For Trevor, a 35-year-old musician in Arizona, the decision to get a vasectomy was easy. He and his wife have long known that they didn’t want children, so the procedure has always been in the back of his mind.
But after learning about the U.S. Supreme Court’s leaked draft decision to overturn Roe v. Wade—which could still change before it becomes final, likely in late June—“It was like, ‘Why am I holding off at this point?’” Trevor says. “It’s such a big thing that I can take care of for my wife and I so easily, so why not?” Trevor (who asked to use only his first name to protect his privacy) is waiting to learn whether his state-provided insurance will cover the procedure, but says he’ll move forward even if he has to pay for some costs himself.
Anecdotally, there are many reports of people considering the same. Google searches for terms like “how much is a vasectomy” and “how to get a vasectomy” surged after Politico broke the news about the leak on May 2, particularly in states where abortion access is under attack, like Texas, Utah, and Missouri.
Searches for “tubal ligation,” otherwise known as tube-tying or female sterilization, also increased significantly after the leak.
And social media was filled with posts urging men to get vasectomies. “Men, It’s Time to Consider a Vasectomy,” reads a recent Slate headline.
As surgeries go, vasectomies are simple. A doctor cuts or blocks the tubes through which sperm travels, keeping sperm out of semen and therefore preventing pregnancy. The procedure is fast, comes with minimal recovery time, and does not affect sexual function, says Dr. Jonathan Clavell, a Houston urologist who has been tweeting about his own recent vasectomy—and who says his patient coordinator has noticed more patients calling to ask about the procedure in recent weeks.
Male and female sterilization have both been used as safe, effective, permanent contraception for decades. But vasectomies have historically been less popular in the U.S. than female sterilization. In 2015, the United Nations estimated that about twice as many women compared to men had been sterilized in the U.S.
“I love the concept of vasectomy going viral,” says Oregon urologist Dr. Ashley Winter. “But not for the reasons that have been happening.” She wishes people were seeking out the procedure of their own accord—because she thinks it’s a great option for couples or individuals who don’t want or are done having kids—rather than because of possible limitations on abortion and other reproductive health care.
Winter is also concerned about misinformation spreading online. For example, some recent social media posts have encouraged men to get vasectomies by stressing that they are easily reversible. While vasectomies can technically be reversed, doing so requires surgery that is much more complex and invasive than the original procedure; it’s also not guaranteed to be successful. Winter tells her patients to think about vasectomy like marriage: though there’s technically an escape hatch, “you should plan for it to be permanent.”
Other social media posts suggest that men should be required to get vasectomies if abortion access is restricted. Such posts might seem tongue-in-cheek, but they take on a darker tone when considering the complicated history of permanent contraception in the U.S. Throughout much of the 1900s, it wasn’t uncommon for doctors to sterilize both women and men (but more often women) without consent or by coercion—especially those with disabilities and from marginalized backgrounds and lower socioeconomic classes. In the first half of the century, the eugenics movement inspired more than half of U.S. states to adopt laws specifically supporting this practice.
“Because of its eugenic past, sterilization in the late 1960s and early 1970s was often seen as a procedure for ‘unfit’ women, especially women with disabilities,”says historian Rebecca Kluchin, who wrote a book about sterilization called Fit to Be Tied.
In 1976, in part to correct those atrocities, health authorities set new rules for female sterilization procedures funded through Medicaid. Patients had to be at least 21 and were required to sign a consent form. They also had to adhere to a mandatory waiting period (eventually set at 30 days) between signing that consent form and having the operation.
Those rules still exist today for people with public health insurance. Some physicians and patients argue it creates an unnecessary barrier to care that applies mostly to lower-income, higher-risk patients. People who can’t take the time off from work or afford to travel to a medical office twice in 30 days may not get the procedure at all.
True as that may be, the policy “came about as a result of historical injustices against people from marginalized communities who were forcibly sterilized against their will and without consent,” says Dr. Aishat Olatunde, a Pennsylvania-based ob-gyn and a member of the nonprofit group Physicians for Reproductive Health. “This consent form came about to protect those populations, but we do see that it can limit access to receiving permanent contraception.”
Even with consent standards in place, there are still reports of blatant violations, like when a nurse working in a for-profit U.S. Immigration and Customs Enforcement (ICE) facility said in 2020 that doctors working there forcibly sterilized some individuals under ICE’s care. Dozens of women corroborated that allegation, and the facility was ultimately shut down last year by the Biden Administration.
Coercion persists in subtler ways, too. Some studies suggest that doctors remain more likely to recommend sterilization to people from marginalized backgrounds. From 2017-2019, almost 40% of U.S. women without a high school degree had been sterilized, compared to 12% of those with a college diploma or higher, according to federal data. Women of color in the U.S. are up to twice as likely to have been sterilized as white women (after controlling for age, insurance status, marital status, and parental status) while women with public health insurance or no insurance are about 1.4 times more likely to have been sterilized than women with private insurance, according to a 2017 report from the American College of Obstetricians and Gynecologists (ACOG).
“Although they may reflect patient preferences, these differences raise concerns that women do not have equal access to the full range of reversible methods and that low-income women and women of color may be counseled differently about contraception than white or privately insured women,” ACOG’s report says.
On the opposite side of the spectrum, some people who want to be sterilized face resistance from doctors who don’t want to perform the procedure. Federal law allows health care providers to decline to perform procedures that conflict with their religious beliefs, and 18 states have additional laws that allow some doctors to refuse to perform sterilization procedures.
Even in states without such laws, it’s not uncommon for patients to encounter resistance from physicians who fear they will later regret the procedure, often because of youth or marital status.
While there isn’t much research on the subject, anecdotal evidence suggests young women are more likely to be denied sterilization than young men. Trevor, the man in Arizona planning to get a vasectomy, says his wife has been turned down for tubal ligation five times, while he’s so far faced little resistance in scheduling his own procedure. The “Childfree” thread on Reddit is full of stories from women struggling to get sterilized, and some women report doctors requiring their partner’s permission to go through with sterilization, even in the present day.
In a 2011 study, almost 60% of surveyed U.S. ob-gyns said they would discourage a 26-year-old patient from getting her tubes tied if her husband disagreed with her decision, and 32% said they would discourage a 26-year-old patient even if her husband was on board. For a hypothetical 36-year-old patient, those percentages dropped to 47% and 10%. Provider thinking may have shifted in the decade since that study was published, but the problem remained widespread enough for ACOG to address it in its 2017 report, writing that, “Paternalism, in which a physician overrides a patient’s autonomy to ‘protect’ her from the consequences of her own decision making, should be avoided.”
Some physician hesitance may be a carryover from outdated medical standards. Through the 1970s, U.S. doctors followed what is colloquially called the “120 rule,” under which a woman could not be sterilized until her age multiplied by her number of children totaled 120. (For example, a 30-year-old patient wouldn’t be eligible for sterilization unless she had four children.) While that rule is no longer used today, some doctors remain skittish about sterilizing young patients who don’t already have children.
That was the case for Jacki Greavu, who is now 30 and lives in Montana. She has always known she doesn’t want children, and began asking doctors to tie her tubes when she was 22. Doctor after doctor refused to perform the operation until she turned 30, warning her that she might change her mind. “They just think if you’re not 30, you’re not old enough to make this kind of decision,” Greavu says.
But she was certain, and finally found a willing physician a few weeks shy of her recent 30th birthday. “I actually bawled inside of his office,” Greavu says. “It was really cool to finally have someone sit down and listen to me.”
Kluchin says medical paternalism is closely linked to the history of forced sterilization. While people who are seen as “unfit” for parenthood—usually because of racist, classist, or ableist thinking—may be pressured into sterilization, people stereotypically seen as “good” parents—often young, relatively affluent white women—may be denied the procedure. “It comes down to…some women’s reproduction seen as beneficial, and others seen as detrimental,” Kluchin says. “That’s the continued trend.”
Clavell, the Houston urologist, says he sometimes treats young men who say they’ve faced similar resistance when trying to get vasectomies. Insurance coverage can also be a barrier. While most health plans must cover female sterilization under the Affordable Care Act, the same isn’t true of vasectomies.
Clavell says he tries to make his practice one where the patient is always in charge. “I am no one to tell you what to do in regards to your body,” he says.
That’s the attitude reproductive-rights advocates wish doctors would take across the spectrum, whether they’re talking about sterilization, contraception, or abortion. If people were trusted to direct their own reproductive health care, medical procedures wouldn’t have to go viral in the wake of a news story, Winter says.
“None of this stuff should be trendy and none of this stuff should be politicized, whether it’s vasectomy, abortion, tubal ligation, none of it,” she says. “All of it is medical care.”
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Contributor: Jamie Ducharme