Their body, their choice.
Since the decision of the Supreme Court of the United States, last June 24, to bury the judgment Roe vs. Wade which for almost half a century guaranteed them the right to an abortion, the Americans are more and more numerous to resort to sterilization by tubal ligation or removal.
Often, they have known it for a long time: they do not want a child, and tubal ligation – sometimes called tubectomy – then appears to them as a panacea.
But their young age makes them lose all credibility in the face of doctors who are reluctant to perform a permanent procedure on them with an immediate contraceptive effect.
The Dobbs decision (2022) of the Supreme Court of the United States, which reformed Roe vs. Wade (1973) on the question of abortion, finally convinced them to fight to obtain this procedure which will allow them to never having to defend, before doctors or judges, their refusal of maternity.
The methods of sterilization in question:
Tubal ligation
Sometimes called tubal ligation (or tubectomy), this surgical intervention intended for adult women who do not (or no longer) wish to conceive a child, aims to mechanically prevent the spermatozoa from accessing the oocyte by cutting or coagulating the mistaken by applying a clip or a ring.
The contraceptive effect is therefore immediate.
This procedure, permanent, nevertheless still allows pregnancies by in vitro fertilization (IVF).
Salpingectomy
Unilateral or bilateral, it involves the removal of both fallopian tubes.
It is generally used to prevent certain cancers such as ovarian cancer.
This surgical act is also performed for contraceptive purposes.
Hysterectomy
This is a surgical procedure that involves removing the uterus.
"The most obvious choice", but not supported by all
"It was really a wake-up call for me," said Frances, 24, from Des Moines, Iowa.
"Abortion is still legal there, but I don't want to rely on that if I were to get pregnant," he told France 24, expressing concern that this right could be taken away at any time. .
Defining herself as non-binary – a person whose gender identity does not fit into the binary male/female norm, believing that she is between the two, a "mixture" of the two, or neither of the two -, Frances claims the right to "not having to go through the very feminine process of pregnancy".
"It's the most obvious choice for me," he says.
The appointment is therefore made: on November 1, her fallopian tubes, these pipes which connect the ovaries to the uterus and are used to transport the eggs for fertilization, will be ligated.
The path that led her to this intervention was not a long calm river and, like many other patients, she had to go out of her way to see her request taken seriously.
The first time they had the formula, Frances was 21, was already sure she did not want children and demanded permanent contraception.
But her gynecologist refuses, sure that they will change their mind.
"Instead, she helped me choose an IUD."
These doubts, this questioning of the ability of young women to make reasonable choices for their bodies is the lot of many patients.
"Nine years ago, when I turned 18, I tried to have my tubes tied. Four different doctors told me no because 'my husband, one day... [might want kids ]'", writes a TikTok user under a video of Dr. Franziska Haydanek, a well-known online gynecologist (@pagingdrfra, on TikTok) to communicate in favor of the free choice of young women to opt for sterilization.
“Any advice for those of us trying to get a hysterectomy?” asks another user who is interested in having the uterus removed.
"Because I swear some of those doctors thought I was asking them to cut out their own uterus!"
Sarah Salkowski, 24, underwent a bilateral salpingectomy – the removal of both tubes – last March.
In an article, she explains that she had to face the skepticism of her gynecologist, who repeatedly questioned her choice to be sterilized, asking her what would happen if she found the "perfect man", and that he wanted children with her.
The young woman, a resident of Michigan (Midwest), was sterilized three months before the Dobbs decision, but says that repeated threats vis-à-vis access to abortion in the United States had influenced her decision.
For her part, if Frances got what she wanted, the doctor who will finally perform her tubectomy nevertheless questioned her for an hour and a half about this wish.
"She ended up accepting because I didn't want to let go," he says, adding that the gynecologist went so far as to ask him for the contact details of his psychiatrist to make sure he was "healthy. of mind".
"I told her that if she refused the procedure, I would continue to ask other doctors until my choice was respected."
>> To read also: "Testimonials: in Texas, abortion is already almost impossible"
Protection in the event of sexual violence
In this process, Alexis was luckier.
"The first doctor I saw approved my operation, so I didn't have to fight rejection like I've seen so many women do," she says.
The 23-year-old lives in Ohio and had a bilateral salpingectomy just a week ago.
"When Roe vs Wade was overturned, I realized that unless I did something 'drastic' or more permanent, I wasn't safe from having a problem with my birth control" , continues the legal assistant.
However, the Midwestern state in which she lives does not necessarily allow this kind of "problem".
In Ohio, the Supreme Court's decision to no longer guarantee the right to abortion immediately allowed the entry into force of a law prohibiting abortion after six weeks of pregnancy, including in cases of rape or of incest.
This is how, last July, a ten-year-old girl was forced to change state to have an abortion after becoming pregnant by her rapist.
She went to the neighboring state of Indiana where access to abortion, although strongly threatened, is still legal for up to 20 weeks of pregnancy.
Because even circumstances as terrible as rape will not save them from having to fight to end an unwanted pregnancy, American women manage this new risk by considering sterilization as a means of protecting themselves.
This is explained by Frances, who specifies that although her partner had considered resorting to a vasectomy – male sterilization – to share the contraceptive burden, they still wanted to have their tubes tied "in the event of an assault. sexual".
Online solidarity between patients... and gynecologists
Witnessing the regression of their rights since the Supreme Court decision, women support each other on social networks where many groups, accounts and discussions are born on the subject.
It was thanks to this solidarity that Alexis was able to gather information and arrive confidently at her appointment.
"I was expecting a fight with my gynecologist, but I went there with a whole lot of knowledge from Dr. Franziska Haydanek. I had answers to all the questions raised by my doctor," she says. she.
"Satisfied that I did my research, he didn't try to change my mind and was supportive."
Two years ago, on Twitter, Amy Lasky, an obstetrician-gynecologist from New York State, called on young women over the age of 21 who are sure they do not want children to contact her if their doctor refuses them. a tubal ligation.
"It's your body, your reproductive decisions," she wrote.
At the end of July, Amy Lasky reiterated her support for women wishing to have sterilization in a tweet aimed at listing in the comments the names of doctors inclined to accept this procedure.
Bears repeating again and this thread also has info of docs around the country who will also perform tubals for childfree https://t.co/RkiQ2gZ1R0
— Amy Lasky, MD (@AmyLaskyMD) July 30, 2022
In March, after the publication of her article, Sarah Salkowski, freshly sterilized, meanwhile started a Reddit thread on which she offers to answer questions about the procedure she has just undergone.
A thread that was used in particular by Frances.
"I took a good look at the Reddit post that was circulating," he told France 24, adding that he had also been helped by the NorugatsNoragrets site, created "in response to gaps in resources specific to female sterilization" , as the home page explains.
On the side of TikTok, Franziska Haydanek has made a name for herself by evoking, in video, the subject of sterilization.
On his initiative, a list has also been created and is circulating online.
It lists doctors "willing to perform a tubal ligation on any patient, aged 21 or over, regardless of marital status or number of children".
In the week since the Supreme Court's decision to revoke Roe vs. Wade, the list has grown to more than 1,000 gynecologists willing to perform sterilizations.
As of August 23, that number had grown to more than 1,350 doctors.
>> To read also: "United States: how personal data could be used to track illegal abortions"
An expensive procedure, the coverage of which depends on insurance
The support of doctors is precious, but in the face of all these pitfalls, that of loved ones is just as important.
“My parents were very involved in my decision-making and fully supported me,” explains Alexis, referring to the presence and help of her parents and her boyfriend during the intervention, then during her recovery.
On the side of Frances, the situation is quite different.
Only his sister and one of his aunts are aware of the surgery he is about to undergo.
"I'm nervous about telling my parents, even though they know I don't want human children," he explains, adding that he has three cats, which already sounds good to him. enough in terms of parenthood.
"I have the
If they apprehend their reaction?
Yes, he said.
"I'm mostly worried about the worst case scenario: they could kick me out of their insurance, since I benefit from it thanks to my mother's work."
Because the only real worry Frances has as her tubectomy approaches is making sure she can afford the surgery.
Her insurance would have to pay for most of it – the cost of such an operation usually ranges between $3,000 and $6,000 – and Frances would then only have to pay $200 or $300.
However, this information as to the involvement of his insurance will not be given until shortly before the intervention, he said.
An uncertainty that fuels his stress and tarnishes his joy at the idea of making this choice for his body.
Patients using Medicaid, the federal state program providing health insurance to low-income individuals and families, experience the same type of barrier.
For insurance to cover sterilization, they must wait at least 30 days after giving consent to schedule the surgery.
“The care depends on the insurance companies, but also on the way the doctor codes the intervention”, specifies Alexis, patient but also legal assistant.
"For most insurance, if the doctor codes the procedure as a 'birth control procedure', it is fully covered. On the other hand, if it is coded as another type of procedure, it can cost several thousand dollars. ."
In Alexis' case, her insurance fully covered the procedure she underwent, and she didn't have to wait to find out what happened to her.
In the United States, the figures for sterilizations requested after the revocation of Roe vs. Wade will not be known until next year, according to the Guttmacher Institute, which provides statistics on birth control and abortion in the United States and in the world.
Until then, however, there is no doubt about the effects of the Supreme Court's decision on the request for birth control.
In Time magazine at the end of July, Dr. Diana N. Contreras, head of health care at the Planned Parenthood Federation of America – the American equivalent of Planned Parenthood – declared that from June 24 to July 14, the organization had recorded a 21% increase in birth control appointments, and a 41% increase in those for IUD (intrauterine device) insertion.
“I have never been so happy to be sterile”, concludes Sarah Salkowski, in her editorial on Medium.
Her anger is now directed at health professionals across the country who refuse to reflect on their hostility to the very concept of childless women, she says.
"Controlling women's bodies and condemning them to reproduce against their will is a cruel practice."
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