Fertility frustrations: Do young women have the right to be sterilised?

By MATILDA BOSELEY 

Soraya has never felt maternal.

As a young girl she had no interest in mothering baby dolls and as she grew up she never dreamt of her future kids.

In fact, the idea of pregnancy fills the 22-year-old with dread. Thinking about something inside her, growing, makes her notably anxious.

“I feel like if I did have a child, I would be one of those parents that put their child in a car and drive into a lake because they can’t handle the pressure.” She is perfectly calm as she says this. For Soraya, this is simply stating the facts.

Hormonal methods of birth control aggravated and intensified her depression and anxiety, so at 18 she did some research and decided that a permanent contraceptive procedure was right for her.

There are several sterilisation procedures, but the most popular is tubal ligation, known colloquially as "having your tubes tied". Performed under general anaesthetic, three small incisions are made in the abdomen, through which clips are attached to the Fallopian tubes, blocking them and preventing eggs entering the uterus.

The Australian government has not released a nationwide survey on contraceptive use since 1998, however, at that time about 19 per cent of women using contraception opted for sterilisation. This method is generally reserved for older women who have finished having children.

But with the changing expectations on women in society, statistics show that more and more young people are choosing not to have children, and some of these young people are opting for sterilisation.

So, when a childless 18-year-old enters the consultation room and requests this permanent procedure, should a doctor perform it? This is a question that has been gaining traction across social media in recent weeks.

Soraya knew that it might be a struggle to convince her doctor, so she prepared a document outlining why she wanted the procedure.

At the end of her first consultation at the Royal Women’s Hospital in Sandringham, her doctor decided her suitability should be assessed by an ethics committee, a process which required her to pass a psychiatric evaluation.

“The [psychologist] kept asking me, 'Why don’t you want kids? How are you sure you don’t want kids?’” Soraya says with evident frustration.

“I said, ‘I don't really feel maternal; it’s just not what I want for my life, and I feel like that’s an okay decision to make’.”

Finally, two years after she received her referral, she was called in to hear the final decision.

“The doctor told me I had passed the evaluations. He told me the psychologist said I was definitely of sound mind, but she was still concerned that I would change my mind later.

“I stormed out of the office. I was in tears. I just went outside and went, ‘Oh God, I can’t believe that I have wasted so much of my life for them to not listen to everything that I said’.”

The doctor followed her out into the car park and it was here that Soraya finally broke down.

“I said to him, ‘I’m sorry but I could join the army at 18, I could adopt a child right now, I could get as much cosmetic surgery as I wanted to – I could do all this shit that includes life-or-death decisions, yet the one thing I can’t do is have control over my own body, because you have decided that one day I might change my mind’. It was like they were putting a hypothetical baby over my own wants and health.”

Some, including Soraya, say medical professionals are acting “paternalistically” when it comes to safeguarding women’s fertility and have ignored the wishes and best interests of these young women. 

However, Dr Patricia Moore, head of the Early Pregnancy and Contraception Unit at The Royal Women’s Hospital, says doctors are right to be cautious when considering the procedure for this demographic.

“I would really, really think hard about it, because it’s not the best way to manage those circumstances. I would want to make sure we had had at least two or three serious conversations about it,” she says.

Dr Moore says some women do not fully understand the procedure when they request it.

“The issue is that a tubal ligation is an irreversible procedure, it’s a final decision. There is a misconception that it is easily undone.”

While reversal procedures can be performed, they have a high failure rate. Only 60 per cent of women can fall pregnant after a reversal and only 50 per cent are able to have a baby.

“When a young person comes in we have to see what their knowledge is and what their expectations are about the procedure. We need to make sure this is actually what the patient wants,” Dr Moore says.

“In my hospital we treat this the same as a urologist would treat a sterilisation in a very young man. It would be treated with the same degree of vigour.”

However, Alana Cooper feels this level of vigour has been taken too far.  She has been trying to get sterilised for 17 years.

When Alana was 19 she had a daughter. She had never planned to have children and said she was taking birth control carefully when she fell pregnant. So, while in the hospital, nursing her newborn, she spoke to her nurse and requested a tubal ligation.

“She said I was too young, ‘you don’t know what you want’.  I said, ‘Well I do, and I don’t want children’.”

Nearly two decades later, at 37, she has not changed her mind.

“My GP said I was still too young and because I had a new partner, he might want kids. It pissed me off quite a bit that they didn’t think I could make that choice for myself.”

While many young women are confident in their decision not to have children, Dr Moore says it is not uncommon for women to regret the procedure.

“We have all had the experience of women regretting that big decision, and it’s terrible. These are women that have had two or three babies and then the relationship fails, and they meet someone later on and want to cement that relationship with new babies.”

For Soraya and Alana, the refusal to perform the sterilisation was highly distressing, but for Kyarra Fischer, although frustrating at the time, it turned out to be a blessing in disguise.

Kyarra’s second pregnancy was rough. Her baby was born prematurely, she was stressed and never wanted to put herself through this situation again. She was 20 and asked her doctor three times for a tubal ligation.

She was refused each time, but in retrospect is glad the doctor turned her down.

“I think mentally I was just not coping and didn’t want more babies at that time, but now that I’m a bit older I realise how glad I was I didn’t take the option of another baby away. Four years later we are having baby No. 3.”

Dr Moore says a change of mind is not the only issue.

“We perform it less and less now because we have really good forms of long-lasting contraceptive.”

In fact, tubal ligation and other permanent contraceptive surgeries may be becoming obsolete as other long-term and reversible options enter the market.

These include hormonal and non-hormonal intrauterine devices (IUD) which can last up to eight years. They have minimal risk of infection or complications and do not affect fertility once removed.

Without comprehensive statistics on Australian contraception use, it is difficult to know if sterilisation procedures are losing favour, however, Dr Moore says in her time as a surgeon she has seen a dramatic decrease in the procedure.

“It requires a surgery so there is an anaesthetic risk and the risk of the procedure.”

Tubal ligation also has a failure rate of about one in 100, with some of these failures resulting in an ectopic pregnancy. This is a serious and potentially dangerous medical condition where a fertilised egg begins to grow outside the uterus.

However, Soraya says she was aware of these facts and had already considered the other options.

“I’ve tried all the hormonal ways – they mess with my emotions, they make everything worse … I can’t use an IUD because of my phobia. I know it’s irrational – everyone who has a phobia knows it’s irrational – but I can't bear the idea of something inside my uterus like that."

Currently Soraya is only using condoms, which she says worries her.  “If I was to get pregnant now, I would have to get an abortion and that would be on them because I gave it my best shot.”

Three years on from her initial appointment, Soraya is just as sure that this procedure is right for her and has begun investigating and saving to have the surgery in Thailand.

“I’ve done my homework. I’m sure this is what I want," she says.