Difficult access to pipe connections. “Some doctors ask for written consent from a colleague”

You are a woman and you don’t want any more children. You have two options: to maintain hormonal or non-hormonal contraception until menopause, or to choose sterilization by tubal ligation. And this is where things get complicated. This surgery has been legal since 2001, but is generally not offered to patients as part of a contraceptive method. And when women do make choices, many, especially the youngest, report encountering medical reluctance and judgment from those around them.

Here’s a look at reporter Lauren Levy as she combs forums and gathers testimony for a thesis on gynecological violence. These stories lead him to investigate and create a book My trunks, my choice. (Ed. The Secret Passenger), published on February 17. The journalist analyzes the origin of the obstacles faced by some women who want to have their tubes tied. It tells the story of female sterilization being used as a tool of oppression against minorities and birth control. A story of struggle, too, of women who want to lighten their motherly burdens, even free themselves entirely from the imperative of motherhood. Interview:

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Madame Figaro .- Who are these French women who choose to use contraception with tubal ligation and what motivates their choice?
Lauren Levy: There are no exact statistics on this topic, but there are two main scenarios. We primarily find women who have already experienced motherhood and are looking for contraceptives to end their reproductive functions. Then we see women who do not imagine themselves as mothers, and whose ecological, feminist or personal beliefs have sealed this non-desire for a child.

Although tubal ligation is legal in France, you mention that women who want to use it face a lot of resistance. Which one?
In theory, two conditions must be met to get your tubes tied: being of legal age and consent. Then, after respecting a reflection period of at least four months, you should be able to operate. Only in practice it is not so simple. For example, many doctors insist on the definitive nature of the operation and still discourage young women from being sterilized. 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 will change your mind”… These health professionals have a rather paternalistic discourse. In order to rule, some also ask for a psychological opinion, which is not mandatory, and even go so far as to ask for written consent from the partner. Which is totally eccentric and against medical secrecy in the first place.

Do barriers persist after the first consultation?
Yes! On the day of surgery, for example, an anesthesiologist may refuse to participate in a tubal ligation due to a conscientious objection, which allows the physician not to commit an act contrary to personal ethics and beliefs. Women report seeing their surgery delayed. And if the doctor using it is obliged to immediately refer the patient to a colleague or colleague, in reality this is not always the case. So, depending on the situation, a woman can hope to get her tubal ligation in a few months or a few years. These barriers lead to discouragement, with some eventually giving up, switching back to another method of contraception due to resistance, or letting their partner take over.

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

Lauren Levy, journalist and author

The number of tubal ligations is expected to drop from 31,473 in 2010 to 21,490 in 2021, according to Health Insurance Ports. Vasectomies increased dramatically over the same period, from 1,908 to 23,306. How can we explain it?
It is difficult to answer, one can only make assumptions. Therefore, it can be said that men are probably becoming more aware of women’s contraceptive burden. But we can also say that vasectomy is easier to achieve than tubal ligation.

Why do you think women have a harder time using permanent contraception?
In our culture, we assume that a woman is destined to be a mother and that she will happily embrace that role. This is reinforced by the so-called “sacred feminine” theory, which associates women with their biological essence and their power to give life. The person himself is not under the yoke of this message, on the contrary. A vasectomy offers him more hero status. He is hailed, even admired, for being one of the rare men who has taken his share of the contraceptive burden and stepped out of the classic scheme. For a woman, giving up motherhood is seen either as a default choice, due to a relationship or fertility problem, or as an unconscious one.

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

Lauren Levy, journalist and author

You also write that tubal ligation is disturbing because it is associated with dark periods in human history, with forced sterilizations used as a tool of birth control and domination over minorities. Does this violence still exist today?
Unfortunately, yes. We have many recent examples of illegal policies aimed at forcibly sterilizing women to better control the demographics of an ethnic group. This is, for example, the case of the Uyghurs, who were imprisoned in camps and killed in mass sterilization campaigns by the Chinese regime between 2015 and 2019, without explanation or obtaining their consent. In Canada, in recent months, aboriginal women have also reported being sterilized without their knowledge during cesarean sections or gynecological surgeries and years later during parenting programs. France is not exemplary either. Until 2016, any transgender person, male or female, who wanted to change their marital status had to be sterilized. We justified the act with medical reasons, we suspected the transitional hormonal treatment that harms the work of the sexual system. But specifically, according to militant associations, they were sterilized because the prospect of a transgender person becoming a parent was worrisome.

It is possible to have a baby after tubal ligation through 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, published in 2014, 2 to 3% of women are consulted about a possible pregnancy after sterilization, but none ultimately turn to assisted reproduction. In fact, when you push the door to the doctor’s office, you have often already thought about the possibility of regret.

To compensate for possible regret, it is possible to freeze your eggs before surgery. Many women claim they are not informed. Why is this information flying under the radar?
The ability to freeze eggs for non-medical reasons is recent, stemming from the Bioethics Law of August 3, 2021. Previously, this could only be done in the context of egg donation. Therefore, this message has not yet fully captured the minds of French women. It also reminds the government of the need to update the information resources available to patients. Training for health professionals should also include a more in-depth module on this contraceptive choice to learn how to better understand it and therefore better support it.

When a person does not want a child, when this choice is informed and consented to, by what means can this be communicated to the medical profession?
Before starting the process, I advise you to inform yourself about the health care staff in advance, it is the best way to listen and not get violent comments. There are also lists of caregivers who are tolerant and open to female sterilization on the Voluntary Sterilization (Ligature, Essure, Vasectomy) Facebook group or on the Gyn&Co website.

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