2023-08-03 11:34:29
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Caption,
Female sterilization is also known as tubal ligation.
Article information
The bleeding began at 10 p.m. on Saturday, July 22.
Paula* (Chilean, 30 years old) was at home. She thought it was her menstruation but after a while she got scared. There was too much pain and blood.
He decided to go to the hospital. Upon arrival, the doctors told her: “You had a loss, a miscarriage.”
His surprise was complete. Such news was never expected.
Paula had made the decision years ago: she did not want to be a mother under any circumstances.
Her birth control pills had failed her and, once again, she regretted that no doctor had wanted to perform surgical sterilization on her, a wish she had had since she was 18 years old.
“If my tubes had been tied, none of this would have happened. It was not a pleasant experience and I feel angry because I have been looking for a professional for years to help me fulfill my desire not to be a mother”, she tells BBC Mundo in an interview carried out just days after having the loss.
What is it and what are its requirements?
Paula represents thousands of women in Latin America who cannot access voluntary surgical sterilization, better known as “tubal ligation”.
This procedure is over 99% effective in preventing pregnancy, making it one of the safest methods available.
The World Health Organization (WHO), in fact, places it among the few “very effective” contraceptives.
In addition, it does not affect the body’s hormone levels (as other contraceptives do), which for many women is a considerable advantage as it has no “side effects”.
How does tubal ligation work?
Female sterilization prevents eggs from traveling down the fallopian tubes, which connect the ovaries to the uterus. This means that a woman’s eggs cannot meet sperm, so fertilization cannot occur. There are several ways to block the tubes, either by applying clips, silicone rings, or by tying or cutting a small piece of the tube. fallopian. It is a relatively simple surgery that is usually ambulatory. It is done through laparoscopy.
Its main difference with the rest of the methods to prevent pregnancy – such as pills, intrauterine devices, the vaginal ring, patches or injectable ampoules – is that it is permanent and irreversible.
Caption,
Paula does not want to have children. It’s a decision she made 12 years ago. “I’ve never had the desire to be a mom. I’ve never had that spark that they say she shows up,” she says.
This can be an important benefit for those women who decided not to have children because they never have to worry about it again: neither taking a daily pill, nor changing the device every month, nor continuing to spend money on contraceptives.
However, for many doctors it is the main reason that leads them to refrain from practicing it.
Even more so if the woman is young and has not had children.
This happens even in countries where access to the procedure is supposedly guaranteed by law.
This is the case of Colombia, Argentina, Brazil, Mexico or Chile, where it is considered a “reproductive right”.
In order to promote responsible maternity and paternity, most of these countries establish as a requirement that the woman be of legal age, that she make the request in writing (signing an informed consent) and that before the procedure she is exposed to counseling in sexual and reproductive health by the treating physician.
Caption,
According to doctors consulted by BBC Mundo, there are many women who find it difficult to adhere to taking one pill a day and therefore prefer a more definitive solution.
But, according to the women and experts consulted by BBC Mundo, on many occasions the above translates into a series of obstacles that make access to the tubal ligation very difficult.
This is the case of Paula, who expressed her wish to be sterilized on 3 occasions, always obtaining a negative response in the counseling given by her doctor.
“The first time I applied for it was at the age of 23, in the Chilean public system. The doctor told me no, that she was very young, that she hadn’t left the university yet, that she was going to change her mind, ”she says.
“The second time I was 25 years old and the answer was the same: that I was not mature enough to make such a decision. And the third time, only 3 years ago, they categorically closed the door telling me that, if I wanted a tubal ligation, I should ask for it abroad”.
Her recent pregnancy, although unsuccessful, puts her on alert.
“With the other contraceptives you can always fail. That is the problem, ”he says.
“I already want to forget about it. And I can’t,” she adds.
Waiting lists
One of the biggest problems faced by women who want free access to this procedure is the long waiting lists that exist in most public health institutions in Latin America.
And the situation for women who do not have children is even more complex.
“In the public system, the waiting lists are huge and women without children are not a priority. For this reason, they are pushed to take care of themselves with other contraceptive methods,” comments obstetrician-gynecologist Gabriel Zambrano, from the Itenü Medical Center in Caracas, about the reality in Venezuela that is repeated in various countries in the region.
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Caption,
In most countries, the medical team has the obligation to give advice to the woman who wants to undergo voluntary sterilization.
According to the latest UN report on family planning, the covid-19 pandemic aggravated this situation, reducing the availability and access to contraceptive services for women, especially those with irreversible action, such as sterilization.
The UN affirms that the reality is worse in low- and middle-income countries, and among the most vulnerable.
In this way, voluntary sterilization ends up being much more accessible to women who can pay for it privately.
This is the case of Amanda Trewhela, a Chilean woman who at 34 achieved sterilization after requesting it for 16 years.
“In the public system, nobody wanted to operate on me because I was very young or because I had no children… So I ended up in the private system. And it is very expensive. That is the biggest obstacle of all ”, he tells BBC Mundo.
Amanda had to pay 4 million Chilean pesos (approximately US$4,800).
“They can tell you everything, the questions are very hard. And one has to face them. But if you don’t have the money, everything goes to the ground ”, he indicates.
Gender bias?
But there is also a cultural problem.
This is stated by Francisca Crispi, a doctor, academic and president of the Medical College of Santiago de Chile, who has spent years studying the issue of women’s sexual rights.
“In Latin America there is an issue of women’s autonomy in the doctor-patient relationship. The bias that women cannot make decisions for themselves, that they are very emotional, ”she warns.
“There is a notion that all women should want to be mothers and, if they don’t want it at that moment, they will regret it later,” she adds.
Indeed, the gynecologist-obstetrician Gabriel Zambrano affirms that “the greatest fear we have is that the woman will regret it… we, the doctors, can be accused of cutting off a patient’s fertility.”
However, for the women consulted by BBC Mundo, this fear of regret that doctors have often causes their reproductive rights and freedom of decision not to be respected.
“There is a judgment towards women in which they infantilize us, they make us think that our decisions are hasty, without thinking about them,” says Paula.
image copyrightGetty Images
Caption,
The issue of female sterilization is not a priority because there are various alternatives to avoid pregnancy, the doctors explain.
Added to all this are religious arguments.
“There are centers that do not provide certain contraceptive benefits for religious reasons, although in this case conscientious objection is not regulated,” says Crispi.
On the other hand, the academic assures that, despite the fact that in many countries the law clarifies that the woman does not need the consent of her partner to access this procedure (this is the case of Argentina or Colombia, for example), the reality is that there are still health centers that ask for it.
“We have many cases in which they ask the opinion of the couple and that ends up becoming a great barrier,” he says.
Paula remembers that this was precisely one of the questions she received when she expressed her desire to have her tubes tied.
“It’s like your husband owns your decisions. It’s a very archaic and patriarchal look because it’s a personal decision,” she says.
In the case of Spain, the situation seems to be different.
According to Dr. José Cruz Quílez, president of the Spanish Contraception Society (SEC), there are no additional questions if a woman has not had children.
“Here, if a woman wants to have her tubes tied, the procedure is done regardless of whether she has been a mother or not,” she explains.
“It’s their right,” he adds.
For Francisca Crispi, all the barriers that exist in Latin America are problematic since contraception is “time dependent.”
“If a woman is denied, it can mean that she has an unwanted pregnancy in the short term. Therefore, this refusal towards certain types of contraception seems problematic to me, ”she points out.
The foregoing becomes even more relevant if the UN figures on unwanted pregnancies are taken into account: according to the international organization, between 2015 and 2019, there were 121 million of this type of pregnancies, which represents 48% of all pregnancies. .
image copyrightGetty Images
Caption,
Tubal ligation is done through laparoscopy. It is usually a relatively simple and outpatient procedure.
Some data:
According to the United Nations Organization, female sterilization is the most widely used contraceptive method in the world. According to the latest family planning report, 219 million women had accessed female sterilization in 2020, which corresponds to 23% of women using contraceptives. Male sterilization, on the other hand, is much lower: it was performed on 17 million men, which represents 1.8%. The Dominican Republic, El Salvador, Mexico and Colombia are the countries in the region where the prevalence of female sterilizations is highest, according to UN data.
“This is finally over”
Two years after being sterilized, Amanda Trewhela says she feels “calm and happy.”
She remembers that when she entered the ward to have the procedure done, a midwife in her 50s approached her to tell her something she will never forget.
“He told me: ‘I think what you are doing is super valuable. I didn’t get to belong to your generation that can make these decisions. I never wanted to have children, but no one ever wanted to operate on me. I’m going to take care of you here.”
Amanda affirms that there she understood that she was part of a “community of women who live with this pain of the obstacles, of the questions, as if we were emotionally and hormonally weak.”
When she woke up from the operation, Amanda started a new life. “I felt an infinite tranquility.
I thought: ‘finally this is over’”.
Paula lives a different reality today.
Barely recovered from her recent abortion, she assures that she no longer has the energy to continue trying to obtain a sterilization.
“Maybe in a few years I’ll run into someone who thinks I’m of reasonable age – and reasonable maturity – to have my tubes tied.”
“Meanwhile, my partner is going to have a vasectomy since they don’t give him any problems or ask him his age or if he has had children or not,” he says, with obvious discomfort.
*Paula is a fictitious name since the interviewee did not want to provide her identity for personal reasons.
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