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?'"

In other words, come back when you're older.

For Green and the growing number of women forgoing motherhood, waiting till they're thirty just isn't good enough. "It's a vast limitation of my reproductive rights," opines Green, thoroughly unimpressed with Dr. Wiener's approach. "Doctors will say, 'I don't like to prescribe elective surgeries for people who don't need them.' Whereas if you don't want to have a baby, you don't want to have a baby and it feels fairly necessary to me."

"It's an issue of agency, and who gets to make that choice," adds Christine Brooks, a post doctoral fellow studying the purposefully barren at the Institute of Trans Personal Psychology in the Bay Area.

According to Brooks, "The argument that these women might change their minds is a paternalistic argument. It questions a woman's inner knowing, her own path in life. It also suggests that women don't know what's best for them and that they have to defer to a medical authority to make life decisions."

Yet doctors routinely make life decisions for other people. And with more than three decades of practice, Dr. Wiener isn't about to question his proficiency on the subject:

"Why do we arbitrarily choose thirty? Because of the thirty years of practice in my life. Because of the number of years of experience that we, as physicians, have come to see that twenty-five, twenty-six, twenty-seven year old women have, historically, more often than not, told you they regretted their decision to get their tubes tied."

Brooks suggests otherwise. Drawing on her research examining "grounded theory exploration of the early articulation of intentional childlessness," for which she interviewed thirty women, she concludes that the consistency of women maintaining their original choice not to have children is extremely high. The real problem, according to Brooks, "is the dearth of choices given to them in terms of their reproductive freedoms. "For instance, they themselves had very positive self-regard, but had to deal with 'the denial of validity' from others." (Or Mrs. Green, if you so happen to be her daughter.) Not surprisingly, many are turning to the Internet for support.

A number of groups, such as childfree.net and Childfree by Choice, have made their views known in cyberspace. It only takes a few clicks to realize that Green is far from alone:

"I am almost 22 and do not want to have sex until I get my tubes tied. The risk of pregnancy is just too horrifying to me. In fact, it is my greatest fear. How do I find a doctor who will perform this procedure on someone my age? Do you have to be 30 in all states? Could enough money get me a ligation? Or could I make some kind of appeal with a convincing argument?"

"I don't think there are laws. Most doctors have a general criteria they'd like you to meet (26 w/2 kids, for example,) but some will do it if you want. My own OB said he'll do that on anyone who wants it -- if you know -- than you know! Just keep calling around to different OB/GYNs and ask what their beliefs are on someone with your age & situation. Keep calling until you find someone. Good luck!"

The frustration is palpable. And it doesn't look like things are going to simmer down anytime soon. The National Center of Health Statistics reports that the percentage of women of childbearing age who define themselves as voluntarily childless is growing, from 2.4 percent in 1982, to 4.3 percent in 1990, to 6.6 percent in 1995, in other words 4.1 million women (the most recent statistic available).

With their numbers increasing, the "childless by choice" have already inspired their own five letter acronym: "DINKS," originally referring to any committed couple without children, stands for Double Income No Kids. The word was created in the 1990s, when demographic studies uncovered the self-obvious fact that couples without children have a higher level of disposable income on average. But apart from its ostensibly light hearted tone, the term does little for those assuming its moniker; DINKS are frequently dubbed egotistical, cold, and money hungry. Unnatural even.

"It's still kind of a cultural norm that you will have and want children," Green says. "I think people are very wary of people who don't want kids."

Some, like Suzan Douglas and Meredith Michaels, authors of The Mommy Myth, have gone as far as to tag the backlash the "new momism."

Douglas and Michaels explain that the new momism oppresses all women by reducing their worth to childbearing and rearing; that in an overwhelmingly child oriented society, a woman is not complete without a child; she must be the primary caregiver of that child, and she must devote herself utterly to her children. Lest she be called "selfish" or "immature."

Whatever one's reasons for declining parenthood (some cite financial motives, others, careers -- there's even an entire group citing environmental reasons and overpopulation) most people simply don't take kindly to those who can, but don't, have kids. Particularly in a time where infertility rates are on the rise.

While Green has no way of knowing for certain whether or not she's fertile, she remains undaunted by her "waste of womb."

"I think there's definitely this idea where a woman's function is to have babies cause your body is made to do it," she says. "My body is made to do a lot of things. It's made to run. That doesn't mean I go running every day. Nor should I have to."

As for Mrs. Green, she's got a long trek in front of her. By her only daughter's estimate, "She should be crying a lot over the next, I don't know, how many years before I'm past my prime childbearing years? I'm guessing twenty years."

At least it's not thirty.


* Names have been changed for this article.
** Planned Parenthood of Boston no longer offers tubal ligations and could not be reached for comment.