better than she knows herself. People, so it seems, are somewhat inept when it comes to distinguishing womanhood from motherhood.

For now (at least) mama Green needn't worry; though she's tried, and will try again, Green has thus far been denied any permanent form of birth control, specifically tubal ligation.

Tubal ligation -- known more commonly as "getting your tubes tied," -- involves closing the fallopian tubes so that the egg cannot travel from the ovary to the uterus, where, normally, a fertilized egg would develop into a fetus.

"[Planned Parenthood of Boston**] said it was much too permanent and weren't going to give it to me, plus my insurance wasn't going to cover it," recalls Green. What's more, according to Green, "It was all and only about my age." She was twenty-two at the time.

Green's experience is not that unusual. Though no actual laws have ever been put into place, most OBGYNs refuse to provide women under thirty with permanent forms of contraception. Dr. Daniel Wiener, assistant professor of obstetrics and gynecology at McGill University in Montreal, is one such doctor.

With thirty plus years of medical practice, Dr. Wiener finds no good reason for putting otherwise healthy patients in surgery: for one, there are anesthetic risks involved. Plus, tubal ligations are considered elective surgeries (assuming the patient can use other, less invasive forms of birth control). More pressing, still, is the fear that a patient may one day change her mind. Sound familiar?

"Twenty-one to thirty, that's a big decade. A huge decade," says Dr. Wiener. "A woman who is twenty-five and says, 'That's it, I've made my choice,' I would probably just have to say, 'You're making a twenty-five year old choice. You sure that's going to be a thirty-eight or thirty-nine year old choice?'"