When it comes to women and healthcare and scientific research, things begin to get a little muddled and underrepresented. This means that many issues faced by women of all races begin falling through the cracks, get overlooked, or get boiled down to "it's just anxiety". Most women have some story of having their concerns thrown to the wayside by providers who seem to consistently boil their fears down to one thing. It's truly unfortunate and disheartening.
One large point of concern has to do with the female reproductive rights. Unfortunately, female reproductive rights have been a long-standing debate not only in this country but all over the world. Given that most cultures are heavily patriarchal, women are often left out of the conversations of their own bodies, their right to choose what is best for themselves, and their desire or not to have children. And while abortion rights are a debate in their own right, I wanted to discuss female sterilization and the patient's autonomy being disregarded in the name of "preventing regret" or Eugenics. Female sterilization is not an uncommon or new method of birth control, but the increasing number of consensual sterilizations is. Female sterilization, or tubal ligation, is a permanent procedure for blocking the fallopian tubes to prevent pregnancy (What Is Female Sterilization and How Does It Work?, 2018). This can be done surgically or non surgically by either burning, removing, tying, or clamping those tubes to prevent an egg from passing through to reside in the uterus.
Forced and nonconsensual sterilizations still happen today, which is unethical and unjust, in many countries, including the United States. It is rooted heavily in the idea of Eugenics, and thousands upon thousands of women found themselves unable to bear children that they so desperately wanted based on mental health conditions, disabilities, race and/or ethnicity, or being of a lower socioeconomic class (Amalraj & Arora, 2022). In 1927, the Supreme Court granted states the right to forcibly sterilize individuals they deemed unfit to parent, "imbeciles", or "to preserve racial integrity", with the case Buck v. Bell. A woman at the time, Emma Buck, was determined to be "feebleminded and sexually promiscuous," and when her daughter, Carrie, turned 17 and became pregnant from an assault, she was forcibly sterilized due to the court deciding "three generations of imbeciles was enough" (The Sterilization of Carrie Buck | Origins, 2022).
After the Supreme Court's decision, the number of coerced or forced sterilizations skyrocketed in the US, with black women unfortunately seeing the highest record amount of procedures. They accounted for approximately 65% of the procedures being recorded, despite it being about 5x more than their population. To this day, the Bell v. Buck decision is not overturned, but just a bit weakened with the ruling of Skinner v. Oklahoma (1942), which found it unconstitutional to do nonconsensual, experimental surgeries on inmates, as well as in some states, but not all, repealing their laws.
Autonomy is defined as self-decision that is free from any controlling interferences or limits, such as a lack of understanding (Maila et al., 2025). As future providers, we should have a vested interest in ensuring our patients are not only informed of their option for sterility should they choose that as their birth control method, but also of their rights to be a parent should they choose. No physician should force their patients to do anything they do not want to do--it disassembles the very delicate balance of trust between patients and providers. Even now, providers have been found to force excessive waiting times or even refuse procedures due to their own personal beliefs or to prevent "regret." Informed consent is used to help uphold the ethical principle of autonomy and minimize certain risks, so why are certain providers assuming that, with that consent, patients still aren't making the right choices for themselves? While most tubal ligations are permanent, it is possible in some cases to reverse them, depending on the type of ligation, so regret cannot be the only reason for refusing treatment. Despite this, "regret" is cited as a refusal for strictly female sterilizations and not males, increasing the incidence of gender based health disparities (Amalraj & Arora, 2022). How can we work to ensure that, in the future, we are consistently upholding autonomy and justice for our female patients in terms of sterilization and other birth control methods? At the end of the day, whose choice is it anyway?
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Wow, this was an incredibly sad read, but also very educational about forced sterilization. I know from researching this topic how this was done to Indigenous women, as recently as 2018 in Canada by forcing them to have tubal litigation and not educating them on their rights and the permanent impacts of doing this (Clarke, E. (2021). Indigenous women and the risk of reproductive healthcare: Forced sterilization, genocide, and contemporary population control. Journal of Human Rights and Social Work, 6(2), 144-147.) This is incredibly sad, and its something that needs to be talked about more in the healthcare profession.
ReplyDeleteThis is such a sad situation but you did an amazing job highlighting what we need to do to improve the future. Your opening talking about women's concerns being "anxiety" reminds me of the long history when women's medical issues were diagnosed as hysteria which resulted in over use of medication or, like this post, forced sterilization.
ReplyDeleteI think the section of regret shows the double standard women are held to. Men that want a vasectomy's are praised for making a responsible decision for their future and family, but women are judged and sometimes considered naive. Even though women are just as capable of making a permanent choice of her reproductive future as men.
Thank you for covering this topic with respect towards the family you mentioned and bringing light to their story.