All of these reasons for refusing sterilization are in direct conflict with ACOG’s ethical guidelines. However, doctors do not face consequences for refusing to perform procedures; The US does not keep track of how many sterilization requests are denied. “So there’s no accountability — no capacity to impose consequences,” Hintz says.
Access to the procedure is not equal throughout society. Echoes of sterilization’s checkered past—in which marginalized groups of women were forced to undergo the procedure, including women of color, women who were poor, and those living with disabilities or mental illness—still linger today. Black, Latina, and Native American women in the United States are up to twice as likely as white women to be approved for sterilization, while women with or without public health insurance are about 40 percent more likely to undergo the procedure than privately insured women.
“The bottom line is that the way this is legislated — and the way these very subjective kinds of assessments can be made — is just a means to perpetuate this very white, rich, able-bodied, cisgender idea of who should have children,” she says. Hintz.
One corner of the internet where those seeking the procedure can find tips and advice is the r/childfree community on Reddit. The subreddit has folders with extensive information on how to request the procedure, an expensive list of doctors who will perform it, and a sterilization binder that members can take to their doctor along with a consent form and a form stating why they want the procedure.
With the increasing number of demands for permanent forms of birth control, abolition Roe it has already caused an increase in the number of people seeking long-term but non-permanent birth control, such as intrauterine devices (IUDs). But the very idea that birth control—permanent or otherwise—could replace access to abortion is inherently flawed, says Krystale Littlejohn, an assistant professor of sociology at the University of Oregon whose work examines race, gender, and reproduction. Despite the fact that most people who can get pregnant use some form of birth control, one in four women will have an abortion in her lifetime. That’s why the “just get the tubes tied” or “just get an IUD” rhetoric that followed Dobbs not helpful, she says.
For one thing, choosing these forms of birth control is not a trivial medical decision: heavier, more painful periods and a potentially painful implantation procedure—often with no pain relief—are among the possible consequences of getting an IUD. Tubal ligation requires an invasive surgical procedure and, like any surgical procedure, can lead to complications.
In fact, the advice to use birth control can be seen as just another form of surveillance over human bodies, Littlejohn says. “When it comes to people suggesting that their friends or their loved ones get long-term birth control, I think people believe they’re helping other people, but what they’re actually doing is invading their human right to bodily autonomy,” she says. RoeIts decline will not only mean that people with wombs are forced to give birth, she says; it’s also about forcing them to use longer-term or permanent forms of birth control.
A person living in a restrictive part of the US may now feel compelled to seek long-term contraception or have their tubes tied—the equivalent of mandatory birth control. “That’s not the solution right now,” she says. “I think it’s really important that we don’t fight reproductive injustice with reproductive coercion.”