The choice not to have children places women in a difficult situation. They are often judged as selfish, and their motives are questioned. They must rely on long-term contraception which poses health risks. Should conception occur, they usually opt for termination of the pregnancy. Ironically, the option of voluntary sterilization is not as available. Here is a BioEdge review of a recent report:
Voluntary sterilization has been legal since 1974 in the United States for women over 21. Why, then, is it so difficult for them to find a doctor who will do the procedure, asks Cristina Richie in the latest issue of the Hastings Center Report.
About one in five white women in the US will never bear a child, writes Richie, a theology graduate student at Boston College. This is the highest proportion in modern history. Of these, half, or 10% will be voluntarily childless. Life for them would be much easier without the stress and inconvenience of contraception. Yet many doctors refuse to sterilize them. Their position is that women may regret their decision in later years. "Yet regret is the competent woman's burden, not the doctor's. Very few providers of other permanent elective treatments like plastic surgery refuse treatment over fear of regret. Why should sterilization be different?" Richie asks.
Why do women want to remain childless? Richie says that there may be several reasons. They may have well-founded fears that pregnancy will damage their health. They may be carriers of a genetic disease. They may have vaguer personal reasons: the financial burden of children or revulsion at traditional maternal roles. One group, the GINKS (green inclinations, no kids), fear creating more agents of pollution and carbon emissions. Some dislike "unnecessary hard work".
Why do doctors refuse? Normally because women are deemed too young or have no children. Many doctors are not trained in sterilisation techniques. Memories of forced eugenic sterilisations early in the 20th century have coloured some doctors' attitudes.
Oddly enough, Richie does not counter the common objection that medicine is about restoring diseased organs to health, not about destroying healthy organs.
Richie argues that it is no business of the doctor what reasons a mentally-competent woman over the age of 21 might have. "American medicine should act as the law permits and good patient care requires, providing sterilization to women who are legally able to obtain it, regardless of parity."