Sterilization is a loaded term. Due to the long standing practice of eugenics in the United States (as well as other nations), we most often associate this term with force or coercion. This association is well founded. From Oregon State’s Board of Eugenics, which ran until 1981, to mass compulsory sterilization of people able to become pregnant in Puerto Rico, there are many examples across the US and her territories that demonstrate the widespread proliferation of forced sterilization on uninformed individuals.
Despite this history, the fact still remains; many people who are able to become pregnant do not wish to do so. But, with a dubious history of consent in the field of sterilization, an issue arises: how can we ensure informed consent before sterilization, without limiting bodily autonomy?
Ensuring Consent in Sterilization
Due to the history of coerced sterilization in the United States, specifically the coercion of people of color and individuals with disabilities, sterilization doctors now focus intently on consent before performing the procedure.
The American College of Obstetricians and Gynecologists recommends (ACOG), amongst other guidelines, that OBGYNs “should consider the role of bias in counseling and care recommendations and avoid actions based on biases about race, ethnicity, socioeconomic status, sexual orientation, and motherhood, which can, despite best intentions, affect the interpretation of patients’ requests and influence provision of care.”
Demographic Disparities
Despite this, disparities remain in the field of sterilization, as well as who gets sterilized. The ACOG states that “African American, Native American, and Latina women are 1.2–2 times more likely to have undergone sterilization than white women”. This takes into account controlling for “age, parity, insurance status, marital status, vasectomy use, and a range of other variables”. Likewise, publicly-insured individuals are 1.4 times more likely to be sterilized than privately insured individuals.
Though there are many factors that impact these numbers, socio-economic standing has much to do with who chooses sterilization. Individuals who have more resources will have fewer consequences of unwanted pregnancies. However, for those who cannot risk pregnancy due to financial reasons, certainty can be essential. The correlation can also be related to a lack of birth control education and availability within certain communities.
Public Funding Restrictions
With many public insurance users choosing sterilization, the Medicaid funding of sterilizations can also be examined. The US Library of Natural Medicine states that individuals seeking publicly funded sterilization must undergo a 30 day waiting period. It also requires that the patient be “at least 21 years old” and “mentally competent”; however, this stipulation is found nowhere in the case of vasectomies.
Unsurprisingly, due to the final nature of sterilization, the healthcare system takes the issue – and consent for it – very seriously. However, with a history of malpractice, eugenics, and coercion, and so many demographic disparities impacting who receives sterilization, it is important that all fields of reproductive rights give equal importance to both consent and autonomy.
For more, visit: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/04/sterilization-of-women-ethical-issues-and-considerations
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