GRSJ224/femalesterilization

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Faces of Sterilization

Female Sterilization's Agency in Empowerment

Introduction

Female sterilization, also known as tubal ligation blocks (or removes part or all of) the fallopian tubes so the egg cannot travel to the uterus. The procedure is done by various surgical techniques, usually under general anesthesia to the desired effect that a woman can no longer become pregnant and is considered a permanent method of birth control [1]. Tubal ligation is considered major surgery, typically requiring the patient to undergo local, general, or spinal anesthesia. A surgeon will then make a small incision at each side of, but just below the navel (laparoscopy) in order to gain access to each of the two fallopian tubes. With traditional tubal ligation, the surgeon severs the tubes, and then ties (ligates) them off thereby preventing the travel of eggs to the uterus [2]. A tubal ligation is considered approximately 99% effective in the first year following the procedure. In the following years however, the effectiveness may be reduced slightly since there is a chance that the scar tissue of the tubes reconnects and allows for an unintended pregnancy [2]. Overall, the procedure is irreversible, thus should only be considered as a permanent form of sterilization.

Young Indian woman

History

The practice of female sterilization is not new. The procedure was first documented to have been used in the early 19th century (1831) by physician James Blundell, while the first published report of the procedure came in 1881[3]. By the 20th century, the practice of female sterilization began to gain popularity, and since then, numerous modifications and altogether new techniques have been developed to improve the procedure. In recent years, the trickle down affect of local anesthetic has allowed for the performance of these procedures in a simplified manner, making them more accessible to lower level medical service centers and in areas of low socioeconomic standing. Internationally, serious complications occur in approximately 2% of the population, making the procedure relatively safe[3]. This has greatly improved the options women now have for managing their bodies and their fertility, as well as becoming a reliable method of family planning.

Prevalence

According to a survey from the Centers for Disease Control and Prevention, approximately 27 percent of American women of reproductive age use female sterilization as their form of birth control[4]. This is equivalent to 10.2 million women. This survey also found that black women (37 percent) and U.S Born Hispanic Women (27 percent) were more likely to use female sterilization than white women (24 percent)[4],questioning why this form of permanent birth control was favored more heavily by women at the intersection of race and minority rather than white women. Furthermore, worldwide female sterilization (in the form of tubal ligation) is the most common contraceptive method, used by 33% of married women[3]. However, interestingly the rate of female sterilization as the primary birth control method is highest in developing countries, and significantly lower in comparison to the rate of vasectomy in affluent ones.

Female Empowerment and Disempowerment

Empowerment

Birth control methods have been synonymous with female empowerment for decades. If women can afford and access birth control, they are able to take control of their fertility, and personal family planning (i.e smaller families, increased income, education etc). In recent history, female sterilization techniques have been improved and women are given one more option for managing their fertility, and by extension their bodily autonomy. While female sterilization has certainly led to the empowerment of some women over their bodies, it is important to note that not all women have the same ease of access to all forms of birth control, and women at the intersection of race, age, poverty, and other descriptors often face more discrimination and difficulty in obtaining the birth control they desire -- including sterilization.

Disempowerment

Various obstacles prevent almost 50% of women in the US from getting the tubal ligations they desire, including young age and hospital policy[5]. While this procedure can certainly empower women to have more choice over their bodily autonomy, many health care providers are allowed to withhold the procedure if they deem the patient "inadmissible[5]". In many cases women in their 20s and early 30s are refused the procedure because providers think they are too young and may later change their mind. Similarly, women without children are often also discriminated against for having the procedure because they may regret it. Many such cases, as the case of Andie [1], seems to presume that the ultimate decision of the woman to do with her body and her fertility what she wants to, is the wrong choice. These policies discriminate women at the intersections of womanhood, young age, and those that do not subscribe to traditional female roles of motherhood.

One study found that postoperative complications from tubal ligation are more likely than with vasectomy, and are significantly more costly. In industrialized nations, mortality is 4 per 100,000 tubal ligations, versus 0.1 per 100,000 vasectomies [6]. In developing nations, the mortality from female sterilization is even more prevalent. This demonstrates that there is a significantly lower risk of complications with a vasectomy, that it is considered a more minor procedure, and that for the same desired effects -- permanent birth control -- it is the cheaper alternative. This thus begs the question, why are there so many more tubal ligations performed than there are vasectomies? One leading cause of the high number of tubal ligations is intricately tied with the status of women in society. In the Indian province of Uttar Pradesh, the prevalence of female sterilization is 30.3%, while vasectomies account for 2.12% of all birth control methods. The same province scores extremely low on the indicator of the status of women (MS), an indictor measuring the restrictions on mobility, participation in decision-making, domestic violence, life expectancy, literacy and more[7]. This is a common denominator in relatively poor countries; high female discrimination rates, and equally high female sterilization.

Compulsory sterilization also known as forced or coerced sterilization programs are government policies which force people to undergo surgical or other sterilization. The reasons governments implement these programs vary in purpose and intent. In the first half of the 20th century, forced sterilization was instituted as part of a eugenics mind frame to prevent the reproduction of members of the population considered undesirable. Today, according to the UN interagency statement on Eliminating forced, coercive and otherwise involuntary sterilization [2], the most common target populations for this practice are women, particularly ethnic minorities, the disabled, the transgender, and the Indigenous[8]. Intersectional analyses of compulsory sterilization as a means of discrimination against these groups is therefore a valuable approach to understanding the various experiences that women face -- beyond solely what is faced by the white, cis-gendered female.

Other bases for compulsory sterilization have included population growth management[9], sex discrimination[10], "sex-normalizing" surgeries of intersex persons, limiting the spread of HIV, and reducing the population of ethnic groups[11]. These programs and their deliberate targeting of minority groups have led many to question if this is not in fact a case of those in power discriminating against women's bodily autonomy and fertility.

Summary

While female sterilization (tubal ligation) is an extremely valuable method of birth control that allows women to take charge of their bodies and their fertility, the ways in which it is used and the limitations that are placed on it's policies has created an atmosphere where some women are disempowered. In order to create effective change, the process of access and affordability for this procedure must shift to emphasis female autonomy over their bodies, regardless of age, race, sexuality, or any other factor. The decision to seek out tubal ligation must be the woman's and the woman's alone. Further, one must consider why the ratio of male to female sterilizations are skewed heavily internationally, and even more so in countries where female autonomy and status is low. Safeguards must be put in place to help fight against such forms of discrimination as are compulsory sterilization in a male dominated society.

References

  1. Greely, H (2018). "Human Reproduction in the Twenty First Century". Journal of Posthuman Studies. 1 (2): 205–223 – via JSTOR.
  2. 2.0 2.1 Falconer, Henrick (2018). "Association between tubal ligation and endometrial cancer risk: A Swedish population‐based cohort study". International Journal of Cancer. 143: 16–21.
  3. 3.0 3.1 3.2 Contraceptive Sterilization; Global issues and trends. Engender Health. 2012. pp. 139–143.
  4. 4.0 4.1 "Female Sterilization". CDC - Center for Disease Control. 2016.
  5. 5.0 5.1 Lueking, A. (2014). "Review of Female Sterilization" (PDF). The New England Journal of Medecine. 3 (12): 122–132.
  6. Awsare, Krishnan, Boustead (2005). "Complications of Vasectomy". Ann R Coll Surg Engl. 87 (6): 406–410.CS1 maint: multiple names: authors list (link)
  7. Tewari, S. (2014). "Status of women in the Naai community of Uttar Pradesh". SAGE Journals. 34 (1).
  8. OHCHR, UN Women, UNAIDS, UNDP, UNFPA, UNICEF and WHO (2014). "Eliminating forced, coercive and otherwise involuntary sterilization". WHO.CS1 maint: multiple names: authors list (link)
  9. Amnesty International (2011). "Thousands at risk for forced sterilization in China". Amnesty International. Retrieved 2018. Check date values in: |access-date= (help)
  10. Singh, A., Ogollah, R., Ram, F., & Pallikadavath, S. (2012). "Sterilization Regret Among Married Women in India: Implications for the Indian National Family Planning Program". International Perspectives on Sexual and Reproductive Health,. 38 (4): 187–195.CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link)
  11. Robyn, L (2018). "STERILIZATION OF AMERICAN INDIAN WOMEN REVISITED: Another Attempt to Solve the "Indian Problem"". Crime and Social Justice in Indian Country. University of Arizona Press. 4 (2): 39–53 – via JSTOR.