Sterilization

Sterilization

What is Sterilization?

_{Sterilization can be defined as the permanent result of a medical procedure that makes a person unable to reproduce. The process may be voluntary and commonly used as a form of contraception. Oppositely, the process may be involuntary as a result of disease, trauma to reproductive organs, or population control. Female sterilization is referred to as a tubal litigation and male sterilization is referred to as a vasectomy. Interestingly, compared to male sterilization, female sterilization is three times more common. This may relate to Saylor’s (2007) statement that some insurance companies are more likely provide financial support for tubal litigation and not the male equivalent. Tubal litigation and vasectomy (female and male sterilization) continue to be widely used methods of contraception, despite the development of newer technologies.}

The History of Sterilization in North America

_{The history of sterilization in North America spans a wide spectrum, starting as a medical procedure in development for people with preexisting medical conditions such as tuberculosis, to eugenic legislation including the practice of forced sterilization, to voluntary choices of contraception and reproduction.}

According to research on female sterilization, “the first reported tubal sterilization was performed at the time of cesarean delivery by Samuel Smith Lungren of Toledo, Ohio in 1880” (p. 189). The idea of sterilization, along with reproduction and contraception, endured controversial throughout the late 19th century and early 20th century. Feminists of the early 20th century fought for control over their own bodies’ capacities regarding reproduction, while a movement, known as the eugenics movement, attempted to control reproduction within society. Moss, Stam and Kattevilder (2013) discovered that a perception developed in the early 1900’s that there was an expanding section of mentally deficient individuals present in society, and combined with the belief that this section of the population was reproducing at a fast rate led to eugenic control. Specifically, Alberta and British Columbia (Canada), instated legislation on involuntary sterilization targeting the mentally ill. Support from the Canadian prairies relates to the geographic location with the United States. In other words, Western Canadian procedures and legislatures were more easily influenced by American trends, including eugenics. Also, anti-immigration and low tolerance for diversity and difference was a dominant perspective in the prairies during the early 20th century. Alberta, in particular, maintained its eugenics program from 1929 to 1972, engaging in thousands of sterilization procedures, specifically 10 times more than British Columbia during its legislation period on eugenics, according to Moss, Stam and Kattevilder (2013).

In the 1940’s, a shift of functionality regarding sterilization emerged, women began approaching Alberta physicians requesting sterilization procedures, “seeking to be relieved of the burden of fertility” (p.170). The concept of birth control, pro-choice and feminism arose from people who were seeking advice because the roles of wife and mother, paired with the challenges of the 20th century, were too demanding, and the definitions of “fit” vs “unfit” labels being blurred by people employing their own reproductive choices in response to eugenicists’ biased views.

Modern Procedures

_{Despite a noticeable decline in sterilization procedures since 1995, female sterilization, or tubal litigation, is a very common gynecologic surgery, just behind abortion and cesarean section. Female sterilization procedures can be performed abdominally, via laparoscopy or hysteroscopy, or through a transcervical approach. By 1948, hysterectomy, surgical removal of a woman's uterus, was “considered to be the only completely safe and permanent method of sterilization, but various other surgical methods of tubal litigation were practiced on a regular basis”.}

Reasons for low use of male sterilization procedures, or vasectomy, include “lack of knowledge, misconception of the procedure, lack of access to the procedure, provider bias, and patient preference” (p. 731). Vasectomy is commonly performed as an outpatient procedure using a non-scalpel technique with a local anesthesia. Puzzling that the demand surrounds female sterilization, when vasectomy is known to be safer, less expensive and equally effective as a contraception method.

Reasoning, Controversy and Politics

_{Sterilization as a contraceptive method is a common procedure in society, despite the controversial history and current reproductive political debates. Ethical concerns surround the appropriateness of contraception in general, and perhaps on a more intense level with sterilization because of its permanent nature.}

With anything medical, consent from the patient should be the most important legal step. And beyond, patients should be the foremost of a physician’s concern, putting aside their own personal biases and informing the patient of all pros and cons of relevant procedures and treatment, including but in no case limited to sterilization surgeries.

It is found that married women are more apt to turn toward sterilization procedures as a form of contraception, relating to age (typically 30 or older), family structure, and socio-economic status. Ansari and Francis (1976) empirically studied the mental effect of female sterilization and found the reason for which they were sterilized, either eugenic, socioeconomic, or medical purposes, to be the most significant factor.This raises concern when young, childless individuals request sterilization. Benn et. al (2005) argues that sterilization of young-childless individuals for non-medical reasons is ethical as long as information of all the risks, including regret is properly conveyed to the individual.

Those cautious towards or condemn sterilization as a contraceptive method “may assert that sterilizing a patient for non-medical reasons does not fall within the remit of medicine” (p. 1324). This highlights the concept of medicalization, more specifically, that society’s doctors are meant to treat medical conditions. It follows that non-medical use of a procedure should not be medicalized. The medicalization of sterility may be an area scholars, medical professionals and pro-life or pro-choice activists dynamically converse about.