The difficult access to tubal ligation: "Some doctors ask for a written agreement from the partner"

You are a woman and do not want any more children.

You have two options: keep hormonal or non-hormonal contraception until menopause, or opt for sterilization through tubal ligation.

And this is where things get complicated.

Legal since 2001, this operation is however generally not offered to patients among the range of contraceptive methods available.

And when women make the choice, many are those - especially the youngest - to report having been confronted with medical reluctance and the judgments of those around them.

Here is the observation made by the journalist Laurène Levy, when she combs the forums and collects testimonies for a thesis on gynecological violence.

These stories push her to investigate and give rise to a book

(Ed. The clandestine passenger), published on February 17.

The journalist analyzes the origin of the obstacles faced by some women who wish to ligate their tubes.

It tells the story of female sterilization, used as an instrument of oppression and birth control on minorities.

The story of a fight too, that of women wishing to lighten their maternal burden, even to completely emancipate themselves from the injunction of motherhood.

Interview.

In video, the legalization of the pill in France

Madame Figaro

There are no precise statistics on this subject, but there are still two major scenarios.

We first find women who have already experienced maternity and are seeking contraception to put an end to their reproductive functions.

Then, we see women who do not imagine themselves to be mothers and whose ecological, feminist or personal convictions have sealed this non-desire for a child.

Read alsoThese women who choose to be sterilized

While tubal ligation is legal in France, you point out that women wishing to access it come up against a lot of resistance.

Which ones?

In theory, two conditions must be met to have your tubes tied: being of legal age and consenting.

Then, after respecting a reflection period of at least four months, you must be able to have the operation.

Only in practice it is not so simple.

For example, many doctors insist on the definitive nature of the operation and still dissuade young women from carrying out sterilization.

They do it much less in front of a 40-year-old woman who is already a mother.

They are told “You are too young”, “You are going to change your mind”… These health professionals hold a rather paternalistic discourse.

To rule, some also ask for a psychological opinion - which is not a mandatory condition - and even go so far as to ask for a written agreement from the partner.

Do the obstacles persist after the first consultation?

Yes.

On the day of the operation, the anesthetist can for example refuse to participate in the tubal ligation, in the name of his conscience clause, which allows the medical profession not to perform an act contrary to personal ethics and convictions.

Women report having seen their operation postponed.

And if a doctor who resorts to it is obliged to immediately redirect the patient to a colleague or colleague, in fact, this is not always the case.

Thus, depending on the situation, a woman can hope to obtain her tubal ligation after a few months or after several years.

These obstacles lead to discouragement, some end up giving up along the way, returning out of spite to another method of contraception or letting their partner take over.

Depending on the situation, a woman can expect to have her tubes tied after a few months or after several years.

Laurène Levy, journalist and author

According to figures from Health Insurance, the number of tubal ligations fell from 31,473 in 2010 to 21,490 in 2021. Vasectomy recorded a sharp increase over the same period, from 1,908 to 23,306.

How can we explain it?

It is difficult to answer, we can only make assumptions.

We can therefore say that men are perhaps beginning to become more aware of the contraceptive burden of women.

But we can also say that vasectomy is easier to access than tubal ligation.

Read alsoThey dared vasectomy: they tell

In your opinion, why do women have more difficulty accessing permanent contraception?

In our culture, we assume that a woman is destined to be a mother and that she will embrace this role with happiness.

This is reinforced by the so-called “sacred feminine” theory which links the woman to her biological nature and her power to give life.

Man himself is not under the yoke of this injunction, quite the contrary.

The vasectomy offers him more hero status.

He is hailed, even admired, for being one of the rare men to take his share in the contraceptive burden and to break out of the classic scheme.

For a woman, refusing motherhood is perceived either as a default choice, due to a relationship or fertility problem, or as unconsciousness.

For a woman, refusing motherhood is perceived either as a default choice or as unconsciousness

Laurène Levy, journalist and author

You also write that tubal ligation is disturbing because it is associated with dark periods in the history of humanity, those of forced sterilizations used as a tool of birth control and domination of minorities.

Does this violence still exist today?

Unfortunately yes.

We have very recent examples of illegal policies aimed at forcibly sterilizing women to better control the demography of an ethnic group.

This is the case of the Uyghurs, for example, imprisoned in camps and victims between 2015 and 2019 of massive sterilization campaigns by the Chinese regime, without explanation or obtaining their consent.

In Canada, in recent months, testimonies from Aboriginal women also report sterilizations without their knowledge, performed during a caesarean section or a gynecological operation and observed years later at the time of a parental project.

France is not exemplary either.

Until 2016, any transgender person, female or male, who wished to obtain a change of marital status had to undergo sterilization.

We justified the act by putting forward medical reasons, we suspected the transitional hormone treatment of harming the functioning of the genital system.

But according to militant associations in particular, they were sterilized instead because the possibility that a transgender person would become a parent was disturbing.

It is possible to have a child after tubal ligation, via IVF.

Is this a frequent situation in France?

It is a possibility but in reality, it is rarely chosen.

According to a study carried out by the gynecology-obstetrics department of Bicêtre Hospital and published in 2014, between 2 to 3% of women consult to consider a potential pregnancy after sterilization, but none ultimately resort to assisted reproduction.

In reality, when you push the door of the doctor's office, you have often already considered the possibility of regret.

What is a tubal ligation?

Performed under general anesthesia, the operation consists of incising at the level of the navel and the pubis to close the fallopian tubes and prevent any meeting between the spermatozoids and the ovum.

There are three surgical techniques: that known as ligation, where each of the tubes is closed with a ring or clip, electrocoagulation, where an electric current is used to coagulate and obstruct the tubes, and finally partial or tubal surgery, also called a salpingectomy.

The intervention is usually done on an outpatient basis but still requires a work stoppage afterwards.

The effectiveness of the operation is immediate, unlike vasectomy which requires waiting for confirmation of a spermogram, 2 to 4 months after the operation.

To compensate for a possible regret, it is possible to freeze your oocytes before the operation.

Many women claim not to have been informed.

Why is this information going under the radar?

The possibility of freezing one's oocytes for non-medical reasons is recent, it dates from the law relating to bioethics of August 3, 2021. Previously, it could only be done in the context of oocyte donation.

This message has therefore not yet fully won over the minds of French women.

It also reminds the government of the need to update the information resources available to patients.

The training of health professionals should also include a more in-depth module on this contraceptive choice, to learn how to better

When one does not want a child, when this choice is informed and consented to, by what means can one make it heard by the medical profession?

Before starting the process, I advise you to find out about the health personnel beforehand, it is the best way to be listened to and not to receive violent comments.

There are also lists of carers who are tolerant and open to female sterilization on the Facebook group “Voluntary Sterilization (ligature, Essure, vasectomy)” or on the Gyn&Co website.