Pseudonymous gas station clerk Eleanor is just 20, but she knows that she never wants children. “I have a lot of trauma from my childhood, and from how my mother treated me,” she tells me. “I wouldn’t want to risk continuing that cycle of abuse.” So, for the last few years, she’s been researching sterilization procedures, specifically a salpingectomy — an operation in which one or both of the fallopian tubes are removed. But it wasn’t until earlier this week, when a leaked draft revealed that the Supreme Court had voted to overturn Roe v. Wade — the landmark 1973 ruling that made safe, legal abortion a constitutional right — that Eleanor finally decided to try and book an appointment with a gynecologist.
“I’m terrified of having to go through pregnancy,” she explains. “If women aren’t already sterile or don’t get sterilized as soon as possible, lives are going to be lost.”
Eleanor is one of many women ramping up their efforts to get sterilized, or even newly considering the procedure in light of the possible countrywide rollback of America’s abortion rights. After the Supreme Court draft was shared by Politico on May 2nd, scores of women took to social media to express newfound interest in sterilization, lament misogynistic doctors who refuse the procedure to women — “because you could change your mind and sue,” read one tweet — and share resources about providers. Over on Reddit’s r/childfree subreddit, a trending post about sterilization information got nearly 1,000 upvotes and over 100 comments.
But for many women, sterilization isn’t as simple as just calling the doctor and booking an appointment. As reported by The Conversation in 2018, women in the U.S. face “extraordinary difficulties in seeking the birth control method of sterilization,” regularly being denied the procedure due to the gendered assumption that they’ll one day regret it, and facing significantly higher monetary barriers to it than men. In fact, a vasectomy is five times cheaper than tubal ligation — another female sterilization procedure in which the fallopian tubes are tied rather than removed.
Still — with abortion potentially soon-to-be banned and access to birth control often being difficult and costly — for a number of women, trans men and non-binary people with vaginas, sterilization may feel like the last option, even if acquiring that, too, is hard. But, as one Twitter user pointed out, “People feeling compelled to get vasectomies/hysterectomies because of current abortion laws is a [very] short trip from forced sterilization.”
America has a long, disturbing history of forced sterilization, which is driven by eugenics and particularly targets women of color and disabled people. It’s still ongoing today — just think back to Britney Spears’ forced IUD as a recent, high-profile example. Similarly, jokingly suggesting that men should be forced to get vasectomies is not only missing the point of bodily autonomy, but actively calling for forced sterilization. Furthermore, as the American College of Obstetrician and Gynecologists (ACOG) noted in its 2017 report on the ethics of female sterilization, women can also be coerced into sterilization — and a ban on abortions may only serve to increase this kind of pressure and intimidation.
Of course, sterilization — or any kind of birth control, for that matter — isn’t the solution to the abortion debate, and affordable, accessible and legal abortions should be accessible to anyone who wants or needs them. “Abortion is an essential component of comprehensive medical care,” says Jen Villavicencio, the lead for equity transformation at ACOG. “Access to abortion care improves the health and wellbeing of those who need it, and data has long shown that restrictions to access to care only cause harm. Quite simply, people will always need access to abortion. Contraception fails, lives change, unexpected complications occur. No matter what an individual’s reason for an abortion, it’s essential that they have access to an abortion when they need it.”
Nevertheless, millions of people like Eleanor, who live in “trigger law” states, may soon be at a loss for anything else to do aside from sterilization. Eleanor’s in Tennessee, where, in June 2020, Republicans voted to ban abortion as early as six weeks after conception — before most women even know that they’re pregnant. After initially being prevented from taking effect thanks to a district court injunction, a federal appeals court blocked the law in September 2021 — but, if Roe v. Wade were to be overturned, as the leaked draft suggests it might be, Tennessee would be one of 13 states that would enforce strict, inhumane abortion laws (following in the footsteps of Texas, which already enacted its near-total ban in September 2021).
“Women’s reproductive health is being held hostage,” Eleanor says. “[Lawmakers] are undoing almost a century of work — and they’re not even stopping abortion, they’re revoking access to safe abortion, meaning women and people with uteruses will die.” She’s right — banning abortion doesn’t stop it happening, it just forces women to go through with life-threatening pregancies, or seek more dangerous ways of acquiring a termination.
Obviously, though, it’s not just the red states in fear of the landmark ruling being overturned. In the battleground state of Pennsylvania, 29-year-old clinical coordinator Ashley (not her real name) is feeling “a stronger sense of urgency” to get sterilized. Ashley’s been thinking about sterilization for a few years, but only just asked her doctor for a bilateral salpingectomy (removing both fallopian tubes) in December 2021. “I might have considered it sooner, but it didn’t even occur to me that surgery would be an option for women who don’t already have several children,” she reflects. (It’s unsurprising that Ashley held this belief, as many doctors do, in fact, refuse to sterilize child-free women.) After a few months of scheduling, Ashley completed a pre-op appointment, and now has her surgery set for next week.
“This week’s news about Roe v. Wade shows me that I’ve been right to be afraid, and that sterilization needs to be a priority,” she tells me. “Even though I was scheduled for the surgery before the news broke, I’m still waiting for prior authorization results and now feel motivated to aggressively push back if I’m denied coverage.”
Many women who’ve already had the procedure done echo Ashley’s view, saying that Monday’s bombshell has made them increasingly thankful that they did it. This is true for 30-year-old project manager Jessica (again, not her real name), who — despite living in Colorado, where the right to an abortion is encoded in state law — decided to undergo a sterilization procedure in February. She had a hysteroscopic endometrial ablation, in which the lining of her uterus was removed; the minimally invasive operation was performed by a doctor that she found in r/childfree.
“I’d been thinking about getting sterilized for several years prior to getting the procedure, but late last year, when we all found out that Roe was in danger of being overturned, my first thought was that I better do it before it’s illegal,” she says. As she used a specifically recommended doctor, Jessica says she was approved for the procedure immediately. “I thought I’d get some pushback, being only 30-years-old and unmarried with no kids, but the doctor didn’t question me at all,” she explains. “The procedure was completed three weeks later.”
Jessica, who’s single and “uninterested in marriage,” has never told her family about the procedure and doesn’t have any plans to (she says her mom would be “devastated”), but she has told some friends, who she says were “100 percent supportive.” Still, she adds, it doesn’t matter what anyone else thinks. “I have no desire to be a parent,” she tells me.
Both Eleanor and Ashley have partners, but each is on board with the decision. Ashley’s partner even decided to get a vasectomy a few months ago, in case she “has issues with completing the surgery.” Interestingly, Ashley says her partner used to be anti-abortion, but now “he understands my fear and believes a woman’s business is between her and her doctor.” Her mom, on the other hand, wasn’t so understanding. Like many doctors, Ashley’s mom believes she’ll change her mind about having children — a common assumption that adds to the stigmatization of childless women. As observed by the New York Times last year, “women who don’t procreate are often labeled unusual, unfulfilled and unhappy” — a 2016 study even reported that some people feel “moral outrage at people who decide not to have children.” The Pope, of course, described it as “selfish.”
But for people who don’t want to be parents, that’s really not the case. “I’ve known my whole life that motherhood isn’t for me,” says Ashley, “and I’m tired of being anxious and dealing with birth control, which fails at times, is temporary and forces me to rely on a doctor to get it in the first place. I’m also afraid of the choice being taken away from me, not just with abortion rights at risk, but also with potential future attacks on contraceptive availability. The only way a woman is guaranteed to successfully opt out of motherhood is through sterilization — and even that is difficult and might be impossible in the near future.”
Although Eleanor, Ashley and Jessica all say they’ve been thinking about sterilization for a number of years, the recent talk of Roe v. Wade being overturned has sprung each of them into action. Where’s the line, then, between elective sterilization and forced sterilization?
If women are considering sterilization because of changing laws, then they may not be independently volunteering to do it. But if the legal rollbacks are pushing those who were already considering sterilization to finally go through with it, that question becomes harder to answer. It’s not being forced in a traditional sense — as it has been on women who truly had no say — but for some, it might feel that way.
In any case voluntary sterilization remains a choice; an increasingly precious thing in a world that seems hellbent on limiting them. And for those pursuing it, that’s what matters most.