JUST LET ME GET STERILIZED!

How inaccessible sterilizations are, and why.

“My Body, My Choice.” It is one of the central claims in the fight for access to pregnancy terminations or, to use a more common term, abortions. But it’s not the only choice regarding the reproductive health of people with uteruses – sterilization is another that is less talked about. And, it’s my choice. For my body.

To be clear: I have not yet had the procedure done, but I’m embarking on the journey that I must take to be sterilized. Personal reasons for sterilizations vary, obviously. Mine are twofold: firstly, as a non-binary person - although I’m very lucky to experience as little dysphoria connected to most areas of my body as I do - I’m very uncomfortable with my uterus. Occasionally, I wear a binder and sometimes, I wish the structure of my body was a little more masculine, but the mere possibility of getting pregnant triggers the most intense discomfort with a hint of panic. It is the amped up version of what I feel when people refer to me as “woman”, “girl” or, worst of all, “female”. It makes me feel like a square that’s supposed to be an ellipse; as if my feet and hands are made of clunky blocks of steel, inadequate and wrong. 

The second reason is the fact that I’m absolutely sure that I never want to push a little human out of my vagina, no matter how much society tells me it will complete me as a person. That doesn’t have to mean I’ll never have children in some way (adoption, etc.) – even though I’m rather sure I don’t want that either – but it means I never want to birth any being. My decision to get sterilized is neither rash nor rushed; it has lived in my mind for years as a seemingly unattainable wish, which I will now pursue. As I’m 20 years old right now and will be 21 or 22 when I can finally be sterilized, the obstacles put in the way of people seeking this procedure pose a massive challenge for me.

Just to put some of the common misconceptions about sterilization out of the way: the procedure blocks or seals the fallopian tubes in some way, so that there is no possibility for the egg to get to a place where it could be fertilized by sperm [1]. Unlike what is thought by a lot of people, the hormone production is not impacted on by the surgery as the ovaries stay intact, although a sterilized person might experience a change in their period regarding the flow, duration, and other variables [2].

Although the law in Germany (where I live, and the country to which the details in this text refer) allows for people to be sterilized as soon as they are considered legal adults, namely after their 18th birthday because of their ability to consent to this type of surgery [3], the reality looks very different. Often, doctors require the person to be 30 years and older unless the surgery is medically necessary [4]. The reasoning behind this is that the process of family planning, should, in the eyes of medical professionals, be completed before making such a decision [5], where a lot of these professionals evidently can’t imagine that a person with a uterus, often referred to simply as “woman” in these contexts, would make the final decision to not give birth, at an earlier point in their life. 

It might seem odd to focus on sterilizations for people with uteruses here, as many sources state similar terms for people with testicles; they also need to have completed their family planning and some sites recommend the same age requirement [6]. But, as is common with these kinds of issues, misogyny and sexism are ingrained in the medical structures surrounding reproductive health in other, more subtle ways. 

The first aspect is financial: while sterilizations for people with uteruses cost from €800 to as much as €1200 in some instances [7], the costs for vasectomies vary from roughly €310 to €500 when a local anaesthetic is used [8]. But this gap isn’t purely rooted in sexism – the differences in procedures and anaesthetic provides a somewhat reasonable explanation. If insurance covered the surgery, none of this would be of concern – but it doesn’t [9]. Meanwhile, other procedures connected to reproductive health are covered regardless of cost – for example, a natural birth in a hospital is around €1500 in the best of cases [10] – as long as they are deemed necessary and valid. The argument here is not at all that pregnant people should pay for a delivery; it’s that people should be able to choose whatever option suits them for their reproductive health and their insurance should pay for it without questioning their choice.

The second aspect is more difficult to grasp and prove, but becomes apparent as soon as one compares the many doctors and clinics providing vasectomies with the few gynaecologists and surgeons offering to sterilize people with uteruses. To illustrate this point: there is a center for vasectomies within twenty minutes by bus from where I live in Hamburg, while I couldn’t find any similar facility in Germany for a uterine sterilization. On my quest to find such a clinic or center, I consulted Google Maps and among the eighty results that I clicked through for “sterilization center”, there was only one gynaecologist’s office in northern Germany, a few surgery-focussed clinics, and the rest were almost exclusively urologists, many with a focus on vasectomies. When I looked further into it, I discovered that the gynaecologists providing sterilizations rarely give extensive information on the topic, but rather write one or two sentences regarding the procedure and/or costs, if that. The vast number of urologists, on the other hand, have loads of information and other sources on vasectomies on their websites. It seems as if the medical profession doesn’t trust people with uteruses to deal with information on sterilizations, as if there was a chance that anyone would decide to have one just from reading about the methods. This resembles a line of argument that is often used for the §219a StGB which outlaws so-called “advertisement” for pregnancy termination, but which also effectively bans all gynaecologists and clinics from providing any specific information on the topic [11].

It’s apparent that the medical field plays a crucial role in controlling certain bodies and denying certain people their agency. This is not a new insight at all, no, because it’s not a new problem. The uterus in particular, as the ultimate signifier of “the women” in a cispatriarchal society, is a focal point in the history of medical practices that exert patriarchal violence in a systemic way. Before having a look at two prominent and highly relevant examples regarding this issue, it needs to be clarified that I will be using the term “women*” instead of “people with a uterus” in order to properly reflect the sexism embedded in medical structures, while at the same time acknowledging the existence and oppression of trans* people.

Hysteria is the first issue I want to adress. This “diagnosis” is very transparent in its connection to the uterus as it comes from the Ancient Greek word for the organ – hysteron – and its history is full of wild guesses by ignorant men who aimed to further disenfranchise women*. While some of the symptoms, especially the ones still included in the way that the word is used today, can be read as a symptoms of actual psychological ailments, some of them were simply choices that society didn’t approve of, such as living as a childfree woman*. Both of these were used as justifications to further violate women*, which would even go so far as the performing of exorcisms, or executions [12]. As at least a number of the women* diagnosed with hysteria suffered from intense trauma related to the cispatriarchy of the time, notably related to sexual assault [13], the violence they experienced as a consequence of the diagnosis seems even more cruel.

The second example of uterus-related medical violence is forced sterilization. Now, it  might seem rather odd to mention this at first, as this article is about me wanting to get sterilized – but it really shouldn’t, since I’m advocating for agency and bodily autonomy to be restored to people with a uterus so that they can choose whether to get sterilized or not. Furthermore, the history of forced sterilization shows how deeply intersectional the issue is, since it is a tool wielded against women* who are deemed ‘unworthy to reproduce’, along with the fact that those women* are usually part of other oppressed groups. In Australia, women* and girls* with disabilities are being sterilized without their consent; in Peru, there was a five-year long program at the end of the last century that forced poor, indigenous people to get sterilized, which is deemed genocidal by Ñusta Carranza Ko, a specialist in the field; and, just last year, new allegations against the US-agency ICE (Immigration and Customs Enforcement) emerged, claiming that there were forced sterilizations performed on immigrant women* in at least one of their facilities [14].

Nevertheless, to presume that this issue only affects women means giving into the cisheteronormative framework for gender that has been a source of violence against women and trans* people for centuries, especially those racialized and otherwise marginalized.. But it has to be taken into account that the oppressive systems designed to strip people with uteruses of their agency was built with a cisgender woman in mind. The lasting effects of denying this group of people their right – our right! – to decide over our own bodies, be it in the case of having or not having an abortion or in that of sterilization, affects cis women just as much as trans* men, non-binary individuals, and other non-women* with a uterus, and targets those who are already the most vulnerable. 

Even though a lot of the parts of the oppressive, misogynistic legal framework for our society have been dismantled, many remain still embedded in laws or live on in practice. The discourse around the sterilization of what are widely perceived and referred to as “women” because of their anatomy, shines a light on one of the most disturbing aspects of the remaining patriarchy: the social perception of certain bodies as a matter of public discussion. Whereas cis-male bodies are allowed to simply exist a lot of the time, other bodies are persistently talked about in the media, in politics and in everyday life, without any consideration for the person that is this body. The more marginalized a person, the more doubted their humanity and the more debated their bodily autonomy. Should people with uteruses actually be allowed to end a pregnancy? Should people be able to choose to be sexworkers? Should trans* people really be able to get gender-affirming surgery if they want? The fact that all of these aspects of people’s bodies are something that we debate as a society, is in and of itself, rather shocking. But when we look at who’s affected by this and who isn’t, it’s pretty obvious that this is just another means of denying marginalized people their agency. In this case, we’re talking about how the ways that women are oppressed extend to other bodies that are read as female, feminine or otherwise non-male. But while the women’s movement and its struggles throughout centuries are finally being increasingly recognized, non-normative bodies and their rich history are still swept under the rug. Plus, some parts of feminist activism today still prefer rejecting trans* causes, instead of examining the intersections that harbour them. 

The infantilization resulting from the persistent questioning of the decisions of a person with a uterus, the lack of information and open discourse around the topic, combined with the financial hurdle and the general inaccessibility further proves how much work remains for intersectional feminism. We need to address the political and economic dimension of all of this in order to finally change how medicine is an essential part of structures of oppression. 

In the meantime, I will go down this road to free myself from the weight that the ability to birth places on my shoulders – fully aware of all the inappropriate questions, the unsolicited advice and the inevitable misgendering that I will have to endure, while also knowing that massive amounts of privilege allow me to take this journey in the first place. It is long overdue that we change all of that.